Factors influencing quality of life in breast cancer survivors

Longitudinal data from 195 breast cancer survivors were used to identify factors affecting the level and rate of change in quality of life after completion of treatment. Women were interviewed up to four times at approximately yearly intervals using Kaplan and Bush's Quality of Well Being instrument (QWB). Random coefficient regression analysis was used to model QWB as a function of time since diagnosis and personal characteristics. QWB scores decreased over time and the rate of decline increased with age (p = 0.032). This was similar to declines in women with benign breast biopsies, but overall QWB levels were lower in women with breast cancer. Having a spouse tended to slow the rate of decline in breast cancer survivors (p = 0.004). The presence of comorbidity was associated with significantly lower QWB levels (p = 0.037) but did not affect the rate of change over time. Education, family history of breast cancer, cancer stage and treatment modalities were not significantly related to QWB levels or rates of change. Breast cancer survivors experience a reduction in quality of life that persists for years after treatment and is similar in magnitude to that associated with other health problems.     

AORTIC TRANSECTION

Background : Traumatic aortic transection is uncommon in those trauma patients reaching hospital alive. Methods : The Victorian Major Trauma Study (VMTS) received data from 25 hospitals in Victoria, a State of 4.4 million people, and identified 1874 patients with blunt trauma and Injury Severity Score (ISS) greater than 15 over a 2-year period (1 March 1992–28 February 1993 and 1 May 1994–30 April 1995). The Federal Office of Road Safety (FORS) examined coronial data from 1 January 1992 to 31 December 1992. These studies allowed a retrospective, population-based review of experience with aortic transection. Results : The VMTS identified 19 patients who reached hospital, with signs of life at the scene of the accident, during a 2-year period. Of these, 8 left hospital alive: 4 without disability and 4 with disability related to non-thoracic injury. The annual incidence of aortic transection for the State, based on FORS data, was 13 per 1 000 000, lower than other reported studies. Review of the management of patients in hospital confirmed the usefulness of initial chest X-ray in diagnosis and the high incidence of associated injury. Conclusions : The study raises a number of issues, including the question of direct referral of patients with severe chest injury to hospitals with cardiothoracic facilities, increased use of transoesophageal echocardiography in diagnosis and increased use of immediate laparotomy and thoracotomy in certain patients.     

TRAJECTORIES OF SCHOOL AND COMMUNITY CONNECTEDNESS IN ADOLESCENCE BY GENDER AND DELINQUENT BEHAVIOR

Previous studies suggest that both school and community connectedness among adolescents are associated with prosocial behaviors and positive outcomes. While delinquency is associated with lack of connectedness to school and community, little research has considered how delinquency affects this relationship for adolescents living in impoverished neighborhoods. This study estimated gendered trajectories of school and community connectedness for adolescents in impoverished neighborhoods as a function of their levels of delinquency. Results showed that delinquency was negatively correlated and that age was positively correlated with school connectedness for both genders. In contrast, community connectedness increased with age for boys, but decreased with age for girls. In addition, delinquency was negatively related to community connectedness for boys, but not for girls. These findings suggest that for adolescents in impoverished neighborhoods, gender‐informed interventions to decrease delinquency could have positive effects on school and community connectedness.     

Changing perceptions of the requirements of cavity preparations.

Perceptions of the requirements of cavity preparations have changed over the years. These have had a significant effect on undergraduate teaching at the University of Bristol Dental School, an explanation of which may help general dental practitioners in their quest for information on this important aspect of dental practice. A method is described for teaching undergraduate dental students cavity preparation in caries-free teeth, based upon the position, shape and extent of imaginary carious lesions. Scale diagrams of teeth are used, on which imaginary caries at the amelodentinal junction has been marked. The students are instructed to apply the principles of cavity preparation to equivalent, but caries-free, teeth in the laboratory. 'Outline forms' and other predetermined cavity shapes are not taught. Dental practitioners may find it appropriate to apply similar thinking to cavities they prepare in everyday practice, in an endeavour to avoid the unnecessary removal of tooth tissue that would be better retained.     

