Goldmann tonometry using Nikon\u27s Tono Shields

Goldmann tonometry, the gold standard for measuring intraocular pressure, has several recommended methods for disinfection of the biprism. The methods approved by the Center for Disease Control include chemical disinfection with isopropyl alcohol, hydrogen peroxide or a dilute bleach solution. These chemicals should eliminate all potential infectious microorganisms if the disinfection procedure is performed properly. However, these same chemicals may cause structural damage to the biprism after prolonged usage, which could result in inaccurate readings. Nikon has posed a solution to this problem by creating the Tono Shield.™ The Tono Shield is a single use, disposable, silicone shield that is placed over the tip of the tonometer biprism for each intraocular pressure reading. The measurements taken with a Tono Shield are consistent and accurate to within ±1 mmHg

Analysis of pH variation of various calcium hydroxide compounds in vitro

Among the reasons for the use of calcium hydroxide products, there is their alkalinity. Variations in the alkalinity of six commonly used calcium hydroxide compounds were studied in vitro at different time intervals. All these compounds rendered the saline solution strongly alkaline. Dycal®, Life®, Nucap® and Reocap®, had a weaker effect as compared with Contrasil® and to Pulpdent® paste. Such differences in the pH values were accompanied by differences in calcium loss, as revealed by scanning electron microscopy. Differences in the alkaline pH values and calcium losses among these calcium hydroxide compounds may account for their different clinical effectiveness in vivo.Une des raisons de l’utilisation des produits à base d’hydroxyde de calcium est leur alcalinité. Les variations alcalines des 6 matériaux à base d’hydroxyde de calcium couramment utilisés ont été testées in vitro à différents intervalles de temps. Dycal®, Life®, Nucap® and Reocap®, avaient un effet plus faible que Contrasil® et Pulpdent® paste. Les différences de valeurs de pH étaient accompagnées de pertes de calcium. Les différentes valeurs de pH ainsi que les pertes de calcium pourraient expliquer leur diverse efficacité in vivo

Frederick P. Muhlhauser to Professor Silver, 11 September 1959

Professional correspondenc

Associations between coronal mass ejections and interplanetary shocks

Nearly continuous complementary coronal observations and interplanetary plasma measurements for the years 1979-1982 are compared. It is shown that almost all low latitude high speed coronal mass ejections (CME's) were associated with shocks at HELIOS 1. Some suitably directed low speed CME's were clearly associated with shocks while others may have been associated with disturbed plasma (such as NCDE's) without shocks. A few opposite hemisphere CME's associated with great flares seem to be associated with shocks at HELIOS

Evaluator-blinded trial evaluating nurse-led immunotherapy DEcision Coaching In persons with relapsing-remitting Multiple Sclerosis (DECIMS) and accompanying process evaluation: Study protocol for a cluster randomised controlled trial

License:Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)Background: Multiple sclerosis is a chronic neurological condition usually starting in early adulthood and regularly leading to severe disability. Immunotherapy options are growing in number and complexity, while costs of treatments are high and adherence rates remain low. Therefore, treatment decision-making has become more complex for patients. Structured decision coaching, based on the principles of evidence-based patient information and shared decision-making, has the potential to facilitate participation of individuals in the decision-making process. This cluster randomised controlled trial follows the assumption that decision coaching by trained nurses, using evidence-based patient information and preference elicitation, will facilitate informed choices and induce higher decision quality, as well as better decisional adherence. Methods/Design: The decision coaching programme will be evaluated through an evaluator-blinded superiority cluster randomised controlled trial, including 300 patients with suspected or definite relapsing-remitting multiple sclerosis, facing an immunotherapy decision. The clusters are 12 multiple sclerosis outpatient clinics in Germany. Further, the trial will be accompanied by a mixed-methods process evaluation and a cost-effectiveness study. Nurses in the intervention group will be trained in shared decision-making, coaching, and evidence-based patient information principles. Patients who meet the inclusion criteria will receive decision coaching (intervention group) with up to three face-to-face coaching sessions with a trained nurse (decision coach) or counselling as usual (control group). Patients in both groups will be given access to an evidence-based online information tool. The primary outcome is ‘informed choice’ after six months, assessed with the multi-dimensional measure of informed choice including the sub-dimensions risk knowledge (questionnaire), attitude concerning immunotherapy (questionnaire), and immunotherapy uptake (telephone survey). Secondary outcomes include decisional conflict, adherence to immunotherapy decisions, autonomy preference, planned behaviour, coping self-efficacy, and perceived involvement in coaching and decisional encounters. Safety outcomes are comprised of anxiety and depression and disease-specific quality of life. Discussion: This trial will assess the effectiveness of a new model of patient decision support concerning MS-immunotherapy options. The delegation of treatment information provision from physicians to trained nurses bears the potential to change current doctor-focused practice in Germany

The Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE): study protocol for a cluster randomised controlled trial

Introduction People with type 1 diabetes (T1DM) require insulin therapy to sustain life, and need optimal glycaemic control to prevent diabetic ketoacidosis and serious long-term complications. Insulin is generally administered using multiple daily injections but can also be delivered using an infusion pump (continuous subcutaneous insulin infusion), a more costly option with benefits for some patients. The UK National Institute for Health and Care Excellence (NICE) recommend the use of pumps for patients with the greatest need, citing insufficient evidence to approve extension to a wider population. Far fewer UK adults use pumps than in comparable countries. Previous trials of pump therapy have been small and of short duration and failed to control for training in insulin adjustment. This paper describes the protocol for a large randomised controlled trial comparing pump therapy with multiple daily injections, where both groups are provided with high-quality structured education. Methods and analysis A multicentre, parallel group, cluster randomised controlled trial among 280 adults with T1DM. All participants attended the week-long dose adjustment for normal eating (DAFNE) structured education course, and receive either multiple daily injections or pump therapy for 2 years. The trial incorporates a detailed mixed-methods psychosocial evaluation and cost-effectiveness analysis. The primary outcome will be the change in glycosylated haemoglobin (HbA1c) at 24 months in those participants whose baseline HbA1c is at or above 7.5% (58 mmol/mol). The key secondary outcome will be the proportion of participants reaching the NICE target of an HbA1c of 7.5% (58 mmol/mol) or less at 24 months. Ethics and dissemination The protocol was approved by the Research Ethics Committee North West, Liverpool East and received Medicines and Healthcare products Regulatory Agency (MHRA) clinical trials authorisation. Each participating centre gave National Health Service R&D approval. We shall disseminate study findings to study participants and through peer reviewed publications and conference presentations, including lay user groups. Trial registration number ISRCTN 61215213