bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiation Sciences Education in Africa: An Assessment of Current Training Practices and Evaluation of a High-Yield Course in Radiation Biology and Radiation Physics
Authors: Stecklein Shane R. , Taniguchi Cullen M. , Melancon Adam D. , Lombe Dorothy , Lishimpi Kennedy , Banda Lewis , Mwaba Catherine , Pupwe George , Mwale Maurice , Munkupa Harry , Kanduza Mulape , Mule Barbara , Mwale Augustine , Court Laurence , Ohrt Jared D. , Kupferman Michael E. , Jhingran Anuja , Msadabwe-Chikuni Susan Citonje
Published: October 2020

PURPOSE

Formal education in the radiation sciences is critical for the safe and effective delivery of radiotherapy. Practices and patterns of radiation sciences education and trainee performance in the radiation sciences are poorly described. This study assesses the current state of radiation sciences education in Africa and evaluates a high-yield, on-site educational program in radiation biology and radiation physics for oncology and radiation therapy trainees in Africa.

METHODS

An anonymous survey was distributed to members of the African Organization for Research and Treatment in Cancer Training Interest Group to assess current attitudes and practices toward radiation sciences education. A 2-week, on-site educational course in radiation biology and radiation physics was conducted at the Cancer Diseases Hospital in Lusaka, Zambia. Pre- and postcourse assessments in both disciplines were administered to gauge the effectiveness of an intensive high-yield course in the radiation sciences.

RESULTS

Significant deficiencies were identified in radiation sciences education, especially in radiation biology. Lack of expert instructors in radiation biology was reported by half of all respondents and was the major contributing factor to deficient education in the radiation sciences. The educational course resulted in marked improvements in radiation biology assessment scores (median pre- and posttest scores, 27% and 55%, respectively; P < .0001) and radiation physics assessment scores (median pre- and posttest scores, 30% and 57.5%, respectively; P < .0001).

CONCLUSION

Radiation sciences education in African oncology training programs is inadequate. International collaboration between expert radiation biology and radiation physics instructors can address this educational deficiency and improve trainee competence in the foundational radiation sciences that is critical for the safe and effective delivery of radiotherapy.
Corticotroph Aggressive Pituitary Tumors and Carcinomas Frequently Harbor ATRX Mutations
Authors: Casar-Borota Olivera , Boldt Henning Bünsow , Engström Britt Edén , Andersen Marianne Skovsager , Baussart Bertrand , Bengtsson Daniel , Berinder Katarina , Ekman Bertil , Feldt-Rasmussen Ulla , Höybye Charlotte , Jørgensen Jens Otto L , Kolnes Anders Jensen , Korbonits Márta , Rasmussen Åse Krogh , Lindsay John R , Loughrey Paul Benjamin , Maiter Dominique , Manojlovic-Gacic Emilija , Pahnke Jens , Poliani Pietro Luigi , Popovic Vera , Ragnarsson Oskar , Schalin-Jäntti Camilla , Scheie David , Tóth Miklós , Villa Chiara , Wirenfeldt Martin , Kunicki Jacek , Burman Pia
Published: October 2020

Context

Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors.

Objective

To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs.

Design

We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored.

Results

Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs.

Conclusion

ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors.
Diabetes, Active Disease, and Afternoon Serum Cortisol Levels Predict Cushing’s Disease Mortality: A Cohort Study
Authors: Roldán-Sarmiento Paola , Lam-Chung César Ernesto , Hinojosa-Amaya José Miguel , Morales-García Mariana , Guillén-Placencia María Fernanda , Pérez-Flores Greta E , León-Suárez Andrés , León-Domínguez Jefsi , Balbuena-Álvarez Salvador , Nava de la Vega Alfredo , Pérez-Guzmán Citlalli Mireya , Gómez-Sámano Miguel Ángel , Enríquez-Estrada Víctor , Gómez-Pérez Francisco J , Cuevas-Ramos Daniel
Published: October 2020

Context

Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population.

Objective

This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality.

Design

We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD.

Results

From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P < 0.001. Cardiovascular disease was the main cause of death (SMR = 4.2, 1.5–9.3, P = 0.01). Multivariate Cox regression models adjusted for potential cofounders showed that diabetes (HR = 5.2, IC 95% 1.8–15.4, P = 0.002), high cortisol levels after 1600 hours at diagnosis (3.4, 2.3–7.0, P = 0.02), and active CD (7.5, 3.8–17.3, P = 0.003) significantly increased the risk of mortality.

Conclusions

Main cause of CD mortality was cardiovascular disease. Main risk factors for mortality were uncontrolled diabetes, persistently high cortisol levels after 1600 hours at diagnosis, and active disease at last follow-up.
Association of Thyroid Hormone Therapy with Mortality in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis
Authors: Peng Carol Chiung-Hui , Huang Huei-Kai , Wu Brian Bo-Chang , Chang Rachel Huai-En , Tu Yu-Kang , Munir Kashif M
Published: October 2020

Context

Benefits of thyroid hormone therapy on mortality in adults with subclinical hypothyroidism remain undetermined.

