bluuebunny/crossref_metadata_2025_split huggingface dataset:
Description of a System Designed to Assist Primary Dental Care Clinicians in Decision-Making with Regard to Specialist Periodontal Referrals and Report of Two Clinical Audits using the System
Authors: Snoad Richard 
Published: September 2005

Introduction Identifying which patients are at risk of significant periodontal breakdown and may need specialist care is a process fraught with problems. This paper summarises factors that should be considered by referring clinicians, describes a system to assist them, and presents the results of two sequential audits carried out in general dental practice using the system. Aims, Materials and Methods The author aims to present the system and the results of two sequential audits, carried out in the same eight general dental practices by 23 general dental practitioners (GDPs) after training from a specialist in periodontics. The system is based on the use of the Basic Periodontal Examination (BPE), a constant pressure periodontal probe, and a computer screen that prompts the clinician who is performing periodontal screening. A series of risk factors, including smoking, presence of relevant systemic disease and age, is used to modulate the score. Patients are then classified into one of three complexity groups. Those in the Complexity 3 group are deemed to be potentially at risk of significant periodontal breakdown and in need of referral for specialist advice and/or care, in accordance with the published British Society of Periodontology guidelines. In each audit a random sample of the records of ten dentate patients over the age of 20 years, who attended for recall or new examinations by each of the 23 GDPs over a calendar month, were assessed to see whether or not BPE scores had been recorded and whether or not those classified as Complexity 3 (and in need of referral) had been correctly identified and referred. Results In both audits the total random sample of patient records was 225 (ten for 22 dentists and five for the remaining dentist who only worked for a short time during the months of the audit). In the first audit cycle 139 (62%) of the random sample of records included a BPE score and 11 (8%) of the patients concerned were identified as Complexity 3 and referred for specialist advice and/or treatment. All 11 accepted the referral and when examined by the specialist in periodontics were confirmed as Complexity 3. In the second audit cycle, which took place seven months later, 179 (80%) of the random sample of patient records included a BPE score and 14 patients were assessed by their GDPs as being Complexity 3. All 14 accepted a referral and were deemed to be Complexity 3 when they were subsequently examined by the specialist in periodontics. Conclusion Although the full potential of the system was not investigated during the two audits, these preliminary results suggest that it may assist referring clinicians in identifying which patients to refer and encourage clinicians to perform periodontal screening.
Developing the First Dental Care Pathway: The Oral Health Assessment
Authors: Hally Jennifer D , Pitts Nigel B 
Published: September 2005

In this paper the authors define the concept of care pathways and explain what they are and how they have been applied in various areas of healthcare. The authors discuss the benefits of the care pathway approach and outline the first national dental NHS (clinical) care pathway and its link to National Institute for Clinical Excellence (NICE) guidance on dental recall intervals. The authors go on to explain that as a result of one of the key recommendations of Options for Change, the concept of care pathways will be extended to the primary dental services of the NHS. The first care pathway will be the Oral Health Assessment (OHA). The authors describe the development of, and rationale for, the OHA and provide details of its planned introduction. The authors conclude that the OHA should act as the initial interface between the primary care team and the dental patient. In so doing it should enable a change in the focus of care, from treatment-based to more prevention-led, personalised care appropriate to the specific needs of individual patients.
Launch of Key Skills in Primary Dental Care
Authors: Eaton Kenneth A 
Published: September 2005

On the morning of Tuesday, 21st June 2005 an audience of approximately 150 attended the launch of the Faculty of General Dental Practice (UK)'s Key Skills in Primary Dental Care e-learning programme. This package consists of seven modules each of which deals with a skill that is fundamental to the safe practice of clinical dentistry, not just in primary care, as the title suggests, but all areas including primary and secondary care. The package is available as a series of seven CD-ROMs or online at a protected website. The seven key skills are: • Infection control. • Legislation and good practice guidelines. • Clinical record keeping. • Team training. • Radiography. • Risk management and communication. • Medical emergencies. The launch consisted of a series of short presentations followed by a question and answer session.
Pharmaceutical Prescribing for Children
Authors: Randall Christine , Palmer Nikolaus OA 
Published: September 2005

