Maxillofacial injuries associated with domestic violence: experience at a major trauma centre.

Domestic violence continues to be a global public health issue, and facial injuries in these cases are common with a reported incidence of up to 94%. Our aims were to identify patients with facial injuries caused by domestic violence, and to find out how confident members of the oral and maxillofacial surgical (OMFS) team were at assessing them. In this 18-month retrospective study of patients seen at King's College Hospital we identified 18 and obtained details on sex, age, nature of maxillofacial injury, mechanism of injury, time to presentation, and alleged assailant, from their electronic records. Most of the patients were female and the mean (range) age was 28 (16-44) years. In 10 cases, the alleged assailant was the patient's current partner. A total of 15 patients presented on the same day as their injury, and only 3 the following day. Punching was the most common mechanism (n=13) followed by use of a weapon. We also circulated a questionnaire among the OMFS team to gain an insight into their attitudes regarding screening for domestic violence. Most OMFS clinicians were only "somewhat confident" at recognising and asking about domestic violence, and few were "very" or "extremely confident". Targeted training for frontline staff in OMFS teams is likely to increase their confidence to identify and manage these patients, and to refer them appropriately.

Structured review of the patient-reported outcome instruments used in clinical trials in head and neck surgery.

The number of clinical trials that relate to patients with cancer of the head and neck is growing. Patient-reported outcomes, which are rarely the primary outcome, are now an important component, and in this structured review to identify and report the characteristics of the questionnaires that have been used in these trials, we summarise the findings reported. We searched several online databases using the key terms: head and neck oncology, head and neck surgery, reconstruction, clinical trials patient-reported outcomes, questionnaires, quality of life (QoL), validated instruments, and patients' satisfaction. We screened 1342 papers to collect information about the topic of the paper, sample size, selection criteria, main advantages and disadvantages of the patient-reported outcome used, and if it was used in conjunction with another measure. A total of 54 were eligible, and from them we identified 22 questionnaires. The primary reason for using a questionnaire was its relevance to the focus of the paper, such as xerostomia, pain, or swallowing. To allow the experience of patients to be the focus of the primary outcome in a clinical trial, we recommend that the measures used should be appropriate, reliable, valid, responsive, precise, interpretable, acceptable, and feasible. The trials used validated questionnaires, but the patient-reported outcome measures tended not to be the focus. There is merit in such measures being the primary outcomes in future trials and these should be designed around an explicit hypothesis.

Ultraviolet disinfection with a novel microwave-powered device.

AIMS: To evaluate the antimicrobial efficacy of a novel u.v. beaker, powered in a domestic microwave oven. METHODS AND RESULTS: Three beakers were compared, with most rapid killing obtained in the Neutra Plasma 50. Ultraviolet light generated within the beakers efficiently killed planktonic and surface-associated Streptococcus mutans, Pseudomonas aeruginosa, vegetative Bacillus stearothermophilus, herpes simplex and polio viruses. Candida albicans and Mycobacterium phleii were less rapidly killed, and only 70% inactivation of B. stearothermophilus endospores was achieved. Irradiation for 45 s reduced viable bacterial counts in saliva by > 99%. CONCLUSIONS: The u.v.-generating beakers efficiently reduced viable counts of bacteria, yeast and viruses. Kinetics of killing varied, reflecting the fact that lethal mechanisms are complex, and probably depend on interplay between u.v. and heat. SIGNIFICANCE AND IMPACT OF THE STUDY: This novel method of generating u.v., using a cheap and widely available power source, provides a rapid, inexpensive and non-toxic method of disinfection with a wide range of applications in hospitals, clinics and the home.

Direct single-reagent fluorescence polarisation immunoassay for valproic acid in serum.

A fluorescence polarisation immunoassay for quantitating serum concentrations of valproic acid was developed and validated. Its low molecular weight and lack of structural features caused difficulties in producing suitable antibodies. However, success was achieved using 2-propyl-6-aminohexanoic acid to make the fluorescein-labelled drug and two immunogens, the first using glutaraldehyde to link the drug derivative to keyhole limpet haemocyanin, and the second by carbodiimide activation of cellulose hydroxyl groups and coupling them to the drug derivative and killed Mycobacteria. It was found that both immunogens produced a good antibody response in sheep. The antibodies were highly specific and the assay results correlated well with an in-house gas-liquid chromatographic method.