ABSTRACT
BACKGROUND: A submucous cleft palate and a congenitally short velum are diagnosed rather late, because symptoms are often mild. OBJECTIVES: The pre- and postoperative clinical symptoms for both conditions are presented. MATERIALS AND METHODS: The data of 180 patients with a submucous cleft palate (161) or congenitally short velum (19) were retrospective analyzed. In 23.3%, a syndromic association was found. RESULTS: Clinical findings for both conditions included middle ear problems, hypernasal speech, nasal penetration, the absence of the posterior nasal spine of the hard palate and/or a bifid uvula with a zona pellucida. The average age at diagnosis was 4.2 years in submucous clefts and 5.7 years in children with a congenitally short velum. Surgical palatoplasty with fusion of soft palate muscles and/or elongation of the soft palate was performed in 83.9% of the children, aiming to achieve sufficient velopharyngeal closure (VPC) with a significant decrease of symptoms and, hence, better conditions for speech therapy interventions. The overall success rate of the VPC was 63.7% with improvement in up to 2 of the 3 clinical symptoms (hypernasal speech, nasal penetration, middle ear problems). Hypernasal speech was more common (in 89.5%) in children with a congenitally short velum before surgery and in 81.3% 8 weeks after surgery; however, prior to surgery they had a short soft palate. CONCLUSION: Surgical intervention was particularly effective in children younger than 5 years. Syndromic diseases are disproportionately associated with soft palate defects.
Subject(s)
Cleft Palate , Velopharyngeal Insufficiency , Child , Child, Preschool , Cleft Palate/complications , Cleft Palate/surgery , Humans , Palate, Hard , Palate, Soft , Retrospective Studies , Treatment Outcome , Velopharyngeal Insufficiency/surgeryABSTRACT
OBJECTIVES: To investigate age of diagnosis, typical symptoms, finding of the palate, therapy options and accompanying diseases. METHODS: A retrospective analysis of 439 patients with symptomatic submucous cleft palate (SMCP), who received a veloplasty operation (butterfly suture technique developed by Haase) was made. RESULTS: SMCP was initially diagnosed at the mean age of 4.9 years. Main symptoms were hyper nasal speech (51%) and conductive hearing loss (45%), which resolved after veloplasty (often in combination with adenotomy and insertion of ventilation tubes). Typical findings of the palate were a lack of posterior nasal spine (68%) and bifid uvula (59%). Following surgery 17.1% required speech therapy and 5.5% needed velopharyngoplasty due to continuing hyper nasal speech. CONCLUSION: SMCP is often diagnosed very late, though symptoms of velopharyngeal insufficiency (hyper nasal speech, Eustachian tube dysfunction) and bifid uvula are present. We therefore recommend that all patients with such findings are examined by an appropriate specialist such as Phoniatrics, Otolaryngologist and Oral-Maxillofacial-Surgeon so that early diagnosis and palatoplasty can be performed. The veloplasty operation (butterfly suture technique) can be recommended as a safe therapy for velopharyngeal insufficiency for patients with symptomatic SMCP.
Subject(s)
Cleft Palate/diagnosis , Cleft Palate/surgery , Velopharyngeal Insufficiency/therapy , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Humans , Infant , Laryngoplasty/adverse effects , Laryngoplasty/methods , Male , Mucous Membrane/pathology , Mucous Membrane/surgery , Otorhinolaryngologic Surgical Procedures/adverse effects , Otorhinolaryngologic Surgical Procedures/methods , Palate, Soft/abnormalities , Palate, Soft/surgery , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Recovery of Function , Reoperation , Retrospective Studies , Speech Therapy/methods , Suture Techniques , Treatment Outcome , Velopharyngeal Insufficiency/diagnosis , Velopharyngeal Insufficiency/etiologyABSTRACT
BACKGROUND: Graduated compression stockings (GCS) can effectively reduce postoperative deep vein thrombosis (DVT) and their use is recommended by expert committees. However, it appears that GCS are not frequently used. The objectives of this study are to evaluate the customary use of GCS in surgical settings in the City of Hamburg, Germany, and to present evidence on the effectiveness of GCS. METHODS: A questionnaire on the use of thromboprophylaxis was sent to 48 surgeons in Hamburg. In addition, a comprehensive search for randomized-controlled trials, reviews, and meta-analyses indexed in MEDLINE (1984-06/2002) and the Cochrane Library (Issue 2, 2002) was conducted to show the effectiveness of GCS compared to nontreatment, other antithrombotic methods, or combined treatment. RESULTS: Of 48 surgeons 39 responded. Seven surgeons dismissed the use of GCS for thromboprophylaxis, 3 used GCS alone, 25 GCS in combination with heparin, and 4 used GCS only for patients at high risk. The review of the literature revealed the effectiveness of GCS in general and for abdominal surgical patients. Enhanced benefit is suggested when combining GCS with another intervention such as low-dose unfractionated heparin. Single application of GCS in orthopedic surgical or neurosurgical patients using venography showed no effect when compared to combined treatment of GCS and low molecular weight heparin. Trials with patients undergoing gynecological and urological surgeries are rare. There is a lack of trials investigating health-related quality of life and costs associated with the use of GCS. Complications are poorly reported. A determination as to the appropriate length of stockings is presently not possible. CONCLUSIONS: GCS should be integral part of DVT prophylaxis in surgical departments. Their ineffectiveness is likely in some surgical populations.
