Epignathus (Palatal teratoma):A case report.

BACKGROUND: A case of a 2.7kg term baby with a large epignathus, a rare congenital teratoma arising from the palate is presented. Birth was by spontaneous vaginal delivery (SVD). The baby survived following a timely multidisciplinary approach to her management. This is the first reported case in Ghana.

Incidence of tardive dyskinesia: a comparison of long-acting injectable and oral paliperidone clinical trial databases.

BACKGROUND: To assess the tardive dyskinesia (TD) rate in studies of once-monthly long-acting injectable (LAI) paliperidone palmitate (PP) and once-daily oral paliperidone extended release (Pali ER). METHODS: Completed schizophrenia and bipolar studies for PP and Pali ER (≥ 6 month duration with retrievable patient-level data) were included in this post hoc analysis. Schooler-Kane research criteria were applied using Abnormal Involuntary Movement Scale (AIMS) scores to categorise probable (qualifying AIMS scores persisting for ≥ 3 months) and persistent TD (score persisting ≥ 6 months). Spontaneously reported TD adverse events (AEs) were also summarised. Impact of exposure duration on dyskinesia (defined as AIMS total score ≥ 3) was assessed by summarising the monthly dyskinesia rate. RESULTS: In the schizophrenia studies, TD rates for PP (four studies, N = 1689) vs. Pali ER (five studies, N = 2054), were: spontaneously reported AE, 0.18% (PP) vs. 0.10% (Pali ER); probable TD, 0.12% (PP) vs. 0.19% (Pali ER) and persistent TD, 0.12% (PP) vs. 0.05% (Pali ER). In the only bipolar study identified [Pali ER (N = 614)], TD rate was zero (spontaneously reported AE reporting, probable and persistent TD assessments). Dyskinesia rate was higher within the first month of treatment with both PP (13.1%) and Pali ER (11.7%) and steadily decreased over time (months 6-7: PP: 5.4%; Pali ER: 6.4%). Mean exposure: PP, 279.6 days; Pali ER, 187.2 days. CONCLUSIONS: Risk of TD with paliperidone was low (< 0.2%), regardless of the formulation (oral or LAI), in this clinical trial dataset. Longer cumulative exposure does not appear to increase the risk of dyskinesias.

Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana.

BACKGROUND: Patients with maxillofacial injuries may sustain concomitant injuries. The presentation of other injuries may be the initial focus of attention of the primary attending surgeon who may miss the maxillofacial injuries to the detriment of the patient. OBJECTIVE: To determine the incidence of injuries associated with maxillofacial injuries at Korle Bu Teaching Hospital (KBTH) from January 2009 to December 2010. METHODS: A prospective study was carried out on patients who were referred to the Maxillofacial Unit of the University of Ghana Dental School and KBTH over the two years with maxillofacial injuries. Their age, sex, type of injury in the maxillofacial region, its aetiology and concomitant injuries were charted. The data was analysed using SPSS 16.0 software. RESULTS: Two hundred and fifty eight (258) patients were seen of which 67 (26.0%) had concomitant injuries. The average age was 29.1 years. The peak incidence was in the age group 21-30 (N=73, 28.3%). 74% were male and 26.0% female. The commonest cause of injury was road traffic accident (RTA) (N=142;55.0%). 52.7% (N=136) of the patients had injuries of the maxillofacial region. 26.7% (N=69) had mandibular fractures, 19.4% (N=50) had middle third fractures and 8.1% (N=21) had fractures of both. Concomitant injuries were mainly orthopaedic (N=31;12%) and the head and spinal region (N=29;11.2%). CONCLUSION: A significant number of patients who suffer maxillofacial injuries also sustain injuries of other parts of the body at KBTH. Prompt multidisciplinary management may contribute to improved outcomes.

An unusually large spindle cell sarcoma of the tongue in a male child.

Reports of spindle cell sarcoma in the tongue are very rare, and seldom in the child. We report a five-year-old male patient who presented with a massive lesion on the right side of the tongue. This was surgically excised and histologically diagnosed as a Spindle cell Sarcoma. Results of bone marrow aspiration further revealed that about 16% of his bone marrow was infiltrated with abnormal pleomorphic vacuolated cells with bluish cytoplasm, consistent with rhabdomyosarcoma (RMS) cells. The child was treated with surgery and chemotherapy with good initial response, but then died after one year following a relapse.

