Consortium for oral health-related informatics: improving dental research, education, and treatment

Advances in informatics, particularly the implementation of electronic health records (EHR), in dentistry have facilitated the exchange of information. The majority of dental schools in North America use the same EHR system, providing an unprecedented opportunity to integrate these data into a repository that can be used for oral health education and research. In 2007, fourteen dental schools formed the Consortium for Oral Health-Related Informatics (COHRI). Since its inception, COHRI has established structural and operational processes, governance and bylaws, and a number of work groups organized in two divisions: one focused on research (data standardization, integration, and analysis), and one focused on education (performance evaluations, virtual standardized patients, and objective structured clinical examinations). To date, COHRI (which now includes twenty dental schools) has been successful in developing a data repository, pilot-testing data integration, and sharing EHR enhancements among the group. This consortium has collaborated on standardizing medical and dental histories, developing diagnostic terminology, and promoting the utilization of informatics in dental education. The consortium is in the process of assembling the largest oral health database ever created. This will be an invaluable resource for research and provide a foundation for evidence-based dentistry for years to come.     

A Cochrane review of patient education for neck pain

Background contextNeck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear.PurposeTo assess whether patient education strategies are of benefit for pain, function/disability, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with or without radiculopathy.Study designCochrane systematic review.MethodsComputerized bibliographic databases were searched from their start to May 31, 2008. Eligible studies were randomized trials investigating the effectiveness of patient education strategies for neck pain. Paired independent reviewers carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences were calculated. Because of differences in intervention type or disorder, no studies were considered appropriate to pool.ResultsOf the 10 selected trials, two (20%) were rated as of high quality. Patient education was assessed as follows: 1) eight trials of advice focusing on activation compared with no treatment, or to various active treatments, including therapeutic exercise, manual therapy, and cognitive behavioral therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods, acuity and disorder types. When compared with rest, two trials that assessed acute whiplash-associated disorder showed moderate evidence of no difference for advice focusing on activation; 2) two trials studying advice focusing on pain and stress coping skills found moderate evidence of no benefit for chronic neck pain at intermediate- to long-term follow-up; and 3) one trial compared the effects of neck school to no treatment, yielding limited evidence of no benefit for pain, at intermediate-term follow-up in mixed acute/subacute/chronic neck pain.ConclusionsThis review has not shown effectiveness for educational interventions for neck pain of various acuity stages and disorder types and at various follow-up periods, including advice to activate, advice on stress coping skills, and neck school. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of specific educational components.     

Quantification of brain maturation and growth patterns in C57BL/6J mice via computational neuroanatomy of diffusion tensor images

Diffusion Tensor magnetic resonance imaging and computational neuroanatomy are used to quantify postnatal developmental patterns of C57BL/6J mouse brain. Changes in neuronal organization and myelination occurring as the brain matures into adulthood are examined, and a normative baseline is developed, against which transgenic mice may be compared in genotype-phenotype studies. In early postnatal days, gray matter-based cortical and hippocampal structures exhibit high water diffusion anisotropy, presumably reflecting the radial neuronal organization. Anisotropy drops rapidly within a week, indicating that the underlying brain tissue becomes more isotropic in orientation, possibly due to formation of a complex randomly intertwined web of dendrites. Gradual white matter anisotropy increase implies progressively more organized axonal pathways, likely reflecting the myelination of axons forming tightly packed fiber bundles. In contrast to the spatially complex pattern of tissue maturation, volumetric growth is somewhat uniform, with the cortex and the cerebellum exhibiting slightly more pronounced growth. Temporally, structural growth rates demonstrate an initial rapid volumetric increase in most structures, gradually tapering off to a steady state by about 20 days. Fiber maturation reaches steady state in about 10 days for the cortex, to 30-40 days for the corpus callosum, the hippocampus, and the internal and external capsules.     

