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In order to find predictors of patient cooperation 40 dentists were asked, in personal interviews, to relate two cases each, one “successful” and one “unsuccessful”, outcome being mainly due to patient's response to motivation efforts. The variables which differentiated must clearly between “successful” and “unsuccessful” cases were, in decreasing order, patient's involvement, patient's psychological state, dentist's involvement, patient's physical state, patient's social relations and patient's general hygiene.

A group of 74 end-stage renal disease outpatients on dialysis completed on of seven forms of the Depression Adjective Check List (DACL) (Lubin, 1981) once a month over a 12-month period. Patient cooperation in filling out the DACL was 95%, indicating patient's acceptance of this fairly unobtrusive instrument. The distribution of usable DACL scores of 53 patients was trifurcated: high = one SD above the mean; medium +/- one SD from the mean; and low = more than one SD below the mean. A one-way ANOVA on the mean number hospitalizations during the 12-month period for each group was significant, F (2,50) = 8.11, p less than .01. The mean number of hospital admissions was highest for the high depression group and lowest for the low depression group. DACL scores of seven patients who died were significantly higher than for the 46 survivors, t (60) = 4.44, p less than .01.

Technique modifications for computed tomographic staging of infiltrative bladder carcinoma are aimed at maximizing image quality and reducing artifactual problems, particularly those associated with the effects of motion owing to poor patient cooperation. Patients unable to tolerate a lengthy procedure or the prone position have been studied using a low density contrast technique with controlled bladder distension. Although the intravesical tumor component often is not as dramatically demonstrated as with the gas insufflation technique the accuracy of both staging procedures appears to be high. The tendency towards overstaging is common to bladder opacification and gas insufflation techniques but this may be reduced considerably by bowel opacification when necessary and the use of intravenous contrast enhancement techniques.

• The management of nasal trauma in children differs considerably from that in adults. In children, the evaluation is decidedly more difficult because of lack of patient cooperation and different anatomical features. The controversy regarding surgical manipulation of the pediatricnose has resulted in confusion as to the proper management of nasal trauma in this age group. On the basis of our experience with these problems, we have developed a philosophy of management; its principles and techniques are described herein. ( Arch Otolaryngol 1984;110:190-192)

SUMMARY Hypnosis is an effective tool in many areas of medicine and surgery. The exacting demands of ophthalmic surgery require good patient cooperation and strict adherence to treatment regimens. Multisystemic diseases compounded by the physiological stress of surgery make it essential that already strained homeostatic mechanisms are interfered with minimally. The cases presented in this report illustrate the beneficial use of hypnosis in the treatment of several high risk patients in unusual situations.

Diazepam appears to be a very useful agent in upper gastrointestinal endoscopy. Titrating the dose to patient response should increase the incidence of amnesia and keep to a minimum the number of endoscopies abandoned due to lack of patient cooperation.

Digital subtraction angiography (DSA), whether used in conjunction with intravenous or intraarterial injection techniques, has an established role in evaluation of peripheral vascular disease. Use of DSA can reduce the time, cost, and patient discomfort of the standard arteriographic study. While it is limited by field size and patient cooperation in some instances, the utility of noninvasive imaging using intravenous DSA and the added anatomic detail of intraarterial DSA for roadmapping and delineation of small distal vessels provide the basis for future integration of standard arteriographic and DSA methods in assessment of peripheral vascular disease.

Five patients with chronic conversion symptoms were treated with narcoanalysis and narcosuggestion using combined methylphenidate and amobarbital. The combination of methylphenidate and amobarbital proved useful because methylphenidate antagonized sedation and allowed optimal patient cooperation. In four cases recovery of neurological function was obtainedin the first or second interview and subsequently improved with practice and positive feedback. In each instance recovery of neurological function during a narcoanalytic interview confirmed the diagnosis of a conversion reaction. The narcoanalytic interview also confirmed or uncovered important psychopathology and psycho dynamics which permitted more accurate treatment of the underlying psychiatric disorders.