This paper is the first in a series which will review the current literature and evidence upon which primary care dentists should base their decisions to prescribe medication for children. As such it will offer guidance and suggest current best practice. The series has been edited by Dr Nikolaus Palmer. This first paper deals with general principles. A second paper on prescribing for children with regard to pain and analgesia also appears in this edition of Primary Dental Care. Future papers will address prescribing for children with relation to: • Fungal and viral infections. • The management of paediatric patients with cardiac problems. • The management of immunocompromised patients. • Sedatives and hypnotics. • Dental trauma. • Emergency drugs. • Fluorides and fluoride supplements.
Atomic Fluorescence Spectrometry with a Graphite Rod Atomizer and Thermostated Electrodeless Discharge Lamps
Authors: Patel B. M. , Reeves R. D. , Browner R. F. , Molnar C. J. , Winefordner J. D. 
Published: September 2005

Atomic fluorescence investigations with a graphite rod atomizer and thermostated multiple element electrodeless discharge lamps (EDL's) are reported for Ag, Cd, Cu, Hg, Pb, Sn, Tl, and Zn. Detection limits in the range 10−10 to 10−14 g have been obtained for these elements using a sample volume of 0.5 µl. The detection limits are better than, or close to, the lowest reported values obtained by other workers using atomic spectrometric methods. No spectral or chemical interferences have been observed when using multiple element EDL's or standard multielement solutions. The atomic fluorescence signal obtained using argon and argon-hydrogen atmospheres has been studied as a function of the gas flow rates and as a function of height above the graphite rod atomizer. Except for Hg, better fluorescence signals are obtained with argon-hydrogen.
Excitation of Spectra of Multiply Ionized Atoms by Capacitor Discharges
Authors: Van Deurzen Cornelius H. H. , Conway John G. 
Published: September 2005

Spectra of vanadium have been produced in a vacuum sliding spark, and their relative line intensities have been measured as parameters of the electrical circuit were varied. Intensity maxima of the spectral lines are interpreted as representing excitation energies and have been found to depend in a definitive manner on the power delivered to the source and on the duration of the discharge. The differential equation of the circuit is solved for the charge and energy transfer rates from the capacitor to the source, and two functions of the continuous circuit parameter [Formula: see text] are defined which greatly assist in interpreting the effect of the circuit parameters on the excitation in the source. A relationship was found between the excitation in the source and the electrical circuit parameters. By means of this relationship one may obtain a good estimate of the excitation gained in the spark source. It is shown that by exercising careful control over the circuit parameters it is possible to separate spectra of neighboring ionization stages through either total pulse or time-resolved observations.
Spectrographic Determination of Trace Elements in Ferrous Materials
Authors: Morello B. , De Gregorio P. , Savastano G. 
Published: September 2005

A method is described for the spectrographic determination of trace elements in ferrous materials. The powdered sample is first mixed with PTFE (polytetrafluoroethylene) and graphite in the ratio 100:10:25. This mixture is then submitted to direct excitation in a 10 A dc arc, utilizing a capped supporting electrode of the Scribner-Mullin type, with reverse polarity (sample: negative; counter electrode: positive), the spectrum being taken from the central-cathodic region of the arc. The method may be used to determine Al, As, B, Co, Cr, Cu, Mn, Mo, Nb, Ni, Pb, Sb, Sn, Ti, V, Zn, and Zr. The detection limits are indicated, as are data on the precision and accuracy obtainable.
Hyperhomocysteinemia and macromolecule modifications in uremic patients
Authors: Perna Alessandra F. , Capasso Rosanna , Lombardi Cinzia , Acanfora Filomena , Satta Ersilia , Ingrosso Diego 
Published: September 2005

