Factors associated with laryngeal injury after intubation in children: a systematic review.

PURPOSE: The purpose of this study is to evaluate all potential factors associated with laryngeal injury after endotracheal intubation in the pediatric population. METHODS: A systematic literature search was conducted in Medline, Embase, Cochrane, web of science and Google scholar up to 20th of March 2023. We included all unique articles focusing on factors possibly associated with intubation-injury in pediatric patients. Two independent reviewers determined which articles were relevant by coming to a consensus, quality of evidence was rated using GRADE criteria. All articles were critically appraised according to the PRISMA guidelines. The articles were categorized in four outcome measures: post-extubation stridor, post-extubation upper airway obstruction (UAO) necessitating treatment, laryngeal injury found at laryngoscopy and a diagnosed laryngotracheal stenosis (LTS). RESULTS: A total of 24 articles with a total of 15.520 patients were included. The incidence of post-extubation stridor varied between 1.0 and 30.3%, of post-extubation UAO necessitating treatment between 1.2 and 39.6%, of laryngeal injury found at laryngoscopy between 34.9 to 97.0% and of a diagnosed LTS between 0 and 11.1%. Although the literature is limited and quality of evidence very low, the level of sedation and gastro-esophageal reflux are the only confirmed associated factors with post-extubation laryngeal injury. The relation with age, weight, gender, duration of intubation, multiple intubations, traumatic intubation, tube size, absence of air leak and infection remain unresolved. The remaining factors are not associated with intubation injury. CONCLUSION: We clarify the role of the potential factors associated with laryngeal injury after endotracheal intubation in the pediatric population.

Fluoride, pH Value, and Titratable Acidity of Commercially Available Mouthwashes.

AIM: The primary objective of this work was to assess total soluble fluoride (TSF), pH values, and titratable acidity (TA) of various mouthwashes "in vitro," and the second was to compare fluoride content on labels with measured TSF. METHODS: Commercial mouthwashes were collected and analysed. Company, type, manufacturer data, and active ingredients (essential oils [EO], cetylpyridinium chloride [CPC], chlorhexidine [CHX], and fluoride) were described. TSF, pH, and TA capacity were measured. Descriptive quantitative analysis were performed per mouthwash. RESULTS: In total, 54 mouthwashes from 20 brands were included. These included mouthwashes with the active ingredients EO (n = 11), CPC (n = 17), CHX (n = 18), and fluoride (n = 32); 27 mouthwashes with more than 1 of these active ingredients; and 4 with none of the above-mentioned ingredients. Fluoride was present in different formulations; most contained sodium fluoride (NaF), and a few had sodium monofluorophosphate and amine fluoride + NaF. The pH values of all evaluated mouthwashes ranged from 4.1 to 7.9. Twenty mouthwashes presented pHs below 5.5, of which 10 contained fluoride. TA ranged from 0 to 48. According to the manufacturer data, mouthwashes with fluoride had concentrations from 217 to 450 ppm, with 90% in the range from 217 to 254 ppm. Laboratory data revealed that TSF ranged from 229 to 500 ppm, with 90% in the range from 229 to 337 ppm. A statistically significant difference was observed between measured TSF and the labelled fluoride content on the packaging of the fluoride mouthwashes (mean difference, 43.92 ± 34.34; P < .001). Most of these mouthwashes contained at least the amount of fluoride as mentioned on the packaging (93%). CONCLUSION: The pH values and TA of commercially available mouthwashes showed a large variation. TSF levels of the fluoride mouthwashes were found to be at least the amount of fluoride as labelled. Dental care professionals should be aware of the pH, TA, fluoride content, and other active ingredients of different mouthwashes to better understand their potential impact on oral health.

[Long-term results of periodontal therapy]. / Langetermijnresultaten van parodontale behandeling.

