Outcome and long-term treatment protocol for topical tacrolimus in oral lichen planus.

BACKGROUND AND OBJECTIVE: Topical tacrolimus has been shown to be beneficial in the treatment of oral lichen planus (OLP). However, long-term effects and its optimal application protocol with gradual reduction have not been studied. Accordingly, we analysed the clinical response of OLP to tacrolimus in our daily clinical practice with a focus on the optimal long-term therapeutic scheme. METHODS: Retrospective analysis of all consecutive patients diagnosed with OLP and treated with topical tacrolimus (0.03% oral rinse) in a clinical setting between 2015 and 2020. The objective clinical response was measured by a 4-point scale (complete remission, major remission, partial remission and no response), and subjective impairment by a 3-point scale (severe, moderate and none). RESULTS: Fifty-seven patients (74% women; median age: 66 years) were included. Fifty-six (98%) patients had prior treatment with topical steroids. After introduction of tacrolimus, objective remission (major or complete) was reached by 28%, 62%, 87% and 97% of patients after 3, 6, 12 and 24 months respectively. Subjective remission was reported by 16%, 48%, 69% and 83% after 3, 6, 12 and 24 months of treatment respectively. The treatment frequency could be gradually reduced from initially twice daily to once daily or less in 28%, 61%, 78% and 87% after 3, 6, 12 and 24 months respectively; 41% of patients completely suspended the treatment at one point, but 67% of them experienced a relapse after a median time of 3.3 months. Four patients (7%) developed a squamous cell carcinoma (SCC) during the observation period. Otherwise, there were only few and minor side-effects. CONCLUSION: Topical tacrolimus can be an effective second-line therapy for OLP refractory to potent topical corticosteroids. The therapy frequency can often be reduced during the maintenance period. Both signs of clinical activity and subjective impairment should guide therapy. Regular follow-up is necessary to recognize possible SCC.

When the prey gets too big: an uncommon road accident involving a motorcyclist, a car and a bird.

We present the postmortem findings of a fatal road accident involving a motorcyclist, a car, and a common buzzard. Both the motorcyclist and the bird died on the scene of the accident and were examined by postmortem full-body CT and autopsy. In addition, a facial injury of the motorcyclist was compared with the dimensions of the buzzard's beak and claws by 3D scan technologies. Blood splatters collected on the bird's beak, feet, and tail were examined by DNA analysis. The overall findings suggested a collision of a common buzzard with a motorcyclist in full speed, causing the motorcyclist to lose control of his vehicle and crash with an approaching car on the oncoming lane.

Design and evaluation of a novel portable erythema-melanin-meter.

BACKGROUND AND OBJECTIVES: Objective evaluation of the pigmentation index (PI) and the eythema index (EI) of human skin is a prerequisite for successful optimization of laser- and intense-pulsed-light (IPL)-based treatment modalities in dermatology. STUDY DESIGN/MATERIALS AND METHODS: We describe a three-wavelength technique for determining PI and EI as well as its particular implementation using LEDs operating at wavelengths of 560, 650, and 710 nm and a large-area photodiode. The instrument has been evaluated both in vitro and in vivo. RESULTS: In vitro, good correlation between the measured indices and results obtained with commercially available techniques has been observed. In addition, linearity of the PI with melanin concentration in the phantom medium up to 7 x 10(-3) nm(-1) (defined as a slope of the optical density spectrum) has been established. In vivo, feasibility of using the technique for predicting the minimal erythema dose (MED), minimal phototoxic dose (MPD), and the threshold of epidermal damage in a photothermal treatment has been demonstrated. CONCLUSIONS: The data suggest that the technique has a substantial potential as a method of pre-treatment diagnostics for photochemical and photothermal procedures.

Computerized documentation of case management. From diagnosis to outcomes.

Documentation of patient care, outcomes, and report writing are important aspects of the role of the case manager. In this article, the author examines the types of documentation approaches used by nurses in recent years and the new applications called for in the case manager role. Issues such as standardized language and multidisciplinary documentation are explored. Approaches to examining computerized documentation systems are presented. Finally, the importance of documentation in demonstrating what nurses do, allowing comparison of outcomes, and supporting reimbursement for nurses, are discussed.

In vivo fluorescence spectroscopy of the human skin: experiments and models.

The results of the experimental investigation of autofluorescence spectra of human skin in vivo caused by the UV radiation of the skin and by the external mechanical pressure applied to the skin are presented. These results are compared with results of Monte Carlo modeling of the autofluorescence of the skin with variable blood content. The proposed simple model of the skin gives the possibility of evaluation of changes of the blood and melanin content within the skin. © 1998 Society of Photo-Optical Instrumentation Engineers.

