Is the UK NICE “Reference Case” Influencing the Practice of Pediatric Quality-Adjusted Life-Year Measurement within Economic Evaluations?

ObjectivesTo report findings from a systematic review, this article sought to address two related questions. First, how has the practice of UK pediatric cost-utility analyses evolved over time, in particular how are health-related outcomes assessed and valued? Second, how do the methods compare to the limited guidance available, in particular, the National Institute for Health and Care Excellence (NICE) reference case(s)?MethodsElectronic searches of MEDLINE, Embase, and Cochrane databases were conducted for the period May 2004 to April 2012 and the Paediatric Economic Database Evaluation database for the period May 2004 to December 2010. Identified studies were screened by three independent reviewers.ResultsForty-three studies were identified, 11 of which elicit utility values through primary research. A discrepancy was identified between the methods used for outcome measurement and valuation and the methods advocated within the NICE reference case. Despite NICE recommending the use of preference-based instruments designed specifically for children, most studies that were identified had used adult measures. In fact, the measurement of quality-adjusted life-years is the aspect of economic evaluation with the greatest amount of variability and the area that most digressed from the NICE reference case.ConclusionsRecommendations stemming from the review are that all studies should specify the age range of childhood and include separate statements of perspective for costs and effects as well as the reallocation of research funding away from systematic review studies toward good quality primary research measuring utilities in children.     

Ductal stent endocarditis resulting in a large aortic pseudoaneurysm

An infant with ductal dependent pulmonary blood flow who underwent neonatal ductal stenting and, 4 months later, developed ductal stent endocarditis due to Streptococcus gallolyticus subsp. pasteurianus was described. The infection was associated with a moderate aortic pseudoaneurysm and the patient was treated with antibiotics as well as surgical aortic pseudoaneurysm repair. This novel and unusual complication of ductal stent placement warrants reporting.     

Spectrophotometric dental colour measurement to assess age in living adults

The aim of this study was to evaluate the usefulness of spectrometrically measured colour parameters of teeth for age estimation in living adults. A total of 329 teeth were selected (162 upper central incisors and 167 upper canines) from 52 men and 50 women aged between 20 and 86 years. Colour measurements were performed in vivo on the vestibular surface of the teeth using a portable contact Spectro-color device. Colorimetric variables (L*, a*, b*), chromaticity coordinates (x, y, z), and indexes of whiteness (WIC, Z%, WI) and yellowness (YI) were calculated. The accuracy of colour values to estimate the age was determined by Receiver Operating Characteristic analysis. A more powerful age discrimination was obtained with upper incisors than with upper canines. Areas under the ROC curve ranged from 0.7 to 0.8 for all dental colour parameters measured in upper central incisors except for the variables L* and Z%, with sensitivity values ranging from 56% to 93% and specificity values from 38% to 92%. We conclude that spectrophotometric dental colour measurement may be an objective and useful tool to estimate age and meets medical ethical standards for application in living adults. However, further research is needed to study the effect of ethnicity and other factors on tooth colour.     

Titanium as a Reconstruction and Implant Material in Dentistry: Advantages and Pitfalls

Commercial pure titanium (cpTi) has been the material of choice in several disciplines of dentistry due to its biocompatibility, resistance to corrosion and mechanical properties. Despite a number of favorable characteristics, cpTi as a reconstruction and oral implant material has several shortcomings. This paper highlights current knowledge on material properties, passive oxidation film formation, corrosion, surface activation, cell interactions, biofilm development, allergy, casting and machining properties of cpTi for better understanding and potential improvement of this material for its clinical applications.