Treatment of periodontitis plays an important role in preventing tooth loss. Over the years, various treatment modalities have been proposed, researched and applied in the dental practice. The non-surgical periodontal therapy of cleaning the root surfaces is still the golden standard in treatment of periodontitis. If pockets of ≥ 6 mm remain after the non-surgical therapy, surgical periodontal therapy could be considered. People with periodontal disease should agree with lifelong periodontal therapy, because after the 'active' (non-surgical and surgical) periodontal therapy, lifelong periodontal maintenance is the most important thing to guarantee periodontal health and stability. The ultimate goal of periodontal therapy is preservation of the natural dentition. Many studies have shown that this goal can be achieved, providing the following circumstances are met: a good oral hygiene and high patient motivation, optimal periodontal treatment, and smoking cessation.

Jejunal closed-loop obstruction without prior abdominal surgery during COVID-19 ICU admittance: A case report.

INTRODUCTION: and importance: Closed-loop obstruction is a specific case of small bowel obstruction in which two sites of the bowel obstruct at one adjacent location. This can result in strangulation with high mortality. This condition is most often observed after abdominal surgery. The exact underlying pathology in patients without prior abdominal surgery is still largely unclear, and only scarce literature on the role of COVID-19 or long-term prone position is available. CASE PRESENTATION: A 74-year-old male patient without prior abdominal surgery was presented to the emergency department with pulmonary and gastro-intestinal symptoms of COVID-19. The patient was known to have diverticulosis of colon and sigmoid. After a complicated ICU course, the patient developed a jejunal closed loop obstruction, and a diagnostic laparoscopy was performed. Fixation of the omentum to the retroperitoneum was released, without observation of further adhesions, bowel torsion or ischemic bowel. Further abdominal course was uncomplicated, however, unfortunately the patient died following pulmonary deterioration. CLINICAL DISCUSSION: The differential diagnosis of small bowel obstruction is extensive; however, adhesions are most often observed. In patients without prior surgery, also adhesions are observed, mainly caused by earlier infections. There might be a role for abdominal COVID-19 infection and prolonged prone position in the emergence of adhesions; however, literature is lacking. Alternatively, asymptomatic diverticulitis might have led to adhesion formation. CONCLUSION: Closed loop obstructions in patients without prior abdominal surgery are uncommon and post-infectious abdominal status might cause adhesions. It is unclear whether abdominal manifestations of COVID-19 and prolonged prone position can also cause adhesions and, thereby, small bowel obstructions.

[A woman with hypoxia after shoulder arthroscopy]. / Een vrouw met hypoxie na artroscopie van de schouder.

A 58-year-old female with a history of obesity, smoking and hypertension underwent shoulder arthroscopy. Prior to the arthroscopy, patient received an interscalene brachial plexus block. After the arthroscopy, patient had an oxygen saturation of 85%, caused by an unilateral diaphragm paralysis due to a phrenic nerve block.

Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study.

PURPOSE: Prolonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors. METHODS: 150 children, aged 0-16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed. RESULTS: The median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due to respiratory distress and in 1 child stridor persisted for which a surgical intervention was necessary. In multivariate analyses, we found the following independent predictors of stridor: intubation on the scene, the use of cuffed tubes and lower age. CONCLUSION: Despite a high incidence for post-extubation stridor, only few children need reintubation or surgical intervention as a result of post-extubation lesions. Intubation on the scene, the use of cuffed tubes and young age are associated with a significant increased risk of post-extubation stridor. Awareness of these factors gives the possibility to anticipate on the situation and to minimize laryngeal injury and its possible future consequences.

Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia.