Childhood Lead Poisoning in Russia: A Site-specific Pediatric Blood Lead Evaluation.

Lead poisoning in children is an international concern. Health effects vary according to a child's blood lead level. Historically, the problem of lead poisoning in Russia had been defined by analysis of hair samples. In Saratov, Russia, during the spring of 1996, the authors conducted the first evaluation of blood lead levels among Russian children. The mean blood lead level of 579 samples analyzed at the Centers for Disease Control and Prevention was 7.7 µg/dL (range 3.0 to 35.7 µg/dL). The sensitivity of hair analysis in identifying blood lead levels above 10 µg/dL was 50%. Most of the environmental samples evaluated (including water, dust, paint, and soil) were within acceptable U.S. remediation standards. Almost one-fourth of the Russian children evaluated during this site-specific investigation had blood lead levels capable of causing adverse health effects in children. Hair analysis is not an adequate method for identifying these children. Additional investigations in other Russian cities are necessary in order to determine the extent of lead poisoning in Russia's children.

Self-care limitations of persons after acute myocardial infarction.

In this descriptive study, the self-care limitations of persons who had experienced their first myocardial infarction were identified during the first 3 months of their convalescent period. The five most frequently occurring limitations identified were patterns of personal and family living that interfere with self-care; intense emotional states, likes or dislikes, overriding interest and concerns; perceptions, meanings, and appraisals not in accord in reality; inability to attend to self with respect to changing conditions; and new, unrecognized requirements for self-care associated with changed health. Assessment of limitation is a framework that nurses might use to evaluate the needs of post myocardial infarction patients.

Implementation and outcomes of a community-based self-help smoking cessation program.

In a time of budget constraints, health professionals are turning to minimal-contact smoking cessation programs as the most financially feasible alternative for smoking cessation. The purpose of this study was to evaluate a program by the American Lung Association using the manual Freedom From Smoking for You and Your Family (Strecher & Rimer, 1988) in a community-based smoking cessation self-help intervention. Results showed a quit rate of 15%, and study findings were consistent with other similar studies. Those most likely to succeed were over 40 years old, better educated, and among the most confident of quitting at the onset.

In vivo evaluation of sunscreens by spectroscopic methods.

BACKGROUND/AIMS: The methods available for testing the efficacy of topical sunscreens have improved considerably in recent years. Nevertheless, so far no simple and rapid test has been proposed to measure in vivo transmission spectra of sunscreens in the UVA region. METHODS: Spectral changes that occur after sunscreen application were measured with a fluorescence spectrometer (LS 50B, Perkin Elmer, UK) equipped with a Y-shape quartz guide for in vivo measurements. Three sunscreens with different protection factors in the UVA range were tested. The excitation-emission maps of human collagen, skin and sunscreens were analysed. RESULTS: As a consequence of the human skin and sunscreen fluorescence map analysis, the optimal spectral regions (both for direct and indirect fluorescence measurements) were detected. In vivo fluorescence and remittance spectroscopy were used to investigate the time dependence in transmission spectra of epidermis with applied sunscreens. We also evaluated the feasibility of in vivo fluorescence measurements for the investigation of the sunscreens'water-resistance. CONCLUSION: The procedure is simple, and values obtained can be used to predict UVA protection on the basis of the mathematical algorithms.

Current developments in research-based interventions: enhancing and advancing the CNS role.

The purpose of this article is to describe current developments in the area of research-based nursing interventions and to suggest ways nurses can translate these new developments into their advanced practice roles. Past and present works by nurse scholars in the areas of classifying and systematic testing of nursing interventions are described briefly. Examples are provided to illustrate how the CNS can incorporate these recent developments in various ways into current practice, particularly as related to utilization and conduct of research.

A community-based smoking-cessation program: self-care behaviors and success.

Given the serious health consequences of smoking, nurses need to be well-informed on how to help various client populations with smoking cessation. Much recent research is focused upon effectiveness of various programs to enhance self-efficacy and self-management skills necessary to succeed in permanent smoking cessation. This study used a model based on Orem's Self-Care Deficit Theory to examine specific variables of importance in smoking cessation using descriptors relevant to understanding self-care actions. The model is used to examine the outcomes of a community-based smoking-cessation program. Results indicate that 15% of the final sample quit smoking and 42% reduced smoking while participating in the program. Additional findings are helpful in describing actions taken by subjects who were and were not successful in quitting. Remedies suggested by the American Lung Association booklet "Freedom from Smoking for You and Your Family" were reported by subjects to be helpful in dealing with the most common problems experienced during smoking cessation. Results are applied to public health nursing, emphasizing that smoking cessation is "a process" in which individuals learn strategies that work for them.