Subject(s)
Bandages , Postoperative Complications/prevention & control , Venous Thrombosis/prevention & control , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Combined Modality Therapy , Female , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Heparin/administration & dosage , Heparin/therapeutic use , Humans , Male , Meta-Analysis as Topic , Randomized Controlled Trials as Topic , Risk Factors , Surveys and Questionnaires , Thrombophlebitis/prevention & controlABSTRACT
Incontinence raises a problem of increasing relevance. Estimates of prevalence and severity are presented in a wide range. Valid assessment instruments are sparse or based on varying definitions. Therefore, existing data of incontinence rates are likely to be overestimated. To exemplify this problem, we reviewed epidemiological articles on female incontinence.
Subject(s)
Urinary Incontinence/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Data Collection/statistics & numerical data , Female , Humans , Incidence , Infant , Middle Aged , Reproducibility of Results , Risk Factors , Urinary Incontinence/classification , Urinary Incontinence/diagnosis , Urinary Incontinence/etiologyABSTRACT
Evidence-based nursing is the concept of critically appraising the best evidence from research. It integrates research evidence with clinical expertise into decision making in nursing care for patients. The method is derived from the new paradigm in medicine--evidence-based medicine, developed as a learning method by epidemiologists at the McMaster University in Canada. This article states the necessity of this method for nursing. With the help of a clinical scenario (fall prevention in the elderly) the author explains how to use evidence-based nursing in practice.
Subject(s)
Evidence-Based Medicine , Nursing Care/methods , Nursing Care/standards , Accidental Falls/prevention & control , Aged , Diffusion of Innovation , Humans , Models, Nursing , Nursing ResearchABSTRACT
OBJECTIVES: To ascertain whether there are randomised-controlled trials (RCTs) and systematic reviews on nursing care, written in German language, which need to be identified for inclusion in systematic reviews of the effects of health care. Quantitative comparison of German-language and international nursing research. METHODS: Searches by Medline and CINAHL (1988-1997) and searches by hand of seven nursing journals, published in German language, to identify RCTs and systematic reviews. MAIN MEASURES: Total number of RCTs identified and number of RCTs published in German language journals. RESULTS: 15 RCTs related to nursing care have been identified. No RCTs have been found by hand search of nursing journals. There were no nurse researchers as first authors for RCTs. CONCLUSIONS: German nurse researchers need to adapt high quality study designs to nursing interventions studies to achieve international research standard.
Subject(s)
Nursing Research , Nursing , Periodicals as Topic , Randomized Controlled Trials as Topic , Review Literature as Topic , HumansABSTRACT
Materials water comes into contact with can promote the microbial growth as it could be shown before. The reaction of an unspecific microorganism flora and of Legionella pneumophila in pipes and hoses has been described in the two previous communications. The investigation with L. pneumophila has shown that even a pathogen organism can grow upon the materials. Therefore it was of special interest to prove whether indicator organisms for the testing of drinking water can grow in pipes and hoses as well. Escherichia coli, Citrobacter freundii and Klebsiella pneumoniae grew after the experimental contamination for many weeks on the rubber hose until the test was finally stopped, in the other pipes and hoses (glass, high-grade steel, PVC, PE, PA, PTFE and silicone) E. coli could be found for maximal 7 weeks, Citrobacter freundii for 1 week and Klebsiella pneumoniae for maximal 3 weeks. In the copper pipe the organisms could be found only for a few days.