BACKGROUND: Impaired metacognition is associated with difficulties in the daily functioning of people with psychosis. Metacognition can be divided into four domains: Self-Reflection, Understanding the Other's Mind, Decentration, and Mastery. This study investigated whether Metacognitive Reflection and Insight Therapy (MERIT) can be used to improve metacognition. METHODS: This study is a randomized controlled trial. Patients in the active condition (n = 35) received forty MERIT sessions, the control group (n = 35) received treatment as usual. Multilevel intention-to-treat and completers analyses were performed for metacognition and secondary outcomes (psychotic symptomatology, cognitive insight, Theory of Mind, empathy, depression, self-stigma, quality of life, social functioning, and work readiness). RESULTS: Eighteen out of 35 participants finished treatment, half the drop-out stemmed from therapist attrition (N = 5) or before the first session (N = 4). Intention-to-treat analysis demonstrated that in both groups metacognition improved between pre- and post-measurements, with no significant differences between the groups. Patients who received MERIT continued to improve, while the control group returned to baseline, leading to significant differences at follow-up. Completers analysis (18/35) showed improvements on the Metacognition Assessment Scale (MAS-A) scales Self Reflectivity and metacognitive Mastery at follow-up. No effects were found on secondary outcomes. CONCLUSIONS: On average, participants in the MERIT group were, based on MAS-A scores, at follow-up more likely to recognize their thoughts as changeable rather than as facts. MERIT might be useful for patients whose self-reflection is too limited to benefit from other therapies. Given how no changes were found in secondary measures, further research is needed. Limitations and suggestions for future research are discussed.

Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial.

PURPOSE: The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention 'REFLEX' aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. METHOD: A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012-2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. RESULTS: Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. CONCLUSION: Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.

Using the Dutch multi-informant Strengths and Difficulties Questionnaire (SDQ) to predict adolescent psychiatric diagnoses.

Knowledge on the validity of the Strengths and Difficulties Questionnaire (SDQ) among adolescents is limited but essential for the interpretation of SDQ scores preceding the diagnostic process. This study assessed the predictive and discriminative value of adolescent- and parent-rated SDQ scores for psychiatric disorders, diagnosed by professionals in outpatient community clinics, in a sample of 2753 Dutch adolescents aged 12-17. Per disorder, the predictive accuracy of the SDQ scale that is contentwise related to that particular disorder and the SDQ impact scale was assessed. That is, 24 logistic regression analyses were performed, for each combination of DSM-IV diagnosis [4: Attention-Deficit/Hyperactivity Disorder (ADHD), Conduct/Oppositional Defiant Disorder (CD/ODD), Anxiety/Mood disorder, Autism Spectrum Disorder (ASD)], informant (3: adolescent, parent, both), and SDQ scale(s) (2; related scale only, related scale and impact scale). Additional logistic regression analyses were performed to assess the discriminative strength of the SDQ scales. The results show both fair predictive strength and fair discriminative strength for the adolescent- and parent-reported hyperactivity scales, the parent-reported conduct scale, and the parent-reported social and prosocial scales, indicating that these scales provide useful information about the presence of ADHD, CD/ODD, and ASD, respectively. The SDQ emotional scale showed to be insufficiently predictive. The findings suggest that parent-rated SDQ scores can be used to provide clinicians with a preliminary impression of the type of problems for ADHD, CD/ODD, and ASD, and adolescent for ADHD.

[Isolated monoparesis of hand or foot caused by cortical ischaemic stroke]. / Geïsoleerde parese van hand of voet door corticale ischemie.

A 78-year-old man presented with painless weakness of his right thumb and index finger. Neurological examination confirmed weakness of the intrinsic musculature of the hand without sensory impairments. Diffusion-weighted imaging (DWI) showed ischaemia of the left cortical hand knob. A 71-year-old man presented with isolated paralysis of plantar flexors and dorsiflexors of the right ankle upon awakening. DWI confirmed a cortical ischaemic cause of the symptoms. Acute isolated hand or foot paresis is a rare symptom of stroke. Early diagnosis is challenging because presentation may simulate a peripheral origin. If the distribution of the intrinsic hand or foot muscle weakness is beyond the territory of a single peripheral nerve or if increased tendon reflexes are present, cortical ischaemia should be considered. DWI is essential for early diagnosis of cortical ischaemia. Rapid initiation of secondary prevention can reduce the risk of stroke recurrence.

Subacute posttraumatic complaints and psychological distress in trauma patients with or without mild traumatic brain injury.