AbstractHyperhomocysteinemia is present in the majority of well-nourished chronic renal failure and uremic patients. Most observations reported in the literature come from studies carried out in end-stage renal disease patients treated with hemodialysis. The underlying mechanisms of the toxic effects of homocysteine in uremia related to cardiovascular disease and other disturbances are still under scrutiny. As a consequence, macromolecules (i.e., proteins and DNA) have been found to be altered to various extents. One of the mechanisms of homocysteine toxicity is related to the action of its metabolic precursor, S-adenosylhomocysteine, a powerful methyltransferase competitive inhibitor. Disruption of DNA methylation has been demonstrated to occur as a result of hyperhomocysteinemia, and/or is associated with vascular damage. DNA hypomethylation has been found in the mononuclear cell fraction of uremic patients with hyperhomocysteinemia. Proteins are also targets of homocysteine-dependent molecular damage. The formation of oxidative products with free cysteinyl residue thiol groups has been demonstrated to occur in blood. The latter also represents a mechanism for the transport of homocysteine in plasma. In addition, homocysteine thiolactone has been shown to react with free amino groups in proteins to form isopeptide bonds, in particular at the lysine residue level. Another type of isopeptide bond in proteins may result from the deamidation and isomerization of asparaginyl residues, yielding abnormal isoaspartyl residues, which have been demonstrated to be increased in uremic patients. Folate treatment exerts a partial, but significant, homocysteine-lowering effect in uremic patients and has been shown to improve the changes in macromolecules induced by high homocysteine levels. In conclusion, both DNA and proteins are structurally modified in uremia as a consequence of high homocysteine levels. The role of these macromolecule changes in inducing the clinical complications of hyperhomocysteinemia in these patients, although still conjectural in some respects, is at present sustained by several pieces of evidence.
Homocysteine – a newly recognised risk factor for osteoporosis
Authors: Herrmann Markus , Widmann Thomas , Herrmann Wolfgang 
Published: September 2005

AbstractOsteoporosis is a widespread problem, which frequently has devastating health consequences through its association with fragility fractures. The total number of fractures, and hence the cost to society, will increase dramatically over the next 50years as a result of demographic changes in the number of elderly people. Thus, prevention of osteoporosis by identifying risk factors or risk indicators, as well as the development of new treatment strategies, are major issues. Recent data suggest that homocysteine (Hcy), folate, vitamin B
Elevated levels of asymmetric dimethylarginine (ADMA) as a marker of cardiovascular disease and mortality
Authors: Böger Rainer H. , Maas Renke , Schulze Friedrich , Schwedhelm Edzard 
Published: September 2005

AbstractThe endothelium plays a crucial role in the maintenance of vascular tone and structure by releasing the endothelium-derived vasoactive mediator, nitric oxide (NO). NO is formed in healthy vascular endothelium from the amino acid precursor L-arginine. Endothelial dysfunction is caused by various cardiovascular risk factors, metabolic diseases, and systemic or local inflammation. One mechanism that explains the occurrence of endothelial dysfunction is the presence of elevated blood levels of asymmetric dimethylarginine (ADMA) – an L-arginine analogue that inhibits NO formation and thereby can impair vascular function. Accumulating evidence from prospective clinical studies suggests that elevated plasma or serum levels of ADMA are associated with an increased risk of major adverse cardiovascular events. This article gives an updated overview of the currently available literature on ADMA and cardiovascular disease from prospective clinical trials. Recently, advances have been made in the development of analytical methods that are reliable and fast enough to allow determination of ADMA in clinical routine.
Measurement of Transcutaneous Hemoglobin Concentration by Noninvasive White-Light Spectroscopy in Infants
Authors: Rabe Heike , Stupp Natascha , Özgün Murat , Harms Erik , Jungmann Holger 
Published: September 2005

