Overregulation of Health Care: Musings on Disruptive Innovation Theory

Disruptive innovation theory provides one lens through which to describe how regulations may stifle innovation and increase costs. Basing their discussion on this theory, Curtis and Schulman consider some of the effects that regulatory controls may have on innovation in the health sector

Before and After Shunt Surgery A Controlled Study Using Computerized Dynamic Posturography (EquiTest)

Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest

Somatosensory abnormalities in atypical odontalgia : A case-control study

Somatosensory function in patients with persistent idiopathic types of orofacial pain like atypical odontalgia (AO) is not well described. This study tested the hypothesis that AO patients have significantly more somatosensory abnormalities than age- and sex-matched controls. Forty-six AO patients and 35 controls participated. Inclusion criteria for AO were pain in a region where a tooth had been endodontically or surgically treated, persistent pain >6 months, and lack of clinical and radiological findings. The examination included qualitative tests and a battery of intraoral quantitative sensory testing (QST). Most AO patients (85%) had qualitative somatosensory abnormality compared with few controls (14%). The most common qualitative abnormalities in AO patients were found with pin-prick 67.4%, cold 47.8%, and touch 46.5% compared with 11.4%, 8.6%, and 2.9%, respectively, in the control group (P<0.001). Between-group differences were seen for many intraoral QST: mechanical detection threshold, mechanical pain threshold (pinprick), dynamic mechanical allodynia (brush), dynamic mechanical allodynia (vibration), wind-up ratio, and pressure pain threshold (P<0.01). In the trigeminal area, between-group differences in thermal thresholds were nonsignificant while differences in cold detection at the thenar eminence were significant. Individual somatosensory profiles revealed complex patterns with hyper- and hyposensitivity to intraoral QST. Between-group differences in pressure pain thresholds (P<0.02) were observed at the thenar eminence. In conclusion, significant abnormalities in intraoral somatosensory function were observed in AO, which may reflect peripheral and central sensitization of trigeminal pathways. More generalized sensitization of the nociceptive system may also be part of AO pathophysiology

Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery : a controlled study using computerized dynamic posturography (EquiTest)

Introduction Postural dysfunction is one of the major features of idiopathic normal pressure hydrocephalus (iNPH). With computerized dynamic posturography (CDP) balance can be assessed objectively. The primary aim of this study was to describe the postural function in iNPH patients pre- and post-operatively in comparison with healthy individuals (HI) using CDP. Subjects and methods Thirty-five patients (16 M, 19 F) with a mean age of 73 (range 49–81) with iNPH, and sixteen HI (7 M, 9 F) aged 73 (62–89) were included. iNPH patients were operated on with a ventriculo-peritoneal shunt. Patients and HI were tested regarding motor function, balance and cognition. CDP, EquiTest (NeuroCom International, Clackamas, OR), was performed before and three months after shunt surgery and twice in HI, with a three-month interval. Results Pre-operatively, the 35 patients had poorer balance measured with the Sensory Organizing Test (SOT) score in every condition (p = 0.01 in SOT 1 and p &lt; 0.001 in SOT 2–6) compared to the HI. The greatest difference was in test conditions measuring mainly vestibular function, where loss of balance (LOB) was frequent. Twenty patients were evaluated three months after shunt surgery and 18/20 (90%) of them were considered shunt responders, with a mean improvement of motor score of 26% (range 5–67%). There was an improvement post-operatively in the weighted composite SOT score (p &lt; 0.05) but no significant change in any of the SOT conditions. LOB was not significantly reduced in any of the test conditions. Conclusion CDP showed that the patients had a poorer balance than the HI. The greatest difference was in SOT 5–6, indicating that the postural disturbance is of primarily central vestibular origin. There was a slight improvement of balance post-operatively

Comparison of Clinical Findings and Psychosocial Factors in Patients with Atypical Odontalgia and Temporomandibular Disorders

