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1项目简介近年来,我国地震、洪涝等灾害事故多发,安全生产、交通事故死亡人数居世界前列,来自临床的统计结果显示,我国14~40岁人群的最大死因是创伤。创伤现场迅速有效的救治也许能挽回其中许多人的生命,但长期以来,我国缺乏对突发自然灾害及意外事故中受伤人员救治的系统、规范、实用的培训。     

Management of dental patients on warfarin therapy in a primary care setting

The surgical management of patients on anticoagulant therapy is often poorly understood in all fields of medicine (not just dentistry). Until now there has been no uniform approach to managing these patients and much of the advice routinely given by medical practitioners and haematologists has fallen behind the recent evidence. Many medical conditions from atrial fibrillation to prosthetic heart valves predispose patients to venous thrombosis and pulmonary embolism (Table 1). In order to prevent these complications, these patients are normally placed on an anticoagulant. By far the most common one in use is Warfarin, which is a derivative of 4 hydroxycoumarin.     

口腔诊疗中低龄儿童行为表现分类标准的制定与信度检验

目的制定并检验口腔诊疗中低龄儿童行为表现的分类标准。方法参考Venham儿童行为和焦虑六分类法制定出低龄儿童在口腔诊疗中行为表现的分类标准，并由11名儿童口腔医护人员对随机选取的24段临床诊疗录像用该标准进行分类。结果此分类标准依据儿童的情绪状态、诊疗中行为表现、医师完成治疗的情况等三方面来对儿童在口腔诊疗中的行为表现进行分类。该分类标准有较好的研究者间一致性（组内相关系数=0．929）和很高的重测信度（Spearman’s相关系数=0．963）。结论该方法可以作为临床对低龄儿童在口腔诊疗中行为表现进行分类的标准。     

Informing research in primary dental care: setting priorities.

This paper suggests that priorities for research in primary dental care should follow the examples set in other areas of primary healthcare. It reviews the history of research in primary dental care, since 1990, and goes on to explain how the Delphi exercise, initiated by the Faculty of General Dental Practice (UK), has identified five priority areas for research in primary dental care. These areas are:1. Research into the application of evidence-based dentistry into practice.2. The effects of different systems of remuneration on treatment patterns in practice.3. The oral health assessment on determining recall intervals and its effect on oral health.4. Factors that influence and affect dentists' treatment modalities.5. The evaluation of the cost benefits of whole team training.     

Evaluation of primary teeth affected by dental trauma in patients visiting a university clinic,Part 1: Epidemiology

Clinical Oral Investigations - The retrospective study reported herein was the first of three that investigated dental trauma in primary teeth. This article discusses the study that aimed to reveal...     

Exposed human pulp caused by trauma and/or caries in primary dentition: a histological evaluation

Abstract –  The aim of this study was to compare the pulpal reactions after exposure due to trauma and/or caries and to suggest the appropriate treatment options for the management of pulp, in the light of the histological findings in the primary teeth. Fifteen primary maxillary incisors with pulpal exposure were examined with light microscope in a blind study. After the histological evaluation, teeth were divided into three groups for the etiological factors due to the exposure according to the patient's files: trauma group, caries group and caries and trauma group. The inflammatory infiltration was diminished from the pulp chamber towards the apical third of the root canal in all of the examined teeth. Teeth in the trauma group presented fewer inflammatory cells in the root canal in comparison with other groups. It was concluded that the teeth with traumatic pulp exposure were considered as more likely to respond positively to pulpotomy technique. Pulpectomy or extraction seemed to be indicated for the decayed or decayed and traumatically injured teeth.     

