Early childhood caries screening tools: a comparison of four approaches

BackgroundEarly childhood caries (ECC) is prevalent and consequential. Risk assessment tools have been proposed that can be used to identify children who require intensive interventions. In this study, the authors compare four approaches for identifying children needing early and intensive intervention to prevent or minimize caries experience for their accuracy and clinical usefulness.MethodsThe authors screened 229 predominantly low-income Hispanic children younger than 3 years with ECC and 242 without ECC by using the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT) and the optional screening measure of culturing Streptococcus mutans. The authors compared four approaches (CAT, CAT minus socioeconomic status, CAT minus socioeconomic status plus mutans streptococci [MS] and MS alone) for accuracy and clinical usefulness.ResultsThe results of the CAT demonstrated high sensitivity (100.0 percent) and negative predictive value (NPV) (100.0 percent) but low specificity (2.9 percent) and positive predictive value (PPV) (49.4 percent). The MS culture alone had the highest combination of accuracy and clinical usefulness (sensitivity, 86.5 percent; specificity, 93.4 percent; PPV, 92.5 percent; NPV, 87.9 percent). When we removed the socioeconomic status element, the CAT's performance improved.ConclusionsSalivary culture of MS alone in a population of young, low-income Hispanic childrenoutperformed the CAT and variations on the CAT for test accuracy (sensitivity and specificity) and clinical usefulness (predictive values).Clinical ImplicationsScreening for ECC by using salivary MS cultures and variations on the CAT are promising approaches for identifying children who need early and intensive intervention to prevent or minimize caries experience.     

The use of oral sedatives in dental care

Oral administration of tranquillizing and anxiety-suppressing drugs has long been the commonest method of achieving light sedation. The benzodiazepines are the drugs of first choice. Benzodiazepines given orally may be indicated to avoid 'treatment stress', alleviate mild anxiety before dental treatment, and facilitate sleep on the night before the treatment. Furthermore, they could be used for the dental treatment of medically poor risk patients, particularly those with cardiovascular disease. The drug can be given either in a fractionated dose or a single dose. The recommended doses for diazepam vary from 0.1–0.8 mg/kg body weight, depending on age, with higher doses in children and lower doses in elderly patients. Few side effects are reported.     

针灸治疗颈椎病系统评价/Meta分析文献质量多元评价研究

目的:基于雷达图多元评价原理,全面评估针灸治疗颈椎病系统评价/Meta分析的文献质量,为临床决策提供直观的图示法证据参考。方法:电子检索国内外多个大型文献数据库,并辅以手工检索。收集合格的文献。从发表年份、设计类型、AMSTAR方法学质量评分、PRISMA发表质量评分、同质性程度、发表偏倚风险6个方面多元评价文献质量。采用Excel 2003将各项目秩数绘制成雷达图,进行直观分析。结果:共纳入8篇合格文献,质量的秩平均得分为3.83-7.67。其中3项研究质量较高,1项研究质量缺陷明显。文献质量加强的环节体现在检索范围、检索策略、纳入排除标准、资料选择偏倚、数据合并的条件和显示等方面。结论:本研究运用雷达图的直观、简单明了的特性,多元化评价同类干预措施的文献质量,为今后针灸临床实践者科学选择证据信息提供了一项图形化评价思路和方法。     

某医院血液科24种抗肿瘤药超说明书用药评价

目的 回顾性调查某院血液科抗肿瘤药物超说明书用药现状并进行循证医学评价,为制定超说明书用药政策提供基线数据,为临床超说明书用药提供合理用药依据。方法 收集昆明医科大学第二附属医院血液科2019年7—12月出院病人的病历资料,依据药品说明书,判断其抗肿瘤药用药医嘱是否超说明书,通过Micromedex的Thomson分级系统对超说明书用药进行评价,Micromedex数据库检索不到的,临床药师进一步查询证据后进行Thomson分级评价。结果 2019年7—12月该院血液科共有24种药品存在超说明书用药,375条超说明书用药医嘱,共有36项不同类型超说书用药,其中有效性等级Class Ⅰ（治疗有效）有2项、Class Ⅱa（证据支持有效）24项、Class Ⅱb（有效性具有争议）9项、Class Ⅲ（治疗无效）1项;推荐等级Class Ⅰ（治疗有效）有2项、Class Ⅱa（证据支持有效）2项、Class Ⅱb（有效性具有争议）30项、Class Ⅲ（治疗无效）2项、Indeterminate（不明确）0项;证据等级Catagory A 0项、Catagory B 35项、Catagory...     