Aims: To systematically compare clinical findings and spychosocial factors between patients suffering from atypical odontalgia (AO) and an age- and gender-matched group of patients with temporomandibular disorders (TMD). Methods: Forty-six AO patients (7 men and 39 women; mean age, 56 years) were compared with 41 TMD patients (8 men and 33 women, mean age 58 years). Results: Mean pain intensity at the time of inclusion in the study was similar between the groups (TMD: 5.3±0.4, AO: 5.0±0.3), but pain duration was longer in AO patients (AO: 7.7±1.1 years, TMD: 4.5±0.1 years). Eighty-three percent of the AO patients and 15% of TMD patients reported pain onset in relation to dental/surgical procedures. Episodic tension-type headache (TTH) occurred equally in both groups (TMD: 46%, AO: 46%) but TMD patients more frequently experienced chronic TTH (TMD: 35%, AO: 18%), myofascial TMD (TMD: 93%, AO: 50%), and temporomandibular joint disorders (TMD: 66%, AO: 2%). Overall, TMD patients had lower pressure pain thresholds and poorer jaw function than AO patients. Mean depression and somatization scores were moderate to severe in both groups, and widespread pain was most common in TMD patients. Conclusion: AO and TMD share some characteristics but differ significantly in report of dental trauma, jaw function, pain duration, and pain site

Blink reflexes in patients with atypical odontalgia

Aim: To examine the blink reflex (BR) evoked by stimulation of the trigeminal (V) nerve branches, to examine the painful V branch before and during a pain provocation test, and to compare the painful and the contra lateral non-painful branch in patients with atypical odon-talgia (AO). Methods: In thirteen patients with AO, the BR was elicited with the use of a concentric electrode and recorded bilaterally with surface EMG electrodes on both orbicularis oculi muscles. Electrical stimuli were applied to the skin above the V1, V2 and V3 nerve branches and to the V branch contralateral to the painful branch. The sensory and pain thresholds were determined. The BR examination of the painful V branch was repeated during a capsaicin pain provocation test. The data were analysed with use of non-parametric statistics. Results: The BR responses evoked by stimulation of the V3 were significantly lower than the BR responses evoked by stimulation of the V1 and V2 (P 0.569), and the BR was not significantly modulated by experimental pain (P > 0.080). The sensory thresholds were significantly lower on the painful side compared to the non-painful side (P = 0.017). The pain thresholds were not different between sides (P > 0.910). Conclusion: These preliminary findings did not indicate major differences in the V nociceptive pathways between sides in AO patients. Future studies comparing the BR in AO patients with healthy volunteers are needed to provide further knowledge on the pain mechanisms in AO

Clinical findings and psychosocial factors in patients with atypical odontalgia : a case-control study

AIM: To provide a systematic description of clinical findings and psychosocial factors in patients suffering from atypical odontalgia (AO). METHODS: Forty-six consecutive AO patients (7 men and 39 women; mean age, 56 years; range, 31 to 81 years) were compared with 35 control subjects (11 men and 24 women; mean age, 59 years; range, 31 to 79 years). RESULTS: The pain of the AO patients was characterized by persistent, moderate pain intensity (mean, 5.6 +/- 1.9) with long pain duration (mean, 7.7 +/- 7.8 years). Eighty-three percent reported that onset of pain occurred in conjunction with dental treatment. No significant difference was found between the groups in number of remaining teeth or number of root fillings. Temporomandibular disorder (TMD) pain (P < .001), tension-type headache (P < .002), and widespread pain (P < .001) were significantly more common among AO patients than controls. Significantly higher scores for somatization (P < .01) and depression (P < .01) and limitations in jaw function (P < .001) were found for the AO group compared with the control group. Significant differences between groups were found in 4 general health domains: role-physical (P < .001), bodily pain (P < .001), vitality (P < .004), and social functioning (P < .001). CONCLUSION: A majority of the AO patients reported persistent, moderately intense intraoral pain that in most cases had an onset in conjunction with dental treatment. AO patients had more comorbid pain conditions and higher scores for depression and somatization. Significant limitation in jaw function and significantly lower scores on quality of life measures were found for AO patients compared with controls