The effectiveness of hyperbaric oxygen therapy for healing chronic venous leg ulcers: A randomized, double-blind, placebo-controlled trial.

Over 30% of venous leg ulcers do not heal despite evidence-based treatment. This study aimed to determine the effectiveness of Hyperbaric Oxygen Therapy (HBOT) as an adjunct treatment for nonhealing venous leg ulcers. A randomized, double-blind, parallel group, placebo-controlled trial was undertaken in three hyperbaric medicine units. Adults with a venous leg ulcer, Transcutaneous Oxygen Measurement indicative of a hypoxic wound responsive to oxygen challenge, and without contraindications for HBOT; were eligible. Of 84 eligible patients, 10 refused and 74 enrolled. 43 participants achieved over 50% ulcer Percent Area Reduction (PAR) after four weeks of evidence-based care and were thus excluded from the intervention phase. Thirty-one participants were randomized to either 30 HBOT treatments (100% oxygen at 2.4 atmospheres absolute (ATA) for 80 minutes), or 30 "placebo" treatments, receiving a validated "sham" air protocol, initially pressurized to 1.2ATA, then cycled between 1.05-1.2ATA for eight minutes before settling at 1.05ATA. The primary outcome was numbers in each group completely healed. Secondary outcomes were ulcer PAR, pain and quality of life, 12 weeks after commencing interventions. The participants' mean age was 70 years (standard deviation (SD) 12.9) and median ulcer duration at enrolment was 62 weeks (range 4-3120). At 12 weeks, there was no significant difference between groups in the numbers completely healed. The HBOT intervention group had a mean of 95 (SD 6.53) ulcer PAR, compared to 54 (SD 67.8) mean PAR for the placebo group (t = -2.24, p = 0.042, mean difference -40.8, SE 18.2) at 12 weeks. HBOT may improve refractory healing in venous leg ulcers, however patient selection is important. In this study, HBOT as an adjunct treatment for nonhealing patients returned indolent ulcers to a healing trajectory.

Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: a prospective clinical trial.

INTRODUCTION: In this study, we tested the efficacy of a tooth sealant polish (Biscover LV; Bisco, Schaumberg, Ill) to prevent enamel demineralization (white spot lesions) for the full duration of orthodontic treatment with fixed appliances. The trial design was an alternating-tooth split-mouth design. METHODS: Patients starting treatment with bonded appliances in a private practice were enrolled. The 6 maxillary anterior teeth received the test sealant or no sealant. The nonblinded orthodontists visually examined the teeth immediately after debonding and rated the presence and severity of white spot lesions using a 4-point scale. The difference in incidence of white spot lesions on treated and control teeth was tested with multivariate binary logistic regression for repeated measures by using the generalized estimating equations approach. RESULTS: Sixty-five subjects were enrolled, and 3 were lost to follow-up, leaving 62 for analysis. There was a slightly lower incidence of white spot lesions on treated teeth (13.5%; 95% confidence interval, 8.6-18.4) compared with the control teeth (17.7%; 95% confidence interval, 12.4-23.7). This difference was statistically significant in the multivariate model (Wald chi-square, 5.07; df = 1; P = 0.024). The odds ratio was equal to 0.68 (95% confidence interval, 0.47-0.95) that treated teeth would show white spot lesions relative to the control teeth. White spot lesion severity was nearly the same for treated and control teeth (mean ± SD = 1.17 ± 0.47 and 1.20 ± 0.48, respectively; Wald chi-square, 3.03; df = 1; P = 0.082). No serious adverse effects were reported. CONCLUSIONS: The sealant did not prevent all white spot lesions for the full duration of treatment. The sealant demonstrated a clinically small but statistically significant ability to prevent white spot lesions.

Benchmarking clinical indicators of quality for Australian residential aged care facilities.

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40-80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase.

Development of a systematic approach to assessing quality within Australian residential aged care facilities: the Clinical Care Indicators Tool.

Recent years have seen the introduction of formalised accreditation processes in both community and residential aged care, but these only partially address quality assessment within this sector. Residential aged care in Australia does not yet have a standardised system of resident assessment related to clinical, rather than administrative, outcomes. This paper describes the development of a quality assessment tool aimed at addressing this gap. Utilising previous research and the results of nominal groups with experts in the field, the 21-item Clinical Care Indicators (CCI) Tool for residential aged care was developed and trialled nationally. The CCI Tool was found to be simple to use and an effective means of collecting data on the state of resident health and care, with potential benefits for resident care planning and continuous quality improvement within facilities and organisations. The CCI Tool was further refined through a small intervention study to assess its utility as a quality improvement instrument and to investigate its relationship with resident quality of life. The current version covers 23 clinical indicators, takes about 30 minutes to complete and is viewed favourably by nursing staff who use it. Current work focuses on psychometric analysis and benchmarking, which should enable the CCI Tool to make a positive contribution to the measurement of quality in aged care in Australia.

Relaçäo entre dimensäo vertical esquelética, contorno mandibular e aumento do comprimento mandibular em indivíduos masculinos / Relationship among skeleton vertical dimension, mandibular-profile, and mandibular lenght increase in males

Um estudo cefalométrico foi conduzido para determinar a relaçäo entre a dimensäo vertical esquelética facial, contorno da borda mandibular direita, contorno da sínfise e crescimento em comprimento da mandíbula em meninos antes do crescimento puberal e depois do crescimento puberal. Os 28 casos utilizados neste estudo foram selecionados dos arquivos do Bolton Longitudinal Growth Study at Case Western University, Cleveland, Ohio. O critério para selecionar a amostra foi: praticabilidade das radiografias cefalométricas laterais nos períodos de desenvolvimento (antes e depois da puberdade); presença de tipos faciais com mordida aberta e sobremordida profunda esqueléticas pela Análise dos Arcos de Sassouni, mesmo nível sócio-econômico. As seguintes variáveis foram medidas ou calculadas: altura da parte superior anterior da face, altura da parte inferior anterior da face; ângulo entre a linha mandibular 1 e linha mandibular 2; altura da sínfise; largura da sínfise; comprimento total da mandíbula; proporçäo da altura da parte superior anterior da face para a altura da parte inferior anterior da face, proporçäo entre altura e largura da sínfise. Coeficientes de correlaçäo de Pearson e análise de regressäo múltipla foram utilizados para analisar os dados. A dimensäo vertical foi a única variável que mostrou correlaçäo significante com o comprimento total da mandíbula. Esta mesma proporçäo também foi a única que diferenciou entre os grupos de mordida aberta e sobre mordida profunda. As variáveis previsíveis (proporçäo vertical e proporçäo da sínfise) somente justificam 21 por cento da variabilidade do comprimento total da mandíbula)