Prompt diagnosis and treatment of necrotizing fascitis reduces the morbidity and mortality rates of this devastating disease. To examine the clinical outcomes of using negative pressure wound therapy in the adjunctive management of wounds secondary to necrotizing fascitis, a retrospective review of medical records was conducted. Participants included 11 consecutive patients (16 wounds) with a diagnosis of necrotizing fascitis admitted to a teaching hospital between 2000 and 2005 and treated on an inpatient basis with negative pressure wound therapy. The patients included seven men, four women (average age 54 years; range 18 to 82 years). Variables abstracted from the medical records and consultation notes included: demographic information, tissue and blood bacteriological data, wound history, wound healing outcomes, duration of negative pressure wound therapy, length of hospital stay, and mortality and morbidity information. Variables were entered into an electronic database and analyzed. Operative tissue biopsies were obtained and all participants received serial surgical debridements as well as infection, nutrition, and hemodynamic support. Negative pressure wound therapy was applied to the wound(s) at 125 mm Hg continuous negative pressure until reconstructive closure could be performed. Most wounds (10) were on lower extremities, seven patients presented with sepsis, and beta-hemolytic Streptococcus was identified in nine wounds. Mean number of negative pressure wound therapy treatment days was 25 (range: 7 to 74), mean length of stay was 67 days (range: 21 to 186). All wounds were successfully closed ĝ€" 73% received split-thickness skin grafts, 27% required flaps, 100% limb salvage was achieved, and all patients survived. No negative pressure wound therapy or dressing-associated complications were observed. Negative pressure wound therapy was found to be a viable adjunctive treatment in the management of wounds associated with necrotizing fascitis.

Research has consistently shown group psychotherapy to be an effective form of treatment. Group cohesiveness, the quantity and magnitude of the strength of the bonds within the group, has received considerable attention. This study describes the integration of the cohesion literature using a random effects meta-analysis to ascertain the magnitude of the relationship between cohesion and outcome as well as explore the effect specific group variables have on this association. Studies were included which measured the relationship between groups comprised of at least three members, included both an outcome and cohesion measure convertible to an effect size, and were published in English. 40 published studies, comprised of 3,323 participants, were analyzed and yielded an omnibus effect size of r = .25, suggesting a positive, moderate relationship exists between cohesion and outcome. Four group variables (group size, treatment duration, treatment setting, and group focus) and a client variable (age) demonstrated markedly stronger relationships with cohesion. The study also examined the most frequently used cohesion measures and definitions as they relate to their relationship to outcome and frequency of use. Clinical implications for group therapists are identified and future research suggested.

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The relationship between speech articulation therapy dose (frequency, intensity, duration) and treatment outcomes are poorly understood. Identifying optimal therapy doses for specific articulation disorders is essential to providing efficient clinical care. Recent research indicates that intensive speech therapy doses-known as boot camps-may promote rapid improvement and generalization for certain speech disorders. Therefore the present investigation examined the effects of a boot camp speech therapy approach to remediate interdental /s/ production in an 8-year-old male. The boot camp included two days of speech therapy involving visual, tactile, and auditory feedback approaches. Therapy was administered 5.5 hours per day across morning and afternoon sessions. Treatment outcomes were evaluated using auditory-perceptual ratings of pre- and post-treatment word pairs. The results indicated that /s/ production improved significantly immediately following the boot camp and improvements were sustained at one week post-treatment (p < 0.05). Medial and final /s/ productions improved more so than the initial /s/ productions. These findings suggest that the speech therapy boot camp approach may be effective for certain individuals with speech sound disorders. Future research should explore dose-response relationships among speech articulation therapy dose in other children with speech sound disorders.

