Dose-Dependent Effects of Zoledronic Acid on Human Periodontal Ligament Stem Cells: An In Vitro Pilot Study.

Bisphosphonates (BPs) are widely used to treat several metabolic and oncological diseases affecting the skeletal system. Despite BPs' well-known therapeutic potential, they also displayed important side effects, among which is BPs-related osteonecrosis of the jaw, by targeting osteoclast activities, osteoblast, and osteocyte behavior. The aim of this study is to evaluate the biological effects of zoledronic acid (ZOL) in an in vitro model of periodontal ligament stem cells (PDLSCs) by using an experimental setting that resembles the in vivo conditions. PDLSCs were treated with different concentrations of ZOL ranging from 0.1 to 5 µM. The effects of ZOL exposure were evaluated on cell viability via 3-[4,5-Dimethylthiaoly]-2,5-diphenyltetrazolium bromide (MTT), cell cycle analysis, apoptosis detection, and immunofluorescence. Quantitative real-time polymerase chain reaction (PCR), colorimetric detection of alkaline phosphatase activity, and Alizarin Red S staining were performed to investigate the osteogenic potential of PDLSCs exposed to ZOL. MTT analysis showed that the viability of PDLSCs exposed to ZOL concentration ≥1.5 µM for 3 and 6 days was significantly lower (P < 0.001) than that of untreated cells. The percentage of apoptotic cells was significantly higher in PDLSCs exposed for 4 days to ZOL at 2 µM (P < 0.01) and 5 µM (P < 0.001) when compared to the control. Moreover, ZOL treatment (3 days) accounted for alterations in cell cycle distribution, with an increase in the proportion of cells in G0/G1 phase and a reduction in the proportion of cells in S phase. Chronic exposure (longer than 7 days) of PDLSCs to ZOL accounted for the downregulation of ALP, RUNX2, and COL1 genes at all tested concentrations, which fit well with the reduced alkaline phosphatase activity reported after 7 and 14 days of treatment. Reduced Col1 deposition in the extracellular matrix was reported after 14 days of treatment. Increased calcium deposits were observed in treated cells when compared to the control cultures. In conclusion, chronic exposure to 1 µM ZOL induced significant reduction of osteogenic differentiation, while ZOL concentrations ≥1.5 µM are required to impair PDLSCs viability and induce apoptosis.

Management and outcomes of health practitioner complaints in Australia: a comparison of the national and New South Wales systems.

OBJECTIVE: The aim of this study was to summarise the process and outcomes of complaints from five regulated health professions in Australia, and to compare these between the national and New South Wales (NSW) systems. METHODS: This is a retrospective cohort study of all complaints lodged from 1 July 2012 to 31 December 2013 for medicine, nursing and midwifery, dentistry, psychology and pharmacy registered practitioners. Data were extracted from the Australian Health Practitioner Regulation Agency, the NSW Health Professional Councils' Authority and the NSW Health Care Complaints Commission databases. The main outcome measures were frequencies and percentages of process decisions and outcomes. RESULTS: Systems differed in classification of complaints as conduct (national 47%; NSW 22%) and performance (national 45%; NSW 71%). Thirty-eight per cent of complaints were investigated or managed through a health or performance stream (national 40%; NSW 34%), but the national system investigated more matters (national 35%; NSW 6%). Over 50% of complaints resulted in 'no further action' (national 60%; NSW 70%). The most common action was caution or counsel (national 12%; NSW 15%), followed by conditions, (national 10%; NSW 5%). Practitioner registration surrender was more common with the NSW than national system (national 0.1%; NSW 1.3%), but registration suspensions or cancellations were similar (national 0.6%; NSW 1.0%). CONCLUSION: The main difference between the two systems is the administrative decision as to how complaints are assessed. In NSW, a classification of a complaint as 'performance' usually means the complaint is not investigated; rather, the practitioner is assessed by peers and may be required to undergo further education and training. Reaching agreement and understanding of complaints that should be investigated and those appropriate for performance review would strengthen a national approach to health complaint regulation. What is known about the topic? The national system of managing healthcare complaints is relatively new (since 2010) compared with the NSW system (since 1993). Annual reports of the regulatory authorities provide summaries of types and outcomes of complaints separately for each profession, and separately for NSW and the national system, but we do not know how the two systems directly compare in terms of complaint management or their outcomes. What does this paper add? This study examined how different types of complaints are managed between the two systems and whether there are any differences in outcomes. The types of complaints are almost identical between the two systems, but classification of complaints as 'performance' or 'conduct' differed. Immediate action is more common in the national than NSW system, especially for health impairment and boundary crossing. Health impairment complaints are much less likely to be discontinued at the assessment stage in NSW compared with the national system. The NSW and national systems are similar in terms of complaints proceeding to either an investigation or performance or health assessment, but the national system investigates more than the NSW system. For many types of complaints the outcomes were similar between systems, but there were clear differences for some types of complaints, such as health impairment and boundary crossing. What are the implications for practitioners? An efficient and fair regulatory system is crucial for maintaining practitioner trust, as well as trust of the public. This study shows that there are many similarities between the national and NSW systems in terms of process and outcomes, but there are differences in the way some types of complaints are assessed between the two systems. This knowledge may assist regulatory authorities in their efforts to achieve a nationally consistent approach to complaints.

Profile of the most common complaints for five health professions in Australia.

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

Redesigning models of patient care delivery and organisation: building collegial generosity in response to workplace challenges.

This case study describes the New South Wales Nursing and Midwifery Office (NaMO) Models of Care Project, a project designed to identify, encourage and disseminate innovations in nursing care organisation and delivery. The project is a 4-year action research project, using a range of interactive engagements including workshops, seminars, questionnaires and websites to achieve the goals. This case study briefly describes the main stimuli for review and redesign of models of care identified through analysis of the clinicians' presentations, and explores the range of responses to the workplace challenges.

Nurses' liability in doctor-nurse relationships.

An exploration of the concepts of professional liability and its application to nursing, with particular emphasis on civil liability. It defines the concept of vicarious liability and explains its origins and purpose. The issue of personal liability and when this is applicable to the nurse is also addressed. A significant part of the discussion confronts the issue of liability in doctor-nurse relationships in clinical practice.