Predicting the experience of dentinal caries or restorative dental treatment in adolescents using D1 and D3 visual caries assessments

Standardised epidemiological caries assessments used in oral health surveys have been shown to be poor at predicting whether a tooth surface will be treated restoratively when a patient visits a dentist. However, it has been argued that oral health surveys may be more relevant in determining needs at the level of an individual or groups of individuals. The objective of this study was to determine the discriminatory power of visual caries assessments at two thresholds (D1 & D3) in adolescents of average age 12.1 years to predict experience of dentinal caries 3 years later or the experience of restorative treatment (not re-treatment) during the 3-year period. The data was derived from a prospective 3-year longitudinal study in which the dental care provided by 41 dentists for 403 adolescents was monitored. Dental caries experience was monitored by annual standardised assessments of caries undertaken by a single trained examiner. ROC analysis showed that caries assessed visually at the D1 threshold in 12-year-olds was a better predictor (P < 0.001) of experiencing some dentinal caries after 3 years (Az = 0.781) than was caries assessed visually at D3 threshold in 12-year-olds (Az = 0.670). Assessing caries visually at either the D1 or the D3 threshold had no discriminatory power for predicting whether an individual would experience some restorative treatment during the ensuing 3-year period (Az for D1 = 0.507; Az for D3 = 0.518).     

A comparison of bleeding and transfusion in patients who undergo coronary artery bypass grafting via sternotomy with and without cardiopulmonary bypass

OBJECTIVE: To determine whether there is a difference between on-pump cardiopulmonary bypass (CABG) and off-pump coronary artery bypass grafting (OPCAB) without heparin reversal with regard to bleeding, transfusion requirements, and incidence of surgical re-exploration of the mediastinum. DESIGN: Retrospective chart review. SETTING: A large academic medical center. PARTICIPANTS: Two hundred adult patients undergoing cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred CABG patients were compared with 100 OPCAB patients. Statistical significance was measured with P values of 相似文献   

Heparin-coated versus uncoated extracorporeal circuit in patients undergoing coronary artery bypass graft surgery

OBJECTIVE: To assess the effect of heparin-coated circuits on bleeding, transfusion, and platelet count in patients undergoing primary coronary artery bypass grafting with full heparinization. DESIGN: Randomized, double-blind study. SETTING: Tertiary-care academic medical center. PARTICIPANTS: Eighty-eight patients undergoing coronary artery bypass grafting requiring cardiopulmonary bypass (CPB) without previous sternotomy. INTERVENTIONS: Subjects received either a heparin-coated or an uncoated extracorporeal circuit for CPB. Heparin, 300 micro/kg, was administered, and supplemental amounts were administered to maintain an activated coagulation time of greater than 480 seconds. Platelet counts were determined during CPB. Mediastinal chest tube drainage was collected in the intensive care unit for 24 hours. MEASUREMENTS AND MAIN RESULTS: The mean platelet counts were similar between the groups during CPB. There was no significant difference in 24-hour mediastinal chest tube drainage (mean +/- standard deviation; median) between the heparin-coated (n = 44, 1096 +/- 401, 1015 mL) and uncoated group (n = 44, 1150 +/- 548, 1040 mL; p = 0.91). The heparin-coated group received less allogeneic packed red blood cells (0.9 +/- 1.6, 0.0 v 1.5 +/- 1.8, 1.0 U; p = 0.04). CONCLUSIONS: The use of a heparin-coated or uncoated cardiopulmonary bypass circuit and full heparinization marginally reduced only red blood cell transfusion but was not associated with platelet sparing or reduced perioperative bleeding.     

The crisis of September 11: the emergency response of Ontario hospitals and other health system partners

The horrific events of September 11, 2001, have caused all individuals and institutions to step back and evaluate their ability to respond to a crisis of previously unimaginable proportions. A media search and incident review of Ontario Ministry of Health and Long-Term Care records confirms that no event in collective memory has had the potential to yield so many hospital patients. This article describes the legislative framework and process by which the ministry either leads or supports an emergency response. Within this context, the authors analyze the early preparations of the ministry and the Ontario hospital system as they readied to accept unknown numbers of patients from the attacks on the World Trade Center in New York City and the Pentagon in Washington, DC. While the focus of the article is on hospitals, the authors also consider the readiness actions taken by the system as a whole, including emergency services, CritiCall and the Ontario Hospital Association. The role of support agencies in helping Ontario's hospitals respond to the crisis is also examined. Whether the preparations undertaken and the commitments made by Ontario's hospitals and other health system partners would have been sufficient remains untested at this time. However, a careful review of emergency response strategies in order to identify any planning gaps is only prudent. This analysis concludes with a discussion of what has been learned and some thoughts on how those lessons can assist the ministry and our hospitals to remain prepared.     

Heterogeneity in Paget disease of the bone

Paget disease of the bone is a common skeletal disorder. Recently, a gene for Paget disease was localized to 18q with subsequent evidence for linkage heterogeneity. We report the identification and clinical characterization of a large pedigree of Paget disease and demonstrate that the Paget disease gene in this pedigree is not linked to the region on 18q, thus confirming linkage heterogeneity.     

An outbreak of food poisoning in a military establishment

Background: An outbreak of food poisoning in a military establishment mess was investigated and remedial measures suggested.