Assessment of medical practitioners' knowledge about paediatric oral diagnosis and gaze patterns using eye tracking technology.

BACKGROUND: Most studies regarding the oral health knowledge of medical practitioners are based on surveys. AIM: To assess medical practitioners' knowledge in diagnosing and managing children oral health issues using eye tracking technology. DESIGN: Forty-one medical practitioners completed a cross-sectional survey questionnaire and subsequently viewed 5 clinical images of children's oral cavities to indicate the issues observed and their management. Tobii eye tracking device captured each participant's visual search behaviours and mean length of fixation (LOF) for each area of interest (AOI). Participant self-reported confidence in examining the oral cavity, and qualification level was recorded for data analysis. RESULTS: No correlation between time spent viewing the soft tissues and self-reported confidence examining the oral cavity was observed (P = .25). Self-reported confidence in examining the oral cavity was not associated with a correct diagnosis. LOF on the decayed teeth was significantly associated with a correct diagnosis of 'caries' (P < .05), and paediatric training was associated with a correct diagnosis of dental caries (P < .05). CONCLUSION: Medical practitioners' diagnosis and management were poorly correlated with their objective visual search behaviours of the intraoral images. Self-reported confidence in examining and managing oral issues was not correlated with a correct diagnosis, with the majority not confident of examining children oral cavity.

Treating Chronic Nonmalignant Pain: Evidence and Faith-Based Approaches.

A significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.

Antibody-directed myostatin inhibition improves diaphragm pathology in young but not adult dystrophic mdx mice.

Duchenne muscular dystrophy (DMD) is characterized by progressive skeletal muscle wasting and weakness, leading to premature death from respiratory and/or cardiac failure. A clinically relevant question is whether myostatin inhibition can improve function of the diaphragm, which exhibits a severe and progressive pathology comparable with that in DMD. We hypothesized that antibody-directed myostatin inhibition would improve the pathophysiology of diaphragm muscle strips from young mdx mice (when the pathology is mild) and adult mdx mice (when the pathology is quite marked). Five weeks treatment with a mouse chimera of anti-human myostatin antibody (PF-354, 10 mg/kg/week) increased muscle mass (P < 0.05) and increased diaphragm median fiber cross-sectional area (CSA, P < 0.05) in young C57BL/10 and mdx mice, compared with saline-treated controls. PF-354 had no effect on specific force (sPo, maximum force normalized to muscle CSA) of diaphragm muscle strips from young C57BL/10 mice, but increased sPo by 84% (P < 0.05) in young mdx mice. In contrast, 8 weeks of PF-354 treatment did not improve muscle mass, median fiber CSA, collagen infiltration, or sPo of diaphragm muscle strips from adult mdx mice. PF-354 antibody-directed myostatin inhibition completely restored the functional capacity of diaphragm strips to control levels when treatment was initiated early, but not in the later stages of disease progression, suggesting that such therapies may only have a limited window of efficacy for DMD and related conditions.

7201 carcinoids: increasing incidence overall and disproportionate mortality in the elderly.

INTRODUCTION: The aim of the study was to determine outcomes for respiratory and gastrointestinal carcinoid tumors utilizing a large cancer registry. METHODS: Cases of respiratory and gastrointestinal carcinoid from the Florida Cancer Data System (FCDS) from 1981 to 2001 were reviewed. Descriptive statistics, age-adjusted tumor incidence, and survival rates were determined. RESULTS: A total of 7201 cases of malignant carcinoid were identified. Pulmonary and gastrointestinal carcinoid tumors comprised 82% of all carcinoids encountered. The mean age was 64.4 +/- 0.15 years. Stratified by location, there were 3000 (51.4%) foregut carcinoids (including those found in the respiratory tree-2325 in the lung), 2130 (36.5%) midgut carcinoids, and 712 (12.2%) hindgut carcinoids. Second, distinct malignancies were observed in 23% of cases. The total age-adjusted incidence rate has increased from 0.62 per 100,000 in 1980 to 5.17 per 100,000 in 2000. Overall median survival was 21.97 months. The median survival was 19.0 months for foregut carcinoids (excluding those arising in the respiratory tract); 33.9 months for midgut tumors; and 22.7 months for hindgut carcinoids. There was a statistically significant better survival for those with midgut tumors than for those in the other groups (P < 0.001). Age < 60 years, white race, and female sex were all associated with better survival (P < 0.01). CONCLUSIONS: The incidence of pulmonary and gastrointestinal carcinoids has dramatically increased since 1981. Tumor location and age > or = 60 years are the strongest predictors of mortality.

