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OBJECTIVE: To determine the frequency of concurrent cervical and lumbar spinal stenosis (i.e., 'tandem spinal stenosis' [TSS]) in a 10-yr review of hospital admissions. DESIGN: In a retrospective study of 460,964 hospital admissions to our 1,000-bed academic community hospital, we identified a base population of 54 patients with TSS. These patients presented with multiple complaints, including neurogenic claudication, progressive gait disturbances, and neurologic signs of both upper and lower motor neuron dysfunction, among others. Since 1964 when TSS was first described, estimates of its frequency have varied widely, ranging from a low of 5% to a high of 28%. RESULTS: Of the 54 cases of TSS identified among the 460,964 patient admissions during a 10-yr period, 36 were men and 18 were women. A total of 51 were >51 yrs of age. For all ages, the frequency rate of TSS in this series was 12 per 100,000 admissions. CONCLUSION: With TSS, the symptoms of either the cervical or the lumbar type initially predominate. Often, only after the primary pathology is treated does the secondary problem become evident. Although TSS occurred relatively infrequently in this series, its potential presence should not be overlooked. [ABSTRACT FROM AUTHOR]

A 10-yr retrospective review of 460,964 admissions to a 1,000-bed community teaching hospital identified 555 patients with a diagnosis of cervical spinal stenosis. Of this number, 118 were classified as 'young.' With an occurrence rate of 26 per 100,000, in this series there was not a significant difference in sex throughout the decade. During the first 5 yrs of this study, 186 patients with cervical spinal stenosis were identified, of whom 37 were <51 yrs of age. Of 369 patients in the remaining 5-yr period with cervical spinal stenosis, 81 were <51 yrs of age. The proportion of those <51 yrs old between the two 5-yr periods was not statistically different. Although spinal stenosis, both cervical and lumbar, has been regarded as a disorder of the elderly, 21% of those with cervical spinal stenosis and 10% with lumbar spinal stenosis can be anticipated to be <51 yrs of age. [ABSTRACT FROM AUTHOR]

Objective: To assess 1) the health values and health ratings of seriously ill hospitalized patients, their surrogate decision makers, and their physicians; 2) the determinants of health values; and 3) whether health values change over time.Design: Prospective, longitudinal, multicenter study.Setting: 5 academic medical centers.Participants: 1438 seriously ill patients with at least one of nine diseases who had a projected overall 6-month mortality rate of 50%; their surrogates; and their physicians.Measurements: Time-tradeoff utilities (reflecting preferences for a shorter but healthy life) and health ratings.Results: At study day 3, patients had a mean time-tradeoff utility of 0.73 +/- 0.32 (median [25th, 75th percentile], 0.92 [0.63, 1.0]), indicating that they equated living 1 year in their current state of health with living 8.8 months in excellent health. However, scores varied widely; 34.8% of patients were unwilling to exchange any time in their current state of health for a shorter life in excellent health (utility, 1.0), and 9.0% were willing to live 2 weeks or less in excellent health rather than 1 year in their current state of health (utility, 0.04). Health rating scores averaged 57.8 +/- 24.0 (median [25th percentile, 75th percentile], 60 [50, 75]) on a scale of 0 (death) to 100 (perfect health). The patients' mean time-tradeoff score exceeded that of their paired surrogates (n = 1041) by 0.08 (P < 0.0001). Time-tradeoff scores were related to psychosocial well-being; health ratings; desire for resuscitation and extension of life rather than relief of pain and discomfort; degree of willingness to live with constant pain; and perceived prognosis for survival and independent functioning. Scores of surviving patients increased by an average of 0.06 after 2 months (P < 0.0001) and 0.08 after 6 months (P < 0.0001).Conclusions: Health values of seriously ill patients vary widely, are higher than patients' surrogates believe, are related to few other preference and health status measures, and increase over time. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this literature review is to document the contributions dental hygienists have made over the past 3 decades to improve the nation's oral health. This historical review encompasses selected literature that acknowledged dental Hygienists' direct involvement in U.S. school-based or school-linked oral health programs from 1970-1999. METHODS: Five researchers independently searched MEDLINE, PubMed, and other electronic databases to identify relevant literature for the years 1970-1999. The search aimed to locate articles authored by or that documented dental Hygienists' involvement as 'service provider' in U.S. school-based oral health programs. For the purpose of this review, service provider was defined as educator, administrator, clinician, examiner, or any other unspecified service performed by a dental hygienist. RESULTS: Fifty-seven articles were retrieved, of which 36 (63%) directly linked dental hygienists to U.S. school-based activities. Twenty-seven articles specifically identified dental hygienists as service providers. Dental hygienists were listed as either primary or contributing author on 19 of these articles. CONCLUSION: The decade of the 1970s revealed very little literature documenting dental Hygienists' involvement in U.S. school-based oral health programs. The 1970s, however, were instrumental in laying the foundation for service in the years that followed. As public health initiatives expanded in the 1980s, dental hygienists were identified in the largest number of papers as key personnel in the areas of education, management, service provider, and author. The decade of the 1990s yielded less literature than the 1980s, yet recognized dental Hygienists' involvement in all aspects of oral health care delivery, program development and management, and authorship. The authors of this review theorize that dental hygienists were engaged in more school-based programs than reported and were involved in the authorship process more frequently than documented. Due to lack of credentials, or the omission of the words 'dental hygienist,' 'RDH,' or 'LDH,' in favor of 'health care provider,' 'auxiliary,' or 'trained health care educator,' it is unknown what portion of contributions made by dental hygienists remain undocumented. [ABSTRACT FROM AUTHOR]