Scale development to measure the patient perception of patient-centered care of dentists in primary care settings of Thailand: a measurement invariance test.

BACKGROUND: Patient-centered care is essential for providing quality services thoroughly at the primary care level, but it is unclear and lacks measurement. This study aimed to develop a reliable and valid instrument to measure patient perception of patient-centered care in primary dental care in Thailand and test the measurement invariance between large and small community hospitals. METHODS: The initial set of 45 items for the patient perception of Patient-Centered Care of Dentist Scale (PCCDS-P version) was developed using a mixed-method approach, which included a literature review, a content validity test, cognitive interviews, and a pre-test. A multistage sampling strategy was used to recruit dental patients or their parents or caregivers from community hospitals across Thailand. Validity was examined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed using Cronbach's alpha coefficient and the intraclass correlation coefficient. Furthermore, a multi-group analysis was conducted to compare the responses of patients from large and small community hospitals. RESULTS: Three hundred thirty-six and One thousand one hundred sixty-seven samples were randomized for EFA and CFA, respectively. The final PCCDS-P version consists of 7 factors with satisfactory reliability and validity and is composed of 42 items: dentist-patient relationship, disease-illness, integrated care, communication, shared information and decision-making, holistic, and empathy and anxiety management. The CFA showed the model fit was consistent with the entire sample. The metric invariance analysis showed that the factor loadings were invariant across patient groups. Overall, Cronbach's alpha coefficient and intraclass correlation coefficient were satisfactory. CONCLUSIONS: The newly developed PCCDS-P version is composed of seven domains with 42 items with good reliability and validity, and it indicated measurement invariance across patients in large and small community hospitals.

Knowledge and attitude toward oral health behavior of overseas students during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has impacted overseas students, including their oral health. Due to movement restrictions, limited living allowances, dental treatment costs, and health insurance fees, overseas students might be more concerned about their oral health. The objective of the present study was to determine the association of knowledge and attitude toward oral healthcare behavior of overseas university students staying in Thailand between January 2020 to July 2022 and explore the experiences of their oral health problems. METHODS: A cross-sectional study was conducted using an online survey in English operated through the Google platform by convenience sampling among overseas Chulalongkorn University students. A newly developed self-administered questionnaire on knowledge and attitude toward oral health-related behavior and experiences in oral health problems was completed voluntarily. Descriptive statistics, Chi-square test, t-test, ANOVA, and Pearson correlations were employed using IBM SPSS version 29. RESULTS: Of 311 overseas students, 55.6% were male. The average age of students was 27.5 ± 4.5 years. 68.81% of students were from ASEAN countries, and 73.31% studied in non-health science programs. The study fields, health and non-health sciences, were associated with knowledge score (p < 0.001) and attitude score (p = 0.004), whereas the type of health insurance had an association with behavior score (p = 0.014) and the student's perspective about dental visits (p = 0.014). Three hundred fifty-nine cases of oral health problems were experienced by 47.3% of overseas students. These problems consisted primarily of tooth hypersensitivity (21.2%), gingivitis (15.3%), caries (14%), cracked or broken tooth (10%), severe toothache (9%), fallen out filling (8%), and wisdom tooth pain (7.8%). There was an association between oral healthcare behavior and oral health problems (p < 0.001), and a negative correlation was found between behavior score and the number of oral health problems (p < 0.001, r=-0.204). CONCLUSION: The oral healthcare habits of overseas university students correlated positively with knowledge and attitude. A negative correlation was observed between behavior and the number of oral health problems. Furthermore, studying in health science programs impacted students' knowledge and attitude toward oral health, while dental treatment coverage insurance affected decisions for dental visits.

Managing knowledge for health care quality: An investigation of rational antibiotic use among Thai dentists.

OBJECTIVES: Because of the irrational use of antibiotics, antimicrobial resistance is now a global concern that requires developing effective strategies against. The aim of this study was to assess the knowledge gap that causes the irrational use of antibiotics among Thai dentists. METHODS: Thai dentists were asked to complete an online questionnaire regarding their knowledge, perception, and attitude towards rationale antibiotic use. The survey was conducted during November to December 2018. RESULTS: Online questionnaires were completed by 588 dentists. Most respondents had a positive perception and were aware of the rational use of antibiotics. However, the use of antibiotics without proper indication and the lack of pharmacological knowledge were found. A mobile application was considered the most preferable approach to manage knowledge for rational drug use. CONCLUSION: Irrational drug use among Thai dentists can be caused by lack of knowledge, attitude, and the perception of each dentist. Policy makers should promote self-learning through knowledge management strategies that can complement the pharmacology courses taught in dental school.