OBJECTIVE: To identify the frequency, nature and profile of complaints for trauma patients with and without mild traumatic brain injury (mTBI), and to assess their relation to anxiety and depression. METHODS: A prospective cohort study in a level-one trauma centre was conducted. Mild traumatic brain injury patients and trauma controls were approached for participation. Two weeks after injury, The Head Injury Symptom Checklist (HISC) and the Hospital Anxiety and Depression Scale (HADS) were administered. RESULTS: Two-hundred seventy two patients with mTBI and 125 TC patients completed the questionnaires. Differences were demonstrated between the two trauma populations on frequency and nature of reported complaints. Ordinal common factor analysis on the mTBI scores yielded three factors: mental distress, physical discomfort, and sensory disbalance, which were all significantly correlated to anxiety and depression scores. Discriminant analyses identified a subset of complaints which could allocate almost 80% of patients to the correct group. CONCLUSIONS: Patients with mTBI showed a different pattern of complaints than orthopaedic control patients. A mental distress factor consisting of both somatic and cognitive complaints proved to be most discriminating and showed high correlations with anxiety and depression.

Model Fit after Pairwise Maximum Likelihood.

Maximum likelihood factor analysis of discrete data within the structural equation modeling framework rests on the assumption that the observed discrete responses are manifestations of underlying continuous scores that are normally distributed. As maximizing the likelihood of multivariate response patterns is computationally very intensive, the sum of the log-likelihoods of the bivariate response patterns is maximized instead. Little is yet known about how to assess model fit when the analysis is based on such a pairwise maximum likelihood (PML) of two-way contingency tables. We propose new fit criteria for the PML method and conduct a simulation study to evaluate their performance in model selection. With large sample sizes (500 or more), PML performs as well the robust weighted least squares analysis of polychoric correlations.

Long-term quality of life in children after open airway surgery for laryngotracheal stenosis.

OBJECTIVES: The purpose of this study is to evaluate the long-term health related quality of life (HRQoL) in a cohort of children surgically treated for laryngotracheal stenosis (LTS). STUDY DESIGN: Prospective cohort study. METHODS: Parents of children between 4 and 18 years at follow-up completed the Child Health Questionnaire Parent Form (CHQ-PF50). Children between 11 and 18 years at follow-up completed the Child Health Questionnaire Child Form (CHQ-CF87). Biographical and pre-operative data were extracted from the hospital records. Post-operative measurements consisted of the Bruce treadmill test and pulmonary function testing (PFT). RESULTS: Fifty-four parents completed the CHQ-PF50; twenty-one children completed the CHQ-CF87. The CHQ-PF50 was significantly worse than the norm population on the subscales physical functioning, role functioning: emotional/behavior, general health perceptions, family activities, parental impact: emotional, and time. CHQ-CF87 was significantly worse than the norm population on physical functioning and better on mental health. After multivariate analysis, presence of co-morbidities and glottic stenosis are the most important pre-operative factors for worse scores on general health. As post-operative measurements, the Bruce treadmill test and peak expiratory flow (PEF) correlate well with HRQoL physical subscales. CONCLUSIONS: At long-term follow-up after treatment for LTS, deficits in HRQoL may still exist. Presence of co-morbidities and glottic stenosis are important negative factors for long-term HRQoL. The Bruce treadmill test and peak expiratory flow on pulmonary function testing correlate well with physical subscales on HRQoL. A long-term multidisciplinary follow-up with assessment of HRQoL is advised in patients treated for LTS. LEVEL OF EVIDENCE: 2B, individual prospective cohort study.

Differential effects of antipsychotic drugs on insight in first episode schizophrenia: Data from the European First-Episode Schizophrenia Trial (EUFEST).

