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At least 1,099 records · Page 61Linked to original sources
PubMed2005

Specialist nurse-led clinics to improve control of hypertension and hyperlipidemia in diabetes: economic analysis of the SPLINT trial.

OBJECTIVE: To determine the cost-effectiveness of specialist nurse-led clinics provided to improve lipid and blood pressure control in diabetic patients receiving hospital-based care. RESEARCH DESIGN AND METHODS: A policy of targeting improved care through specialist nurse-led clinics is evaluated using a novel method, linking the cost-effectiveness of antihypertensive and lipid-lowering treatments with the cost and level of behavioral change achieved by the specialist nurse-led clinics. Treatment cost-effectiveness is modeled from the U.K. Prospective Diabetes Study and Heart Protection Study treatment trials, whereas specialist nurse-led clinics are evaluated using the Specialist Nurse-Led Clinics to Improve Control of Hypertension and Hyperlipidemia in Diabetes (SPLINT) trial. RESULTS: Good lipid and blood pressure control are cost-effective treatment goals for patients with diabetes. Modeling findings from treatment trials, blood pressure lowering is estimated to be cost saving and life prolonging (-1,400 dollars/quality-adjusted life-year [QALY]), whereas lipid-lowering is estimated to be highly cost-effective (8,230 dollars/QALY). Investing in nurse-led clinics to help achieve these benefits imposes an addition on treatment cost-effectiveness leading to higher estimates: 4,020 dollars/QALY and 19,950 dollars/QALY, respectively. For both clinics combined, the estimated cost-effectiveness is 9,070 dollars/QALY. Using an acceptability threshold of 50,000 dollars/QALY, the likelihood that blood pressure-lowering clinics are cost-effective is 77%, lipid clinics 99%, and combined clinics 83%. CONCLUSIONS: A method is described for evaluating the cost-effectiveness of policies to change patient uptake of health care. Such policies are less attractive than treatment cost-effectiveness (which implies cost-less self-implementation). However, specialist nurse-led clinics, as an adjunct to hospital-based diabetic care, combining both lipid and blood pressure control, appear effective and likely to provide excellent value for money.

Blood Glucose↗
PubMed2006

Use of internal splinting to realign a noncompliant sternum in a cat with pectus excavatum.

CASE DESCRIPTION: A 5.5-month-old female domestic longhair cat was examined because of dorsal deviation of the caudal aspect of the sternum and progressively worsening dyspnea during play activities. CLINICAL FINDINGS: A diagnosis of pectus excavatum was made clinically and confirmed radiographically. The cardiac silhouette was shifted into the right hemithorax. The vertebral index (VI) and frontosagittal index (FSI), which are radiographic indices used to grade the extent of the deformity, were 5.2 and 3.0, respectively. Minimum thoracic height was 13 mm at this time. TREATMENT AND OUTCOME: The sternal malposition was corrected during surgery; for stabilization, an internal splint was provided by use of a plate that was applied to the ventral side of the sternum. Radiographic indices improved until day 85; at that time, an increase in the distance between plate and sternum was detected, and plate removal was advised. The radiographic indices improved again after plate removal. At 310 days after surgery, VI was 9.6, FSI was 1.6, and minimum thoracic height was 34 mm. No dyspnea was evident during physical examination. CLINICAL RELEVANCE: Results of treatment suggest that this technique may be useful as an alternative surgical option for cats with pectus excavatum that have a noncompliant sternum.

Animals↗
PubMed1982

Pneumatic trouser splints in the treatment of severe osteogenesis imperfecta.

Twelve patients with severe osteogenesis imperfecta have been managed by closed osteotomy to correct lower limb long bone deformity, followed by support in pneumatic trouser splints. The apparatus was well tolerated, fractures were rare, and there was a significant improvement in patient mobility. This conservative method compares favourably with the published series of multiple osteotomies and intramedullary rodding.

Bone Diseases, Developmental↗
PubMed1992

The von Rosen splint compared with the Frejka pillow. A study of 408 neonatally unstable hips.

101 children in Tromsö, Norway, treated with the Frejka pillow for 4.5 months because of neonatal hip instability (NHI) were compared with 307 children in Malmö, Sweden, treated with the von Rosen splint for 3 months. The pelvic radiographs, taken when the treatment was terminated, were assessed by the acetabular index (AI) and the cases of failure were evaluated. The AI showed no difference between the two groups. The Frejka group had 4 patients who received further treatment because of remaining acetabular dysplasia and/or subluxation while the von Rosen group had none. The difference in risk of failure might partly be explained by different criteria for failure.

Female↗
PubMed1999

No advantage from splinting the wrist after open carpal tunnel release. A randomized study of 82 wrists.

To study the value of postoperative splinting after open carpal tunnel surgery, we randomly selected 82 wrists for 4 weeks of postoperative immobilization or no immobilization. The distributions of scar discomfort or pain and "pillar pain" were equal in the two groups both at 6 weeks and 6 months. Median sick leave was 6 weeks in both groups. Median VAS values for persistent discomfort and pain at 2 weeks, 6 weeks and 6 months were similar in the two groups. Grip strength was reduced compared to preoperative values by about 20% and keypinch strength by about 10% in both groups at 6 weeks and had returned to normal by 6 months. Pinch between the thumb and the tips of fingers 4 and 5 was considerably reduced postoperatively, but similar in both groups. We conclude that 4 weeks of postoperative immobilization confers no detectable benefit.