Comparison of two caries prevention programs among Thai kindergarten: a randomized controlled trial.

BACKGROUND: Intensified preventive regimen based on a 'high-risk' approach has been proposed instead the routine prevention that is generally given to the whole population. The effectiveness of these regimens may still be an issue. Therefore, the aim of this study was to compare two preventive programs carried out in a Public School for kindergarten children. METHODS: The data from clinical examinations were used to assess the caries risk for 121 children. Children with at least 2 carious lesions were considered as high risk for dental caries development. These children were randomized into two groups. Half (High risk basic-HRB group) were provided the basic prevention regimen (oral-hygiene instruction and hands-on brushing practice for teachers and caregivers, daytime tooth brushing supervised by teachers at least once a week, newly erupted first permanent molar sealant, provision of toothbrush, fluoride-containing dentifrice, and a guidebook), which was also given to low-risk children (Low risk basic-LRB group). The other half (High risk intensive-HRI group) were additionally given an intensified preventive regimen (F-varnish application, primary molar sealant, and silver diamine fluoride (SDF) application on carious lesions). Clinical examinations were performed semiannually to determine the dmfs caries increment of the three groups. RESULTS: The 89 children completed the 24-month examination were 3- to 5-year-old with 19, 35, and 35 children in the LRB, HRB, and HRI group, respectively. The new caries development at 24 months of the HRB group (75%) was higher than that of the HRI group (65.7%) and the LRB group (21.1%). One-way analysis of variance (ANOVA) indicated no significant differences of caries increment between the HRB and HRI groups at the end of our study (p = 0.709). CONCLUSIONS: The negligible difference in caries increment between the HRI and HRB groups implies that intensified prevention produced minimal additional benefit. Offering all children only basic prevention could have obtained virtually the same preventive effect with substantially less effort and lower cost. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR), TCTR20180124001. Registered 24 January 2018 - Retrospectively registered.

Post-treatment patient-reported outcome measures in a group of Thai dental implant patients.

OBJECTIVE: The aims of this study were to evaluate and analyze the factors affecting patients' perceptions and satisfaction after receiving implant treatment. MATERIAL AND METHODS: Questionnaires were mailed to 691 patients who had completed implant treatment for at least 6 months. The questionnaire consisted of 23 items, including demographic data, seven items on perceptions, and nine items on satisfaction. RESULTS: Of the returned 382 questionnaires, 188 and 194 were from patients treated by postgraduate students and specialists, respectively. Dentists were the most common main source of implant information (55.8%). Although 90% of the patients felt that they were well informed about implant treatment, some inaccurate perceptions remained: 18% believed that "Dental implants require less care than natural teeth," 35.6% that "Dental implants last longer than natural teeth," and 75% that "Treatment with dental implants has no risks or complications." Approximately 90% of the patients were satisfied with their chewing, phonetics, aesthetic outcome, and dental implant treatment; however, some were dissatisfied with the cost. Although gender, age, educational level, main source of information, implant number, and implant position had some impact on patients' perceptions and satisfaction; monthly income did not. The clinicians' expertise affected patients' perceptions, but not satisfaction. CONCLUSIONS: Although most patients had accurate perceptions with regards to implant treatment, some misperceptions about the need for a maintenance care still exist after treatment. Most patients were satisfied with their treatment outcome regardless of monthly income and the clinicians' expertise level.

Development and Evaluation: The Satisfaction of Using an Oral Health Survey Mobile Application.

INTRODUCTION: Surveying oral health at the community level should be done at regular intervals. Dental health personnel must assess the oral health status and needs of the community through the collection and interpretation of reliable health information. Thus, the aims of this study were (1) to develop a mobile application for oral health surveys, (2) to analyze the oral status of school children in Bangkok using the newly developed application, and (3) to evaluate user satisfaction with using the Oral Health Survey Mobile Application (OHSMA). MATERIALS AND METHODS: The OHSMA Android app was created to facilitate the collection and transfer of oral health status data. The survey data on the oral health status of Grades 1-6 Thai schoolchildren were collected and analyzed using the OHSMA. A 5-point Likert scale questionnaire was used to evaluate the satisfaction of 125 dental students when using this new application compared with using paper forms. RESULTS: The prevalence of dental caries in 441 schoolchildren was 79.7%. The total mean decayed, missing, and filled for primary teeth (dmft) and decayed, missing, and filled for permanent teeth (DMFT) were 4.09 (d + D = 3.29, m + M = 0.15, and f + F = 0.65). Users indicated high satisfaction scores for three OHSMA features: font, color, and proper size. The results showed that paper forms were easier for inputting and recording the data compared with the OHSMA. However, the OHSMA was significantly easier for searching data and reporting data compared with paper forms (OHSMA 3.80, paper forms 3.35; p < 0.001, and OHSMA 3.80, paper forms 3.51; p < 0.001), respectively. CONCLUSIONS: Despite some limitations, this study suggests that the mobile application has the potential to collect valuable oral health survey data.

