Cutaneous manifestation of IgG4-related disease mimicking dermatitis artefacta

Dermatitis artefacta is a self-inflicted cutaneous disease presenting as sharply delineated ulcers, usually in accessible sites such as the head and neck. IgG4-related disease (IgG4-RD) is a recently recognised immune-mediated condition causing a fibroinflammatory process, resulting in the formation of tumefactive lesions in various organs, rarely presenting primarily in the skin. We report a case of cutaneous IgG4-RD clinically presenting as dermatitis artefacta.     

Fabricating Crowns to Fit Existing Removable Partial Dentures: An Illustration of Two Techniques

The prosthetic treatment of a structurally compromised abutment tooth supporting a removable partial denture may present a variety of restorative modalities. Ideally, a surveyed crown is made for the individual tooth, which is later followed by a new removable partial denture fit to the contours of the crown. Frequently, however, the removable partial denture is clinically acceptable, and remaking the prosthesis is not indicated. In these cases, the crown can be made to fit the existing removable partial denture. Fabricating crowns to fit existing removable partial dentures can be accomplished using a direct method, an indirect method, or combinations of these techniques. Direct techniques traditionally use acrylic resin and inlay wax intraorally to develop a custom pattern that captures the contours of the clasp assembly. Indirect techniques use a pick-up impression to allow the crown pattern to be waxed against the denture framework on a cast in the laboratory. Combination methods use either a direct-indirect or indirect-direct approach. The direct-indirect method develops the preliminary resin pattern directly on the tooth and finalizes the contours in wax on a master cast. The indirect-direct technique initiates a crown pattern on a die and completes it either intraorally or on the die after the intraoral refinements. This article reviews the literature for methods of fabricating surveyed crowns under existing removable partial dentures. Additionally, two cases are presented that illustrate an indirect and combination direct-indirect technique for making the restorations.     

UK dentists' attitudes and behaviour towards Atraumatic Restorative Treatment for primary teeth

BACKGROUND: Atraumatic Restorative Treatment (ART) was introduced a decade ago as a minimal intervention treatment for caries in unindustrialised countries, but UK general dental practitioners (GDPs) may also be using this technique. OBJECTIVE: This study aimed to determine the materials and techniques used by a group of UK GDPs to treat caries in primary teeth. METHOD: A questionnaire, designed to determine GDPs' use of materials and techniques in the restoration of caries in primary teeth, was distributed to 600 GDPs in Scotland and England, with an explanatory letter and reply-paid envelope. The questionnaire included colour illustrations of two carious cavities in primary molar teeth and a request that respondents draw the cavity outline that they would use on the illustrations. The cavity outlines were assessed independently by two examiners. All other data were collated and analysed. RESULTS: 390 usable replies were received, a response rate of 65%. Of the respondents, 99% treated child patients and 42% of respondents were aware of ART. For treatment of a small Class II cavity, 37% drew a cavity outline without extension beyond removal of caries and a majority suggested use of an adhesive material (51% glass ionomer, 13% compomer). For cavity preparation, 47% of respondents used a drill, 10% an excavator and 41% used both. For treatment of a large occluso-lingual cavity, again most used an adhesive technique (44% glass ionomer, 12% compomer) for its restoration, while 50% used a drill, 7% an excavator and 42% used both for cavity preparation. CONCLUSION: Most respondents used adhesive materials for restoration of caries in primary molars, but, despite 42% of respondents stating that they were aware of the treatment, "true" ART was adopted by fewer than 10% of respondents.     

Effect of fluoridated salt intake in infancy: a blind caries and fluorosis study in 8th grade Hungarian pupils