Head and neck tumours in Ghanaian children. A 20 year review.

Histological reports on tumour specimens recorded at a teaching hospital in Accra, Ghana from 1989 to 2008 were reviewed to determine the incidence of head and neck tumours in children less than 16 years old. There were 4546 reports of head and neck tumours (2041 malignant, 2505 benign). Of these 613 met the study age selection criteria. 186(30.3%) were malignant and 427(69.7%) benign. The male to female ratio for malignant tumours was 1.86:1, benign 0.73:1 and for all tumours 1:1.04. Lymphoma (54.8%), nasopharyngeal carcinoma (19.9%) and rhabdomyosarcoma (14%), together constituted over 88% of malignant neoplasms. The commonest benign neoplasm was squamous papilloma (76/427) 17.8%, and then haemangioma (60/427) 14.05%. The incidence increased with age, peaking in those aged 12-16 years. The commonest site for benign tumours was the larynx and for malignant tumours the neck (cervical lymph nodes). Relative to all head and neck malignancies, the incidence of childhood head and neck malignancies was 11% (186/2041). This study reveals that malignant head and neck tumours are not rare in Ghana compared to benign tumours and the incidence of rhabdomyosarcoma is higher in females.

Hemispheric brain abscess: a review of 46 cases.

BACKGROUND: Brain abscess is a space occupying lesion that still prevails in many developing countries but less common in developed countries. It can be a preventable cause of fatal illness if diagnosed and treated appropriately. There is little or no information of the condition in Ghana. In this review we report our experience at the Neurosurgical unit of Korle Bu Teaching Hospital (KBTH) over a four year period. STUDY DESIGN: A retrospective study of 46 patients with brain abscess(es) seen between January 1994-December 1998 was carried out at the Neurosurgical unit of KBTH, Accra, Ghana. Using hospital records of 46 patients an evaluation of computerized tomography (CT) scans of brain abscesses and the different methods of surgical treatment were made. RESULTS: 33 (72%) were male and 13 (28%) were female. 32 (70%) of the patients were aged 20 years or younger. Brain C.T. Scan was the main diagnostic imaging study performed on all the patients. In all but one case the diagnosis was a solitary abscess (98%). 38 patients (83%) had burr hole drainage under sedation and local anaesthesia and 12 under general anaesthesia. All patients were managed with appropriate antibiotics and steroids. There were 5 fatalities. CONCLUSION: Simple burr hole drainage combined with appropriate medical treatment was found to be satisfactory in managing these patients.

Chronic subdural haematoma: review of 96 cases attending the Korle Bu Teaching Hospital, Accra.

BACKGROUND: Chronic subdural haematoma is not uncommon in Africa. Early diagnosis and treatment is satisfying. Simpler operative procedures are generally effective. This review is meant to find out the situation regarding the condition in Ghana. STUDY DESIGN: A retrospective study of patients with chronic subdural haematoma admitted to and treated by the Neurosurgical Unit of Korle Bu Teaching Hospital between January 1995 and December 1998 was undertaken. The case notes, computerise axial tomography (CT) scans and operative records were reviewed and the relevant data extracted. Incomplete records were excluded. RESULTS: 96 patients were involved. The mean age of the patients was 46.9 years, with male to female ratio of 16:1. The most common presenting feature was headache (64.7%). Time of injury to presentation was about 2 months. 81 were treated using burr hole and drainage and 15 by craniotomy and stripping of membranes. Eighty four were treated under general anaesthesia. Two were reoperated on because of recurrent bleed. There were two (2) deaths. Ninety patients had a Glasgow Outcome Score of good at the time of their last review. CONCLUSION: The data suggests that burr hole and closed drainage is a very effective method of managing CSDH.

A specialized home care intervention improves survival among older post-surgical cancer patients.