Objective

To summarize the impact of thyroid hormone therapy on mortality in adults with subclinical hypothyroidism.

Data Sources

PubMed, Embase, Scopus, Web of Science, and Clinicaltrials.gov from inception until April 25, 2020.

Study Selection

Studies comparing the effect of thyroid hormone therapy with that of placebo or no therapy in adults with subclinical hypothyroidism on all-cause and/or cardiovascular mortality.

Data Extraction

Two reviewers independently extracted data and performed quality assessments. Random-effects models for meta-analyses were used.

Data Synthesis

Five observational studies and 2 randomized controlled trials with 21 055 adults were included. Overall, thyroid hormone therapy was not significantly associated with all-cause (pooled relative risk [RR] = 0.95, 95% confidence interval [CI]: 0.75-1.22, P = .704) or cardiovascular (pooled RR = 0.99, 95% CI: 0.82-1.20, P = .946) mortality. Subgroup analyses revealed that in younger adults (aged <65-70 years), thyroid hormone therapy was significantly associated with a lower all-cause (pooled RR = 0.50, 95% CI: 0.29-0.85, P = .011) and cardiovascular (pooled RR = 0.54, 95% CI: 0.37-0.80, P = .002) mortality. However, no significant association between thyroid hormone therapy and mortality was observed in older adults (aged ≥65-70 years).

Conclusions

Use of thyroid hormone therapy does not provide protective effects on mortality in older adults with subclinical hypothyroidism. However, thyroid hormone therapy for subclinical hypothyroidism may show benefits on morality in adults aged <65 to 70 years.
Antifibrogenic Activities of CYP11A1-derived Vitamin D3-hydroxyderivatives Are Dependent on RORγ
Authors: Janjetovic Zorica , Postlethwaite Arnold , Kang Hong Soon , Kim Tae-Kang , Tuckey Robert C , Crossman David K , Qayyum Shariq , Jetten Anton M , Slominski Andrzej T
Published: October 2020

Previous studies showed that noncalcemic 20(OH)D3, a product of CYP11A1 action on vitamin D3, has antifibrotic activity in human dermal fibroblasts and in a bleomycin mouse model of scleroderma. In this study, we tested the role of retinoic acid-related orphan receptor γ (RORγ), which is expressed in skin, in the action of CYP11A1-derived secosteroids using murine fibroblasts isolated from the skin of wild-type (RORγ +/+), knockout (RORγ -/-), and heterozygote (RORγ +/-) mice. CYP11A1-derived 20(OH)D3, 20,23(OH)2D3, 1,20(OH)2D3, and 1,20,23(OH)3D3 inhibited proliferation of RORγ +/+ fibroblasts in a dose-dependent manner with a similar potency to 1,25(OH)2D3. Surprisingly, this effect was reversed in RORγ +/- and RORγ -/- fibroblasts, with the most pronounced stimulatory effect seen in RORγ -/- fibroblasts. All analogs tested inhibited TGF-β1-induced collagen synthesis in RORγ +/+ fibroblasts and the expression of other fibrosis-related genes. This effect was curtailed or reversed in RORγ -/- fibroblasts. These results show that the antiproliferative and antifibrotic activities of the vitamin D hydroxy derivatives are dependent on a functional RORγ. The dramatic changes in the transcriptomes of fibroblasts of RORγ -/- versus wild-type mice following treatment with 20(OH)D3 or 1,20(OH)2D3 provide a molecular basis to explain, at least in part, the observed phenotypic differences.
There and back again - a zebra's tale
Authors: Bartlam-Brooks Hattie , Wilshin Simon , Hubel Tatjana , Hailes Stephen , Bennitt Emily , Wilson Alan M.
Published: October 2020

Animals need to navigate between resources such as water, food and shelter and how they achieve this is likely to vary with species. Here, using high accuracy GPS data, we study repeated journeys made by wild zebra (Equus quagga) through a naturally vegetated environment to explore whether they consistently follow the same route through the area or whether they use a range of routes to reach their goal. We use a model to distinguish and quantify these two possibilities and show that our observations are consistent with the use of multiple routes. Our model performs better than assuming uniform angular distribution of trajectories. The typical separation of the routes was found to be small (1.96 m), while the scale at which neighboring trajectories are informative to direction of travel was found to be large (with a confidence interval of (1.19, 26.4) m). Our observations are consistent with the hypothesis that zebra are able to navigate without having to return to previously used routes, instead using numerous different routes of similar trajectories.
The comparison of seafood consumption preferences and habits in Ordu and Samsun (Turkey)
Authors: Güvenin Onur , Erdoğan Sağlam Naciye
Published: October 2020

