Minimizing risk of bias in clinical implant research study design

The field of clinical implant research has been flourishing in recent years. The number of related publications has been on the rise, as has the number of dental journals. However, the information gathered from surveillance studies on the quality of reporting and methodologic quality of published studies is unsettling. An important challenge faced by researchers endeavoring to conduct implant studies is how to factor the differences between implant surfaces and dental surfaces in the study design. Given the considerable experience that has been gained in the research methodology of the study of teeth and periodontal tissues, clinical implant research studies have often been conducted without giving much consideration to the fundamental differences between implants and teeth. This article discusses study design related to implant research in view of these differences. Observational and interventional study design methodology is discussed, and guidelines are provided to inform researchers on how to minimize bias in the design and implementation of these clinical studies when implant‐related outcomes are studied.     

Fixation of complex proximal humeral fractures in elderly patients with a locking plate: A retrospective analysis of radiographic and clinical outcome and complications

Purpose: The optimal surgical treatment of displaced type B and C fractures of the proximal humerus in the elderly remains controversial. Good clinical results have been reported by plating these fractures as well as a high rate of complications. Our retrospective study aims to evaluate clinical recovery and complications using the S3 locking plate in elderly patients. Methods: Fifty-one patients older than 65 years of age, with a complex proximal humeral fracture type B or C (AO classification system), were included. Patients have been followed up for a minimum of 12 months. We assessed callus formation, radiological results, clinical outcome (according to the Constant Shoulder Score System) and complications. Any difference in the clinical recovery among the 2 types of fracture pattern (B and C) was investigated. Results: The mean time of fracture healing was 12.4 weeks. The mean Constant score at 3, 6 and 12 months was 68, 73 and 75 respectively. No statistically significant difference in the clinical outcome was observed between the B and C fracture patterns (p > 0.05). We noticed an overall of 5 complications (9.8%). There was no need to revision any of the implants. Conclusion: Anatomic reduction and proper plate positioning are essential for minimizing implantrelated complications. In our experience the S3 angular stability system offers a proper osteosyntesis and a good clinical recovery with a low rate of complications.     

Use of Structured Clinical Documentation to Identify Patients’ Parental Concerns and Their Childrens’ Wellbeing

Children of parents with mental illness are at high risk of adverse health and functional outcomes, but little is known about how the community mental health staff identify and document these. This file audit examines parents’ case managers’ recording of children’s needs and safety, on relevant components of New South Wales’ Mental Health Structured Clinical Documentation. The audit identified 280 parental files. Study findings indicate that parenting issues form an important load of work on community mental health teams, highlighting the need for systematic identification of parental status in mental health patients.     

Coronary Artery Perforation following PCI: An Interesting Finding into the Pericardial Space

Coronary artery perforation is a known complication of percutaneous coronary intervention and potentially life threatening. Normally, these perforations are small and localized. We report the successful surgical management of a coronary artery perforation following stent insertion with extrusion of an 8-cm endarterectomy length of the circumflex coronary artery with a brief review of the recent literature.     

Assessment of simulated internal resorption cavities using digital and digital subtraction radiography: a comparative study

Abstract – Aim: To compare the diagnostic accuracy of digital radiography with that of digital subtraction radiography in the detection of simulated internal resorption cavities. Materials and Methods: Simulated internal resorption cavities of varying sizes were created using round burs in 18 single‐rooted teeth with visible pulp chamber, which had been extracted from dentate dry mandibles and split into two halves in a mesio‐distal direction. Resorption cavities were created in the buccal half of the root in the cervical, middle, and apical third. Digital radiographs were taken from three different horizontal view angles before and after the creation of the cavities. This process was followed by digital subtraction radiography to evaluate their detection. Seven experienced observers and all specialists in endodontics were asked to examine the digital and digital subtraction images for the presence of the cavities. The data were analyzed using SPSS 14. Results: The overall sensitivity of digital subtraction radiography was superior to digital radiography and with statistically better results for all cavities regardless of their location (cervical, middle, apical third) (P < 0.05). The detection of the cavities was affected by the root third in which they were located. Cavities in the apical third were more easily detected compared with those in the middle or cervical third of the root. Small‐sized lesions (0.5 mm, 0.6 mm) in the middle and apical third were more frequent and more easily detected using subtraction imaging. Conclusion: Digital subtraction radiography is superior to digital radiography for the detection and monitoring of the progress of internal root resorption.     

Ileal Neobladder and Its Variants

Orthotopic neobladder substitution represents an important step in the evolution of urinary diversion. It is now considered the diversion of choice for the majority of patients, both male and female, who undergo cystectomy and is the procedure with which other types of diversion must be compared. Nevertheless, in the preoperative setting, all options for urinary diversion should be explained comprehensibly to the patient, along with the potential short- and long-term risks and the beneficial effects of each type of diversion. With regard to the risk of urethral recurrence, the decision to perform a neobladder ultimately depends on the intraoperative frozen section analysis of the distal urethral margin.Neobladder construction is based on the concept of detubularization and folding to construct a low-pressure reservoir. All parts of the small and large intestine as well as the stomach have been intensely studied for the construction of neobladders. In this respect, there is substantial agreement in the literature that the terminal ileum possesses superior anatomic and functional characteristics.Given the lack of prospective randomized trials, controversies still exist with regard to the technique for preventing reflux in orthotopic substitutes and the superiority of one neobladder technique over others, provided the detubularized intestinal segment is reconfigured to an adequate-sized spherical reservoir.