Accuracy of familial reporting of a child's medical history in a dental clinic setting

PURPOSE: Accurate reporting of medical history information is essential to provide safe and successful dental treatment to children. The purpose of this study was to evaluate the accuracy of health histories reported by parents/guardians of pediatric patients presenting for dental treatment by comparing them to the histories provided in the child's medical chart. METHODS: Data collection from the dental record was performed using the medical history questionnaire from the child's first visit as the data source. Data collected focused on knowledge of the child's medical conditions, current medications, allergies, immunization status, and need for prophylactic antibiotics. Corresponding data were collected from the child's medical chart. Statistical analysis included kappa analysis and calculation of sensitivity, specificity, and failure-to-report rates. RESULTS: The study group consisted of 226 children (99 girls, 127 boys), with a mean age of 10.35 years. The patients were divided into 2 groups based on their medical status (healthy vs medically compromised). For the medically compromised children, parents had high sensitivity reporting rates (>75% sensitivity) for only 2 out of the 9 medical categories. For both groups, <50% of the medicine, allergy, and need for prophylaxis categories had sensitivity rates above 75%. Failure-to-report rates of 40% to 60% were common, with some as high as 80%. Weighted failure-to-report rates were consistently higher for medically compromised children compared to healthy children. CONCLUSIONS: Parents/guardians of children presenting for dental treatment are not always able to accurately report vital medical history information. Therefore, pediatric dentists need to more closely examine the dental health questionnaire and make every attempt to obtain accurate information to provide appropriate care for each patient.     

An evaluation of a training programme in primary care research for general dental practitioners

AIMS: To determine whether general dental practitioners would find seminars on research methods in primary care research of interest and whether they would be stimulated to plan their own research. METHOD: Questionnaire with both open and closed questions distributed to participants at the end of the seminars. 10 seminars in locations throughout the north west of England were planned. RESULTS: 98 dentists attended the seminars of whom 81 returned questionnaires, giving a response rate of 82.6%. More than 60% found the seminars and the specially developed teaching manual very useful. However there was somewhat less enthusiasm for undertaking research projects. CONCLUSIONS: The findings suggest that some GDPs are interested in primary care research but are not keen to initiate or plan research themselves.     

Assessment of Atraumatic Restorative Treatment (ART) on the permanent dentition in a primary care setting in Nigeria

Objectives: To assess the acceptability of ART and to evaluate on a longitudinal basis the survival rate of single surface occlusal ART restorations in the permanent dentition. Design: Longitudinal Study of ART restorations. Setting: Primary Oral Health Care Setting. Participants: Aged 8–19 years in a low socioeconomic community, Southwestern Nigeria. Interventions/methods: Ninety‐three ART restorations were applied on single surface occlusal caries by a dentist who had undergone training on ART. Main outcome measures: Six monthly follow‐up of patients to evaluate restoration retention and marginal defect was conducted by an independent evaluator. Results: Over 90.0% of the subjects had never undergone dental treatment, yet 63.0% perceived dental treatment as painful. After undergoing the treatment as many as 98.0% admitted that ART was not painful. On the question of their willingness to make recall visits, about 95.0% responded in the affirmative and about 96.0% reported that they would encourage others to come for treatment. The cumulative survival rate of single surface occlusal ART restorations after 2 years was 93.5% (SE = 2.3%). Conclusions: ART was shown to be acceptable and effective in the management of single surface occlusal caries in the permanent dentition in these Nigerian children and adolescents outside the traditional clinical setting.     

Real-time screening tool for identifying post-traumatic stress disorder in facial trauma patients in a UK maxillofacial trauma clinic

Post-traumatic stress disorder (PTSD) is a distressing consequence of a traumatic event associated with an increased suicide risk and reduced quality of life. Surgeons often have low confidence in identifying psychological problems. The prevalence of PTSD following facial trauma ranges from 23% to 41%. This highlights the importance of identifying and managing at-risk patients to optimize both mental and physical recovery. IMPARTS (Integrating Mental and Physical healthcare: Research, Training and Services) provides electronic screening tools to guide the non-mental health clinician in the ‘real-time’ identification, documentation, and management of potential mental health problems. The bespoke IMPARTS facial trauma screening tool was piloted in a UK oral and maxillofacial surgery trauma clinic from July 2015 to November 2017. A total of 199 patients completed screening, with 48 (24%) screening positive for possible PTSD. Further analysis of these 48 patients revealed that four (8%) had PTSD symptoms alone; three (6%) also screened positive for depression, 17 (35%) for co-existing symptoms of anxiety, and 24 (50%) for PTSD, anxiety, and depression. IMPARTS was found to be a highly effective tool aiding the non-mental health clinician to screen for PTSD and initiate prompt management. The data captured informs planning of the psychological support service.     