This study aims to determine the consumption behavior of seafood of people in Ordu and Samsun by a questionnaire composed of 17 questions. The questionnaire was randomly applied on 1287 people. Some characteristics such as age, gender, profession, educational status and income level of people were also considered to correct results.
37.1% of the respondents who consumed seafood products between 1-3 kg stated that they choise more poultry meat (44.4%) than fish meat (17%). Searching consumption of seafood due to seasons; 39% in winter and 33.7 % in fall. And also, from spring to winter, consumption of seafood has increased. According to the consumer preferences, 94.4% of preferred fresh fish and that 19% preferred weekly, 48.7% preferred fish once a month. Anchovy (43.7%) is the most commonly consumed seafood, and its consumption is common as frying (47.6%). When the consumer preferences were examined, it was determined that 94.4% preferred fresh fish, 19% preferred weekly, 48.7% preferred fish once a month. When the survey results are evaluated considering the fish potential of Ordu and Samsun provinces, we see that it is well below the potential.
Relationships between body size - otolith size for seven demersal fish species from the Marmara Sea, Turkey
Authors: Daban İsmail Burak , Arslan İhsanoglu Mukadder , İsmen Ali
Published: October 2020

The total length-otolith length (TL-OL), total length-otolith width (TL-OWi), total length-otolith weight (TL-OW) and total weight-otolith weight (TW-OW) relationships of seven fishes in the Marmara Sea, Turkey were calculated. Measurements of sagittal otoliths (length, width and weight) and individuals (total length and total weight) from these species (Gaidropsarus biscayensis, Mediterranean bigeye rockling; Arnoglossus kessleri, Scaldback; Solea solea, Common sole; Uranoscopus scaber, Stargazer; Lophius budegassa, Blackbellied angler, Lepidorhombus boscii, The four-spot megrim and Lesueurigobius friesii, Fries's goby) were given. Linear regression analysis (y = bx + a) was used to determine the relationship between each morphometric character and the coefficient of determination (r2) were calculated. Highest determination coefficient were determined for L. budegassa and A. kessleri to TW-OW, for S. solea, and U. scaber to TL-OL, for G. biscayensis and L. boscii to TL-OWi, for L. friesii to TL-OW. The relatively lower determination coefficients were found for G. biscayensis, compared with others. These relationships provide vital information on species identification and size estimation of fish in predator-prey studies, we believe these results will be useful in future studies of stomach contents.
The role and importance of photonic sensors in seafood safety applications
Authors: Duman Elifcan , Altınelataman Can , Tokaç Adnan
Published: October 2020

Microbiological, chemical, sensory analyses known as traditional methods are used for determination of fish quality including many concepts such as microbiological quality, sensory quality, nutritional properties, product specific properties, freshness, species-specific physical properties. With the developing technology; these time-consuming and error-free analyzes have been replaced by sensor technology, which is very suitable for quality measurements in order to achieve the expected speed and high standard and to be open to improvement. In this study, optical sensors and their applications are emphasized and a general evaluation is made about the usability of seafood processing technology in terms of food safety.
Linking Neighbors’ Fertility: Third Births in Norwegian Neighborhoods
Authors: Bergsvik Janna
Published: October 2020

Geographical variations in fertility and the diffusion of fertility across space and social networks are central topics in demographic research. Less is known, however, about the role of neighborhoods and neighbors with regard to geographical variations in fertility. This paper investigates spatial variations in family size by analyzing third births in a neighborhood context. Using unique geo-data on neighbors and neighborhoods, this paper introduces a new geographical dimension of fertility variation and contributes to our understanding of geographical variations in fertility.
Flexible, ego-centered neighborhoods are constructed using longitudinal geo-data taken from administrative registers (2000-2014). Data on inhabitants’ residential address, their housing, family situation and fixed effects for statistical tracts are used to account for sorting into housing and urban versus rural districts.
The analysis shows that the likelihood of two-child couples having another child increases with the share of families in the neighborhood that have three or more children. This relationship remains unchanged, even after controlling for the sociodemographic characteristics of couples, the educational level attained by neighboring women as well as time-constant characteristics of neighborhoods. Results are consistent across various neighborhood definitions ranging from the 12 to the 500 nearest neighbors. However, the association between neighbors’ fertility becomes stronger as the number of neighbors increases, suggesting that selective residential sorting is an important driver. Consequently, this study indicates that transitions to third birth may be linked to social interaction effects among neighbors, in addition to well-known processes of selective residential sorting.
Active aging and internet use to improve the quality of life
of the seniors
Authors: Román-Graván Pedro , Pérez-Hurtado Manuel , Tadeu Pedro
Published: October 2020