To assess whether malabsorption of specific sugars is easily detected in a pediatric population by interval measurement of breath hydrogen excretion, hydrogen concentration was determined following administration of oral sucrose to six sucrose-intolerant children with congenital sucrase-isomaltase deficiency and in 16 sucrose-tolerant control subjects. Breath samples were collected by means of a newly devised nasal prong technique not requiring active patient cooperation and suitable for use in all age groups. Breath hydrogen concentrations obtained by samples collected by this method correlated highly (r = 0.94) with the previously validated modified Haldane-Priestley tube method for sampling alveolar air. Identification of sucrose-intolerant individuals was achieved on the basis of hydrogen excretion: peak values, expressed as parts per million above baseline (deltappm), equalled 114 +/- 63 (mean +/- SD) versus 2.4 +/- 3.6 deltappm in control subjects (P = 0.007). Best discrimination between the groups occurred at 90 minutes postingestion. The findings validate this simple method for collection of expired air and demonstrate that breath hydrogen determination permits the noninvasive detection of sucrose malabsorption in children.

Pitfalls in the interpretation of electronystagmographic traces may be avoided by the reduction of artefacts in recording. These artefacts are often the result of poor physical conditions and lack of patient cooperation during recording. This paper examines technique in the clinical practice of eletronystagmography and suggests methods of minimising some of these recording artefacts.

In an earlier publication, the intestinal placement of Miller-Abbott-tubes using routine gastroscopic equipment was proposed for the conservative treatment of intestinal obstruction. In addition to the technical advices presented at this early stage of personal experience, we now recommend to 1. insert the tube primarily through the nostrils, 2. extract the tip through the mouth, 3. grasp the leading ligature of the tube tip extracorporally by means of the biopsy instrument and 4. guide the tube tip to the target area by orogastric approach. This technical improvement excludes difficulties in respect to patient cooperation or other special disadvantages and made 26 intestinal intubations in an uninterrupted series an easy and worthwhile procedure.

Low patient cooperation erodes many of the proven benefits of antihypertensive therapy. Over the last few years, there have been important advances in our understanding of the nature and management of patient compliance in hypertension and other chronic illness. In this article we review the theoretical foundation of compliance behavior; methods of measuring compliance; established and promising approaches to managing compliance; ethical consideration in measuring, improving, and researching compliance; the current state of implementation of compliance techniques in practice settings; and the efforts to disseminate information on compliance through undergraduate and continuing health professional education programs.

Thirteen cervical timing headgears, then commercially available, were subjected to testing under laboratory conditions. Continuous and intermittent forces were applied, these being varied between 200 and 1000 gm. Forces were applied by attaching the cervical straps to a cylindrical drum, to activate the timer switch. Each headgear showed only moderate variation in accuracy under different phases of the testing, although timing accuracy varied considerably between individual headgears. The overall performances produced mean timing accuracy values exceeding 90 per cent in only four appliances, indicating that these ‘Patient Motivators’ did not provide a consistently dependable recording of headgear usage.

• Fifty-six patients underwent an adjustable rectus muscle recession procedure. This procedure permits the surgeon to enhance or diminish the amount of muscle recession on the evening after surgery or the first postoperative day if cover-testing indicates an inappropriate amount of undercorrection or overcorrection. The adjustable rectus muscle recession technique seems to be a practical and effective means to change the strabismic deviation postoperatively. The procedure requires patient cooperation and is most suitable for patients age 15 years and older. The procedure has been effective in altering the angle of deviation, and this alteration has been stable during the follow-up period in most cases. In this initial series, the reoperation rate was low, postoperative alignment was excellent, and complications were minimal. ( Arch Ophthalmol 95:817-820, 1977)

Pulmonary radionuclide studies in children provide reliable information on regional lung perfusion and ventilation. They are easily and safely performed and they do not usually require full patient cooperation. Their clinical indications and applications are not as well defined as and frequently differ from those in pulmonary disorders of the adult patient. Radiation exposures resulting from radionuclide pulmonary examinations are well within acceptable limits set up for a variety of radiologic diagnostic procedures. Our lung scanning experience with a spectrum of congenital and acquired cardiopulmonary diseases is presented and the contribution of the radionuclide methods to the specific problems facing the pediatrician or the surgeon is discussed.

