Did a Goals-of-Care Discussion Happen? Differences in the Occurrence of Goals-of-Care Discussions as Reported by Patients,Clinicians, and in the Electronic Health Record

Context

Goals-of-care discussions are associated with improved end-of-life care for patients and therefore may be used as a process measure in quality improvement, research, and reimbursement programs.

Diagnosis of alveolar bone changes with digital subtraction images and conventional radiographs. An in vitro study

The purpose of the present study was to compare the diagnostic properties of radiographs obtained with Ultra-Speed and Ektaspeed films when analyzed conventionally radiographs and after conversion in digital subtraction images. Artificial lesions, measuring 0.5, 0.7, 0.9, and 1.1 mm in diameter, were drilled in a dry skull with slow-speed burs. Standardized radiographs were obtained by means of acrylic bite blocks and a modification of the Rinn system. The results of this study demonstrated that sensitivity in the detection of the lesions was doubled after digitizing and displaying subtraction images compared with the conventional radiographic interpretation, independent of the use of Ektaspeed or Ultra-Speed films for the original radiographs. The diagnostic information seemed to be equal in radiographs obtained from Ultra-Speed and Ektaspeed films after digitization and image processing procedures.     

Linear evaluation of the development of sagittal jaw relationship

In cephalometrics both angular and linear variables have been proposed in the analysis of sagittal jaw relationship and jaw position. Angular measurements can be erroneous as a result of changes in facial height, jaw inclination, and total jaw prognathism; linear variables can be affected by the inclination of the reference line. In the present article, a method of geometric correction of linear analysis of sagittal jaw relationship and jaw prognathism (based on a standardized occlusal plane) is described. The method is applied to radiographic material (from King's College Hospital, London) of 33 children who, at the age of 19, exhibited Class I occlusal patterns. While uncorrected linear measurement suggested stability of the sagittal jaw relationship from the age of 11 to 19 years, the geometrically corrected value demonstrated a marked reduction in sagittal jaw relationship. The method is developed further to demonstrate the increase in jaw prognathism measured as lined parameters with origin at point sella, the results illustrating again the advisability of correction of geometric errors.     

Clinical short term study of marginal integrity of resin restorations

The marginal adaptation of 649 Durafill and Silux fillings in beveled and acid etched enamel cavities was assessed in a clinical study. The investigation included Class III with and without lingual extension, Class IV and Class V. The frequency of marginal discoloration and marginal gaps after 15 months was markedly reduced in all Classes when a low-viscous resin was used prior to application of the restorative.     

The fate of impacted lower third molars after the age of 20. A four-year clinical follow-up

Seventy dental students (mean age: 20 years) with 130 asymptomatic, non-ectopic, impacted mandibular 3rd molars were followed for 4 years. At the initial visit 26 were impacted in soft tissue, 30 were partially impacted in bone, and 74 were completely impacted in bone. The following items were registered at each visit: regional pocket depths, signs and symptoms of pathology, degree of impaction, presence of upper 3rd molar. No signs or symptoms of pathology were observed in any of the subjects at the 2 visits. The 4-year visit revealed that 49 3rd molars had been removed, the reason being pericoronitis or caries in 30%, mild symptoms in 39% and for prophylactic reasons in 31%. Of the remaining 81 3rd molars: 71% of the soft tissue impactions, 25% of partial bony impactions, and 8% of complete bony impactions showed complete and normal eruption. The remaining 3rd molars were either static or had advanced in the degree of eruption. It is concluded that non-ectopic, impacted 3rd molars in the given age group may have a chance to completely erupt. The treatment for asymptomatic impacted 3rd molars in young adults, therefore, might be observation instead of prophylactic removal.     

Unresectable primary tumor of head and neck: does neck dissection combined with chemoradiotherapy improve survival?

A study regarding patients with primary and previously untreated advanced histologically proven squamous cell carcinoma of the head and neck was performed to compare two treatment modalities: neck dissection followed by chemoradiotherapy (Group I) versus chemoradiotherapy alone (Group II). Fifty-four patients were randomly chosen to receive Group I or II treatment. Our results demonstrate that Group I treatment has a higher and statistically significant disease-specific survival rate. We suggest that an association of neck dissection plus chemoradiotherapy can be useful in the event of unresectable advanced carcinomas.     

Monitoring of intraoral free flaps with microdialysis

Because of the confined nature of their position, monitoring intraoral free flaps is a challenge, but it is essential to detect vascular complications in time to ensure the possibility of salvaging the flap. Microdialysis has been the standard technique of choice at the Department of Plastic Surgery, Aarhus University Hospital, since September 1998. In this study we present our experience of monitoring 78 intraoral free flaps. It is a retrospective evaluation of patients’ casenotes from November 1998 to March 2008. Sixty-five of the 78 flaps healed without complications. Sixty-one of these showed no sign of ischaemia in the microdialysis values; in 4 cases the microdialysis system caused technical problems. Thirteen patients were reoperated on based on the results of microdialysis analysis, and in all but 2 cases critical ischaemia was found. Ten of the 11 critically ischaemic flaps were saved. The overall loss rate of flaps was 1.3%. The 2 flaps that were reoperated on but no critical ischaemia found were 2 fibular flaps during the time that we were learning how to monitor with microdialysis (1999 and 2000). Since then we have developed a decision algorithm for standard monitoring, and since 2000 we have had no false positive results. We have never lost a flap from neglected ischaemia. Our results show that microdialysis is a safe and reliable technique for postoperative monitoring of intraoral free flaps.