Incarcerated Amyand Hernia Associated With Acute Appendicitis and Incidental Finding of Serrated Adenoma.

BACKGROUND: Amyand hernias are rare as they represent 0.5% of all hernias. An Amyand hernia that is discovered due to acute appendicitis is even rarer, accounting for approximately 0.11% of cases. Furthermore, appendiceal neoplasms are infrequently encountered in only 0.7-1.7% of appendectomy specimens. PURPOSE: This paper presents the case of an 85 year-old man presenting with acute appendicitis located within an amyand hernia as well as a serrated adenoma noted on final pathology. CONCLUSIONS: An Amyand hernia is a rare diagnosis. We proceeded with laparoscopic appendectomy and interval inguinal hernia repair. Pathology should be reviewed for all patients and proper follow up ensured for all incidental findings.

Using a Checklist to Improve Family Communication in Trauma Care.

Modern concepts of patient-centered care emphasize effective communication with patients and families, an essential requirement in acute trauma settings. We hypothesized that using a checklist to guide the initial family conversation would improve the family's perception of the interaction. Institutional Review Board-approved, prospective pre/post study involving families of trauma patients admitted to our Level I trauma center for >24 hours. In the control group, families received information according to existing practices. In the study group, residents gave patient information to a first-degree family member using a checklist that guided the interaction. The checklist included a physician introduction, patient condition, list of known injuries, admission unit or intensive care unit, any consultants involved, plans for additional studies or operations, and opportunity for family to ask questions. An 11-item survey was administered 24 to 48 hours after admission to each group that evaluated the trauma team's communication in the areas of physician introduction, patient condition, ongoing treatment, and family perception of the interaction. Responses were on a Likert scale and analyzed using the Wilcoxon-Mann-Whitney test. There were 130 patients in each group. The study group had significantly (P < 0.05) better responses in 8 of 11 items surveyed: physician spoke to family, physician introduction, understanding of their relative's injuries, admitting unit, consultants involved, urgent surgical procedures required, ongoing diagnostic studies, and understanding of the treatment plan. In conclusion, using a checklist improves the perception of the initial communication between the trauma team and family members of trauma patients, especially their understanding of the treatment plan.

Involving patients in clinical research: the Telescot Patient Panel.

BACKGROUND: To date, patient involvement in the development of clinical research work has been limited. In 2011, the Telescot research team commenced work on a feasibility trial to investigate home telemonitoring of blood pressure for people who have experienced stroke or transient ischaemic attack (TIA). The team decided to involve patients in the development of the research. OBJECTIVES: To improve research design through patient involvement. METHOD OF PATIENT INVOLVEMENT: A modified form of the 'Scrutiny Panel' approach was used to involve people who had stroke in the research project. RESULTS: The Patient Panel supported the research in three key ways: it informed patient communication; it presented patient perspectives on the applicability and usability of the intervention; and it guided the development of the qualitative study. DISCUSSION: The initiative was considered a positive experience for all. However, challenges were identified in terms of the time and cost implications of undertaking patient involvement. IMPLICATION FOR RESEARCH PRACTICE: Importance is attached to adequate project planning and development, partnership working with community-based organizations and the necessity for clear role delineation between patients and professionals to enable effective collaborative working. CONCLUSIONS: The Telescot Patient Panel was beneficial in supporting the development of the feasibility trial. The Panel approach was considered transferable to other clinical research contexts.

Monitoring ear health through a telemedicine-supported health screening service in Queensland.

The prevalence of ear disease and hearing loss is greater for Indigenous children than for their non-Indigenous counterparts. In 2009, we established a mobile ear-screening service in South Burnett, in which an Indigenous Health Worker (IHW) assesses children at school and shares results by telemedicine with ear, nose and throat (ENT) specialists, who in turn provide review and biannual surgical outreach to the community. We reviewed service data for the first six years of the service (Jan 2009-Dec 2014), to calculate: total number of completed assessments; total number of patients failing at least one screening test; and overall proportion of failed screening assessments per annum. Subgroup analysis was conducted by usual home postcode. The service has provided 5539 screening assessments. The mean screening failure rate for children outside of postcode 4605 (Cherbourg/Murgon area) was 22% (range 17-29%) and 38% for children living inside postcode 4605 (range 34-41%). While screening activity has increased by more than 50% since 2009, there has been a slight reduction in the proportion of children failing assessment, with the mean failure rate changing from 33% in 2009 to 26% in 2014. These early results suggest that community-based screening, integrated with specialist ENT services may improve ear and hearing health.

Multiple lines of evidence for the origin of domesticated chili pepper, Capsicum annuum, in Mexico.

