Stability of practice beliefs and preferences for patients among private general dentists: a comparison of 1997 and 2007

Background:  Practice beliefs and dentist preferences for patients have been related to service rates and appropriateness of care. If practice beliefs and preferences for patients are stable then they could restrain long-term changes in practice styles and service rates. The aim of this paper was to assess the stability of practice beliefs and preferences for patients between 1997 and 2007.
Methods:  Practice beliefs and dentist preferences for patients were recorded on a five-point Likert scale using mailed questionnaires from a random sample of dentists in 1997 (response rate = 60 per cent) and 2007 (response rate = 77 per cent).
Results:  In both 1997 and 2007, n = 215 dentists provided data. For practice beliefs, 1 out of 8 items were significantly different (p < 0.05; McNemar's test) between the two observations (12.5 per cent of practice belief items) while 5 out of 37 dentist preferences for patient characteristics items were significantly different (13.5 per cent of items).
Conclusions:  The majority of items were not significantly different over time. This demonstrates a generally high degree of stability over time in the level of agreement with dentist practice beliefs and preferences for patients. Given that it may be difficult for clinicians to change practice beliefs and behaviours that have become established, it is important for policy makers to understand the relationship between provider characteristics and service patterns and for educators to positively shape beliefs and behaviours through undergraduate and continuing education.     

Aligning research to meet policy objectives for migrant families: an example from Canada

Background  

'Evidence-based policy making' for immigrants is a complicated undertaking. In striving toward this goal, federal Canadian partners created the Metropolis Project in 1995 to optimize a two-way transfer of knowledge (researchers – policy makers) within five Canadian Centres of Excellence focused on migrants newly arrived in Canada. Most recently, Metropolis federal partners, including the Public Health Agency of Canada, defined one of six research priority areas as, immigrant 'families, children, and youth'. In order to build on previous work in the partnership, we sought to determine what has been studied within this research-policy partnership about immigrant 'families, children, and youth' since its inception.     

Low-dose tryptophan depletion in recovered depressed women induces impairments in autobiographical memory specificity

Background  

Depressed patients perform poorly on tests of autobiographical memory specificity (AMS); this may have negative consequences for other important cognitive abilities, delays recovery from mood episodes, and, in recovered patients, may mediate vulnerability to future episodes. Although the cognitive mechanisms underlying AMS deficits are beginning to be understood, the neurobiological mechanisms remain unclear. Serotonin is implicated in both depression and long-term memory; therefore, temporary lowering of brain serotonin function via acute tryptophan depletion (ATD) offers a means of studying the role of serotonin in autobiographical memory specificity.     

Identification Of Two New Pmp22 Mouse Mutants Using Large-Scale Mutagenesis And A Novel Rapid Mapping Strategy

In some alcohol-related pathologies of chronic alcoholism women are more vulnerable than men. A consecutive sample of 62 chronic alcoholics was studied, 18 females and 44 males, aged between 28 and 69 years to assess the incidence and distribution of peripheral neuropathy with regard to gender. All patients underwent clinical and neurological observations, laboratory tests, and electroneurography. Total lifetime dose of ethanol (TLDE) and other risk factors for neuropathy (disease duration, age, nutritional status) were calculated and correlated to sural nerve sensory-evoked potential (SEP) amplitude. In 42 patients (67.7%), we observed the presence of clinical and/or infraclinical neuropathy, mostly axonal, in 29 males (65.9%) and 13 females (72.2%). In women, compared to men, TLDE and disease duration were significantly inversely correlated to sural nerve SEP amplitude, i.e in women, SEP amplitude is significantly reduced in relation to TLDE and disease duration increase. These data indicate a higher sensitivity of females towards the toxic effects of ethanol, other than malnutrition, on peripheral nerve fibres.     

AN UNUSUAL CASE OF LEFT PARADUODENAL HERNIA

Paraduodenal hernias are the commonest form of intra-abdominal hernia. We report on a rare paraduodenal hernia involving the duodenojejunal recess.     

Return to sport following scaphoid fractures:A systematic review and meta-analysis

BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies reported on Percutaneous Screw Fixation [RRS 97%(32/33); RTS 6.5 wk], and five studies reported on Open Reduction Internal Fixation [RRS 98%(49/50); RTS 7.9 wk]. Six studies recorded fracture union data: Union rate 97%(69/71); mean time to union9.8 wk. On meta-analysis, RRS(RR = 1.09; 95% confidence interval(CI): 1.00-1.18;P 0.045), RTS(MD 2.3 wk; 95%CI: 0.79-3.87; P 0.002), union rates(RR = 1.14;95%CI: 1.01-1.28; P 0.030) and mean times to union(MD 4.2 wk; 95%CI: 3.94-4.36; P 0.001) were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments,however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union.     

Childhood epilepsy with a small number of seizures may be left untreated: an international prospective study

Aims. It is unknown whether treatment with antiepileptic drugs in children with epilepsy with a presumed good prognosis is always necessary. We aimed to study the course of newly diagnosed epilepsy in children with a presumed good prognosis who are managed without AED treatment. Methods. A total of 151 children (one month to 12 years of age) with two to five lifetime unprovoked seizures (excluding febrile convulsions), were followed for three years. Treatment was initially withheld. Children with symptomatic epilepsy, or absence or myoclonic epilepsy, were excluded. AED treatment was started after >10 lifetime seizures or an episode of status epilepticus during follow‐up, or if the parents or treating physician deemed it otherwise necessary. Results. During follow‐up, 113 children continued to meet our criteria for refraining from treatment with antiepileptic drugs, yet 30 started treatment at the request of the parents. Thirty‐eight children at some time met the criteria to start treatment, but the parents of 16 declined treatment. In all, 99 (66%) children maintained the no‐treatment regime. Ninety‐eight children (65% of 151) reached terminal remission for at least one year, including 83 who did not receive antiepileptic drug treatment (84% of the untreated 99). Mean terminal remission was significantly longer in the group with a total of <10 seizures compared to those with >10 seizures. Treatment did not increase the length of terminal remission. Adverse events, including traumatic injury, occurred equally in the treated and untreated children. Measures of quality of life suggested a better outcome in those without treatment. Conclusions. Children with newly diagnosed epilepsy with a presumed good prognosis may not need immediate AED treatment. Postponing treatment does not alter the chance of remission or the risk of accidents and adverse events and appears to be associated with a good quality of life.