Clinical record keeping by general dental practitioners piloting the Denplan 'Excel' accreditation programme

BACKGROUND: Denplan is a private capitation-based system of providing primary dental care in the UK. An additional programme called Denplan Excel has been developed which requires General Dental Practitioners to instigate various quality processes within their practices in order to become accredited. Clinical record keeping is one area where standards are monitored. This study reports changes in record keeping at patient recall appointments following the implementation of the Denplan Excel programme. METHOD: Fifty dentists participating in the Denplan Excel pilot programme from different areas of the UK were sampled by means of cluster sampling. Twenty records for each dentist were sampled and items recorded for patients recalled both pre- and post-pilot were compared. RESULTS: The majority of dentists recorded presenting complaint, diagnosis and treatment plan both pre- and post-pilot. However, post-pilot there were a number of improvements in record keeping. Caries recorded on a grid increased from 7% of records to 46%, basic periodontal examination increased from 48% to 85% of records and the updating of medical history increased from 51% to 65% of records. These findings were all significant at the p<0.01 level. CONCLUSION: Changes can be achieved by voluntary participation in a system of structured record keeping.     

Resistance to sliding with 3 types of elastomeric modules

INTRODUCTION: Super Slick (TP Orthodontics, LaPorte, Ind), a polymeric-coated ligature, has recently been introduced to the orthodontic market. The manufacturer claims it will significantly reduce friction. The purposes of this study were to determine whether Super Slick modules show lower friction than round and rectangular modules and to put the frictional forces into perspective with a self-ligating bracket. METHODS: Maxillary premolar, stainless steel, self-ligating, and monocrystalline brackets with .022-in slots were used with straight lengths of .018-in and .019 x .025-in stainless steel wires. Buccal segment models were set up with 1 molar band and 2 premolar brackets for each test group: self-ligating brackets with the slide closed, self-ligating brackets with the slide open, and monocrystalline brackets. The latter 2 groups were tested with all 3 types of elastomeric module. Each setup was tested both under dry conditions and after soaking in a water bath for 1 hour. RESULTS: The self-ligating brackets demonstrated virtually zero friction with each combination of wire and environmental condition. When the different bracket and elastomeric module combinations were compared, significant differences were observed. In all but 2 combinations, round modules provided the least resistance to sliding and rectangular modules the greatest, with Super Slick modules in between the 2. The self-ligating bracket provided the least resistance to sliding of all the bracket/ligation combinations and almost entirely eliminated friction under the conditions of this experiment. CONCLUSIONS: Super Slick modules demonstrated greater resistance to sliding than conventional round modules, but not rectangular. Self-ligating brackets provided the least resistance to sliding of all bracket/ligation combinations and were the only method that almost entirely eliminated friction. The .018-in and .019 x .025-in wires exhibited similar friction in the dry state, but, when wet, the .018-in wire produced less friction. Ceramic brackets demonstrated greater resistance to sliding than stainless steel brackets. Lubrication reduced the friction with .018-in wires and increased it for .019 x .025-in wires.     

An investigation into the use of an anaerobic adhesive with two commercially available orthodontic brackets.

OBJECTIVES: The two objectives of this experiment were to determine the surface temperature of enamel following acid etching, rinsing and drying, and to see whether two commercially available orthodontic brackets could be bonded to enamel using an anaerobic adhesive. METHODS: Enamel surface temperature was determined in vivo using a surface temperature probe on a total of 60 patients. Stainless steel orthodontic brackets were bonded to human enamel using an anaerobic adhesive and a control orthodontic adhesive. The enamel was etched prior to bonding either with a solution of 37% o-phosphoric acid or, in the case of the anaerobic adhesive specimens, with a solution of 37% o-phosphoric acid containing copper (II) chloride. After bench curing the specimens were shear bond tested to failure and the load at debond recorded in each case. RESULTS: The bond test results were analyzed using median force to debond (N) and 95% confidence intervals, Kaplan-Meier survival probabilities and log-rank tests. CONCLUSIONS: After etching rinsing and drying the enamel surface temperature ranged from 21.54 to 24.19 degrees C, which is within the range suitable for anaerobic adhesive use. Bond testing to failure demonstrated that bracket base design affected the measured force to debond with both the anaerobic adhesive under test and the control adhesive. In addition, the anaerobic adhesive was affected by the material composition of the bracket base and curing time. After 1h of curing and using the Miniature Twin bracket, the measured force to debond exceeded the 10 min force to debond results of the control adhesive. SIGNIFICANCE: It is possible to bond commercially available orthodontic brackets to teeth using an anaerobic adhesive.     

Strongylophorines: natural product inhibitors of hypoxia-inducible factor-1 transcriptional pathway

Rapidly increasing experimental and clinical data provides evidence for the role of hypoxia inducible factor-1 (HIF-1) as a crucial mediator of tumor survival and progression. In our effort to identify inhibitors of the HIF-1 activation pathway, we screened fractions from marine invertebrates. Fractions from an extract of Petrosia (Strongylophora) strongylata potently inhibited the HIF-1 activation pathway. Strongylophorines 2, 3, and 8 isolated from the active fractions were found to be responsible for the HIF-1 inhibition with EC 50 values of 8, 13, and 6 microM, respectively.     

A structured vocabulary for indexing dietary supplements in databases in the United States

Food composition databases are critical to assess and plan dietary intakes. Dietary supplement databases are also needed because dietary supplements make significant contributions to total nutrient intakes. However, no uniform system exists for classifying dietary supplement products and indexing their ingredients in such databases. Differing approaches to classifying these products make it difficult to retrieve or link information effectively. A consistent approach to classifying information within food composition databases led to the development of LanguaL?, a structured vocabulary. LanguaL? is being adapted as an interface tool for classifying and retrieving product information in dietary supplement databases. This paper outlines proposed changes to the LanguaL? thesaurus for indexing dietary supplement products and ingredients in databases. The choice of 12 of the original 14 LanguaL? facets pertinent to dietary supplements, modifications to their scopes, and applications are described. The 12 chosen facets are: product type; product source; part of source; physical state, shape or form; ingredients; preservation method; packing medium; container or wrapping; contact surface; label claims/consumer group/dietary use; geographic places and regions; and adjunct characteristics of dietary supplements.     

Childhood asthma: can computers aid detection in general practice?

BACKGROUND: Childhood asthma remains underdiagnosed in general practice. Computers with a patient interface have the potential to screen children for asthma in a time-efficient manner. AIM: To develop a concise, validated self-report measure that calculates an 'asthma score' that predicts likelihood of asthma and its severity in childhood. DESIGN OF STUDY: Computerised questionnaire survey in general practitioners' (GPs') waiting rooms, followed by a written questionnaire and either bronchial challenge or skin allergy testing at the regional teaching hospital. SETTING: Children between 18 months and 18 years old accompanied by a parent or guardian in five group practices in Newcastle in New South Wales, Australia. METHOD: The responses from both the computerised questionnaire and the written questionnaire were compared with physician assessment of asthma, based on an existing validated questionnaire and clinical tests. RESULTS: Six items were identified to be independently and significantly associated (at P < 0.05) with the presence of asthma and its severity: parent or self-reported asthma, previous diagnosis, wheeze in the past year, physical activity affected by symptoms, night cough in the past year, and visits to a GP in the past year. From the regression model a linear score was derived that indicates whether a child is likely to have asthma and its likely severity. CONCLUSIONS: The asthma score is a valid indicator of asthma and its severity in children in general practice.