Attitudes regarding a warranty and the expected longevity of dental treatment amongst New Zealand dentists, dental students, and patients: a mixed methods survey.

OBJECTIVES: To investigate and compare estimates of the longevity of dental treatment, expectations for free remedial treatment, and attitudes about formal dental warranties among dentists, students, and patients. MATERIALS AND METHODS: This is a mixed-method cross-sectional questionnaire survey with convenience sampling from dentists, dental students, and patients in New Zealand. A questionnaire was distributed to New Zealand dentists (n = 28) and final-year dental students (n = 27). A separate questionnaire was provided to patients in a university dental clinic (n = 43). Mann-Whitney U, Chi-square and Pearson Correlation, and Binary logistic regression tests were used to test for differences between groups and correlations amongst variables. Qualitative data were analysed thematically. RESULTS: Dentists believed that their posterior composite resin restorations would last longer (p = 0.014), would remediate failed crowns for longer (p = 0.002) and would provide longer crown warranties (p = 0.003) compared to students. Patients had higher expectations for restoration longevity and free remediation for failed treatment. Students were generally more willing to provide warranties. Crowns were perceived to be the most warrantable, while endodontic treatment was the least warrantable. Recall attendance, mechanical failure, and adequate oral hygiene were commonly proposed as warranty conditions for restorations and crowns. There was little consensus about complete dentures and endodontic treatment. CONCLUSIONS: There are significant disparities between the expectations of patients and clinicians regarding treatment longevity and free remediation times. Clinicians, in general, are willing to provide free remediation within a specified time frame, except for endodontic treatment, but are hesitant to provide formal dental warranties.

Improving care for people with bronchiectasis: opportunities and challenges highlighted from service evaluation.

BACKGROUND: Bronchiectasis is a serious, debilitating condition warranting specialist care. AIMS: To determine if care provided in a tertiary hospital general respiratory clinic was guideline concordant and to validate the Bronchiectasis Severity Index (BSI) in the Australian context. METHODS: A single-centre ambispective study was conducted. The first stage involved a retrospective medical record audit between 1 January 2015 and 31 December 2016. All aspects of bronchiectasis management were reviewed. In the second prospective phase the cohort was followed for 4 years to determine survival and the validity of the BSI determined. RESULTS: A total of 145 patients was included, with mean age of 65 years (standard deviation = 16.6). The aetiology of bronchiectasis was explicitly documented for 58 (40%) patients, with potential causes identified in another 37 patients. Post-infectious aetiologies were described in 62 (43%) patients. Most patients had lung function testing (n = 142; 97%) and sputum culture results (n = 120; 83%). Long-term antibiotics were prescribed to 49 (34%) patients. Only patients culturing Pseudomonas spp. were prescribed inhaled antibiotics. Documentation regarding essential management recommendations was low, including airway clearance (46%), pneumococcal vaccination (27%) and written action plans (32%). Severe disease was common, with more than one-third (34-48%) having BSI scores >9. One-fifth (21%) of the cohort died during the 4-year follow-up period. The BSI was significantly associated with mortality risk (odds ratio 7.7; 95% confidence interval = 3.1-19.3; P < 0.001). CONCLUSION: Our cohort had a high proportion of patients with severe disease and significant mortality; some, but not all, aspects of recommended care were delivered.

COVID-19 pandemic 2020: a tertiary Melbourne hospital's experience.

BACKGROUND: The COVID-19 pandemic has affected different parts of Australia in distinct ways across 2020 and 2021. In 2020, Melbourne was the epicentre of COVID-19. As one of the key tertiary centres caring for the patients affected by the outbreaks, the Royal Melbourne Hospital (RMH) managed the majority of the Victorian inpatient caseload. AIMS: To review the demographics, management and outcomes of patients with COVID-19 cared for by the RMH services in 2020. METHODS: A single health service retrospective cohort analysis of demographics, interventions and outcomes was conducted to characterise the RMH experience in 2020. RESULTS: From January to December 2020, 433 patients required admission more than 24 h. The demographics of affected patients and outcomes changed over the course of the study. Overall, 47% (203/433) required oxygen, most frequently (36%; 154/433) with low-flow devices (nasal prongs or hudson mask), and 11% (47/433) of patients required admission to intensive care. We recorded a 30-day mortality of 24% (104/433) mortality overall, rising to over 50% in patients aged over 80 years. CONCLUSIONS: The experience of this health service in 2020 demonstrated changing demographics over time, with associated differences in outcomes; notably marked mortality in older populations, frequent complications and limited inter-site transfer possible with mobilised resources.

Correlation between CT angiography and digital subtraction angiography in acute ischemic strokes.

OBJECTIVE: CT angiography (CTA) is not necessarily performed for all acute ischemic strokes due to variations in national guidelines across different regions. It follows that in the absence of CTA, missed identification of large vessel occlusion (LVO) potentially leads to opportunity lost for endovascular thrombectomy. Although the accuracy of CTA is well validated in chronic arterial stenosis, it has not been adequately investigated in acute ischemic stroke. We aimed to investigate the accuracy of CTA compared with digital subtraction angiography (DSA) in detecting LVO in acute ischemic stroke. METHODS: This was a retrospective study of acute ischemic strokes with large vessel occlusion which underwent endovascular thrombectomy. We included patients who had a CTA prior to DSA and did not receive intravenous thrombolysis. Images were reviewed by 2 blinded assessors. Positive predictive value (PPV), and negative predictive value (NPV) of CTA were calculated against DSA. RESULTS: Seventy-seven patients were included. The median age was 67 (IQR 57-78) and 46 (59.7 %) were male. Median NIHSS was 18 (IQR 12-22). There were 284 arterial segments categorized into 215 anterior arterial segments in 54 patients and 69 posterior arterial segments in 23 patients. The median time between CTA and DSA was 126 min (IQR 91-153 min). CTA showed PPV of 91.1 % and NPV of 95.1 % compared with DSA. CONCLUSIONS: We showed that CTA was reasonably accurate in identifying large vessel occlusion in acute ischemic stroke. We propose that current regional guidelines should include CTA for all acute ischemic strokes.

The PAR2 signal peptide prevents premature receptor cleavage and activation.

Unlike closely related GPCRs, protease-activated receptors (PAR1, PAR2, PAR3, and PAR4) have a predicted signal peptide at their N-terminus, which is encoded by a separate exon, suggesting that the signal peptides of PARs may serve an important and unique function, specific for PARs. In this report, we show that the PAR2 signal peptide, when fused to the N-terminus of IgG-Fc, effectively induced IgG-Fc secretion into culture medium, thus behaving like a classical signal peptide. The presence of PAR2 signal peptide has a strong effect on PAR2 cell surface expression, as deletion of the signal peptide (PAR2ΔSP) led to dramatic reduction of the cell surface expression and decreased responses to trypsin or the synthetic peptide ligand (SLIGKV). However, further deletion of the tethered ligand region (SLIGKV) at the N-terminus rescued the cell surface receptor expression and the response to the synthetic peptide ligand, suggesting that the signal peptide of PAR2 may be involved in preventing PAR2 from intracellular protease activation before reaching the cell surface. Supporting this hypothesis, an Arg36Ala mutation on PAR2ΔSP, which disabled the trypsin activation site, increased the receptor cell surface expression and the response to ligand stimulation. Similar effects were observed when PAR2ΔSP expressing cells were treated with protease inhibitors. Our findings indicated that there is a role of the PAR2 signal peptide in preventing the premature activation of PAR2 from intracellular protease cleavage before reaching the cells surface. The same mechanism may also apply to PAR1, PAR3, and PAR4.