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Objective: To determine fungal allergen reactivity prevalence by intradermal dilutional testing in patients with and without chronic rhinitis or rhinosinusitis symptoms., Study Design: Prospective comparison of fungal allergen reactivity prevalence in symptomatic and asymptomatic patients., Setting: University medical center., Methods: Group I (chronic rhinitis and/or rhinosinusitis symptoms) and Group II (asymptomatic) patients underwent intradermal dilutional testing with usual and fungal allergens., Results: Fungal reactivity occurred in 65% (13/20) of Group I, and 13% (4/30) of Group II (P < 0.0002 by chi(2) testing). Group I was more reactive to non-fungal allergens (85% vs. 33%, p < 0.0004), and to all allergens considered together (95% vs. 40%, p < 0.0001)., Conclusions: Patients with chronic rhinitis and rhinosinusitis symptoms were more reactive to fungal and nonfungal allergens. Fungal allergens were as likely as nonfungal to elicit reactivity., Significance: These findings suggest a role for fungal hypersensitivity in chronic rhinitis and chronic rhinosinusitis.

Urinary incontinence (UI) is a widely prevalent problem that affects people of all ages and levels of physical health, both in healthcare settings and in the community. Contributing to the problem are that many practitioners remain uneducated about this condition, individuals are often too ashamed or embarrassed to seek professional help, and there are significant variations in diagnostic and treatment practices. Five types of UI are stress, urge, overflow, functional and manufactured incontinence. Stress, urge and overflow are caused by factors within the urinary tract and will be concentrated on in this article. To diagnose UI a three-part assessment should be conducted, including the patient history, physical examination, and urinalysis. A behavioral program should be designed which incorporates identification and education for both patient and clinician. Treatment options include pelvic floor exercises (Kegel), vaginal cones, bladder training (retraining), habit training (timed voiding), electrostimulation and biofeedback, clean intermittent catheterization, indwelling catheters, medications, collagen injections, surgery, and absorption products. Most patients can be helped dramatically or cured with the appropriate treatment.

Although principles of wound care management are the same as any other means of healthcare delivery, how you deliver care in the home is different. Patients in the home care setting have very different needs than patients in more controlled environments. When dealing with patients in the home setting there are more obstacles to overcome than in environments such as the hospital or extended care facility. Getting the patient to comply to the orders you give can be difficult. Also, the goals of patients do not always match the goals of their healthcare providers. Therefore, the caregiver must alter the goals of treatment accordingly for each patient. This manuscript illustrates two case studies in which the needs and priorities of the home care patient guided changes in the goals of caregiving.

The recognition and treatment of manufactured incontinence requires a thorough understanding of the pathogenesis of urinary incontinence. It is important to realize that is frequently not only what is done to the patient but what is not done or even what is overlooked.