中医治疗代谢综合征的循证思维方法

现代研究证明,胰岛素抵抗在代谢综合征的病因机制中处于中心地位。作者试图探讨中医在治疗代谢综合征中的循证思维方法。     

探究循证护理在急性心肌梗死并发心律失常护理中的应用

目的探究在急性心肌梗死合并心律失常患者中采用循证护理的应用效果。方法选取我院收治的急性心肌梗死合并心律失常患者60例,分成对照组与观察组各30例,对照组采用常规护理,观察组采用循证护理,比较两组护理效果。结果对照组患者住院时间比对照组少,治疗效果明显优于对照组,差异具有统计学意义(P0.05)。结论实施循证护理效果良好,能减少住院时间,值得临床推广。     

Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria

Juvenile idiopathic arthritis (JIA) is the most common diagnosis in children and adolescents with rheumatic disorders. In many children and adolescents, JIA is successfully treated with non-steroidal anti-inflammatory drugs (NSAID) and physiotherapy. However, in a significant number of cases the disease is resistant to this therapy, and treatment with second line disease-modifying antirheumatic drugs (DMARDs) is required. Methotrexate (MTX) is frequently referred to as first-choice second-line agent for the treatment of JIA. To increase drug safety, the Working Groups for Children and Adolescents with Rheumatic Diseases in Germany (AGKJR) and Pediatric Rheumatology Austria have initiated the formulation of evidence-based recommendations. Evidence is based on consensus expert meetings, a MEDLINE search with the key words Methotrexate and juvenile arthritis limited to age 0–18 years, standard textbooks and review articles, data from the central registry of the German Research Center for Rheumatic Diseases (Deutsches Rheumaforschungszentrum Berlin DRFZ), experience with MTX in adults with rheumatoid arthritis (RA), and recommendations of the German Society of Rheumatology (DGRh). Based on these data, evidence and recommendations are graded, and evidence-based recommendations for the use of MTX in children and adolescents with rheumatic disease are presented.Section Pharmacotherapy of the Working Group Pediatric Rheumatology Germany and Austria: I. Foeldvari; J.P. Haas, A. Haeffner, D. Hobusch,G. Horneff, A. Hospach, R. Keitzer, G. Klaus, M. Metzler, H. Michels, T. Niehues, I. Pilz, M. Sailer Höck, M. Schöntube, L. Schuchmann, K. Schumacher, H.W. Seyberth, E. Siemers, A. Urban, E. Weißbarth-Riedl. Working Group Pediatric Rheumatology North-Rhine-Westfalia: S. Benseler, G. Bürk, S. Fahl, I. Foeldvari, D. Föll, M. Frosch, G. Ganser, S. Kastner, I. Kleine, E. Lainka, K. Mönkemöller, J. Neubert, U. Neudorf, T. Niehues, J. Roth, S. Seeliger, N. Wagner, R. Wieland, H. Winowski.     

Clinical audits to improve critical care: Part 2: Analyse,benchmark and feedback

Clinical audits are an essential part of the cycle designed to ensure that patients receive the best quality of care. By measuring the care delivered against established best practice standards, it becomes possible to identify shortcomings and to plan targeted strategies and processes for continuous improvement. The success of a clinical audit depends upon defined goals, motivation of stakeholders, appropriate tools and resources, and clear communication.In part 1 of this series, an overview of the structures and processes needed to prepare and collect data for clinical audits in the critical care setting was provided [A.J. Ullman, G. Ray-Barruel, C.M. Rickard, M. Cooke, Clinical audits to improve critical care: Part 1 Prepare and collect data, Aust Crit Care, 2017, in press]. In part 2, we discuss how to analyse the collected audit data, benchmark findings with internal and external data sets, and feedback audit results to critical care clinicians to promote evidence-based practice and improve patient outcomes.     

Biological,psychological and social processes that explain celebrities’ influence on patients’ health-related behaviors

Background

Celebrities can have substantial influence as medical advisors. However, their impact on public health is equivocal: depending on the advice’s validity and applicability, celebrity engagements can benefit or hinder efforts to educate patients on evidence-based practices and improve their health literacy. This meta-narrative analysis synthesizes multiple disciplinary insights explaining the influence celebrities have on people’s health-related behaviors.

Methods

Systematic searches of electronic databases BusinessSource Complete, Communication & Mass Media Complete, Humanities Abstracts, ProQuest Political Science, PsycINFO, PubMed, and Sociology Abstracts were conducted. Retrieved articles were used to inform a conceptual analysis of the possible processes accounting for the substantial influence celebrities may have as medical advisors.

Results

Fourteen mechanisms of celebrity influence were identified. According to the economics literature, celebrities distinguish endorsed items from competitors and can catalyze herd behavior. Marketing studies tell us that celebrities’ characteristics are transferred to endorsed products, and that the most successful celebrity advisors are those viewed as credible, a perception they can create with their success. Neuroscience research supports these explanations, finding that celebrity endorsements activate brain regions involved in making positive associations, building trust and encoding memories. The psychology literature tells us that celebrity advice conditions people to react positively toward it. People are also inclined to follow celebrities if the advice matches their self-conceptions or if not following it would generate cognitive dissonance. Sociology explains how celebrities’ advice spreads through social networks, how their influence is a manifestation of people’s desire to acquire celebrities’ social capital, and how they affect the ways people acquire and interpret health information.

Conclusion

There are clear and deeply rooted biological, psychological and social processes that explain how celebrities influence people’s health behaviors. With a better understanding of this phenomenon, medical professionals can work to ensure that it is harnessed for good rather than abused for harm. Physicians can discuss with their patients the validity of celebrity advice and share more credible sources of health information. Public health practitioners can debunk celebrities offering unsubstantiated advice or receiving inappropriate financial compensation, and should collaborate with well-meaning celebrities, leveraging their influence to disseminate medical practices of demonstrated benefit.

Electronic supplementary material

The online version of this article (doi:10.1186/2049-3258-73-3) contains supplementary material, which is available to authorized users.