Clinical evaluation of resin-bonded gold alloy veneers

STATEMENT OF PROBLEM: Clinical performance of resin-bonded alumina-abraded type III cast gold alloy veneers has not been reported. PURPOSE: This retrospective study evaluated the survival of such restorations for the management of tooth wear and other restorative problems. MATERIAL AND METHOD: This clinical study evaluated 25 patients between 14 and 60 years of age treated with a total of 158 cast gold veneers cemented with Panavia Ex cement. Restorations placed between January 1990 and February 1996 (mean age 48 months) were evaluated. Factors, including age, gender, operator, site, design, the extent of dentin exposure, the presence of previous restorations, dynamic and static occlusion, rubber dam, cause, and methods of interocclusal space creation, were evaluated with Cox regression. Survival probability was evaluated with Kaplan-Meier analyses. Significance was taken as P <.05. RESULTS: Failures occurred for 7.6% of restorations in 28% of patients. Alumina-abraded gold alloys cemented with Panavia Ex cement had an estimated 89% survival probability at 60 months using Kaplan-Meier analyses. The only variable to statistically influence survival was operator (P <.0001). Operator differences were due to a single operator who placed only 2 restorations in the same patient, both of which failed unusually quickly. CONCLUSION: Resin-bonded alumina-abraded type III cast gold alloys can be successfully used to restore both anterior and posterior teeth and were associated with an estimated 89% survival probability at 60 months.     

OC10Topical pimecrolimus for the treatment of erosive oral lichen planus

Introduction A wide variety of topical and systemic therapies are proposed for the treatment of symptomatic erosive or ulcerative oral lichen planus (OLP). The calcineurin inhibitor tacrolimus has been shown to be an effective means of treating OLP recalcitrant to other therapies. More recently, pimecrolimus has also been suggested to be of benefit in the treatment of such disease. Case Summary A 50‐year‐old male with a 7‐year history of histopathologically proven erosive OLP had been treated with a wide variety of topical and systemic therapies, including tacrolimus ointment. Despite this his condition remained problematic with frequent episodes of severe erosive disease predominantly affecting the buccal mucosa bilaterally. Clinical examination revealed extensive intra‐oral erosive disease, particularly affecting the right buccal mucosa. Twice daily topical application of 1% pimecrolimus ointment (Elidel®) was instituted. This resulted in resolution of his symptoms and a significant improvement in the clinical appearance of his oral lesions within a 2‐month period. Conclusion Topical pimecrolimus may be an effective therapy for symptomatic erosive or ulcerative OLP recalcitrant to other topical and systemic therapies, including topical tacrolimus. There is a need for appropriate studies to establish the efficacy of pimecrolimus for the treatment of OLP and to ascertain whether topical calcineurin inhibitors increase the malignant potential of OLP.     

Paracetamol for pain relief after surgical removal of lower wisdom teeth.

Background: Paracetamol has been commonly used for the relief of postoperative pain following oral surgery. In this review we investigated the optimal dose of paracetamol and the optimal time for drug administration to provide pain relief, taking into account the side effects of different doses of the drug. This will inform dentists and their patients of the best strategy for pain relief after the surgical removal of wisdom teeth. Objectives: To assess the beneficial and harmful effects of paracetamol for pain relief after surgical removal of lower wisdom teeth, compared to placebo, at different doses and administered postoperatively. Search strategy: We searched the Cochrane Oral Health Group's Trials Register; the Cochrane Pain, Palliative and Supportive Care Group's Trials Register; CENTRAL; MEDLINE; EMBASE and the Current Controlled Trials Register. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomized controlled trials (RCTs), to manufacturers of analgesic pharmaceuticals, we searched personal references in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 24th August 2006. Selection criteria: Randomized, parallel group, placebo controlled, double blind clinical trials of paracetamol for acute pain, following third molar surgery. Data collection and analysis: All trials identified were scanned independently and in duplicate by two review authors, any disagreements were resolved by discussion, or if necessary a third review author was consulted. The proportion of patients with at least 50% pain relief was calculated for both paracetamol and placebo. The number of patients experiencing adverse events, and/or the total number of adverse events reported were analysed. Main results: Twenty-one trials met the inclusion criteria. A total of 2048 patients were initially enrolled in the trials (1148 received paracetamol, and 892 the placebo) and of these 1968 (96%) were included in the meta-analysis (1133 received paracetamol, and 835 the placebo). Paracetamol provided a statistically significant benefit when compared with placebo for pain relief and pain intensity at both 4 and 6 hours. Most studies were found to have moderate risk of bias, with poorly reported allocation concealment being the main problem. Risk ratio values for pain relief at 4 hours 2.85 (95% confidence interval (CI) 1.89 to 4.29), and at 6 hours 3.32 (95% CI 1.88 to 5.87). A statistically significant benefit was also found between up to 1000 mg and 1000 mg doses, the higher the dose giving greater benefit for each measure at both time points. There was no statistically significant difference between the number of patients who reported adverse events, overall this being 19% in the paracetamol group and 16% in the placebo group. Authors' conclusions: Paracetamol is a safe, effective drug for the treatment of postoperative pain following the surgical removal of lower wisdom teeth.