La Organización Mundial de la Salud utiliza el término “envejecimiento activo” para denominar al proceso mediante el que se
pretende mejorar la calidad de vida de las personas mayores, desarrollando los medios para favorecer su salud, su
participación en la sociedad y su seguridad. El objetivo de este estudio es el de analizar el efecto del uso de Internet, sobre
el estado de ánimo, en una muestra constituida por 654 estudiantes del Aula de Experiencia de la Universidad de Sevilla.
Para ello, se utiliza una versión reducida de la Escala de Depresión Geriátrica (GDS) de Yesavage y se recogen datos
sociodemográficos, relativos a la situación personal, a la práctica de actividad física y al uso de Internet mediante un
cuestionario diseñado ad hoc. Tras realizar un análisis descriptivo y de correlación de los datos, se encuentra que la variedad
de usos que se hace de internet correlaciona significativamente, de forma negativa, con el número de respuestas que indican
depresión en la escala GDS (p<0,001). Las aplicaciones de Internet que se asocian a mejores niveles de bienestar
psicológico son usar Internet para leer prensa, ver vídeos en YouTube y participar en redes sociales.
Redes de ciudades pequeñas en el territorio peruano. Un análisis tipológico a partir del caso de la región La Libertad
Authors: Vilela Malpartida Marta , Vega Centeno Pablo
Published: October 2020

En países como Perú, la actividad económica a escala global ocurre en territorios diversos de población dispersa. No se han podido evaluar de manera eficiente sus efectos debido a que hemos estudiado poco las redes urbanas cuando hay aglomeraciones pequeñas y dispersas en el territorio. Por ello, el interés se centró en realizar un estudio sobre cómo se distribuyen y relacionan las diferentes localidades que ocupan territorios de geografía diversa y accidentada. La investigación propone la elaboración de tipologías de redes en unidades territoriales como estrategia de análisis para identificar el rol de intermediación de las ciudades pequeñas. Para el análisis tipológico se tomaron como indicadores la densidad de ocupación, la distribución de servicios públicos, los usos del suelo y la contracción espaciotemporal. Como estudio de caso se eligieron tres unidades territoriales en la región de La Libertad, en el norte del Perú. Los resultados permitieron identificar tipologías de redes de ciudades pequeñas que muestran marcadas diferencias en la ocupación del territorio.
Robotic-assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty
Authors: Bhimani Samrath J. , Bhimani Rohat , Smith Austin , Eccles Christian , Smith Langan , Malkani Arthur
Published: October 2020

Aims

Robotic-assisted total knee arthroplasty (RA-TKA) has been introduced to provide accurate bone cuts and help achieve the target knee alignment, along with symmetric gap balancing. The purpose of this study was to determine if any early clinical benefits could be realized following TKA using robotic-assisted technology.

Methods

In all, 140 consecutive patients undergoing RA-TKA and 127 consecutive patients undergoing conventional TKA with minimum six-week follow-up were reviewed. Differences in visual analogue scores (VAS) for pain at rest and with activity, postoperative opiate usage, and length of stay (LOS) between the RA-TKA and conventional TKA groups were compared.

Results

Patients undergoing RA-TKA had lower average VAS pain scores at rest (p = 0.001) and with activity (p = 0.03) at two weeks following the index procedure. At the six-week interval, the RA-TKA group had lower VAS pain scores with rest (p = 0.03) and with activity (p = 0.02), and required 3.2 mg less morphine equivalents per day relative to the conventional group (p < 0.001). At six weeks, a significantly greater number of patients in the RA-TKA group were free of opioid use compared to the conventional TKA group; 70.7% vs 57.0% (p = 0.02). Patients in the RA-TKA group had a shorter LOS; 1.9 days versus 2.3 days (p < 0.001), and also had a greater percentage of patient discharged on postoperative day one; 41.3% vs 20.5% (p < 0.001).

Conclusion

Patients undergoing RA-TKA had lower pain levels at both rest and with activity, required less opioid medication, and had a shorter LOS.
Contemporary Cleaning and Shaping of the Root Canal System
Authors: Tomson Phillip L , Simon StÉPhane R
Published: October 2020

Prevention or treatment of apical periodontitis is aimed at disinfecting the root canal system so that the periradicular tissues are not vulnerable to attack from microbiota within the tooth. This is achieved by a process of cleaning and shaping the root canal space. The fundamental principles underlying this process have not changed in decades. In contrast, the armamentarium available to the clinician continues to evolve rapidly. The use of specially designed nickel titanium (NiTi) files to create a glidepath allows the clinician to manage tight curved canals more predictably in situations which would otherwise have proved too difficult using conventional techniques. Other files, designed to shape the canal, have been developed using metallurgic principles which permit NiTi files to be more flexible and resistant to cyclic fatigue. These newer systems also require fewer instruments to prepare a canal and some, which have adopted a reciprocating (rotational) motion, may only require one file. Progress is also being made in enhancing efficacy of irrigant activity using negative apical pressure systems, sonic and ultrasonic agitation techniques. These contemporary techniques used to clean and shape the root canal system should result in improved confidence and predictability when managing endodontic disease.
Endodontic Risk Management: A Dento -Legal Perspective
Authors: Patel Shreeti , D'Cruz Len
Published: October 2020

This article provides an overview of some of the issues in the assessment and management of endodontic patients which may lead to dento-legal problems. It covers assessment, the appropriate use of radiographs, special tests and the importance of following the correct consent process. It outlines why record-keeping is particularly important, and looks at problems that occur, such as perforation, fractured instruments and hypochlorite accidents.