Ziel dieser Studie war es, die Behandlungsqualität und Behandlungsdauer der Kiefer- orthopädischen Abteilung einer Universitätsklinik zu bestimmen. Dazu wurden die Behandlungsmodelle vor und nach der Behandlung mit Hilfe des PAR (Peer Assess- ment Rating)-Indexes beurteilt. Weiterhin wurden mögliche Einflußgrößen auf die Behandlungsqualität und Behandlungsdauer untersucht. Die Behandlungsunterlagen von 100 fortlaufend abgeschlossenen Patienten (62 weiblich, 38 männlich) wurden retrospektiv ausgewertet. Das durchschnittliche Alter bei Behandlungsbeginn lag bei 14,9 Jahren (7,4 - 42,2 Jahre). Am häufigsten wurde die Behandlung im Alter von 9 oder 10 Jahren begonnen, 24 Patienten waren er- wachsen. Die Angle-Klasse II (71%) war am zahlreichsten vertreten, gefolgt von der Angle-Klasse I (21%) und der Klasse III (8%). 77 Patienten versäumten vereinbarte Termine, 38 Patienten mußten wegen ungenügender Mitarbeit ermahnt werden. Es kam ein breites Spektrum kieferorthopädischer Behandlungsgeräte zum Einsatz. Bei 95 Patienten wurde eine festsitzende Apparatur verwendet. Bei 52 Patienten er- folgte die Behandlung ausnahmslos mit dieser Apparatur, 33 Patienten wurden auf- einanderfolgend mit herausnehmbaren und festsitzenden Geräten behandelt und 10 Patienten kombiniert kieferorthopädisch und kieferchirurgisch. Nur 5 Patienten wur- den ausschließlich mit herausnehmbaren funktionskieferorthopädischen Geräten the- rapiert. Bei 31 Patienten wurden während der kieferorthopädischen Behandlung Zähne extrahiert. Der PAR Wert vor Behandlungsbeginn lag für die Gesamtgruppe bei durchschnittlich 23,9 Punkten. Der PAR Wert nach Behandlungsende lag bei 5,2. Die prozentuale Verbesserung betrug 75,6%. 65 Patienten hatten nach Behandlungsende einen PAR Wert ? 5 und 89 Patienten einen PAR Wert ? 10. Nur 4 Patienten erreichten einen PAR Wert von null. Die Verteilung der Patienten auf die einzelnen Verbesserungs- Kategorien lautete: greatly improved" 33 Patienten, improved" 65 Patienten, worse - no different" 2 Patienten. Auf die Behandlungsqualität hatte keiner der untersuchten Faktoren (Behandlungsmittel, Extraktion/Nichtanlage, Angle-Klasse, Mitarbeit und Geschlecht) einen signifikanten Einfluß. Die mittlere Behandlungsdauer aller Patienten betrug 39,1 Monate (8 - 85 Monate). Auf die Behandlungsdauer hatten von den untersuchten Faktoren (PAR Anfangswert, Behandlungsmittel, Extraktion/Nichtanlage, Angle-Klasse, Mitarbeit, Geschlecht und Alter bei Behandlungsbeginn) der PAR Anfangswert bei festsitzender Behandlung, die Behandlungsmittel, die Mitarbeit und das Alter bei Behandlungsbeginn einen signifikanten Einfluß. Die Behandlung mit herausnehmbaren und anschließend fest- sitzenden Apparaturen dauerte mit durchschnittlich 56,2 Monaten erwartungsgemäß am längsten. Die alleinige Behandlung mit festsitzenden Apparaturen benötigte im Schnitt 30,3 Monate, eine kieferorthopädisch-kieferchirurgische Kombinationsthera- pie beanspruchte 27,1 Monate. Extraktionen und/oder Nichtanlagen zeigten Tenden- zen zu längeren Behandlungszeiten. Jüngere Patienten benötigten eine signifikant längere Behandlungszeit. / The aim of this study was to assess the treatment standards and treatment time in a university clinic. Pre-treatment and post-treatment study casts were assessed by the PAR (Peer Assessment Rating) Index. The influence of various factors upon treat- ment quality and treatment duration was analysed. The treatment records of 100 consecutively finished patients (62 females and 38 males) were evaluated retrospectively. The mean age was 14.9 years (7.4 42.2 years) at the pre-treatment stage. Most of the patients were between the ages of 9 and 10 years old, 24 patients were over the age of 18. At the start of treatment, 71 patients had an Angle Class II, 21 an Angle Class I and 8 patients an Angle Class III. There were 77 patients who failed at least once to show up for their appointments and 38 patients had negative chart entries regarding appliance wear. There was a wide range of appliance types used in this sample. The treatment involved fixed appliances for 95 patients. 52 patients were treated only with this type of appliance, 33 were treated with removable and fixed appliances successively and 5 patients were treated solely with removable functional appliances. 10 patients received combined orthodontic treatment and orthognatic surgery. 31 patients had extractions of permanent teeth as part of their treatment. The average pre- and post-treatment PAR scores were 23.9 and 5.2, repectively. The mean percentage reduction in PAR score was 75.6%. Post-treatment, 65 patients fell in the 0-5 PAR score group and 89 patients had a PAR score of 10 or less. However, only 4 patients scored 0 at the end of treatment. 33 patients have been "greatly im- proved", 65 patients "improved" and 2 ranked "worse or no different". Of all the fac- tors examined (type of therapy, extractions/agenesis, Angle Classes, compliance and gender) none showed a significant influence on post-treatment PAR scores. The mean treatment duration was 39.1 months (8 - 85 months). When treatment time was analysed, with all the factors examined (pre-treatment PAR score, type of treat- ment, extractions/agenesis, Angle Classes, compliance, gender and age at treatment start) only pre-treatment PAR score in the fixed appliance group, type of treatment, compliance and age at treatment start, were significantly related. As expected, the sequence of removable and fixed appliances required the longest treatment time (56.2 months). Fixed appliance therapy alone took 30.3 months, a combination of orthodontics and orthognatic surgery lasted for 27.1 months on average. Extractions and/or congenitally missing permanent teeth showed a tendency to higher treatment times. Inadequate compliance did significantly prolong treatment duration. Younger patients required longer treatment times.