DENTAL CARIES AND RELATED ORAL HEALTH FACTORS AMONG 9 TO 18 MONTH OLD THAI CHILDREN.

Dental caries can occur as soon as the first tooth erupts. We studied the caries prevalence and related risk factors among children aged 9-18 months in U Thong District, Suphan Buri Province, Thailand. A total of 151 children, whose primary caregivers were willing to participate in this study, were evaluated for decayed, missing, and filled tooth surfaces (dmfs). Questionnaires were given to the primary caregivers of the study subjects to ascertain their socio-economic status, oral hygiene habits, and child-feeding habits. The Mann-Whitney U and Kruskal-Wallis tests were used to evaluate bivariate outcome data. Hierarchical multiple regression analysis was used to determine variables predictive of dental caries in the studied children. The prevalence of dental caries among the 151 subjects was 32.5%; 15.9% had at least one cavity (cavitated caries) and 16.6% had white lesions (non-cavitated caries). The mean dmfs score was 2.83 ± 6.48. Significant associations were seen between the dmfs score and the number of erupted teeth (p < 0.001) and toothpaste usage (p < 0.01). Hierarchical multiple regression analysis revealed four factors significantly associated with caries: number of erupted teeth, which had the highest Beta value (P = 0.35, p < 0.01), nighttime bottle feeding (P = 0.17, p < 0.05), frequency of drinking sweetened milk (P = 0.17-0.18, p < 0.05) and falling asleep with a bottle in the mouth (P = 0.18, p < 0.05). Nighttime bottle feeding, frequency of drinking sweetened milk and falling asleep with a bottle in the mouth were important caries risk factors and the number of erupted teeth was a strong caries risk predictor. Dentists should educate caregivers about these risk factors.

Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study.

BACKGROUND: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. OBJECTIVE: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. METHODS: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients' information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. RESULTS: Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). CONCLUSIONS: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app.

The Older Adults' Intention to Use Silver Diamine Fluoride for Dental Caries Treatment.

Purpose: This study aimed to determine the intention of older adults to use silver diamine fluoride (SDF) for treating tooth decay. Patients and Methods: A group of Thai-speaking individuals between the ages of 60 and 90 were asked to participate in the study. They were provided with information about SDF and then asked to complete a questionnaire based on the Theory of Reason Action (TRA). The questionnaire consisted of 23 questions divided into seven constructs aimed at determining the determinants of the intention to use SDF. These constructs were behavioral belief, evaluation of behavioral outcome, normative belief, motivation to comply, attitude towards behavior, subjective norm, and intention. The responses were rated on a 4-point Likert scale ranging from 1 (Strongly disagree) to 4 (Strongly agree). The characteristics and TRA scores of the participants were analyzed and compared based on their intention to use SDF, using the Chi-square test and t-test. Multiple logistic regression was employed to determine the determinants of the intention to use SDF. Results: The study involved 588 participants, with an average age of 65.3 years (SD= 5.53). Of the participants, 52.7% were women, 58.1% were unemployed or retired, 80.8% lived with family, 63.4% had less than sixth-grade education, 62.9% had a monthly family income of less than 10,000 baht, and 63.6% had underlying diseases. The study found that 82.7% of the participants intended to use SDF for dental caries treatment, with an average score of 2.86 out of 4. The study also found that age, family income, underlying diseases, dental health problems, and fear of the dentist significantly affected their intention. Behavioral beliefs and evaluations of behavioral outcomes significantly affected the intention to use SDF treatment. Conclusion: Most older adults in the study intended to use SDF for dental caries treatment.

Physicians' awareness of medication-related osteonecrosis of the jaw in patients with osteoporosis.