SUMMARY

In common with other areas of dentistry there are risks in delivering endodontic treatment in general practice. Successful endodontic treatment combines a predictable technique, an understanding of ones limitations and excellent communication with patients. It must be remembered that complaints are not often about the treatment itself, but more commonly, due to the management of he patient. A happy patient is usually one that is no longer in pain.
Microbiology of Root Canal Infections
Authors: Sakko Marjut , TjÄDerhane Leo , Rautemaa-Richardson Riina
Published: October 2020

Inflammatory reaction in the periapical tissues is induced by microbial infection in the root canal system. The aim of root canal treatment is to preserve healthy periapical tissues or to provide healing of them in restorable teeth, which have sufficient periodontal support. The amount of microbial cells in the root canal system and their virulence as well as host responses influence on the degree of periapical inflammation and symptoms. Microbial biofilm formation is typically seen on root canal walls but some microbial species are able to invade the dentine tubules to varying depth. In prolonged and complicated infections, or in case of risk of systemic spread of infection, root canal sampling for microbiological diagnostics is recommended. Anaerobic gram-negative rods are commonly isolated organisms in primary infections. In post-treatment disease, the microflora is dominated by facultatively anaerobic gram-positive cocci and rods such as Streptococcus, Enterococcus, Peptostreptococcus and Actinomyces species. Instrumentation, disinfection and interappointment medication in strict aseptic conditions are essential steps for eradication of microbial species from the infected root canal system. During past decades, Enterococcus faecalis and Candida albicans have been commonly associated organisms in treatment-resistant infections. Novel microbial detection methods are giving increasing knowledge about microbial species associated with endodontic infections and their roles in them.
Adult Dental Trauma: What should the Dental Practitioner Know?
Authors: Chauhan Ravi , Rasaratnam Lakshmi , Alani Aws , Djemal Serpil
Published: October 2020

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.
Meeting Patient and Professional Needs: Views of Stakeholders on a Training Initiative for Dwsis in Endodonti CS in London
Authors: Al-Haboubi Mustafa , Newton Paul , Gallagher Jennifer E
Published: October 2020

Background and aims

A pilot scheme was established across London to train NHS primary dental care practitioners to provide endodontic treatment of moderate difficulty. It was co-led by the former London Deanery (Health Education England: North West London) and local NHS commissioners. This research aimed to explore key stakeholders’ perceptions about the purpose of the initiative, its advantages, disadvantages and future implications.

Methods

Nineteen semi-structured interviews were conducted with stakeholders (commissioners and providers of the educational initiative; commissioners and providers of care, including trainees, principal dentists and specialists) involved in establishing, running and participating in the initiative and wider endodontic service provision in London. Interviews were based on a topic guide informed by the literature, and a workshop involving the London trainees. Interviews were recorded, transcribed and analysed using framework methodology.

Results

The project was perceived as supporting four key areas: addressing services, improving quality/outcomes, delivering education and enhancing professional status. There was evidence that dentists were harnessing health policy in facilitating ‘reprofessionalisation’ of dentistry with the creation of dentists with enhanced skills (DwSIs). Learning outcomes from the pilot were related to the accreditation of the participants, service tariffs, reimbursement for endodontic treatment on the NHS, and the need for continuity within and between services across the dental system. Uncertainty about funding and the changes within the NHS were among the concerns expressed regarding the future of the initiative.

Conclusion

The findings of this research suggest that extending the skills of primary care practitioners may contribute to the reprofessionalisation of dentistry, which has much to contribute to patient care and the development of an integrated and accessible dental care system of quality, with improved outcomes for patients. The implications for health policy and further research are discussed.
The Admin Effect: Managing the Orthodontic Patient Journey to Ensure Patient Satisfaction and Quality of Care
Authors: Fennell Isobel , Rammell Suzi , Blakeman Jen
Published: October 2020

By continually assessing the administrative processes we aim to ensure the patient's journey is a positive experience from the outset. We are able to review and adopt change where necessary and recognise areas in need of modification. Being proactive as a team is paramount in providing high quality and seamless care for our patients at all times.
Obtaining Consent in Orthodontics: Difficulties and Considerations
Authors: Tyson Joe
Published: October 2020