Objective. To compare transcutaneously spectroscopically measured hemoglobin values with venous hemoglobin values in infants.
Study Design. Prospective study in healthy preterm and term infants who were breathing spontaneously.
Results. Recordings were obtained from 85 stable infants (median gestational age at measurement: 36 weeks [range: 34–43 weeks]; median body weight: 1890 g [range: 1095–4360 g]). The spectroscopic hemoglobin values were corrected for inhomogeneous distribution of hemoglobin in the tissue. The venous and spectroscopic hemoglobin values were then compared by using the Bland-Altman method, which gave an error of &lt;5%.
Conclusions. This pilot study could illustrate a good relation between the 2 methods for measuring hemoglobin. Larger studies are required to validate the spectroscopic method in those with conditions that affect the skin microcirculation (eg, septicemia).
Explaining the Poor Bacteriologic Eradication Rate of Single-Dose Ceftriaxone in Group A Streptococcal Tonsillopharyngitis: A Reverse Engineering Solution Using Pharmacodynamic Modeling
Authors: Blumer Jeffrey L. , Reed Michael D. , Kaplan Edward L. , Drusano George L. 
Published: September 2005

Objective. To explore pharmacokinetic factors underlying the poor bacteriologic eradication rate with a single 500-mg dose of ceftriaxone for streptococcal tonsillopharyngitis and to identify the minimum ceftriaxone dose required for effective treatment.
Methods. Population modeling techniques were applied to pharmacokinetic data derived from paired plasma and tonsil samples from 153 children to assess the contribution of pharmacokinetic variability to patients' responses to ceftriaxone. In addition, a Monte Carlo simulation was performed to determine (1) the amount of time that free ceftriaxone concentrations must exceed the minimum inhibitory concentration (MIC) of group A Streptococcus to achieve bacteriologic eradication and (2) the ceftriaxone dose required to maintain free drug concentrations above the target MIC for the requisite amount of time. Ceftriaxone MICs for group A Streptococcus were obtained from a previous trial, in which all MICs (n = 115) were ≤0.064 mg/L; 33.9% were susceptible at ≤0.016 mg/L, 66.4% were susceptible at 0.032 mg/L, and 1.7% were susceptible at 0.064 mg/L.
Results. Mean population pharmacokinetic parameters and their variances reflected substantial variability of clearance and half-life in the target population. Tonsillar ceftriaxone protein binding was 89.1%. The proportions of 1000 simulated patients with free ceftriaxone concentrations that exceeded MICs of 0.016 mg/L, 0.032 mg/L, and 0.064 mg/L at 24 hours were 71.7%, 65.4%, and 57.2%, respectively, and at 48 hours were 41.8%, 35.8%, and 28.6%, respectively. The amount of time that free ceftriaxone concentrations need to exceed MIC to achieve bacteriologic success was estimated to be 36 hours. Using this time criterion, two 500-mg doses of ceftriaxone separated by 18 hours should achieve a bacteriologic cure rate of ∼95%.
Conclusions. Pharmacokinetic variability and high ceftriaxone tonsillar protein binding explain the high microbiologic failure rate for a single 500-mg dose of ceftriaxone in group A streptococcal tonsillopharyngitis. Monte Carlo simulation suggests that a second dose administered 18 hours after the first will be required to achieve an acceptable bacteriologic cure rate.
The Association Between Television Viewing and Irregular Sleep Schedules Among Children Less Than 3 Years of Age
Authors: Thompson Darcy A. , Christakis Dimitri A. 
Published: September 2005