Disocclusion of the teeth has been postulated to have a deregulating or promoting influence on mandibular growth. The clinical effects of disocclusion were evaluated with a prospective pilot study of 16 children with mixed dentition who wore either a maxillary Hawley biteplane or the functional regulator of Frankel. The pilot study was used to assess individual variations to establish the feasibility of a larger, more statistically valid investigation. The biteplane was used to evaluate the effects of vertical mandibular displacement on craniofacial growth. The Frankel regulator was used to evaluate the effects of both vertical and horizontal mandibular displacement. The relationships between patient cooperation, personality characteristic, and treatment effects were also evaluated. After 9 months of treatment, the biteplane group had an increase in the mandibular plane angle with little or no horizontal mandibular growth and tendency toward an interior open bite. This was deemed to be clinically detrimental and the biteplane therapy was discontinued. The results of this study are presented to aid the clinician in his or her decision to use biteplane therapy. In the biteplane group, the bite opening was associated with molar, and not incisor, extrusion. Though the biteplane group had primarily a vertical increase in the length of the lower third of the face, the Frankel group had a combination of anterior and inferior mandibular growth. In both groups, the mandibular incisor usually moved anteriorly. The maxially incisor usually moved labially in the biteplane group and lingually in the Frankel group, although exceptions were in both groups. Correlation coefficients between self-esteem, compliance, and cognitive level were not statistically significant. These findings suggest that a constant protracting force on the mandible, rather than bite opening only, may be necessary for increasing mandibular length. Thus the biteplane should only be used to increase the vertical dentoalveolar and facial heights in patients with normal anteroposterior maxillary-mandibular relationships.

Nine cleft lip and palate children exhibitng collapse of maxillary segments and cross-bite were treated orthodontically with the functional regulator (FR) for periods ranging from 6 to 18 months. The purpose of this investigation was to evaluate quantitatively treatment of cleft palate patients with the functional regulator and to evaluate the effect of the appliance on their speech. Cleft palate patients typically have speech, nose, and lip defects which make patient cooperation and appliance acceptance more difficult. However, patient cooperation was considered good with an average mean of 12.7 hours per day of appliance wear and a range of 5.6 to 18.2 hours. Change in interimplant dimension was measured on frontal radiographs, and dental changes were measured of serial dental casts. The resulting data indicated no significant change in maxillary width or cross-bite relationship. The functional regulator was not clinically useful in this sample when the treatment objective was primary expansion of collapsed maxillary segments in the cleft palate patient. Good speech-production skills prior to treatment will minimize the adverse effect that the FR has on speech intelligibility. A significant amount of accommodation to the appliance occurs within 1 week after insertion, but maximum improvement in speech intelligibility occurs with full-time wear of the appliance for as many hours per day as possible.

Eleven patients with spinal canal block from metastatic epidural tumor, documented with Pantopague myelography, were given an additional injection of up to 5 cc of air. This technique forced contrast material past the block in 10 of 11 cases. It failed in one case in which symptoms had been present for 19 days. Air injection allowed visualization of more cephalad lesions and defined the superior extent of the initial obstructing lesion without the need for a lateral cervical or cisternal puncture. It caused transient discomfort but no neurologic deterioration. This technique is less painful, requires less patient cooperation, expedites localization, and does not require the special skills needed for cervical puncture.

A major limitation of methods presently used for detecting amblyopia in preverbal children and infants is their dependence on patient cooperation. In response to this problem, we have introduced the use of chloral hydrate sedation as a means of obtaining the pattern visual evoked potential (P-VEP) in uncooperative infants. Twenty-five infants were studied: 14 with clinically diagnosed amblyopia, four with questionable amblyopia, and seven with no clinical sign of amblyopia. In patients with known amblyopia, P-I amplitudes from the amblyopic eye were greatly diminished when compared with responses obtained from the non-amblyopic fellow eye, with amplitude ratios ranging from 0 to 0.66 (mean 0.36). In contrast, P-I responses from non-amblyopic infants were quite symmetrical, with amplitude ratios of 0.82 to 0.98 (mean 0.92). These results indicate that the P-VEP can be obtained during chloral hydrate sedation and that P-1 responses reflect the presence or absence of amblyopia. Performing P-VEP during chloral hydrate sedation thus holds promise as an important clinical tool for the diagnosis of amblyopia in uncooperative infants and children.