Salt fluoridation is effective at inhibiting caries, but fluorosis prevalence data are deficient. OBJECTIVES: The purpose was to undertake a blind study of caries and tooth mottling in 8th grade school pupils from south-east Hungary who had resided (test) or not resided (control), until November 1985, in a 350 ppm F-/kg domestic salt-fluoridated area during their early years of life. METHODS: In Szeged, blind clinical caries and anterior tooth mottling scoring (+10% repeats) of 49 previously salt-fluoridated (mean age 14.14 years) and 59 non-salt-fluoridated subjects (mean age 14.08 years) were undertaken by one examiner, in June 1997. In addition, radiographic and photographic recordings were taken. In Glasgow, four dental and two lay staff scored the projected 35 mm colour transparencies (+10% repeats) of each pupil's six upper anterior teeth, for tooth mottling. All clinical, radiographic and photographic data were then analysed. RESULTS: Mean DMFS scores were 9.18 (SD=10.72) for test users and 4.51 (SD=6.24) for control users (P<0.01) and, based on repeat observations, clinical reliability=0.99; X-ray reliability=0.95. Clinically, three test children had fluorosis of 10 teeth, with eight teeth in two controls. Photographic scoring by the clinical examiner gave a 97.2% clinical match, while photographic agreements for all four dentist pairs were 92.5%-97.2%, with lay observers' agreements at 89.8%. For both groups, 10% repeats produced 98.5% agreements. In a sole test case "fluorosis" photographic unanimity was obtained, and non-unanimous "possible fluorosis" was recorded by two to four panel members for only three other test and two control subjects. CONCLUSIONS: No evidence was found that significant anterior tooth fluorosis resulted in subjects exposed previously to 350 ppm F-/kg domestic salt from birth to 2.3-4.8 years of age. However, no caries benefit was demonstrated after the 11.5-year salt fluoridation gap. Caries differences seemed social class-related, city-based controls having less disease than rural test subjects, in spite of an identical F- tablet regimen in all schools from 1987, until subjects were 10 years old. These data emphasise (a) the superiority of sustained community-delivered fluoridation and (b) the need to maintain constant fluoride delivery to tooth surfaces, certainly well beyond 10 years of age.     

Primary Care Staff Perspectives on a Virtual Learning Collaborative to Support Medical Home Implementation

BACKGROUND

Many organizations rely on quality improvement collaboratives (QICs) to facilitate Patient-Centered Medical Home (PCMH) implementation, and there is a trend toward conducting QIC activities virtually to reduce costs and expand their reach. However, the evidence base for QICs is limited; questions remain about how QICs operate, why they succeed or fail, and how they are experienced by participants.

OBJECTIVE

We surveyed participants in an innovative Virtual Collaborative (VC) designed to support PCMH implementation within one Veterans Integrated Service Network, to understand why and for whom the VC was more/less effective and identify opportunities for improvement.

DESIGN

This anonymous online survey was designed to assess participants’ views on the VC’s usefulness, impact, and acceptability, and to explore variations by role, practice setting, prior training, and overall engagement in VC activities.

PARTICIPANTS

Respondents were 353 primary care staff, including providers, nurses, and support staff.

MEASURES/APPROACH

The survey comprised 32 structured and three free-response items. Structured items assessed participation in and perceived usefulness of VC activities; perceived acceptability of the training format; overall perceived impact; and basic demographics. Responses were dichotomized and compared using Chi-square tests. Free-response items inviting constructive criticism of the VC were coded and summarized to identify themes and illustrative quotes.

RESULTS

The VC most benefited respondents with prior PCMH training and those who fully participated in VC activities. Respondents especially valued the opportunity to share experiences with other teams. Non-providers and those new to PCMH felt learning content did not meet their needs. Reported barriers to full participation included staffing constraints, insufficient and/or unprotected time, and inadequate leadership support.

CONCLUSIONS

Our study offers practical lessons for others considering a virtual collaborative model for PCMH spread. Findings contribute to the evidence base for QICs overall and virtual QICs in particular, highlighting the value of seeking input from “the trenches.”

     

Assessing the utility of the standards for reporting trials of acupuncture (STRICTA): a survey of authors

OBJECTIVE: To inform the potential revision of Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA), we sought the opinion of acupuncture trial authors and systematic reviewers to rank the utility of the guidelines and asked trial authors about their experiences using them. DESIGN: Questionnaires ranking STRICTA items and qualitative responses about experience using the guidelines. SAMPLE: The authors of 38 randomized controlled acupuncture trials randomly selected from a systematic search of those published in 2004 and 2005 were contacted with a questionnaire. Authors of 14 Cochrane acupuncture systematic reviews or protocols published in the same time frame were also sent a questionnaire. RESULTS: Fifty-four percent (54%) (28/52) of the sample responded. Among the trial authors, 58% (11/19) used STRICTA to help guide their writing, but more than half of these reported that the editing process had removed some or all of the STRICTA-specific items. STRICTA was seen as a helpful reference, but authors requested that some items be clarified. Respondents tended to rank the utility of STRICTA highly overall, but five items in particular were not highly valued; three of these pertained to details on the trial acupuncturists' background. Authors flagged potential difficulties of reporting unusual trial designs in the current format of STRICTA. CONCLUSIONS: Authors of acupuncture trials and systematic reviews believe that STRICTA contributes to the reporting of acupuncture interventions and rate it highly. Because very few acupuncture studies are published in STRICTA-adopting journals, the editing process for journals unaware of the guidelines may be responsible for deleting acupuncture intervention-specific items. Several items remain unclear, and the relevance of STRICTA to some trial designs is questioned. A review of STRICTA is warranted to clarify and reconsider items, and targeted promotion to non-complementary and alternative medicine journals should be considered.