Background. Regular sleep schedules are an important part of healthy sleep habits. Although television viewing is associated with altered sleep patterns and sleep disorders among children and adolescents, the effect of television viewing on the sleep patterns of infants and toddlers is not known.Objective. To test the hypothesis that television viewing by infants and toddlers is associated with having irregular naptime and bedtime schedules.Methods. We used data from the National Survey of Early Childhood Health, a nationally representative, cross-sectional study of the health and health care of children 4 to 35 months of age. Our main outcome measures were whether children had irregular naptime and bedtime schedules. Our main predictor was hours of television watched on a daily basis. We performed multivariate logistic regression analyses, adjusting for a variety of factors including demographic information, measures of maternal mental health, and measures of family interactions, to test the independent association of television viewing and irregular naptime and bedtime schedules.Results. Data were available for 2068 children. Thirty-four percent of all children had irregular naptime schedules, and 27% had irregular bedtime schedules. Mean hours of television viewing per day were as follows: 0.9 hours/day (95% confidence interval [CI]: 0.8–1.0 hours/day) for children &lt;12 months of age, 1.6 hours/day (95% CI: 1.4–1.8 hours/day) for children 12 to 23 months of age, and 2.3 hours/day (95% CI: 2.1–2.5 hours/day) for children 24 to 35 months of age. In our logistic regression model, the number of hours of television watched per day was associated with both an irregular naptime schedule (odds ratio: 1.09; 95% CI: 1.01–1.18) and an irregular bedtime schedule (odds ratio: 1.13; 95% CI: 1.04–1.24).Conclusions. Television viewing among infants and toddlers is associated with irregular sleep schedules. More research is warranted to determine whether this association is causal.
Fragmented Care for Inner-City Minority Children With Attention-Deficit/Hyperactivity Disorder
Authors: Guevara James P. , Feudtner Chris , Romer Daniel , Power Thomas , Eiraldi Ricardo , Nihtianova Snejana , Rosales Aracely , Ohene-Frempong Janet , Schwarz Donald F. 
Published: September 2005

Objectives. To identify systematic problems in coordinating care for inner-city minority youths with attention-deficit/hyperactivity disorder.
Methods. We recruited participants from inner-city minority communities in a single metropolitan area for a focus group study. We held separate meetings for pediatricians, mental health therapists, school staff, and parents (both black and Latino). We audiotaped and transcribed the meetings. We identified themes by consensus and used root cause analysis as a conceptual framework to guide our analysis.
Results. We held 13 focus group meetings. Participants uniformly perceived insufficient communication and coordination of care. Five themes representing system and human factors that contributed to this fragmentation in care emerged: (1) a lack of consensus about who should oversee care; (2) changes in health care providers or teachers; (3) uncertainty in the diagnosis, insufficient training, and few resources; (4) distrust and blame that emerged when relationships among people who care for the child were absent or otherwise inadequate; and (5) lack of support from employers, friends, and family to engage in collaborative care.
Conclusions. Using a root cause analysis framework, we identified system- and human-level factors that were perceived to impede communication and coordination of care for this population of children with attention-deficit/hyperactivity disorder. These results suggest that better organizational policies that define provider responsibilities and accountability, support the coordination of care, bridge relationships between agencies, and provide additional education and resources may improve collaboration. Additional study is needed to assess the generalizability of these finding to other settings.
Early Analgesia for Children With Acute Abdominal Pain
Authors: Green Robert , Bulloch Blake , Kabani Amin , Hancock Betty Jean , Tenenbein Milton 
Published: September 2005

Objectives. The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.Methods. This was a double-blind, randomized, placebo-controlled trial involving 5- to 16-year-old children who presented to the emergency department of a children’s hospital with a chief complaint of acute abdominal pain that was thought by the pediatric emergency attending physician to require a surgical consultation. Subjects were randomized to receive intravenously administered morphine or normal saline solution. Clinical data and the emergency physician’s confidence in his or her clinical diagnosis (0–100%) were recorded systematically with a standardized form. This was repeated 15 minutes after administration of the study medication. The surgeon assessed the child within 1 hour and completed a similar data collection sheet. Pain was assessed, with a color analog scale, before and after study medication administration. Each subject was monitored for 2 weeks after enrollment.Results. One hundred eight children were enrolled; 52 received morphine and 56 received a placebo saline solution. There were no differences between groups in demographic variables or the degree of pain. There were no differences between groups in the diagnoses of appendicitis or perforated appendicitis or the number of children who were observed and then underwent laparotomy. The reduction in the mean pain score was significantly greater in the morphine group (2.2 vs 1.2 cm). The emergency physicians’ and surgeons’ confidence in their diagnoses was not affected by the administration of morphine.Conclusions. Our data show that morphine effectively reduces the intensity of pain among children with acute abdominal pain and morphine does not seem to impede the diagnosis of appendicitis.