Consent in orthodontics is a complex and ever-changing topic, and the importance of achieving informed consent before any examination or procedure is carried out is paramount. This article will discuss some key points when considering the correct way of achieving informed consent, highlight some areas of difficulty when managing the consent process with younger children and also aim to clarify the differences between the level of consent necessary in orthodontics compared to dentistry as a whole.
Interprofessional Education in An Orthodontic Outreach Training Centre
Authors: Cure Richard
Published: October 2020

Interprofessional education (IPE) describes those occasions when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. In the UK, orthodontic treatment is now delivered by a highly skilled team. Historically, education and training for orthodontic team members has been delivered ‘uniprofessionally’ in secondary care hospital settings, despite 96% of dental care, including orthodontics, being delivered in primary care. This paper describes an evaluation of IPE in Leamington Spa Orthodontics (LSO), a University-approved, primary care outreach training centre, where all members of the orthodontic team deliver patient care and are educated together in an IPE environment. The study methodology is realist evaluation, which aims to describe and understand the educational environment and identify how stakeholders perceive their experiences. This study describes a quality assured, primary care model of integrated education and patient care, which enhances interprofessionality and offers an alternative strategy for the future for commissioning of education and clinical care.
Patient Feedback on Orthodontic Therapist Student Outreach Training
Authors: Ireland Robert S , Hopkins Elizabeth M
Published: October 2020

The introduction of orthodontic therapists as a new group of dental care professionals (DCPs) requires that their training in specialist orthodontic practices has provision for monitoring the level of supervision and clinical care provided by the students. The University of Warwick Diploma in Orthodontic Therapy programme has developed a patient questionnaire with the aim of assessing the patient's perception of the student. The observational questionnaire was designed to cover the four General Dental Council (GDC) domains and learning outcomes for orthodontic therapists, such that patient response could potentially provide valuable feedback to support the training programme. Each of the 10 students had 30 questionnaires to complete. The questionnaire was anonymous and it was designed to be suitable for both young patients and their carers to complete in less than five minutes. The response rate was very high, with 291 of the 300 questionnaires being completed. The level of co-operation may have been partly due to the ease of completion of the questionnaire, but might suggest the willingness to provide supportive feedback for the students. This study provided formative feedback to students’ educational and clinical development without impacting on a student's clinical activity and will be used to develop further assessment tools.
The use of Miniscrews in Orthodontics: A Review of Selected Clinical Applications
Authors: Mizrahi Eliakim
Published: October 2020

This paper provides a brief review of the history and development of mini screws and presents its structural features, with particular reference to the screw sizes relevant to clinical orthodontics, site selection and the different placement techniques.

It covers the clinical applications of miniscrews, incorporating the principle of direct and indirect anchorage as well as the use of intraoral auxiliaries for distal movement of molars. The role of palatal miniscrews for retraction of anterior teeth, and when used in combination with buccal miniscrews for intrusion of buccal teeth is also covered along with the possible causes of miniscrew failure. Finally, a conclusion is put forward that the use of miniscrews in orthodontics has a valid clinical basis and will enhance the scope of orthodontic practice.
The Emergency Dental Appointment: Restorative Emergencies Part 1 – Tooth Related Problems
Authors: Rodriguez Jose M , Kalsi Harpoonam , Bavisha Kalpesh , Darbar Ulpee
Published: October 2020

Dental emergencies affect a large proportion of the population. While there is ample information in the literature on how to manage medical emergencies in dental practice, there is little information on common dental emergencies and how to manage them. In the UK, the 2009 Adult Dental Health Survey reported 9% of dentate adults reporting pain at their clinical examination.1 The prevalence of non-pain related restorative dental emergencies is estimated to be higher, and will be a common presenting situation in the dental clinic. Often these unplanned events cause difficulties for dental practitioners, who are already constrained by time, to fit in these patients and manage them.

Over and above this, the increasing life spans, retention of teeth into later life and finite life of dental restorations all add to the challenges encountered by the dental practitioner. Prompt and effective management of these conditions often leads to optimising patient experience, but also offers better outcomes.

This two-part series provides an overview of the more common dental emergencies encountered by the dental practitioner and their management. Paper 1 focuses on the management of common tooth-related emergencies and includes non-odontogenic and odontogenic pain. Paper 2 focuses on the management of osseointegrated dental implant related emergencies.
Medicolegal Considerations in Providing Emergency Dental Care in Practice
Authors: Sanderson Susie
Published: October 2020

The unpredictability of unscheduled emergency dental care carries its own clinical, communication and management challenges with associated medicolegal risks. Providing emergency dental treatment for unfamiliar patients in an unfamiliar environment amplifies the hidden pitfalls which failure to avoid can create potentially damaging critical incidents in a practitioner's professional life. These are preferably avoided through consistent attention to best practice and risk management. Day to day processes, such as excellent record-keeping, valid consent and effective communication are under the spotlight in the event that a patient complains, raises a concern with a regulator or seeks compensation following alleged negligent care. This paper aims to highlight the dento-legal pitfalls that may be pertinent in such a challenging situation.
Minimum Intervention (Ml) Oral Healthcare Delivery Implementation – Overcoming the Hurdles
Authors: Banerjee Avijit
Published: October 2020

