A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627]

Background  

A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples.     

Randomized clinical trials in perinatology in Latin America.

Latin America needs means to obtain accurate figures about its health conditions in order to apply its resources to priority areas. In addition, health actions must be carefully evaluated to assess their impact, operation and costs. The randomized clinical trial (RCT) is the only design able to show the effectiveness of interventions of moderate effect. Also, it gives appropriate information about the expected effect of the interventions and implies an expediate implementation of interventions in the same places where the project has been performed. In a review of RCTs performed in Latin America on perinatal medicine it can be concluded that some of the focus of research is irrelevant to the region and there is not an orientation towards the cooperative solution of predominant problems in the area. It is imperative for researchers, in Latin America to initiate joint activities in order to assess which are the research priorities of the area, to focus their research on these priorities and to join their efforts in collaborative studies.     

Comparison of different bioglass applications on root caries – A laboratory-based study

The aim of this in-vitro study was to assess the effect of bioglass with different concentrations on root caries.Ninety freshly-extracted teeth with root caries were randomly assigned to a single-use prophylaxis paste containing 15 % bioglass for 30 s with 1,450 ppmF toothpaste (15 % bioglass, n = 30), 1,450 ppmF toothpaste with 5 % bioglass (5 % bioglass, n = 30), and toothpaste containing 1,450 ppmF (Control, n = 30). Each sample received a standard brushing procedure for 10 s twice a day using the toothpastes. Teeth were immersed in remineralising solution with pH of 7 at 37 °C for 720 h. Surface roughness (Ra) was measured at baseline and after the application of the products at 0.5, 1, 4, 12, 24, 48, 168, 336 and 720 h. Subsequently, three samples from each group were randomly selected to measure calcium ion release over 15 h immersion in deionised water. These samples were then analysed using the SEM for the qualitative assessment of lesion topography. Repeated measures ANOVA, Wilcoxon paired tests and percentage changes were carried out to assess Ra. Calcium ion release data was analysed using one-way ANOVA and Tukey post-hoc tests.After 720 h, 15 % bioglass had the highest decrease in Ra (Mean-difference = 1.502 µm, p = 0.001), then 5 % bioglass (Mean-difference = 0.723 µm, p = 0.09) whereas the control had the lowest Ra decrease (Mean-difference = 0.518 µm, p = 0.55). The differences in Ra between the groups were highly significant (p < 0.001). The cumulative calcium ion release was significantly high for the 5 % bioglass in comparison to the 15 % bioglass, whilst the control had the lowest release (p < 0.001). SEM analysis showed the presence of bioglass particles only on 15 % bioglass samples.The use of prophylaxis paste with 15 % bioglass and 1,450 ppmF toothpaste was promising to reverse/arrest root caries when compared to the toothpaste containing 1,450 ppmF with 5 % bioglass for a period of 30 days.