Although antipsychotics are widely prescribed, their effect of on improving poor illness insight in schizophrenia has seldom been investigated and therefore remains uncertain. This paper examines the effects of low dose haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on insight in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. The effects of five antipsychotic drugs in first episode psychosis on insight were compared in a large scale open randomized controlled trial conducted in 14 European countries: the European First-Episode Schizophrenia Trial (EUFEST). Patients with at least minimal impairments in insight were included in the present study (n=455). Insight was assessed with item G12 of the Positive and Negative Syndrome Scale (PANSS), administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. The use of antipsychotics was associated with clear improvements in insight over and above improvements in other symptoms. This effect was most pronounced in the first three months of treatment, with quetiapine being significantly less effective than other drugs. Effects of spontaneous improvement cannot be ruled out due to the lack of a placebo control group, although such a large spontaneous improvement of insight would seem unlikely.

In vitro evaluation of temperature changes in the root canal induced by ultrasonic scalers.

OBJECTIVE: To evaluate in vitro the thermal effects induced by four different ultrasonic scalers on the temperature in the root canal during ultrasonic scaling. METHODS: An extracted lower central incisor provided with a thermocouple in the root canal and a tube, entering the tooth incisally and exiting it apically to simulate an artificial bloodstream, was placed in a model of the lower jaw with soft artificial gingiva. Tested ultrasonic scaler systems included: EMS PM-600, Satelec P-max, Dürr Vector and Dentsply Cavitron. The tooth was scaled with each system at full water supply of 21°C. Furthermore, the amount of water supply was determined to maintain during scaling a constant temperature in the root canal. Finally, thermal changes due to scaling without water were assessed. RESULTS: Except for the Vector all scaler systems showed a temperature decrease in the root canal. The Vector with water/polish suspension showed a trend towards an increase in temperature. To maintain a constant temperature in the root canal the Cavitron needed twice the amount of water compared with PM-600 and P-max. Without water, all scaling systems induced a temperature increase. CONCLUSION: For safe ultrasonic scaling, care should be taken that the cooling water has room temperature and that, dependent on the scaler system, the proper amount of water is supplied.

Measurement bias detection through Bayesian factor analysis.

Measurement bias has been defined as a violation of measurement invariance. Potential violators-variables that possibly violate measurement invariance-can be investigated through restricted factor analysis (RFA). The purpose of the present paper is to investigate a Bayesian approach to estimate RFA models with interaction effects, in order to detect uniform and nonuniform measurement bias. Because modeling nonuniform bias requires an interaction term, it is more complicated than modeling uniform bias. The Bayesian approach seems especially suited for such complex models. In a simulation study we vary the type of bias (uniform, nonuniform), the type of violator (observed continuous, observed dichotomous, latent continuous), and the correlation between the trait and the violator (0.0, 0.5). For each condition, 100 sets of data are generated and analyzed. We examine the accuracy of the parameter estimates and the performance of two bias detection procedures, based on the DIC fit statistic, in Bayesian RFA. Results show that the accuracy of the estimated parameters is satisfactory. Bias detection rates are high in all conditions with an observed violator, and still satisfactory in all other conditions.

Characteristics and surgical outcome of 98 infants and children surgically treated for a laryngotracheal stenosis after endotracheal intubation: excellent outcome for higher grades of stenosis after SS-LTR.

INTRODUCTION: To describe the characteristics and surgical outcome of 98 infants and children treated for an acquired laryngeal stenosis after intubation for respiratory support. MATERIAL AND METHODS: We retrospectively reviewed our data from the last 18 years (1994-2013) concerning infants and children with an acquired laryngotracheal stenosis who were treated in our hospital with a laryngotracheal reconstruction or a cricotracheal resection. Outcome was defined by decannulation ratio. RESULTS: Of the 98 infants and children who were studied, 54% were preterm, 18% neonates, 13% infants and 14% children. Ninety-one SS-LTR's, two DS-LTR's and five CTR's were performed as primary surgery; three revision operations were performed (DS-LTR). Seventy-seven children had a tracheostomy prior to surgery; decannulation ratio was 93% after primary surgery and 95% after inclusion of revision surgery. For SS-LTR, the decannulation ratio was 93%, including grade III stenosis with comorbidities. Male sex and glottic involvement of the stenosis are correlated to failure of decannulation. Intubation in the term neonatal period is correlated to complicated post-operative course after SS-LTR. CONCLUSIONS: Excellent results of surgery for acquired laryngotracheal stenosis can be obtained with a high decannulation rate. Even for higher grades of stenosis with comorbidities and glottic involvement, an SS-LTR is an effective surgical treatment for acquired laryngeal stenosis.