A serious adverse effect of antiresorptive drugs, which are widely used to treat osteoporosis, is medication-related osteonecrosis of the jaw (MRONJ). Physicians can reduce the risk of MRONJ by educating patients and emphasizing the importance of good oral health. However, limited information is available regarding physicians' awareness and clinical practices associated with MRONJ. Hence, this study aimed to examine physicians' awareness related to MRONJ and associated clinical practices. This study was a cross-sectional study conducted from December 2022 to February 2023. An online self-administered questionnaire was sent to physicians in Thailand who prescribed antiresorptive drugs for osteoporosis. Most respondents agreed that antiresorptive drugs might cause MRONJ (92.3%), poor oral health increased the risk of MRONJ (84%), and MRONJ is an important consideration in patients with osteoporosis (85%). Of the respondents, 48.1% and 15.5% always referred patients to dentists before and during antiresorptive therapy, respectively. Approximately 60% of physicians informed patients of the MRONJ risk before prescribing antiresorptive drugs, and 30% inquired about patients' oral symptoms at the follow-up visit. Overall, 44% of physicians advised patients to receive oral health care; the most common reason for not advising this was that respondents did not consider themselves to be adequately knowledgeable to detect oral health problems. These findings indicate that while most physicians who prescribed antiresorptive drugs for osteoporosis were aware of and considered MRONJ in their practice, several took insufficient action to prevent it. This highlights the need to emphasize clinical practice guidelines and collaboration between physicians and dentists.

The gingival phenotypes and related clinical periodontal parameters in a cohort of Pakistani young adults.

Objective: To evaluate the gingival phenotypes of healthy young adult Pakistanis attending a dental institution. Methods: A cross-sectional study of gingival phenotype, probing depth (PD), papilla height (PH), gingival width (GW), gingival thickness (GT), crown width (CW) and crown length (CL) of maxillary central incisors was conducted in 510 healthy, Pakistani young adults, aged 20-35 years, attending a regional dental hospital in Pakistan. The K-means clustering technique was employed to delineate clusters based on the characteristics of the periodontal phenotypes. The resultant data was compared with the available international findings. Results: Three quarters (76 %) of the 510 patients examined exhibited a thick gingival phenotype, and the remainder a thin phenotype. The K-means clustering deployed the individual into three different clusters 1, 2 and 3, with varying ratios of PD, GW, CW/CL, with significant variations across the three clusters (p < 0.05). Our data where a vast majority of the cohort exhibited a thick gingival phenotype is comparable to most of the populations sampled in other regions of the world. Conclusion: Taken together the current data, a first for a Pakistani population, indicate that healthy, young adult Pakistanis had differing gingival phenotypes and crown forms, with the thick gingival phenotype predominating. These results are similar to reports from most other regions of the world. However, a larger study with a broader swathe of the Pakistani population is required to derive country specific data on the subject.

Validity and reliability of the Early Childhood Caries Perceptions Scale (ECCPS) to assess health beliefs related to early childhood caries prevention among primary caregivers of children under 5 years of age.

Primary caregivers' child oral health care beliefs and practices are major factors in the prevention of Early Childhood Caries (ECC). This study assessed the validity and reliability of a newly-developed scale--the Early Childhood Caries Perceptions Scale (ECCPS)--used to measure beliefs regarding ECC preventive practices among primary caregivers of young children. The ECCPS was developed based on the Health Belief Model. The construct validity and reliability of the ECCPS were examined among 254 low-socioeconomic status primary caregivers with children under five years old, recruifed from 4 Bangkok Metropolitan Administration Health Centers and a kindergarten school. Exploratory factor analysis (EFA) revealed a four-factor structure. The four factors were labeled as Perceived Susceptibility, Perceived Severity, Perceived Benefits and Perceived Barriers. Internal consistency measured by the Cronbach's coefficient alpha for those four factors were 0.897, 0.971, 0.975 and 0.789, respectively. The ECCPS demonstrated satisfactory levels of reliability and validity for assessing the health beliefs related to ECC prevention among low-socioeconomic primary caregivers.

Comparing pre- and post-treatment patients' perceptions on dental implant therapy.

BACKGROUND: Appropriate patients' perceptions as one of Patient Reported Outcome Measures (PROMs), are shown to be critical for the sustainable success of implant therapy, little is known however of how they prospectively evolve throughout the treatment process. OBJECTIVE: This study aimed to prospectively assess patients' perceptions before and after treatment with dental implants and to identify the impact of patients' characteristics on their perceptions. MATERIALS AND METHODS: Patients' perceptions on implant therapy were prospectively assessed by means of purpose-made questionnaire, rating the extent of agreement/disagreement with a set of statements on a visual analog scale. The questionnaire was collected before initial consultation with the implant dentist and post-treatment at least 1 month after prosthetic loading of the implant. Changes in patients' perceptions were analyzed with the Wilcoxon signed-rank test. RESULTS: Pretreatment questionnaire was collected from 359 patients. While 245 of them proceeded with implant therapy, 145 received final restoration within the timeframe of the study and completed the post-treatment questionnaires between 1 and 6 months after prosthesis delivery. The most common source of information was dental professions (72.4%). Although patients' perceptions were more realistic at post-treatment, few improper perceptions persisted as only 51% of patients agreed with the statement "There is a chance of dental implant failure," 28% agreed with the statement "Dental implants last longer than natural teeth," and higher percentage of patients agreed with "Dental implant therapy is appropriate for all patients." CONCLUSIONS: Although patients appear to harbor more realistic perceptions of implant therapy, certain improper perceptions still persist at post-treatment. The design of appropriate patient educational program might be essential to correct misperceptions that might affect long term success of implant therapy. This study had been registered on Thai Clinical Trials Registry (TCTR) with the TCTR identification number: TCTR20181101001.