The United Nations Minamata Convention aims to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds. In those 55 countries signed up to it to date (the convention came into force in those countries on 16 August 2017), dental caries management has been thrust indirectly into the limelight once again via the resulting phase down and ultimately, phase out of dental amalgam as a restorative material.20 It is interesting how the dental profession has become fixated on the notion of a post-amalgam world, with significant efforts concentrating on trying to develop the perfect amalgam substitute restorative material to be used to 'treat’ caries.

However, on more detailed examination of the treaty, it is abundantly clear that the United Nations and the WHO, at a global level, appreciates the significant concerns over the lack of an appropriate strategy of preventing this most prevalent of non-communicable diseases known to humankind in the modern world.1–4 Ml oral healthcare is very much now on this global agenda, with developing links between dental caries, general social health determinants and other health and social sectors, and will therefore help drive oral health change with implementation strategies at the population and individual level while also developing sustainable workforce development models globally. Even though minimally invasive surgical skills, procedures and materials need to be developed and taught, the principle consideration should be given as to how “all stakeholders can incite preventive behaviour change in all stakeholders.” This is the biggest challenge in delivering better oral health to current and future generations. The quest continues…
The Role of the Dental Team in the Prevention of Systemic Disease: The Importance of considering Oral Health as part of Overall Health
Authors: Yonel Zehra , Sharma Praveen
Published: October 2020

The global burden of non-communicable disease (NCD) is significant and the World Health Organization highlighted tackling non-communicable diseases (NCDs) as a key strategic objective in their 'Global action plan for the prevention and control of noncommunicable diseases, 2013–2020’. Dental teams see a large proportion of the UK population at regular intervals, including when patients deem themselves to be in good dental health. Given that many NCDs have shared risk factors, often behavioural with implications for oral and general health, dental teams are ideally placed to provide preventative advice for diseases beyond the oral environment. This article aims to assess the key risk factors for NCDs and oral diseases as well as assess the potential for dental care professionals (DCPs) to provide patients with general health advice based on their individual risk factors.
Patients with Psychiatric Disorders: What the General Dental Practitioner Needs to Know
Authors: Shah Keval Sv , Okon-Rocha Ewa , Fan Kathleen
Published: October 2020

Psychiatric illness is extremely common and the general dental practitioner (GDP) will inevitably encounter patients with such an illness. This article outlines common psychiatric conditions that the GDP should be familiar with alongside its impact on oral health. It also gives a systematic approach to dealing with a patient who presents to practice with an undiagnosed psychiatric illness, whereby the illness interferes with delivery of suitable dental care.
A Person-Centred Approach to Holistic Assessment
Authors: Mills Ian James
Published: October 2020

Holistic assessment is an important aspect of providing high quality care focused on meeting a patient's individual needs. A holistic assessment should take into consideration the overall health of the patient, including their physical, psychological, social and spiritual wellbeing. This paper aims to clarify the meaning of 'holistic’ in relation to dentistry and describes how this relates to treating the person as a whole, rather than be aligned to any particular treatment philosophy.

The importance of a person-centred approach in undertaking a holistic assessment is highlighted. A brief overview of the relational aspects of person-centred care (PCC) is provided and it is suggested that four key dimensions of PCC should be considered as important factors in holistic assessment: connection, caring attitude, communication and control.
Quality Assurance in Custom Dental Devices: A Technologist'S Perspective
Authors: Griffin Anthony
Published: October 2020

Manufacturing of custom-made dental devices such as removable dentures, fixed prosthodontics and orthodontics are subject to the requirements of the Medical Devices Directive (MDD). Many dental laboratories often enhance these requirements by implementing quality assurance procedures that then provide enhanced consistency. This paper provides a dental technologist's view of some of the systems currently being used in dental laboratories to provide a quality assured product and associated issues.
Challenges in Treating the Class Ii Edentulous Patient
Authors: Stokes Graham
Published: October 2020

With a significant portion of edentulous patients presenting with a skeletal Class II relationship, specific denture needs for this patient group need to be considered. This paper examines the factors that need to be taken into account to prevent common problems from occurring when providing full dentures for a Class II edentulous patient.
Mandibular Implant Overdentures: Treatment and Medico-Legal Considerations
Authors: Stilwell Charlotte
Published: October 2020

