Responding to complaints

Patients and relatives do complain about their experience of healthcare. There may be different reasons for this. Formal complaints can be prevented. Once received, formal complaints should be answered promptly, with reference to the notes. Responses should be comprehensive and answer all the expressed concerns. It is helpful to liaise with all staff involved. Complaints provide us with feedback on the clinical services we provide and can be used as a driver for change and service improvement. Patient advice and liaison (PALS) departments are a valuable resource for complaint management.     

Response of adiponectin and its receptors to changes in metabolic state after gastric bypass surgery: dissociation between adipose tissue expression and circulating levels

BackgroundAdiponectin is an adipokine with anti-atherogenic and insulin-sensitizing properties. Specific adiponectin receptors, adiponectin receptors 1 (AdipoR1) and 2 (AdipoR2), are present in adipose tissue, indicating adiponectin might have autocrine/paracrine effects on its production or action. In addition, endoplasmic reticulum oxidoreductase 1-Lα might mediate regulation of its secretion. The study aim was to determine the subcutaneous adipose tissue (SAT) adiponectin gene and protein expression and their correlation to metabolic parameters during metabolically distinct times after gastric bypass surgery.MethodsA total of 12 morbidly obese male patients underwent SAT biopsy during gastric bypass surgery, active weight loss (negative energy state), and at weight stabilization (steady state energy). The SAT mRNA and protein content of adiponectin, AdipoR1 and AdipoR2, and endoplasmic reticulum oxidoreductase 1-Lα protein levels and the serum levels of adiponectin were assessed.ResultsSAT adiponectin, AdipoR1, and AdipoR2 gene expression increased significantly at the negative energy state, with no further change at steady state energy (P <.05, P <.05, and P = .04, respectively), without significant increases in protein at any stage. Changes in SAT adiponectin protein correlated with changes in AdipoR1 and AdipoR2 during steady state energy (P = .003 and P = .002, respectively). Changes in SAT adiponectin expression did not correlate with those in circulating levels. Changes in endoplasmic reticulum oxidoreductase 1-Lα did not correlate with either SAT or circulating levels of adiponectin.ConclusionOur data indicate distinct functions of adiponectin receptors, AdipoR1 and AdipoR2, mediate the autocrine/paracrine actions of adiponectin. The lack of correlation between changes in SAT adiponectin gene and protein expression and its circulating levels suggests that adipose tissue synthesis and release of adiponectin are highly regulated pathways.     

Modified Apexification Procedure for Immature Permanent Teeth with a Necrotic Pulp/Apical Periodontitis: A Case Series

The current American Association of Endodontists clinical considerations for a regenerative endodontic procedure state that a regenerative procedure is suitable for immature permanent teeth with necrotic pulp when the pulp space is not needed for a post/core in the final restoration. Therefore, many immature permanent teeth with necrotic pulp that have sustained a substantial loss of coronal tooth structure either from caries or trauma are treated by apexification or mineral trioxide aggregate/Biodentine (Septodent, Lancaster, PA) apical barrier techniques in which no further root maturation would occur. This case series presents 10 immature permanent teeth with necrotic pulp in which a post/core was likely required in the future for adequate coronal restoration because of loss of substantial coronal tooth structure and a modified apexification procedure was used. All 10 cases after the modified apexification procedure showed no clinical symptoms/signs and showed radiographic evidence of healed/healing of periapical lesion after a 2-year review. Eight cases showed increased thickness of the apical root canal walls, increased apical root length, and apical closure. The overall percentage change in root length was 7.52%, in root width at the apical one third it was 18.89%, and in radiographic root area it was 15.04% at the 24- to 72-month follow-up period. This modified apexification procedure allows for the tooth to be restored with a post/core if required for the final restoration in the future as well as continued root development.     

Comparison between Hydrofluoric Acid and Single-Component Primer as Conditioners on Resin Cement Adhesion to Lithium Silicate and Lithium Disilicate Glass Ceramics

This study aimed at evaluating the effects of different surface conditionings on the microshear bond strength (µSBS) of a self-adhesive resin cement to VITA Suprinity (ZLS) and IPS e.max CAD (LD). Three surface conditioning protocols were performed on ZLS and LD before luting with a self-adhesive resin cement (RelyX Unicem 2, RXU): hydrofluoric acid (HF), HF + silane (HF + S), or Monobond Etch & Prime (EP). In each group, 15 cylindrical buildups of RXU were prepared on five milled bars and submitted to a µSBS test. Data were statistically analyzed with two-way ANOVA and Tukey’s post hoc test (p < 0.05). Failure modes were recorded and classified as adhesive, mixed, cohesive in resin, or ceramic, and statistically analyzed with Fisher’s exact test (p = 0.05). One additional bar per group was used for the morphological characterization of the conditioned surface by means of SEM. The material per se did not significantly influence adhesion (p = 0.744). Conditioning protocol was a significant factor: EP yielded significantly higher μSBS than HF (p = 0.005), while no significant differences emerged between EP and HF + S (p = 0.107), or HF + S and HF (p = 0.387). The material-conditioning protocol interaction was not statistically significant (p = 0.109). Significant intergroup differences were found in distribution of failure modes: mixed failures were predominant in the ZLS/EP group, while the other groups showed a prevalence of adhesive failures. The self-etching primer showed promising results in terms of immediate bond strength of a self-adhesive resin cement to lithium-silica-based glass ceramics, suggesting its alternative use to hydrofluoric acid and silane conditioning protocols.     

Evolution and new application of the alumina ceramics in joint replacement

Alumina and zirconia are the structural ceramics used in orthopedics. Alumina offers better tribological characteristics and high chemical–physical stability, but poor toughness. For this reason it is not used for complex shape and thin ceramic components. On the opposite, zirconia is tougher and less stable. A new alumina matrix composite material, called Biolox^® Delta (CeramTec AG, Plochingen, Germany), has been obtained in order to mix and enhance positive characteristics of both materials.     

Everglades restoration and water quality challenges in south Florida

This paper provides background information and a brief overview of water quality issues for the rest of the papers in this volume that are concerned with Everglades restoration. The Everglades of Florida have been diminished over 50% of their former extent. The Everglades are no longer a free-flowing wetland ecosystem, but are now subject to a complicated system of water management that is regulated primarily for flood control and consumptive use. Attempts to restore a more natural hydropattern to the remaining undeveloped Everglades are made more difficult by the natural extremes in rainfall, flat landscape, highly porous geology, and inaccessibility of the remaining natural areas. The Comprehensive Everglades Restoration Plan (CERP) seeks ecosystem restoration by adding water storage capacity, reducing groundwater seepage, improving regulatory delivery and timing of water to avoid environmental damage, and where feasible, improving the quality of water to be used for Everglades restoration. Water quality issues that currently exist for south Florida include eutrophication (especially phosphorus), mercury, and contaminants from agricultural production and the urban environment. Lands once in agricultural production that will be converted back to wetlands or will become reservoirs may contribute to the water quality concerns. Stormwater runoff from managed lands that will be used for restoration purposes will also present water quality challenges. The state continues to seek water quality improvement with a number of pollution reduction programs, and CERP attempts to improve water quality without sacrificing even more natural areas; however providing water quality sufficient for use in recovery of remaining Everglades wetlands and estuaries will remain a daunting challenge.