Absenteeism↗
PubMed2005

Suture knot on the repair splint: a simple method to facilitate reconstruction of the sella turcica during endonasal endoscopic transsphenoidal surgery. Technical note.

Reconstruction of the sellar floor after pituitary tumor removal is sometimes difficult because the repair graft is difficult to handle in the narrow space. This is especially problematic if the endonasal endoscopic approach is used. The authors devised a technique to facilitate this procedure by placing a suture knot on the repair splint. This allows the material to be grasped securely with forceps and improves manipulation even within the narrow nasal cavity. This technique has proved useful when performing the endonasal endoscopic approach, and it is also expected to be useful when conducting the conventional sublabial transsphenoidal approach.

Endoscopy↗
PubMed2002

A prospective trial of night splinting in the treatment of recalcitrant plantar fasciitis: the Ankle Dorsiflexion Dynasplint.

Twelve patients were treated with the Ankle Dorsiflexion Dynasplint (Dynasplint Systems Inc, Severna, Md) for recalcitrant plantar fasciittis. Using a modified plantar fasciitis functional assessment scale and a visual analog pain assessment scale for evaluation, 75% of patients reported improvement ofsymptoms at 1-month follow-up. The average percentage of weekly sleeping hours spent in the splint was 95%. There was no tendency to deterioration of results by 6 months postsplinting. The Ankle Dorsiflexion Dynasplint is effective in the treatment of recalcitrant heel pain in a majority of patients. This study supports its use for the treatment of recalcitrant plantar fasciitis.

Adult↗
PubMed1983

The use of Hexcelite in splinting the thumb.

Hexcelite Orthopaedic Tape can be used effectively for splinting thumb joints. The open weave material is easily molded, lightweight, and durable. It is useful in the rehabilitation management of a variety of thumb disorders and is well accepted by patients.

Casts, Surgical↗
PubMed1986

Splinting proximal interphalangeal joint flexion contractures: a new design.

Proximal interphalangeal joint flexion contracture is a common and persistent problem in hand rehabilitation. This article discusses the advantages and disadvantages of several current splint designs for correcting this contracture and introduces an alternate design that uses wire in a 3-point pressure system. The advantages of this design include ease of fabrication, patient appeal, and effectiveness.

Contracture↗
PubMed2006

Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial.

OBJECTIVE: The goal was to compare the efficacies of botulinum toxin A (BTX) treatment and Johnstone pressure splint (JPS) treatment against hip adductor muscle spasticity among children with spastic diplegic cerebral palsy. METHODS: For each patient in the BTX group, a total of 300 IU of BTX was injected into adductor and medial hamstring muscle groups. In the JPS group, long leg JPS were administered for 30 minutes 3 days per week. Bobath neurodevelopmental exercises were administered to both groups 3 days per week during the study period. All cases were assessed by using gross motor function measurements, passive hip abduction goniometric measurements, modified Ashworth Scale scores, and measurements of the distance between the knees as indicator variables. RESULTS: We found that there was statistically significant improvement in all indicators for both groups. BTX treatment was found to be superior to JPS treatment in terms of the indicator variables of our study.

Adolescent↗
PubMed1999

Ear, nose, and throat devices; classification of the nasal dilator, the intranasal splint, and the bone particle collector. Food and Drug Administration, HHS. Final rule.

The Food and Drug Administration (FDA) is classifying the nasal dilator, intranasal splint, and the bone particle collector into class I (general controls). FDA is also exempting the devices from the requirements of premarket notification. This action is taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the amendments), the Safe Medical Devices Act of 1990 (SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA).

Bone and Bones↗
PubMed1975

Dynamic splints for rehabilitation after surgical treatment of ankylosis.

Using strictly surgical techniques without rehabilitation often leads to a systemic pattern of relapse within approximately a year's time. With the technique proposed, we have obtained functional recuperation that has persisted for more than five years (Fig 4). We feel the splints are useful because they afford comfort to the patient, a shorter hospitalization period, and no risk of infection.

Activator Appliances↗
PubMed1999

Two-prong splint in the treatment of proximal humeral fracture.

Twenty-nine patients with two-, three- and four-part proximal humeral fractures were treated by two-prong splint. At the latest follow-up, 22 patients had excellent and satisfactory results according to the Neer criteria, with only two failures. Avascular necrosis was detected in only one patient. Given these results, we conclude that the present method can be the treatment of choice for these injuries.

Adolescent↗
PubMed1976

Compliancy in splint-wearing behaviour of patients with rheumatoid arthritis.

Forty-six patients with rheumatoid arthritis affecting their hands were questioned to establish whether or not they complied with the medical specialist's instructions about wearing splints. Only one-third of the patients appeared to comply. A high extraversion score (measured on the EPI questionnnaire) identified half of the patients who did not comply. All patients scored significantly lower then the population norm on the introversion-extraversion dimension, indicating that this dimension may be involved in the psychosomatic aspect of rheumatoid arthritis.

Adult↗
PubMed1999

Splinted all-ceramic laboratory technique for implant restorations.

The fabrication of esthetically pleasing implant restorations remains a common and frustrating challenge for dental technicians as well as clinicians. Poor implant placement and post surgical gingival response often creates a difficult foundation on which to build a successful restoration. Castable, cast-to and prepable abutments are employed to correct these problems as they allow some measure of control of angulation and depth of the clinical restoration. This article details the restoration of two implants with ceramic implant abutments and splinted crowns. The technique described achieves a high level of esthetics despite less than ideal conditions.

Adult↗