The effect of instructions on cognitive strategies and performance in biofeedback.

An experimental study was conducted in which 40 subjects, randomly assigned to four groups, were given differing instructions about using auditory biofeedback to lower forehead muscle tension. During each of three sessions, measures were taken of forehead electromyograph (EMG) and ability to discriminate and control muscle tension in order to measure learning during biofeedback. Cognitive strategies used by subjects were measured by taped verbal reports which were judged using four criteria based on two models of learning in biofeedback: "feedforward" and "feedback." Data were analyzed by chi-square, ANOVA, ANCOVA, and content analysis. Results indicate that subjects used predominantly a feedforward type of learning strategy in all four groups. Implications for teaching during biofeedback are discussed.

Beating a path to nursing's door: scientific support for holistic practice.

Nursing has a long history of a holistic focus on patient care. The current emphasis on the need for holism indicates that the "world" is more aware of the value of nursing. To enhance this possibility, nurses need to use empirical evidence to support holistic practice.

Noncompliance revisited: a disciplinary perspective of a nursing diagnosis.

One of the nursing diagnoses accepted by NANDA is noncompliance. However, this diagnosis has been criticized because it implies coercion and dominance by health professionals, and because of the negative stereotyping the term promotes. The authors argue that noncompliance should not be used as a nursing diagnosis because of incongruence with nursing history, philosophy, ethics, theory, and the need for clinical utility of diagnoses. Alternative diagnoses are proposed.

Mitral valve prolapse and its effects: a programme of inquiry within Orem's Self-Care Deficit Theory of Nursing.

The optimum growth and scientific progress of nursing knowledge during the next century will depend upon the development and execution of focused programmes of clinical and theoretical research. The planning and design of such programmes must originate with the clear definition of nursing research questions. Nesting such questions within established theoretical frameworks provides a nursing context, lends precise language and suggests relevant variables for study. The development of a sequence of related studies exploring and describing the self-care needs of people with symptomatic mitral valve prolapse illustrates one such systematic research programme. Orem's Self-Care Deficit Theory of Nursing was used as a theoretical framework for four completed studies which describe one population's need for nursing assistance. The evolving nature of the research programme and plans for future research are discussed.

Perspectives of the person with mitral valve prolapse syndrome: a study of self-care needs derived from a health deviation.

Epidemiological studies in the United States indicate that 5% of the population or nearly 7 million people have Mitral Valve Prolapse. This incidence has also been confirmed by British physicians. Approximately half of these persons seek medical care for treatment of symptoms. Persons with symptoms are often said to have "Mitral Valve Prolapse Syndrome." The purpose of this study was to describe experiences and self-care needs of persons diagnosed with Mitral Valve Prolapse Syndrome (MVPS). In Phase I of the study, medical records of 124 subjects were reviewed to identify the medical experience and typical symptoms associated with MVPS. In Phase II, 20 subjects with typical symptoms were interviewed using a semi-structured questionnaire based on health deviation self-care requisites developed by Orem. Results of this pilot study indicate that interviewed subjects with MVPS frequently had unresolved health concerns and were seeking help. Nursing assistance may therefore be needed to help such clients understand this health deviation, to make decisions regarding appropriate actions, and to accomplish self-care actions.

The spouse: a factor in recovery after acute myocardial infarction.

Literature supports the concept that the response of a patient's spouse influences the recovery process of a patient after an acute myocardial infarction (AMI). This was a 6-month, longitudinal, descriptive study of 17 married couples in which one of the pair experienced his or her first AMI. The study examined the question: "Is there a relationship between the spouse's social support, family stress, marital satisfaction, and sexual comfort and the patient's recovery after AMI?" Data were collected at three times during the 6-month period after AMI. Results showed a significant relationship between the spouse's family stress, marital satisfaction, and sexual comfort and the patient's recovery. Also, a significant relationship was found between the spouse's sexual comfort and marital satisfaction. This was the first reported study that examined sexual comfort over time and investigated sexual activities other than intercourse.

Perceptions of body image and health status in persons with mitral valve prolapse.

Twenty subjects with diagnosed Mitral Valve Prolapse (MVP) were interviewed regarding self-care needs. Transcripts were analyzed for evidence of perceived health state and altered body image. The majority of subjects described experiences indicating that their perceptions of body image and health state were affected by the diagnosis of MVP. Using Smith's (1981) four categories of health perceptions, most subjects were judged to perceive their health state from a combination of clinical, role-performance and adaptive perspectives.