Results of 23,810 cases of ductal carcinoma-in-situ.

BACKGROUND: Screening mammography has increased the number of patients diagnosed with ductal carcinoma-in-situ (DCIS) in the past 20 years. The Florida Cancer Data System is the largest single source incident cancer registry in the United States. We analyzed this registry to determine the changing incidence and treatment patterns for DCIS. METHODS: Patients with DCIS from 1981 to 2001 were identified. Age-adjusted rate, descriptive statistics, and incidence of future DCIS and invasive breast cancer were calculated. RESULTS: A total of 23,810 DCIS patients were identified. The age-adjusted rate of DCIS has risen from 2.4 to 27.7 per 100,000 women between 1981 and 2001. Median age was 64 years; 85% of patients were white, 6.6% African American, and 7.5% Hispanic. Median tumor size was .9 cm. Forty-seven percent of patients had breast-conserving therapy (BCT). Half of the 53% of patients undergoing mastectomy underwent a modified radical mastectomy. Eight percent received no surgical treatment. Sentinel lymph node biopsy was used in 2.7% of patients who underwent a mastectomy. After BCT, 37.5% received adjuvant radiotherapy, and only 13% were treated with hormonal therapy. CONCLUSIONS: The incidence of DCIS has risen dramatically with the advent of screening mammography. Increasing numbers of these patients are treated with BCT, although a large proportion are still treated with mastectomy, in some cases combined with axillary dissection. Sentinel lymph node biopsy and tamoxifen are important components of therapy, the use of which is slowly increasing in the treatment of DCIS.

Parathyroid cancer, a continued diagnostic and therapeutic dilemma: report of four cases and review of the literature.

Parathyroid cancer presents a diagnostic challenge as a rare endocrine malignancy usually not recognized preoperatively and often not conclusively identified intraoperatively. We examined a cluster of parathyroid cancers treated at University of Louisville-affiliated hospitals during a 5-year interval. Clinical and histologic data from patient records at University Surgical Associates, the University of Louisville Hospital, Norton Hospital, and the Louisville Veterans Administration Medical Center in Louisville, KY were retrospectively reviewed. During the study interval surgical exploration of the neck was undertaken on 175 patients with primary hyperparathyroidism; four parathyroid malignancies (2%) were identified. Three of the four patients exhibited symptomatic hyperparathyroidism with very high diagnostic calcium and parathormone levels. All patients had multiple coexisting diseases and two had undergone previous parathyroid surgery. Sestamibi scan localized the lesion in two patients, ultrasound was used in one patient, and a positron emission tomography scan was needed to identify the lesion in the fourth. Intraoperative findings varied from multiple nodules involving the thyroid and paratracheal nodules to otherwise normal-appearing enlarged parathyroid gland. External pathologic review was needed to conclusively establish the diagnosis in all cases, even though initial histologic analysis was suggestive of malignancy. All patients are alive, well, and free of disease. This rarely occurring malignancy may be suggested by very high preoperative calcium parathormone levels. Intraoperative and histologic findings are often inconclusive resulting in therapeutic decisions made by the operating surgeon on the basis of limited or incomplete information.

The effects of dictyostelids on the formation and maturation of myxomycete plasmodia.

Dictyostelids (cellular slime molds) and myxomycetes (plasmodial slime molds) are two groups of mycetozoans usually present and often abundant in the soil and litter microhabitats of terrestrial ecosystems. Because they utilize the same food resource and occur together in a spatially limited and clearly defined microhabitat, the potential for ecological interactions would seem to exist. However, relatively few previous studies have considered this aspect of mycetozoan ecology. In the present study twenty-eight isolates (8 species) of dictyostelids were co-cultured in all possible pair-wise combinations with fourteen isolates (7 species) of myxomycetes to determine if there were any effects on the production of fruiting bodies. Dictyostelids showed little or no delay in culmination and only random and inconsistent reductions in sorocarp abundance when co-cultured with myxomycetes. In contrast, myxomycetes displayed a number of specific effects. The heterothallic isolates exhibited delays in plasmodial formation and/or maturation, with some pairings showing little to no effect, while others displayed nearly complete inhibition of plasmodial formation or maturation. Apomictic isolates, in general, were much less affected, with only a few combinations displaying significant delays in both formation and maturation of plasmodia.