Long-term experiences of pain after a fragility fracture.

Little is known about long-term pain after a fragility fracture. In this secondary analysis, we determined that pain continues to influence many patients' lives more than 1 year after a fracture and that health care providers do not seem to adequately recognize or manage these long-term consequences. INTRODUCTION: We characterized perspectives on long-term pain among men and women who had sustained a fragility fracture. METHODS: We conducted a secondary analysis of qualitative data from 67 individuals recruited in three primary studies (47-89 years old; 55 women, 12 men). Eligible individuals from the primary studies were those who had reported pain related to their fracture beyond 6 months. Data about reported pain were re-analyzed using qualitative description as articulated by Sandelowski. RESULTS: Thirty-four individuals (47-89 years old; 4 men; 8 had sustained a vertebral fracture) reported pain related to their fracture in the primary studies. Thirty-one (91%) participants had sustained a fragility fracture at least 1 year previously (range 1-13 years). Patients described long-term pain beyond typical fracture healing times, generally unrelieved by analgesics, which affected their mobility, functional activity, independence, sleep, and energy. Health care providers were perceived to under-estimate timelines regarding the decrease of post-fracture pain and to not manage that pain. Participants reported that pain management was inadequate and that they developed their own strategies to respond to it. CONCLUSIONS: Pain continues to influence many patients' lives more than 1 year after a fragility fracture. Patient narratives could be useful to help health care providers to better recognize and manage this long-term consequence of fractures.

Understanding views on everyday use of personal health information: Insights from community dwelling older adults.

BACKGROUND: Older adults apply various strategies to pursue healthy aging, but we know little about their views and use of personal health information to accomplish those ends. METHODS: As a first step in formulating the role of personal health information management (PHIM) in healthy aging, we explored the perspectives of older adults on health and health information used in their everyday lives through four focus groups with 25 community-dwelling adults aged 60 and over. RESULTS: We found that the concept of wellness-the holistic and multidimensional nature of health and wellbeing-plays prominently in how older adults think about health and health information. Participants expressed wellness from a position of personal strength, rather than health-related deficits, by focusing on wellness activities for staying healthy through: (1) personal health practices, (2) social network support, and (3) residential community engagement. CONCLUSION: Although these themes involve personal health information, existing PHIM systems that focus on disease management are generally not designed to support wellness activities. Substantial opportunity exists to fill this wellness support gap with innovative health information technology designed for older adults. Findings carry implications for the design of PHIM tools that support healthy aging and methods for engaging older adults as co-producers of this critical support.

Treatment receipt and outcomes among lung cancer patients with depression.

AIMS: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. MATERIALS AND METHODS: A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. RESULTS: In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio = 1.14, 95% confidence interval: 1.03-1.27, P = 0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P = 0.003). There was no association of depression diagnosis with surgery (odds ratio = 0.83, 95% confidence interval: 0.56-1.22, P = 0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio = 1.02, 95% confidence interval: 0.89-1.16, P = 0.78) or chemotherapy (odds ratio = 1.07, 95% confidence interval: 0.83-1.39, P = 0.59) or radiation (odds ratio = 1.04, 95% confidence interval: 0.81-1.34, P = 0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. CONCLUSIONS: Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.

Effects of aging prior to freezing on poultry meat tenderness.

The objective of this study was to investigate the effects of aging prior to deboning and deep-freezing on the tenderness of cooked broiler breast fillets. Broilers (Ross-208) that were 37 and 38 d old were slaughtered in a licensed poultry meat plant. After spray chilling, carcasses with BW between 1,080 and 1,300 g were selected for the study and transported to a chilling room (2 to 4 degrees C). The whole carcasses were aged for up to 24 h. During the aging process, continuous measurements were made of pH values, electric conductivity, and firmness of the raw fillets. After the aging process, the carcasses were deboned, and the breast fillets were immediately frozen to an internal temperature of -20 degrees C. Tenderness was measured both mechanically with a Warner-Bratzler shear force device and by sensory testing. The ultimate pH values in the fillets were reached during the first 5 h of aging. Electric conductivity increased during the whole aging period. During the first hours of aging, firmness increased significantly, corresponding with the onset of rigor mortis. After between 8 and 9 h of aging, firmness decreased significantly. Shear force values of aged fillets also changed significantly; the highest values were found at the beginning of aging, which then decreased from the sixth hour. The results of the instrumental tenderness measurements were confirmed by the sensory evaluations. Implementation of in-plant measurements of firmness, thus, seemed to be useful in predicting the sensory quality of poultry meat.

An accuracy evaluation of four removable die systems.

STATEMENT OF PROBLEM: The advent of implant dentistry has redefined the need for accuracy of working cast models. Die stone expansion and errors introduced by removable die casts may exceed the accuracy required for the passive fit of implant prostheses. PURPOSE: Several removable die systems claim improved accuracy because of their design and/or technical advancements. This study evaluated the 3-dimensional accuracy of 4 removable die systems. All 4 systems tested use either 1 or 2 pins as the repositioning device. MATERIAL AND METHODS: Four removable die systems were evaluated (Belle de St. Claire, Pindex, DVA, and conventional brass dowel system). Master model impressions were made with polyvinyl siloxane material and were later cast with type IV die stone material. Comparative dimensional analysis between the master model and the solid and sectioned casts was made by placing the cast in a standardized position and fabricating an individual custom base for each cast. Landmarks were measured with a traveling microscope, and by mathematically rotating the casts. Discrepancies beyond that of stone expansion or residual stress release at the time of die separation were due to the inability to precisely reposition the removable die of the sectioned cast. Data were analyzed with multivariate analysis of variance and paired t tests at alpha = .05 (n = 10). RESULTS: Significant differences were found among die systems tested (P = .005). When sectioned dies were compared with the master model, the accuracy of all 4 die systems was within 0.055 mm of the master model. Once sectioned, the Pindex system had the least linear expansion in the y dimension, and the brass dowel system demonstrated the least reseating discrepancy in the z (occlusogingival) dimension. CONCLUSIONS: All 4 die systems provided a similar degree of dimensional accuracy, although Pindex showed the least horizontal movement and the brass dowel system produced the least occlusogingival reseating discrepancy.

A method for true coordinate three-dimensional measurement of casts using a measuring microscope.

Exact 3-dimensional measurements are more useful for researchers and clinicians than are relative distance measurements. Through the use of a measuring microscope and a personal computer, the technique presented in this article provides meaningful and accurate (0.005 mm) 3-dimensional measurements of casts in true coordinates (x, y, z). By fabricating the master cast with reference landmarks, leveling the casts before measurement, removing the cast between repeat measures, and mathematically rotating the data points, this technique places all the landmarks in a standardized reference plane that allows for the comparison of dimensional changes between different casts.