The study of crop origins has traditionally involved identifying geographic areas of high morphological diversity, sampling populations of wild progenitor species, and the archaeological retrieval of macroremains. Recent investigations have added identification of plant microremains (phytoliths, pollen, and starch grains), biochemical and molecular genetic approaches, and dating through (14)C accelerator mass spectrometry. We investigate the origin of domesticated chili pepper, Capsicum annuum, by combining two approaches, species distribution modeling and paleobiolinguistics, with microsatellite genetic data and archaeobotanical data. The combination of these four lines of evidence yields consensus models indicating that domestication of C. annuum could have occurred in one or both of two areas of Mexico: northeastern Mexico and central-east Mexico. Genetic evidence shows more support for the more northern location, but jointly all four lines of evidence support central-east Mexico, where preceramic macroremains of chili pepper have been recovered in the Valley of Tehuacán. Located just to the east of this valley is the center of phylogenetic diversity of Proto-Otomanguean, a language spoken in mid-Holocene times and the oldest protolanguage for which a word for chili pepper reconstructs based on historical linguistics. For many crops, especially those that do not have a strong archaeobotanical record or phylogeographic pattern, it is difficult to precisely identify the time and place of their origin. Our results for chili pepper show that expressing all data in similar distance terms allows for combining contrasting lines of evidence and locating the region(s) where cultivation and domestication of a crop began.

Changes in paediatric hospital ENT service utilisation following the implementation of a mobile, indigenous health screening service.

In 2009, we established a mobile ear-screening service for children in a remote community approximately 350 km north-west of Brisbane. We compared pre-implementation health service utilisation data (2006-2008) with data for the following three years. The study included only children in schools that had participated in screening since the start of the screening programme and for which data for the 6-year study period were available. In the baseline period there were 329 ear, nose and throat (ENT) outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane for children from the selected catchment area. Of these, 166 (51%) were failure-to-attends (FTAs). In the following three years, there were 105 appointments, of which 40 (38%) were FTAs. In the baseline period, 100 children received surgical procedures at the RCH; in the following three years there were 43. In the three years following implementation, 136 children were booked to receive surgical procedures locally at the Cherbourg hospital, and 117 (86%) were completed. Since no other major health service changes occurred in the region during the study period, we conclude that the telemedicine-enabled screening service improved access to specialist care in the community and resulted in fewer outpatient and surgical appointments at the tertiary centre in Brisbane.

A mobile telemedicine-enabled ear screening service for Indigenous children in Queensland: activity and outcomes in the first three years.

A mobile ear-screening service was established in an Aboriginal community in central Queensland. Telemedicine allowed ear nose and throat (ENT) specialists at the tertiary children's hospital in Brisbane to assess children at a distance using pre-recorded information comprising video-otoscopic images and the results of tympanometry and audiometry. During the first three years, 1053 children were registered with the service. A total of 2111 screening assessments were carried out at 21 schools in the region. The average screening rate achieved in the community was 85%. More than half of all assessments resulted in a referral to the ENT specialist (for online assessment) or local doctor (for treatment). Twenty specialist ENT online clinics were conducted during which 415 patients were reviewed. Over half of all online review cases (55%) resulted in appointments at the next ENT outreach clinic for further review and/or surgery. The community-based screening service led by local Indigenous health workers, and linked to a tertiary children's hospital by telemedicine, was an effective method for routine screening of children at risk of hearing impairment.

The feasibility of a community-based mobile telehealth screening service for Aboriginal and Torres Strait Islander children in Australia.

OBJECTIVE: The increasing prevalence and earlier onset of chronic health conditions amongst Aboriginal and Torres Strait Islander people has become a concerning and significant problem. Telehealth may be a useful application for the early detection, monitoring, and treatment of chronic diseases such as ear disease and vision impairment. This study evaluates whether it is feasible to integrate a mobile telemedicine-enabled ear and eye-screening service with existing community-based services for Australian indigenous children. MATERIALS AND METHODS: A collaborative service was established with the local community and delivered from a van fitted with screening equipment and telemedicine capabilities. Indigenous children (0-16 years) were assessed at school by an aboriginal health worker for conditions impacting hearing and vision. Screening data and video-otoscopic images were uploaded to a database and made accessible to specialists via a secure Web site. Those children who failed an ear-screening assessment, tele-otology clinics were conducted remotely by an ear, nose, and throat specialist, who reviewed cases and provided a diagnosis and treatment plan. Similarly, children who failed vision assessments were referred to an optometrist for follow-up care. RESULTS: During the first 6 months, the service visited 12 of the 16 schools in the region, screening 442 of the 760 consented children (58%). Of the 183 (41%) children who failed ear screening, 59 were reviewed remotely by an ear, nose, and throat surgeon, with 9 children booked for surgery. Three hundred and four or 41% of the consenting children completed an eye assessment, in which 46 (15%) failed and required referral to the optometrist. CONCLUSIONS: It is feasible to integrate a mobile telehealth screening service with existing community-based services to provide specialist review and treatment planning at a distance. Community consultation, engagement, and collaboration in all areas of the project have been important.