A retrospective study of traumatic dental injuries in a Brazilian dental trauma clinic

Abstract – The purpose of this retrospective study was to analyse data from the records of patients seen in the dental trauma emergency clinic in a general hospital in the city of Recife, Brazil, during the years 1997–1999, according to sex, age, cause, number of injured teeth, type of tooth and type of trauma. The records of all patients seen by dentists were collected. Altogether, 250 patients from 1 to 59 years of age presenting 403 dental injuries were examined and/or treated. The causes of dento-alveolar trauma were classified in five categories: home injuries, street injuries, school injuries, sports activities, violence. The type of trauma was classified by dentists working at the dental trauma clinic on the basis of Andreasen's classification. The gender difference in the number of cases of trauma was statistically significant (males 63.2% vs females 36.8) ( P <0.0001). Fracture in enamel only (51.6%) and fractures in dentine (40.8%) were the most commonly occurring types of injury. Injuries were most frequently diagnosed as serious among the youngest patients (up to 15 years of age); 82.4% of intrusive luxation cases were diagnosed in the 1–5 years age group. The main causes of tooth injury were falls (72.4%), collisions with objects (9.2%), violence (8.0%), traffic accidents (6.8%) and sports (3.6%). Trauma caused by violence was found to be statistically significant in the 6–15 years age group ( P <0.0005).     

Breaking bad medical news in a dental care setting

BackgroundDental care providers may diagnose diseases and conditions that affect a patient’s general health. The authors reviewed issues related to breaking bad medical news to dental practice patients and provide guidance to clinicians about how to do so.MethodsTo help reduce the potentially negative effects associated with emotionally laden communication with patients about serious health care findings, the authors present suggestions for appropriately and sensitively delivering bad medical news to both patients and their families in a supportive fashion.ResultsPreparing to deliver bad news by means of education and practice is recommended to help prevent or reduce psychological distress. One form of communication guidance is the ABCDE model, which involves Advance preparation, Building a therapeutic relationship or environment, Communicating well, Dealing with patient and family reactions, and Encouraging and validating emotions. An alternative model is the six-step SPIKES sequence—Setting, Perception, Invitation or Information, Knowledge, Empathy, and Strategize and Summarize. Using either model can assist in sensitive and empathetic communication.ConclusionsFor both practitioners’ and patients’ well-being, empathetic and effective delivery of bad medical news should be included in dental school curricula and continuing education courses.Practical ImplicationsDental care providers should be familiar with the oral manifestations of diseases and the care needed before the patient undergoes medical treatment and use effective communication necessary to share bad news with patients.     

Extramural clinic in comprehensive care education

The interaction between dentist and patient is central to the provision of effective healthcare. A multidisciplinary team containing expertise in the social and behavioural sciences, medicine, dentistry, education and information technology was formed to design a CD-ROM to support more traditional teaching and learning in this area. The final version of the program consists of a 'virtual' patient from whom students are asked to take a medical history. The 'patient' interacts with the student and responds to the style of their questioning by changes in anxiety, or degree of annoyance. To date, the CD-ROM has been evaluated in two stages. The first stage was a predictive formative evaluation by the research/development team, and the second stage was a formative evaluation by 144 dental students of the first full prototype. A third stage, to be conducted next year, will involve measuring the longer term impact of the CD-ROM through the assessment of students' abilities to communicate with patients. The evaluation had two components: students made rates of how useful and easy to use they found the program, and students' attitudes towards interacting with patients were evaluated adopting constructs from the theory of Planned Behaviour. Students were positive about the use of the CD-ROM, though they requested some changes in the functionality of the program. Compared to a sample of students who had not used the CD-ROM, the students who used the CD-ROM felt more positive about communicating with their patients, at the end of the course, and expressed stronger intentions to communicate well with patients.
We conclude that the CD-ROM we have developed in a useful adjunct to learning in dentist–patient communication .