The concept of a two-implant overdenture as the minimum standard of care or first choice treatment for the edentulous mandible was first proposed in 2002 and has since been backed by an overwhelming body of evidence supporting greater patient satisfaction and improved quality of life. This article examines the implant overdenture concept and its various options and discusses best practice from both the patient's and a medico-legal standpoint.
Ransomware and Cyber Security: The King that did Not Wannacry
Authors: Adams-Collman Jason
Published: October 2020

A large-scale ransomware attack that affected the NHS in May 2017 caused widespread disruption and put millions of patient records at risk. How can dental practices reduce their vulnerability to the threat of a cyber attack and ensure security and safety of digitally-held patient data, such as X-rays?
Cone Beam Computed Tomography (CBCT) in General Dental Practice
Authors: Drage Nicholas
Published: October 2020

Cone beam computed tomography (CBCT) can be a useful adjunct to conventional plain film radiography, but its use must be carefully justified as the radiation dose is generally higher. Factors affecting the dose include the field of view (FOV) size, the exposure factors, the angle of rotation and voxel size. Once justified, the exposure should be fully optimised to ensure the dose to the patient is kept as low as possible while ensuring there is no reduction in the diagnostic yield. The European Commission (EC) and the Faculty of General Dental Practice (FGDP)(UK) have published selection criteria on the use of CBCT in dentistry. This article provides an overview of CBCT and summarises the latest guidance on selection criteria relevant to the general dental practitioner.
Human Factors in Dentistry
Authors: Horton Michael A
Published: October 2020

The term “human factors” has been batted around in the healthcare setting, and more recently in relation to dentistry. You may think this doesn't relate to you, but in reality, human factors encompass every member of the team in every process and procedure we carry out.

It is by recognising that human factors exist that we also recognise that as professionals we cannot be perfect all the time. Recognising and attempting to mitigate those errors forms a fundamental part of human factors.

In our everyday life we make numerous errors which have little consequence normally, but they are all the result of human factors. If we translate the causes of these to healthcare, then to be distracted, to change routine or not make a list, for example, has consequences that may be much more serious.
Grey Matters: 2006 and All That
Authors: Rattan Raj , D'Cruz Len
Published: October 2020

The article is intended to put the current NHS dental contract in England into context and identify areas where there has been confusion about interpretation of certain clauses. The article describes these as grey areas and provides a rationale for logically interpreting these issues, such as urgent treatment, mixing NHS and private treatment and defining what a course of treatment is.

These are the views of the authors based on significant personal experience of the contract, both as practitioners and as dento-legal advisers.
Dento-legal Aspects of Advertising and the use of Social Media by Dental Professionals
Authors: Kaney Helen
Published: October 2020

The aim of this article is to highlight, from a dento-legal perspective, the risks to dental professionals of advertising and the use of social media. The method of research and writing was the use of online searching and the author's own experience of this subject. The article highlights the relevant risks and concludes that social media use in particular, is an excellent tool for networking and communication, but that it must be used properly.
Consent to Treatment in the Post-montgomery ERA: Principles and Implications for the Dental Team
Authors: Blum Igor R. , Hooper Stephen
Published: October 2020

This paper examines recent changes in relation to the legal and regulatory requirements around the consent process in the UK and how to protect patients’ rights to make decisions about their treatment. In addition to the implications of the Montgomery case on UK law of consent, key governmental and professional body regulatory guidance on the subject of consent are taken into account and discussed to facilitate a robust and valid consent process in the dental care environment.
Accuracy of Intra-oral Scans Compared to Conventional Impression in Vitro
Authors: Haddadi Yasser , Bahrami Golnosh , Isidor Flemming
Published: October 2020

AIM

The purpose of the present study was to assess the accuracy of intra-oral scans and conventional impression measured at various points on a single tooth preparation.

Methods

Ten conventional silicone impressions, and ten intra oral-scans using eight different digital intra oral digital scanners were taken of a prepared master tooth. The conventional impressions were directly digitised using a laboratory scanner. Each scan/impression was superimposed on a high-accuracy digital model of the prepared master tooth. For each superimposition, the deviation from the prepared master tooth was measured at six points on four two-dimensional cross-sections. Data was analysed using two-way analysis of variance (ANOVA).

Results

Most intra oral scanners had lower accuracy at the preparation margin compared to smooth surfaces. When only conventional impression and the latest intra oral scanners of various manufacturers are considered, the mean discrepancy at the preparation margin was 50μm (SD 16) for conventional impression, 15μm (SD 4) for Trios 3, 26μm (SD 4) for LAVA TDS, 29μm (SD 7) for CEREC Omnicam, 30μm (SD 6) for CS 3600 and 64μm (SD 7) for GC Aadva. The increased accuracy of Trios 3 was statistically significant (p<0.05).

Conclusions

At the preparation margin, Trios 3 performed significantly better than conventional impression and the other intra oral scanners. LAVA TDS, CEREC Omnicam and CS3600 showed similar accuracy at the margin, yet better than conventional impression and GC Aadva.