The approach to management of decubitus ulcers is challenging and complex. Management should be targeted to prevention. Many factors will influence the development of ulcers and their healing. These factors include physiologic as well as sociologic elements. The physician's approach must be to consider all potential contributing factors and to translate these into an appropriate program of prevention and education and treatment where necessary. The treatment program should be based on physiologic principles, but should also take into account the full patient and his psycho-social emotional needs. Patient cooperation is very important. With good medical care and full cooperation of the patient, management can achieve a healed wound and a restored patient. If either of these elements are not present, the complications may include chronic local infection with abscess formation, osteomyelitis, sepsis, amyloidosis, and death.

The development of sensory neuromas in a postoperative field is a recognized and undesirable complication. Neuroma formation can impair patient cooperation and postoperative function. Treatment efforts are frequently unrewarding and may contribute to the patient's frustration. Intercostal-brachial neuromas which develop following first rib resections are representative of this problem. Posterior intercostal neurectomy may provide an alternative treatment modality.

The dynamic retinoscopy technique that has undergone the most quantitative study is the Monocular estimate method (MEM). For reasons of examiner preference, patient cooperation, or equipment availability it may be useful for the practitioner to have alternative methods available to assess accommodative status. The purpose of this study was to compare data obtained by two experienced examiners using Bell, Cross, and Nott retinoscopies, MEM and Binocular cross cylinder (BCC) to evaluate accommodative lags of 10 young adult subjects. Statistical analysis revealed no significant differences between the results of the two examiners (p less than 0.2672). Results obtained by the MEM, Cross, and Nott techniques were not significantly different, but those obtained by Bell and BCC were significantly different from the other three techniques. The results of this study suggest that an examiner may use MEM, Cross retinoscopy, or Nott retinoscopy interchangeably to evaluate accommodative lag of the young adult subject.

Pronation of anesthetized patients may result in complications. Neuromuscular block increases the risk. To minimize the risk, the authors devised a technic of "awake pronation," evaluating its feasibility, in 11 consecutive patients in a 1-year period for 12 operations; all attempts were successful and without complicatons. Neuroleptanalgesia is achieved with droperidol and fentanyl, topical anesthesia of the upper airway is induced with lidocaine, awake intubation is performed orotracheally under direct vision, and pronation is accomplished with patient cooperation.

• Postocclusion reactive hyperemia and isolated leg exercise were evaluated as techniques for functional evaluation of lower extremity arterial insufficiency by comparing them with treadmill exercise. Sixty patients with claudication and six normal subjects were evaluated. Changes in Doppler ankle pressures were measured after each form of stress. With substantial occlusive disease, there is a drop in pressure with gradual recovery. Postocclusion reactive hyperemia and isolated leg exercise are abnormal if the pressure does not return to resting levels within two minutes. There was good correlation between the three methods. Postocclusion reactive hyperemia avoids the problems of patient cooperation inherent in the other two methods. Postocclusion reactive hyperemia should probably replace treadmill exercise as the first method of stress testing lower extremities. ( Arch Surg 113:1171-1173, 1978)

Two different treatment contracts, one with and one without active patient cooperation were compared during two 4-month periods on a short-term psychiatric ward. Attitudes and symptoms were measured at admission after 5 days and at discharge by an independent rater and by self-ratings. The length of stay was similar during the two periods. Patients with cooperation contracts showed a significantly larger reduction of anxiety compared with the others. Patients benefitting most from a cooperation contract were those with socio-psychological treatment contract objectives and those treated in a basic activation group. It is concluded that treatment contracts with an active patient cooperation on a short-term psychiatric ward are useful especially for patients not primarily suitable for specific psychotherapy or specific psychopharmacological treatment.

