Defining Predoctoral Prosthodontic Curriculum: A Workshop Sponsored by The American College of Prosthodontists and the Prosthodontic Forum

Prosthodontic educators participated in a workshop held at The American College of Prosthodontists annual session in Kansas City, MO, in October 1996. Their goal was to review elements of the predoctoral prosthodontic curriculum to establish a consensus on the levels of expected skill and knowledge. Skill components were designated at the competency and exposure levels, while knowledge components were designated at the understanding and familiarity levels. The workshop recommendations were distributed to American and Canadian dental schools and the communities of interest for comments in January 1997. The workshop recommendations were reviewed and finalized at the American Association of Dental Schools annual meeting in Orlando, FL, in March 1997. The recommendations may be used by dental educators to prioritize curricular elements in relation to limited time dedicated to the prosthodontic curriculum. Outcomes assessment methods will be needed to ensure competency in the new dentist.     

The effect of age on the intravenous sodium glycocholate test

The clearance of an injected dose of sodium glycocholate has been studied in a group of 23 control subjects who had no evidence of liver disease. A significant correlation was found between bile salt clearance and age. No significant difference was found between the bile salt clearance of male and female subjects. Data derived from a simple compartmental model indicated that decreased clearance of bile salt with age was not specifically related to degenerative changes in hepatocellular integrity, hepatic uptake of bile salts or bile flow.     

A randomized, placebo-controlled trial of recombinant human granulocyte colony-stimulating factor administration in newborn infants with presumed sepsis: significant induction of peripheral and bone marrow neutrophilia

Host defenses in the human neonate are limited by immaturity in phagocytic immunity. Such limitations seem to predispose infected newborns to neutropenia from an exhaustion of the neutrophil reserve. Among the critical defects thus far identified in neonatal phagocytic immunity is a specific reduction in the capacity of mononuclear cells to express granulocyte colony-stimulating factor (G-CSF) after stimulation. However, the safety, pharmacokinetics, and biological efficacy of administration of recombinant human (rh)G-CSF to infected human newborns to compensate for this deficiency is unknown. Forty-two newborn infants (26 to 40 weeks of age) with presumed bacterial sepsis within the first 3 days of life were randomized to receive either placebo or varying doses of rhG-CSF (1.0, 5.0 or 10.0 micrograms/kg every 24 hours [36 patients] or 5.0 or 10.0 micrograms/kg every 12 hours [6 patients]) on days 1, 2, and 3. Complete blood counts with differential and platelet counts were obtained at hours 0, 2, 6, 24, 48, 72, and 96. Circulating G-CSF concentrations were determined at hours 0, 2, 6, 12, 14, 16, 18, 24, and 36. Tibial bone marrow aspirates were obtained after 72 hours for quantification of the bone marrow neutrophil storage pool (NSP), neutrophil proliferative pool, granulocyte progenitors, and pluripotent progenitors. Functional activation of neutrophils (C3bi expression) was determined 24 hours after rhG-CSF or placebo administration. Intravenous rhG-CSF was not associated with any recognized acute toxicity. RhG-CSF induced a significant increase in the blood neutrophil concentration 24 hours after the 5 and 10 micrograms/kg doses every 12 and 24 hours and it was sustained as long as 96 hours. A dose-dependent increase in the NSP was seen following rhG-CSF. Neutrophil C3bi expression was significantly increased at 24 hours after 10 micrograms/kg every 24-hour dose of rhG- CSF. The half-life of rhG-CSF was 4.4 +/- 0.4 hours. The rhG-CSF was well tolerated at all gestational ages treated. The rhG-CSF induced a significant increase in the peripheral blood and bone marrow absolute neutrophil concentration and in C3bi expression. Future clinical trials aimed at improving the outcome of overwhelming bacterial sepsis and neutropenia in newborn infants might include the use of rhG-CSF.     

Evaluation of fracture resistance of resins used for provisional restorations

Fracture resistance of provisional restorations is an important concern for the restorative dentist. Fracture resistance of a material is directly related to the transverse strength. This study evaluated the transverse strengths of provisional resins under varied conditions. Uniform samples were made from seven resins and tested immediately after the set of the material, after 7 days of dry storage, and after 7 days of wet storage. The fractured samples from the 7-day wet storage group were repaired with the same provisional material the sample was made from and fractured again to determine transverse strength for repaired samples. Five of the resins tested demonstrated statistically similar strength in the 7-day wet group. Two were found to be significantly weaker. Absorption of water resulted in a slight, but insignificant decrease in strength. Transverse strengths varied widely in the repaired group, and all materials showed a statistically significant reduction compared with the 7-day wet storage group.     

The short-term health outcome of out-patient rheumatology consultations in relation to rationing: a pilot study

The objectives were to test whether the short-term health outcome of rheumatology out-patients differs according to clinical priority. The setting was an NHS regional rheumatology out-patient department serving a catchment population of over 1 million. The subjects were 249 consecutive rheumatology out-patients categorized on the basis of the referral letter as 'urgent' (n = 50), 'soon' (n = 100) or 'routine' (n = 99). Primary outcome measures were the proportion of patients reporting improvement in health categorized by clinical priority (urgent, soon or routine) or main diagnostic group (inflammatory or non- inflammatory disease). Secondary outcome was change in health status measured using the EuroQol generic health instrument (EQ-5D). Small but insignificant differences in the proportion of patients reporting health improvement were found between the urgent (28%), soon (23%) and routine (17%) categories (Kruskal-Wallis, P = 0.186). Thirty per cent of patients with inflammatory joint disease reported improvement compared with 17% of those with non-inflammatory conditions (Mann- Whitney U, P = 0.019). In patients reporting improvement, the median (interquartile range) improvement in EQ-5D health utility score was +0.2 (0.58) (P = 0.0001) and that of visual analogue health score was +5 (16) (P = 0.001). Clinical priority setting, by giving priority to some patients over others, results in rationing by delay. These data do not support the hypothesis that fewer patients given a low clinical priority gain health benefit compared with those given a high priority. However, those with inflammatory joint disease do appear to have better short-term health outcomes.      

Steroid sensitive Acanthamoeba keratitis.

A 44-year-old woman with proven Acanthamoeba keratitis was successfully treated medically with resultant 6/9 vision. During the treatment, repeated attempts to titrate the patient off topical corticosteroids resulted in recurrent flare-up of inflammatory keratitis from which Acanthamoeba could not be recultured. It is suggested that steroid administration during the course of Acanthamoeba keratitis may need to be withdrawn extremely slowly to avoid the recurrence of what appears to be an immunological corneal reaction.