Saddle and leg forces during lateral movements in dressage.

REASONS FOR PERFORMING STUDY: In the equestrian world it is assumed that riders use changes in weight distribution and leg forces as important instruments to give horses directions about speed and direction of movement. However, the changes of these forces have never been quantified. OBJECTIVES: To investigate the distribution of normal forces (perpendicular to surface) underneath the saddle and of normal forces exerted by the rider's legs during lateral movements. MATERIALS AND METHODS: Eleven riders performed 3 different exercises: riding straight ahead, shoulder-in and travers at trot. Three saddle force systems were used simultaneously. The magnitudes of the forces were summed for the total area, the inside and the outside half of the saddle and inside and outside leg. Mean and maximum summed forces were analysed statistically. RESULTS: The saddle forces showed a rhythmic pattern but leg forces were more irregular. Mean total saddle force was lower (P = 0.006) when riding straight ahead (671 ± 143 N) than when riding shoulder-in (707 ± 150 N) or travers (726 ± 165 N). Mean inside saddle force was higher (P = 0.003) when riding travers (468 ± 151 N) than when riding straight on (425 ± 121 N) or shoulder-in (413 ± 136 N). Maximum outside leg force was higher (P = 0.013) when riding travers (47.2 ± 33.9 N) than when riding straight on (31.6 ± 24.1 N) or shoulder-in (34.2 ± 27.3 N). CONCLUSION: The study helps to give a biomechanical background to well established but intuitive horse riding techniques.

Safety and efficacy of two manual toothbrushes.

OBJECTIVE: The purpose of this study was to test the efficacy and safety of a newly designed multi-level manual toothbrush (Profit-Haije-Brush) compared with a control flat-trimmed manual reference toothbrush from the American Dental Association (ADA). MATERIAL AND METHODS: For this study, 36 healthy subjects without previous experience in the use of the Profit-Haije-Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra-lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2-min brushing exercise. After brushing, plaque and gingival abrasion were re-assessed. A questionnaire was filled out to investigate the subjects' attitudes towards both brushes. RESULTS: The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively (P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post-brushing scores were 13.49 and 13.77 for the PHB and ADA respectively. CONCLUSION: Statistically, the multi-level PHB was significantly more efficacious than the flat-trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed.

The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia.

BACKGROUND AND AIMS: Many people with schizophrenia have severe cognitive impairments that hamper their activities. The effect of pharmacological and behavioural interventions on cognitive functioning has been demonstrated, but even after successful intervention considerable impairments can remain. Therefore, we sought for alternative ways to help patients cope with the effects of their cognitive impairments. In the present study, we have evaluated the efficacy of short message service (SMS) text messages to compensate for the effects of cognitive impairments in schizophrenia in daily life. DESIGN: A waiting list controlled trial was conducted: patients were quasi-randomly assigned to an A-B-A (baseline-intervention-follow-up) condition or an A-A-B-A condition that included an additional 7-week waiting list. The waiting list was included to control for the effect of time on relevant outcome. METHOD: Sixty-two people with schizophrenia or related psychotic disorders were included in the study. All patients showed impaired goal-directed behaviour in daily life-situations. Patients were prompted with SMS text messages to improve their everyday functioning. The primary outcome measure was the percentage of goals achieved. RESULTS: The overall percentage of goals achieved increased with prompting, while performance dropped to baseline level after withdrawing the prompts. Keeping appointments with mental health workers and carrying out leisure activities increased with prompting, while medication adherence and attendance at training sessions remained unchanged. A majority of the patients enjoyed receiving the SMS text messages. DISCUSSION: Prompting can significantly improve achievement of a number of relevant goals. For other goals, combining prompting with interventions that enhance motivation seems indicated.