Comparison of rotary instrumentation and continuous wave obturation to reciprocating instrumentation and single cone obturation with a hydrophilic sealer.

This in vitro study compared the effectiveness between ProFile 29 Series rotary system followed by continuous wave obturation and the Endo-Eze system. Thirty-six human mandibular canine and premolar teeth were randomly separated into 2 groups of 18. Each tooth was embedded in resin and sectioned at 2, 6, and 12 mm from the apex and viewed under the scanning electron microscope at 50-150x magnification. The percentages of canal space occupied by gutta-percha, sealer, debris, and voids were measured and analyzed with Image J software. Results were calculated by using an analysis of variance model with fixed effects for method, distance, and distance interaction. Repeatability of measurements and intraclass correlation coefficients were calculated. These results demonstrated that obturation with the continuous wave technique achieved significantly more gutta-percha occupying the canal space than the Endo-Eze system. Under the conditions of this study, the continuous wave technique was less likely to exhibit voids than the Endo-Eze technique. Furthermore, neither the Profile Series 29 nor the Endo-Eze system cleaned and shaped elliptical canals consistently.

An in vitro comparison of microleakage between Resilon and gutta-percha with a fluid filtration model.

This investigation compared microleakage of teeth obturated with gutta-percha and teeth obturated with Resilon by using a fluid filtration model. Forty-six human, single-rooted, mandibular premolars were studied. Teeth were randomly assigned to 2 experimental groups of 21 teeth each, designated as group G (gutta-percha) and group R (Resilon). Two control groups, both containing 2 teeth, served as positive and negative controls. Group G, gutta-percha and AH 26 sealer, and group R, Resilon and Epiphany sealer, were obturated by using warm vertical condensation. The specimens were tested for microleakage with an in vitro fluid filtration apparatus at 10 psi at 4 intervals: 1, 7, 30, and 90 days. A two-way repeated measures analysis of variance model with fixed effects for group, time, and group by time interaction was used to analyze microleakage data. This study demonstrated that canals obturated with Resilon and Epiphany sealer leaked statistically less than canals obturated with gutta-percha and AH 26 sealer at day 1 (P < .0014), day 7 (P < .0002), day 30 (P < .0015), and day 90 (P < .0170). The mean fluid microleakage for both group G and group R increased from day 1 to day 90. The results showed that Resilon is a suitable replacement for gutta-percha as a root canal filling material on the basis of its increased resistance to fluid microleakage.

An in vitro evaluation of the contents of root canals obturated with gutta percha and AH-26 sealer or Resilon and Epiphany sealer.

The purpose of this study was to compare the contents of root canals obturated with gutta percha and AH-26 sealer (Dentsply, Tulsa, OK) to canals obturated with the Resilon and Epiphany (Pentron, Wallingford, CT) system. Canal contents were assessed by determining the percentage of canal space occupied by core material, sealer, voids, and debris. Forty extracted human maxillary anterior teeth were instrumented, and the teeth were randomly assigned to either the gutta percha/AH 26 group or the Epiphany/Resilon group. Canals were obturated, and the teeth were subsequently embedded in resin and sectioned horizontally at 2, 4, and 6 mm from the anatomic apex. Sections were photographed by using a low vacuum scanning electron microscope. Image-J (Wayne Rasband; National Institute of Health, Bethesda, MD) software was used to quantify the proportion of core material, sealer, voids, and debris in each canal. Percentages and statistical comparisons for each method were compared. There were no significant differences found among the two groups in terms of the percentage of core (p = 0.9), sealer (p = 0.58), debris (p = 0.999), or voids (p = 1.00). Additionally, there were no differences in the percentage of core material, sealer, debris, or voids at any of the examined levels (2, 4, or 6 mm).

Push-out bond strength of a new endodontic obturation system (Resilon/Epiphany).

Endodontic sealers should demonstrate adhesive properties to dentin to reach the objectives of the obturation of the canal space and seal the canal space both apically and coronally, thus decreasing the chance of endodontic treatment failure. Adhesion to dentin with bonding to the tooth structure in the canal may provide greater resistance to tooth fracture and greater clinical longevity of an endodontically treated tooth. In this study, human single-canal canines were endodontically treated and obturated with two different endodontic obturation systems (Epiphany/Resilon system and gutta-percha/AH 26). Thirty roots (divided into two groups) were horizontally sliced for a push-out strength test, which was performed from apical to coronal in the universal testing machine. Differences in push-out bond strength between the two different material systems were obtained using repeated measures analysis of variance on ranks. Gutta-percha had significantly higher push-out bond strength than Epiphany (p<0.0001).