Is Pulse-Dye Laser Therapy an Effective Treatment for Burn Scars?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not pulse-dye laser therapy is an effective treatment for burn scars. STUDY DESIGN: Systematic review of two randomized controlled trials and one case series study published in 1998, 2003, and 2012. DATA SOURCES: Two randomized controlled trials and one case series study published after 1997 were obtained using Medline and PubMed OUTCOMES MEASURED: Symptoms of pruritus, pain, and burning sensation measured for improvement by patient survey of pain scales and parent’s reports of complaints in pediatric patients with symptoms by way of pain scales and medication requests. Cosmetic appearance was measured by physician and patient evaluation, photograph of pre and post treatment burn scar evaluation by blinded non-medical evaluators, 3D topographic imaging, and the Vancouver Scar Scale. RESULTS: Bailey et al. (2012) and Alster et al. (1998) demonstrated improvement in a majority of the subjects’ burn scar cosmetic characteristics, while Alster also showed significant improvement in burn scar pruritus. Allison et al. (2003) showed an improvement in pruritus symptoms but not significant in cosmetic appearance as compared to the control. CONCLUSION: Evidence to support the efficacy of pulse-dye laser therapy as a treatment for the symptoms and cosmetic appearance of burn scars is inconclusive at this point in time due to the lack of a large subject population, standard of measurement, and a wide spectrum of subject age making it difficult to properly collect significant amounts of data to strongly support the efficacy of pulse-dye therapy in treating burn scars

EFFECTS OF LUMBAR SPINAL FUSION ON LUMBOPELVIC RHYTHM DURING ACTIVITIES OF DAILY LIVING

Abnormalities in lumbopelvic rhythm (LPR) play a role in occurrence/recurrence of low back pain (LBP). The LPR before spinal fusion surgery and its changes following the surgery are not understood. A repeated measure study was designed to investigate timing and magnitude aspects of LPR in a group of patients (n = 5) with LBP before and after a spinal fusion surgery. Participants completed a forward bending and backward return task at their preferred pace in the sagittal plane. The ranges of thoracic and pelvic rotations and lumbar flexion (as the magnitude aspects of LPR) as well as the mean absolute relative phase (MARP) and deviation phase (DP) between thoracic and pelvic rotations (as the timing aspects) were calculated. Thoracic, pelvic, and lumbar rotations/flexion were respectively 2.19° smaller, 17.69° larger, and 19.85° smaller after the surgery. Also, MARP and DP were smaller during both bending (MARP: 0.0159; DP 0.009) and return (MARP: 0.041; DP: 0.015) phases of the motion after surgery. The alterations in LPR after surgery can be the result of changes in lumbar spine structure due to vertebral fusion and/or new neuromuscular adaptations in response to the changes of lumbar spine structure. The effects of altered LPR on load sharing between passive and active components of lower back tissues and the resultant spinal loads should be further investigated in patients with spinal fusion surgery

Decline of the edentulism epidemic in Australia

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included. Prepared by LA Crocombe and GD SladeAustralian Research Centre for Population Oral Health, The University of Adelaide, South Australia; prepared by LA Crocombe and GD Slad

Trends in dental caries experience of school children in Australia - 1977 to 1993

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Data on the dental health of Australian school children from 1977 to 1985 have previously been reported. Significant features included a secular decline in caries experience as defined by the number of decayed, missing and filled teeth in both the deciduous dentition (dmft index) and permanent dentition (DMFT index), and a change in the distribution of caries experience within the child population in Australia, indicated by increasingly smaller percentages of children accounting for greater proportions of total disease experience. The aim of the present paper was to extend the annual reporting on caries experience in Australia up to and including 1993, and to document the change in the distribution of caries within the child population since 1977. In addition, the data are compared with dental targets for children for the year 2000 in Australia and internationally. Caries data were obtained for the years 1977-1993 for children who were patients at School Dental Services in each State and Territory of Australia. Caries experience was recorded by uncalibrated dentists and dental therapists during routine dental examinations. From 1977-89 data were weighted by State and Territory estimated resident populations. From 1989, the data were stratified according to age, year, and State, and weighted to reflect proportions in the national estimated resident population for each State/age stratum. Between 1977 and 1993 there has been a decline in caries experience for 6 year old children from a dift++ of 3.13 to a dmft of 1.90, and an increase in the per cent with dmft = 0 from 33.1 per cent to 53.2 per cent with dmft = 0 in 1993. Over the same time period the DMFT for 12 year olds reduced from 4.79 to 1.10 and the per cent while DMFT = 0 increased from 10.5 per cent to 53.1 per cent. Projection of the decline in DMFT indicates the dental health target for 12 year old children of DMFT = 1.0 by the year 2000 should have been achieved by the end of 1995.M.J. Davies, A.J. Spencer, G.D. Slad

Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample

Background: Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. Methods: Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. Results: All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. Conclusions: Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population

High-dimensional graphical networks of self-avoiding walks

We use the lace expansion to analyse networks of mutually-avoiding self-avoiding walks, having the topology of a graph. The networks are defined in terms of spread-out self-avoiding walks that are permitted to take large steps. We study the asymptotic behaviour of networks in the limit of widely separated network branch points, and prove Gaussian behaviour for su#ciently spread-out networks on in dimensions d>4