CONTEXT: Changes in the healthcare system have resulted in shortened hospital stays, moving the focus of care from the hospital to the home. Patients are discharged post-operatively with ongoing needs, and whether they receive nursing care post-hospitalization can influence their recovery and survival. Little information is available about the factors that influence outcomes, including the survival of older cancer patients after cancer surgery. OBJECTIVE: To compare the length of survival of older post-surgical cancer patients who received a specialized home care intervention provided by advanced practice nurses (APNs) with that of patients who received usual follow-up care in an ambulatory setting. We also assessed potential predictors of survival in terms of depressive symptoms, symptom distress, functional status, comorbidities, length of hospital stay, age of patient, and stage of disease. DESIGN: A randomized controlled intervention study. SETTING: Discharged older cancer patients after surgery at a Comprehensive Cancer Center in southeastern Pennsylvania. PATIENTS: Three hundred seventy-five patients aged 60 to 92, newly diagnosed with solid cancers, were treated surgically between February 1993 and December 1995. One hundred ninety patients were randomized to the intervention groups and 185 to the usual care group. INTERVENTION: The intervention was a standardized protocol that consisted of standard assessment and management post-surgical guidelines, doses of instructional content, and schedules of contacts. The intervention lasted 4 weeks and consisted of three home visits and five telephone contacts provided by APNs. Both the patients and their family caregivers received comprehensive clinical assessments, monitoring, and teaching, including skills training. MAIN OUTCOME MEASURE: Time from enrollment of patients into the study until death or last date known alive at the end of November 1996. RESULTS: During the 44-month follow-up period, 93 (24.8%) of 375 patients died. Forty-one (22%) of those who died were patients in the specialized home care intervention group, compared with 52 (28%) in the usual care group. Stage of disease at diagnosis differed between the two groups at baseline (38% late stage patients in the intervention group compared with 26% in the control group, P = .01), so stratified analysis was performed. Overall, the specialized home care intervention group was found to have increased survival (P = .002 using stratified log-rank test). Among early stage patients only, there was no difference in survival between the intervention and control groups. Among late stage patients, there was improved survival in the intervention group. For example, 2-year survival among late stage intervention group cases was 67% compared with 40% among control cases. When Cox's proportional hazard model was used to adjust for significant baseline covariates, the relative hazard of death in the usual care group was 2.04 (CI: 1.33 to 3.12; P = .001) after adjusting for stage of disease and surgical hospitalization length of stay. CONCLUSIONS: This is the first empirical study of post-surgical cancer patients to link a specialized home care intervention by advanced practice nurses with improved survival. Additional research is needed to test home care interventions aimed at maintaining quality of life outcomes and their effects on survival of post-surgical cancer patients.

Participant characteristics before and 4 months after attendance at a family caregiver cancer education program.

Recent trends in health care have placed an increased burden on cancer caregivers. In response, nurses and social workers have been taught to implement a 6-hour psychoeducation program for cancer caregivers that addresses symptom management, psychosocial support, and resource identification. Longitudinal data from a convenience sample of 187 cancer caregivers who attended the program are reported. Data were collected before attendance and 4 months later. Findings confirm the chronic and consuming nature of cancer caregiving. Data indicate that perception of burden did not worsen even when caregiving tasks increased in intensity. Caregiver perceptions of their own health actually improved over time. In addition, the number of caregivers who said they were well informed and confident about caregiving after program attendance increased over time. Further study that randomizes caregivers to intervention/control groups is needed to substantiate the role of similar programs in enhancing caregiver skills and minimizing caregiver burden over time.

The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care.

OBJECTIVE: Immunizations and other cost-effective preventive services remain underused by many children, especially those living in poverty. Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns, we designed and tested an intervention combining these strategies. We studied whether a system of semiannual assessment and feedback, coupled with financial incentives, could improve pediatric preventive care in a Medicaid health maintenance organization (HMO). METHODOLOGY: We randomly assigned primary care sites serving children in a Medicaid HMO to one of three groups: a feedback group (where physicians received written feedback about compliance scores), a feedback and incentive group (where physicians received feedback and a financial bonus when compliance criteria were met), and a control group. We evaluated compliance with pediatric preventive care guidelines through semiannual chart audits during the years 1993 to 1995. RESULTS: Compliance with pediatric preventive care improved dramatically in the study period. Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores (from 56%-73%), as well as scores for immunizations (from 62%-79%) and other preventive care (from 54%-71%). However, no significant differences were observed between either intervention group and the control group, nor were there any interaction (group-by-time) effects. CONCLUSIONS: Feedback to physicians, with or without financial incentives, did not improve pediatric preventive care in this Medicaid HMO during a time of rapid, secular improvements in care. Possible explanations include the context and timing of the intervention, the magnitude of the financial incentives, and lack of physician awareness of the intervention.

A comparison of social functioning among black and white women with breast cancer.