A practical procedure for estimating dietary intake of salt would facilitate examination of the possible relationship between salt intake and hypertension and could provide feedback to aid persons in changing salt intake when such is recommended. This is a study with 19 subjects of a sampling procedure of estimating sodium output which requires less patient cooperation than that needed for a 24-hr urine sample. Each subject provided timed urine samples for portions of the entire 24-hr period for three consecutive days. Sodium excretion for any one of the entire 24-hr periods correlated well with the mean 24-hr excretion for the 3-day period. The mean sodium excretion of the three 9-hr overnight urine samples correlated equally well with the mean 24-hr excretion for the entire 3-day period. This latter procedure, which puts far less a burden of compliance on the subjects, is suggested as preferable to obtaining a 24-hr urine sample. For purposes of checking compliance with dietary suggestions, it is possible to replace the analysis for sodium with a simple titrator strip that measures chloride.

To evaluate the reliability of automated perimetry results, fluctuation is one of the most important factors. This fluctuation is, however, influenced not only by the cooperation of the patient but also by the disease state and the defect depth. To estimate patient cooperation, an additional test is necessary. In Octopus perimetry, this has always been performed with the so-called catch trials. In a large series of visual fields, we analyzed the rates of false responses in catch trials and the factors influencing them.

Although therapeutic hemapheresis has grown dramatically in the past decade, its utilization and popularity in pediatrics remain limited. The lack of well-defined indications for treatment and technical difficulties in the management of hemapheresis for small patients have prevented its widespread use. However, there have been more than 130 reports describing the use of hemapheresis in children less than 15 years of age, including more than 20 reports describing it in children less than 5 years. Only one controlled trial of hemapheresis in children has been published. It studied the use of plasma exchange for the treatment of diabetes mellitus. In general, practitioners depend upon the accepted indications in adults to justify usage of this therapy in children. Unfortunately, major differences exist in the adult and pediatric presentation of certain diseases and there has not been universal acceptance of the indications for this therapy in children. Numerous technical difficulties continue to plague the development of hemapheresis therapy in pediatrics and therefore continue to limit the number of studies undertaken. The major technical difficulties include vascular access and excessive extracorporeal volume. These problems are not insurmountable since several patients less than 1 year of age have been successfully treated by hemapheresis. The various techniques used in these cases will be discussed. Additional problems unique to the pediatric population are the difficulty in getting approval for research studies that involve minors, the complexity of informed consent, the problem of patient cooperation and compliance, and the difficulty of explaining a complicated procedure to children of varying developmental levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Forty patients with endoscopically proven duodenal ulceration have cooperated in a clinical trial to compare the ulcer healing effect of colloidal bismuth subcitrate (CBS) at standard dosage administered either twice or four times a day. No statistically significant difference was found to exist between ulcer healing in the two groups after 4 weeks (70% and 95%, respectively), and it is concluded that twice daily CBS is an effective treatment for duodenal ulcer with clear advantages as regards patient cooperation.

Pulmonary function tests in horses are in the early stages of development and there will be a limit in the range of tests available since those requiring patient cooperation cannot be conducted in animals. Some tests such as blood gas analysis, A-aDo2 and delta Ppl measurements could presently be used to a greater extent under field conditions. Others that require expensive equipment and considerable technical assistance will be limited to the larger referral type veterinary clinics until the time is reached when there is adequate information to select those procedures that give a reasonable cost to benefit ratio to make their use more widespread.

Our sample of 376 dentists in general practice provided a number of useful insights into the problems that dentists experience with their patients. For general problems of patient cooperation, the frequency of occurrence and annoyance to the dentist were related. High on the list in both categories were maintaining poor oral hygiene, missing or being late for appointments, and not paying bills. Not providing an accurate history ranked first in bother to the dentist but appears to occur infrequently. When specific chair problems were considered, an inverse relationship was found between frequency of occurrence and bother to the dentist. Showing fear was the most frequent behavior but ranked lowest in bother. Grabbing the dentist's hand ranked first in bother but last in frequency of occurrence. Some annoying patient behaviors, such as those that devalue, criticize, or question the dentist's performance, are attempts to cope with anxiety. Viewed in this fashion, the incidence of fear-related behaviors may be higher than actually perceived by dentists. Because such behaviors are likely to result in feelings of personal assault on the dentist's part, they are likely to have a deleterious effect on the dentist-patient relationship. Dentists who are able to avoid feeling threatened by patient hostility may be able to successfully resolve the potential conflict to the mutual benefit of both dentist and patient. The actual problems that dentists have with their patients have been neglected and need extensive research. Our study is a first attempt to outline the boundaries of this area. Even these descriptive findings point to crucial elements in dentist-patient relationships. We hope that our findings will lead to further research on the dentist in the dentist-patient equation as well as to practical means of coping with the problems that patients present.