The Evolutionary History and Tissue Mapping of Amino Acid Transporters Belonging to Solute Carrier Families SLC32, SLC36, and SLC38

Members of the solute carrier families (SLC) 32, 36, and 38, together also designated the β-group of SLCs, are known to transport neutral amino acids. In this paper, we show that these three families were present before the split of the animal lineage and that they are likely to share a common decent. We also show that the APF transporters found in plants are most likely homologous to the mammalian β-group, suggesting that this type of transporters arouse early in the evolution of eukaryotes. We performed detailed tissue expression analysis of all the members of the β-group in rat and found several examples of highly specific expression patterns, with SLC38A7 being exclusively found in liver, SLC38A5 in blood, and SLC38A4 in muscle and liver. Moreover, we found that SLC38A10 is expressed in several endocrine organs. We also found that SLC38A1 is highly up regulated in the cortex from rats treated with diazepam and that SLC38A2 is significantly down regulated in the same tissue. In addition, we performed a detailed expression analysis of SLC38A1 and SLC38A6 in mouse brain using in situ hybridization, which showed that both these transporters are widely expressed in the brain. Electronic Supplementary Material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is an acute-onset, monophasic, immune-mediated polyneuropathy that often follows an antecedent infection. The diagnosis relies heavily on the clinical impression obtained from the history and examination, although cerebrospinal fluid analysis and electrodiagnostic testing usually provide evidence supportive of the diagnosis. The clinician must also be familiar with mimics and variants to promptly and efficiently reach an accurate diagnosis. Intravenous immunoglobulin and plasma exchange are efficacious treatments. Supportive care during and following hospitalization is also crucial.     

Southampton needle sensation questionnaire: development and validation of a measure to gauge acupuncture needle sensation

OBJECTIVE: The specific sensations (deqi) generated during acupuncture are thought to be important for a positive clinical outcome, particularly when treating pain. It is important to be able to measure these sensations and discriminate between deqi and pain. A greater understanding of this will greatly aid researchers who wish to conduct mechanistic studies of acupuncture. Previous questionnaire designs failed to consider patient experience and, hence, may have been flawed. The aim of this study was to generate and validate a new sensation questionnaire, that was able to discriminate between pain and deqi, taking into account patient experience and expert opinions. DESIGN: The questionnaire was designed following qualitative interviews with patients, literature review, and consultation with experts. The questionnaire was piloted and then validated. It was successfully completed by 227 patients and analyzed using factor analysis and partial correlation. SETTING: Patients were recruited via the physical therapy department at Southampton General Hospital and from private practice clinics in and around the Southampton area. SUBJECTS: The subjects were patients receiving acupuncture for any condition. RESULTS: Two (2) factors were clearly demonstrated: "Aching deqi" (7 items) which suggested deqi with pain and "Tingling deqi" (7 items) suggesting deqi only. One (1) item related solely to pain and 2 further items did not load into any factor. CONCLUSIONS: The final questionnaire is presented containing 17 items and is shown to be a valid, rigorous, soundly grounded, and patient-centered measure, capable of accurately recording deqi. We suggest that analysis should include a partial correlation of certain sensations against a pain visual analogue scale to ascertain how painful each sensation was, particularly if the questionnaire is to be used in a context in which pain and deqi need to be separated or their relationship clarified.     

Vasculitic neuropathies

The classification of vasculitis and the clinical features of vasculitic neuropathy are reviewed. Vasculitic neuropathy usually presents with painful mononeuropathies or an asymmetric polyneuropathy of acute or subacute onset. Neurologists should categorize vasculitic neuropathy in terms of clinical features (eg, systemic or non systemic) and in terms of histopathology (eg, nerve large arteriole vasculitis or nerve microvasculitis). Systemic vasculitis should be classified further into one of the primary and secondary forms. Steroids and cytotoxic agents have been the mainstay of therapy for most forms of vasculitic neuropathy. Dosing, potential side effects, and management recommendations of conventional therapies are provided.