Results of a comparative study of interviews with 102 women (61 white, 41 black) who were treated for breast cancer suggest that black women have more difficulty in social functioning, especially the resumption of household activities. Implications for social work practice are discussed.

Effects of home care on caregivers' psychosocial status.

PURPOSE: To examine changes in the psychosocial status of caregivers of post-surgical patients with cancer, and how their status was affected by (a) whether caregivers had physical problems of their own, and (b) whether the patient received a home care intervention. Many studies in this area to date have not included sufficient measurement points to identify fluctuations in psychosocial status over time. In addition, many have used caregiver health as an outcome rather than a predictor. DESIGN: Longitudinal, randomized trial using a sample of 161 caregivers of cancer patients being treated at one large university hospital in the northeastern United States, 1993-1996. Half the patients were randomly assigned to receive a standardized home-care nursing intervention. The population of interest was caregivers of patients who were (a) diagnosed with a solid-tumor cancer within the past 2 months, (b) age 60 or older, (c) hospitalized for surgical treatment of the cancer and expected to live at least 6 months, and (d) had a complex problem at hospital discharge. All caregivers were living with the patient at time of discharge. METHODS: Data were collected in structured interviews administered at the time of the patients' discharge and approximately 3 and 6 months later. Psychosocial status was measured using the Caregiver Reaction Assessment and the CES-Depression scale. A repeated-measures analysis of variance was performed for each psychosocial measure, using as factors Time (i.e., interview 1, 2, or 3), Group (treatment and control), and Caregiver Physical Problem. FINDINGS: Overall, psychosocial status improved from baseline to 3 months, and was about the same at 6 months. Among caregivers with physical problems, the psychosocial status of those in the treatment group declined compared to those in the control groups in the 3 months after discharge; an opposite pattern was observed in the following 3 months. CONCLUSIONS: People who are caregivers for cancer patients and have physical problems of their own are at risk for psychologic morbidity, which may have a delayed onset. This delay may reflect the replacement of an initial optimism with discouragement as the reality of long-term illness sets in. Home care may create a situation in which caregivers are required to confront the realities of long-term caregiving quickly, cutting short their initial optimism, but also preparing them for what is to come.

Testing a theory for health-related quality of life in cancer patients: a structural equation approach.

The purpose of this study was to test a Roy Adaptation Model-based theory of health-related quality of life in patients with newly diagnosed cancer. Using a structural equation model, health-related quality of life (HRQOL) was regarded as a latent variable measured by 4 empirical indicators representing the 4 biopsychosocial response modes of the Roy Adaptation Model (RAM). The response modes are physiologic, self-concept, interdependence, and role function. These were empirically represented by physical symptoms, affective status, social support, and functional support, respectively. In this secondary analysis, 3 RAM propositions were tested in a sample of 375 newly diagnosed postsurgical cancer patients 60 years and over. These were: (a) that the 4 response modes are interrelated; (b) that environmental stimuli of gender, race, age, income, marital status, cancer treatment, and severity of illness influence the biopsychosocial response modes; and (c) that the biopsychosocial responses soon after diagnosis predict biopsychosocial responses 3 months later. The analyses did not support the proposition that all 4 response modes were interrelated. The results, however, revealed that severity of illness and adjuvant cancer treatment had the strongest association with the biopsychosocial responses and should be considered the focal environmental stimuli. The remaining environmental stimuli can be considered contextual. Also, the proposition that initial biopsychosocial responses predicted later responses was supported.

Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.

OBJECTIVES: A randomized controlled trial evaluated the impact of feedback and financial incentives on physician compliance with cancer screening guidelines for women 50 years of age and older in a Medicaid health maintenance organization (HMO). METHODS: Half of 52 primary care sites received the intervention, which included written feedback and a financial bonus. Mammography, breast exam, colorectal screening, and Pap testing compliance rates were evaluated. RESULTS: From 1993 to 1995, screening rates doubled overall (from 24% to 50%), with no significant differences between intervention and control group sites. CONCLUSIONS: Financial incentives and feedback did not improve physician compliance with cancer screening guidelines in a Medicaid HMO.

The effects of home nursing care for patients during terminal illness on the bereaved's psychological distress.