When surgical resection of intraoral neoplasms is contraindicated, treatment by surface mold irradiation may be used. Success or failure of this mode of treatment may depend on the fabrication of a surface mold that can deliver the prescribed amount of therapeutic radiation in the desired amount of time. A technique for modification of an existing complete denture prosthesis for use as a surface mold has been described. Patient cooperation is essential for successful use of this modified prosthesis.

In the patient with cardiac trauma, radionuclide imaging may provide important information about cardiac mechanical function, vascular anatomy and integrity, myocardial perfusion, and myocardial metabolism. Studies require only minimal patient cooperation, can be performed relatively rapidly and often at the bedside, and may be repeated at frequent intervals for serial evaluations. These studies provide valuable adjunctive knowledge when selected and interpreted with knowledge of the mechanism of injury, timing of the examination relative to the time of injury, and most likely differential diagnoses.

Researchers and practitioners have expressed considerable interest in contingency contracting as a promising intervention strategy for enlisting patient cooperation, particularly with regard to long-term treatment regimens. After brief examination of the theoretical background, the authors summarize advantages of contracting, describe elements essential to the development of a contract, and enumerate those ingredients in the contracting process thought to be critical for achieving optimal results. They review relevant research efforts in terms of their designs, methods, target and contracted health-related behaviors, contingencies employed, and initial and follow-up results. On the basis of this review, current issues regarding contingency contracting are raised, and practical considerations for large-scale application are noted along with recommendations for future research.

The role of trauma as leading cause of death and disability in children is universally appreciated. Similarly, the contribution of diagnostic radiology to the management of an injured child is well understood. In recent years, nuclear medicine and diagnostic ultrasound have begun to have an impact on the assessment of the traumatized patient. These newer diagnostic techniques are not merely duplications of radiographic examinations: nuclear medicine studies allow for unique assessment of organ function while ultrasonography can determine the internal morphology of a soft tissue organ or mass. The radiation exposure to the patient is low as in nuclear medicine, or nonexistent as with ultrasonography. Furthermore, these examinations can be performed rapidly and require little, if any, patient cooperation, and these are features of importance when dealing with traumatized children.

In spite of improved preventive measures, decalcification around bonded orthodontic appliances continues to be a problem for the clinician. Various fluoride-containing mediums have been proposed as aiding in the elimination of this problem; however, almost all are dependent on patient cooperation for their success. An ideal preventive system would be one that would operate independently of patient cooperation. The purpose of the present study was to compare a visible light-activated, fluoride-releasing bonding system with a visible light-activated conventional bonding system relative to bracket retention and prevalence of decalcification. Twenty-two patients were entered into the study, representing 206 experimental brackets and 206 control brackets. The average treatment period was 25 months. No significant differences in bracket retention rates were found between the two systems. Significantly, 26 teeth in the control group demonstrated decalcification (12.6%), whereas none of the teeth in the experimental group did. The results of this study suggest that a visible light-activated, fluoride-releasing bonding system is capable of adequately retaining brackets while aiding in the prevention of decalcification around bonded appliances.

Even strict observation of absolute and relative contraindications does not always prevent complications during endoscopic procedures. Most accidents, however, can be traced to disregard for contraindications, among which lack of patient cooperation plays a particular role. In case of complications, the endoscopist should consider himself responsible for the further care of the patient. In case of an accident during an examination, repair and restoration of vital functions have absolute priority over completion of the examination, so that the patient will not be subjected to further risks unnecessarily.

The second-generation cast-brace system offers some advantages over previous systems of cast-brace treatment for fractures of the femur. Because the thigh section is adjustable, loosening of the cast-brace is not a problem. The device can be applied earlier and need not be reapplied when the girth of the thigh is reduced. Using a roller traction system, the cast-brace can also be used initially for traction and suspension without the complexity of traditional systems. With the use of commercially available plastic knee joints, special skills in alignment of the joints are not necessary, and no specially trained personnel need be on hand. The lightweight thigh section coupled to custom-fit plaster leg section, with the foot and ankle free, are less bulky than a totally plaster cast-brace with metal side joints. Walking may be begun earlier with the device, and in-patient hospital time is reduced. However, this system requires a high level of patient cooperation in that the patient is free to adjust the system himself and, therefore, the system may not be safe for application in all settings.

When oxygen concentrators became available on form FP10 in 1985 the Department of Health and Social Security issued clear guidelines for their prescription for long term treatment. Reassessment of those patients prescribed a concentrator in one district showed that 29 out of 61 patients did not fulfil these criteria. Furthermore, in only 28 cases was the daily use of the machine appropriate, though this did not reflect poor patient cooperation but was a result of inadequate prescribing instructions. In addition, 12 out of 54 patients continued to smoke. Overall, in only 18 of the 61 cases was both the prescription appropriate and the concentrator properly used. These results suggest a need for better cooperation between general practitioner and hospital in the initial assessment of patients for long term oxygen treatment and better education of both doctor and patient in the use of oxygen concentrators.

The increased use of radiation therapy for the control of oral cancer necessitates that all dentists concerned with the rehabilitation of oral cancer patients be familiar with this treatment modality. Radiologic equipment, the rationale for their use, and the sequelae to oral treatment are discussed. Misconceptions have developed concerning the advisability of prescribing complete dentures following radiation therapy. However, clinical experience in the Maxillofacial Unit at the University of California, San Francisco, indicates that most radiation patients can wear complete dentures. The need to follow sound prosthodontic techniques is advocated, along with a few modifications related specifically to the radiation patient. Patient cooperation and meticulous care during and following the placement of dentures are stressed to minimize the risk of tissue necrosis and to preserve the well-being of the patient.

The author’s successful method for placement of a needle in the lumbar subarachnoid space is described.Details are given relative to anesthesia, midline position by patient cooperation, lack of dural pop, and placement of the needle tip wholly in the subarachnoid space.

Knowledge of the basic principles and ideals in crown and bridge prosthodontics, as well as technical procedures, is essen­ tial. If an operator learns from his own mistakes, however, and from those of others, his efforts may result in greater success. Experience is a good teacher, but this does not imply that years of doing something wrong should be considered years of experience. Every new experience may bring forth some form of error which can be avoided in the future. In dentistry it is not possible to blame shortcomings on unusual clinical findings, on lack of patient cooperation or on other such excuses. Success in dentistry rests primarily on a reliable and sound diag­ nosis, on good judgment and on accurate operative procedures. Some of the common failures in fixed bridge prosthodontics are loose retainers, fractures of soldered joints, fractures of porcelain or acrylic resin, fractures of the abutment teeth or holes in retainer or pontic. Failures may result in recurrent caries or loss of abutment teeth. A loose retainer may be caused by in­ correct design, inadequate retention, in­ accuracy in the fit of the bridge, or an incorrect mounting technic. Fractures of soldered joints may be caused by a poor soldering technic, use of an inferior solder or by inadequate bulk of solder. Fractures of porcelain or acrylic resin may arise from inadequate protection of the porcelain or resin or from use of un­ suitable metals. Fractures of the abutment teeth may stem from an incorrect design of the re­ tainer, from inadequate bulk of metal, from use of metals of inferior physical properties or from weak abutment preparation. Holes in the retainer or pontic may be due to inadequate bulk of metal, to ex­ cessive abrasion or to a porous spot caused by shrinkage. Recurrent caries may result from a poor retainer, neglect or poor oral hygiene on the part of the patient, abnormal sus­ ceptibility to caries, or from inadequate embrasures and interproximal areas. Loss of the abutment teeth may be caused by apical involvement or by ex­ treme periodontal involvement.