BACKGROUND: Although some studies have examined the effects of terminal illness care models such as hospice care on survivor outcomes, no studies could be found that examined whether nursing care affected such outcomes. OBJECTIVE: To determine whether specialized oncology home care services provided to terminally ill patients with lung cancer positively influenced bereavement psychological distress among survivors, compared with other models of care. METHODS: A secondary analysis was performed to test the effects of home nursing care for terminally ill patients on spousal psychological distress during bereavement. Forty-six patient-spousal dyads were randomly assigned to either an oncology home care group (OHC), a standard home care group, or an office care control group. Patient-spousal dyads were entered into the study 2 months after the patient's diagnosis of lung cancer and received follow-up until the patient died. Bereaved spouses continued to receive follow-up for 25 months after the patient's death. RESULTS: Psychological distress was significantly lower initially among spouses of patients that received the OHC intervention compared with the other two groups. Significant mean group differences were found on the subscales of depression and paranoid ideation; marginal group differences were found on the subscales of hostility and psychoticism. There were no significant differences among the groups at 25 months. CONCLUSIONS: These results suggest that the bereaved's psychological distress can be positively influenced depending on how their loved one is cared for during the terminal phase of illness.

Periodontal status and oral hygiene practices of pregnant and non-pregnant women.

One hundred pregnant and another hundred non-pregnant women aged between 16-45 years attending the outpatient clinic of the department of Obstetrics and Gynaecology of Korle-Bu Teaching Hospital were examined and their periodontal status assessed using the Community Periodontal Index for Treatment Needs (CPITN). Selection was by convenient sampling. Only second and third trimester pregnant women were included in the study. Results were recorded using World Health Organization (WHO) standard oral health assessment form and analysed using SPSS for Windows. Overall there was a higher incidence of gingival bleeding or worse score among the pregnant (89%) than the non-pregnant women (61%). This was the case in each of the three age groups considered. Among the non-pregnant women the mean number of sextants with healthy gingivae was above 3.5 in all age groups with an average of 3.78. The mean for second trimester pregnant women was 1.55 and third trimester 2.73. The mean number sextants with bleeding gingivae was 0.698 among the non-pregnant women, whilst that for second trimester and third trimester women were 3.20 and 1.96 respectively. The commonest method of oral hygiene among both the pregnant and non-pregnant women was a combination of the use of chewing stick and toothbrush with paste. The second commonest method was chewing stick alone among the pregnant women and among the non-pregnant women toothbrushing with paste. The mean number of sextants with gingival bleeding among the second trimester pregnant women was consistently high (> 3) irrespective of the method of oral hygiene used. The level of gingival bleeding during pregnancy is not significantly affected by any of the methods of oral hygiene used (p < 0.05) which is higher during the second trimester compared with the third trimester of pregnancy.

A test of the fit between the Corbin and Strauss Trajectory Model and care provided to older patients after cancer surgery.

The Corbin and Strauss Trajectory Model proposed that nursing care should differ along a trajectory of eight phases to meet patients' and families' needs. Seventy-nine patients with breast, prostate, or gastrointestinal cancer were determined to be in either the stable or the unstable phase of their illness. Contrary to expectations, documented nursing interventions did not significantly differ between stable and unstable trajectory phases, although significant differences were found when comparisons were made across cancer sites. These findings suggest that the trajectory framework may require modification for use with oncology patients.

A phase II study of 5-fluorouracil, leucovorin, adriamycin, and cisplatin (FLAP) for metastatic gastric and gastroesophageal junction adenocarcinoma. A Penn Cancer Clinical Trial Group and Roswell Park Cancer Institute Community Oncology Research Program Trial.

A Phase II study was performed to evaluate the activity and toxicity of 5-fluorouracil, leucovorin, Adriamycin, and cisplatin combination chemotherapy (FLAP) in patients with previously untreated advanced gastric and gastroesophageal (GE) junction adenocarcinoma. Forty-two consecutive patients were enrolled to received FLAP in this multi-institutional trial. Response, toxicity, and survival data were noted. Fifteen of 42 (36%) patients demonstrated objective responses, with two complete responses (5%) and 13 partial responses (31%). The median time to disease progression was 17 weeks, and the overall survival duration was 30 weeks. Myelosuppression was significant, requiring dose modifications, but there were no treatment-related deaths. FLAP is an active regimen in the treatment of advanced gastric and GE junction adenocarcinoma. We are presently using this regimen in the neoadjuvant setting in patients with gastric and GE junction cancers.