Patients with tympanic membrane perforations or nonepithelialized mastoid bowls have in the past frequently been precluded from swimming. With the introduction of the protective ear cap (Fig 1), a dependable method has been achieved for allowing the patient to swim and yet not get water in the external auditory canal. Additional efforts to modify the basic design to make the appliance smaller or for use without a snug fitting bathing cap have met with uniform failure. Patient cooperation and understanding are extremely important. For this reason the appliance has been primarily limited to use in adults. Although selected patients as young as 13 years have been fitted, the results in teen-agers younger than 15 years are less satisfactory. Material The material (Permlastic*) used in fabrication of the appliance can be obtained from most dental supply houses in three grades, light-bodied, regular, and heavy bodied. We prefer to use the light-bodied

60 patients were followed up from early pregnancy to term and their cooperation in taking oral iron was verified by regular stool tests for iron. After two months 19 patients (32%) were not taking the iron tablets. In those patients who had haemoglobin levels over 12 g. per 100 ml. at term, 86% of the stool tests were positive for iron in contrast to those with levels less than 12 g. per 100 ml. at term where only 25% of the stool tests were positive. Lack of patient cooperation is an important consideration in the treatment and prevention of iron-deficiency anaemia of pregnancy. By early assessment of the reliability of the patient in taking oral iron those who may require parenteral iron can be selected.

Impulse oscillometry offers an advantage over spirometry when conducting pulmonary function tests. Not only does it require minimal patient cooperation, it provides useful data in a form amenable to engineering methods. In particular, the data can be used to obtain parameter estimates for electric circuit-based models of the respiratory system, which can in turn aid the detection and diagnosis of various diseases/pathologies. Of the six models analyzed during this study, the DuBois model and a newly proposed extended RIC model seem to provide the most robust parameter estimates for our entire data set of 106 subjects with various respiratory ailments such as asthma and chronic obstructive pulmonary disease. Such a diagnostic approach, relying on estimated parameter values, may require additional measures to ensure proper identification of diseases/pathologies but the preliminary results are promising.

Background CMR allows investigating cardiac contraction, rotation and torsion non-invasively by the use of tagging sequences. Three-dimensional tagging has been proposed to cover the whole-heart but data acquisition requires three consecutive breath holds and hence demands considerable patient cooperation. In this study we have implemented and studied k-t undersampled cine 3D tagging in conjunction with k-t PCA reconstruction to potentially permit for single breath-hold acquisitions. Methods The performance of undersampled cine 3D tagging was investigated using computer simulations and in-vivo measurements in 8 healthy subjects and 5 patients with myocardial infarction. Fully sampled data was obtained and compared to retrospectively and prospectively undersampled acquisitions. Fully sampled data was acquired in three consecutive breath holds. Prospectively undersampled data was obtained within a single breath hold. Based on harmonic phase (HARP) analysis, circumferential shortening, rotation and torsion were compared between fully sampled and undersampled data using Bland-Altman and linear regression analysis. Results In computer simulations, the error for circumferential shortening was 2.8 ± 2.3% and 2.7 ± 2.1% for undersampling rates of R = 3 and 4 respectively. Errors in ventricular rotation were 2.5 ± 1.9% and 3.0 ± 2.2% for R = 3 and 4. Comparison of results from fully sampled in-vivo data acquired with prospectively undersampled acquisitions showed a mean difference in circumferential shortening of −0.14 ± 5.18% and 0.71 ± 6.16% for R = 3 and 4. The mean differences in rotation were 0.44 ± 1.8° and 0.73 ± 1.67° for R = 3 and 4, respectively. In patients peak, circumferential shortening was significantly reduced (p Conclusion Undersampled cine 3D tagging enables significant reduction in scan time of whole-heart tagging and facilitates quantification of shortening, rotation and torsion of the left ventricle without adding significant errors compared to previous 3D tagging approaches.

Lack of patient cooperation in breathholding is generally considered a contraindication to percutaneous liver biopsy in the adult patient. Liver biopsy can, if the need is compelling, be carried out under general anesthesia in the operating room with ventilation being stopped momentarily.

The patency of palmar arches must be ascertained before radial-artery cannulation is performed. A simple test in which digital pulsation is felt after proximal occlusion of the radial artery has been devised for that purpose. The method is reliable, does not require active patient cooperation, and can be carried out in all clinical situations where the radial artery can be felt.