Comparing patient-reported outcomes and experiences among static, dynamic computer-aided, and conventional freehand dental implant placement: A randomized clinical trial.

OBJECTIVE: The purpose of this study was to compare patient-reported outcomes and experiences (PROs and PREs) among three techniques of dental implant placement, including (a) conventional freehand, (b) dynamic, and (c) static computer-aided implant surgery (CAIS). MATERIAL AND METHODS: Ninety patients were randomly assigned to have dental implant placed with one of the three protocols. Participants were asked to fill in a series of self-administered questionnaires assessing (1) preoperative expectations, (2) postoperative healing events during the first week after surgery, and (3) experiences and overall satisfaction with the procedures at 2 weeks. Differences within the groups were analyzed by Wilcoxson signed-rank test. Kruskal-Wallis test was used for comparisons among the three groups. RESULTS: Eighty-eight patients completed the study. Patients' expectations on chewing difficulty, the postoperative experience of duration of pain, speaking limitations, and impact on routine activities were significantly different among groups (p = 0.04, 0.01, 0.038, and 0.046, respectively). Overall, patients appeared to significantly underestimate the duration of postoperative pain (p = 0.035) and swelling (p = 0.001). No significant difference in magnitude of postoperative pain, swelling, and painkiller consumption was found among the groups. The short-term functional limitations after surgery were deemed acceptable by most participants and 89% were satisfied by the overall procedure. CONCLUSIONS: Surgical placement of dental implant with conventional freehand, static, and dynamic CAIS techniques did not result in any difference in the level of postoperative pain and swelling, and appeared to lead to equal levels of satisfaction as expressed by the patients postoperatively.

Dental Student Hand Hygiene Decreased With Increased Clinical Experience.

OBJECTIVE: To investigate the effectiveness, related knowledge, attitudes, and practices of hand hygiene (HH) among dental students with different levels of clinical experience. DESIGN: This was a cross-sectional analytical study. Bacterial samples on the participants' hands were obtained using a swab technique before and after handwashing, for oral surgical procedures. After culturing, the colony-forming units were counted. Self-reported questionnaires reflecting the knowledge, attitudes, and practices related to HH were completed by the participants. SETTING: This study was performed in a primary oral health care institution, Faculty of Dentistry, Chulalongkorn University (Bangkok, Thailand). Bacterial samples and self-reported questionnaires were collected in the Department of Oral and Maxillofacial Surgery. Bacterial culture was performed in the Department of Microbiology. PARTICIPANTS: The 120 participants comprised first, second, third-year clinical training students (CTs), and postgraduate dental students (PGs) (32, 34, 30, and 24 participants, respectively). RESULTS: More than 99% of the bacteria were eliminated from the participants' hands after handwashing. Significantly higher numbers of bacteria were recovered from the hands of the PGs compared with those of the CTs, and the hands of the third-year CTs compared with those of the first-year CTs (p < 0.001), after HH. The first-year CTs had the highest attitude scores, whereas the PGs had the lowest practice scores. The knowledge scores were similar in all groups. CONCLUSION: HH effectiveness, attitudes, and practices of dental students decreased as students gained more clinical experience, whereas knowledge did not. Our results suggest that HH instruction should be given throughout the duration of dental students' education.

Cost effectiveness of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer.

INTRODUCTION: Concurrent chemoradiation has been advocated to be more effective than radiation alone in the treatment of cervical cancer. However, it certainly has more side effects. Hence, it is worthwhile to investigate the cost-effectiveness (CE) of concurrent chemoradiation in comparison with radiation alone in locally advanced cervical cancer. MATERIAL AND METHOD: The treatment of cervical cancer was modeled using the decision tree where the treatment option would be either concurrent chemoradiation or radiation alone. Patients receiving each treatment had different risks of tumor recurrence. Costs in this analysis were separated into four major categories: costs for treatment of cervical cancer, costs for treatment of major side effects, costs for follow up cancer patients, and costs for diagnosis including supportive care of recurrent cervical cancer Charges were used for the costs of chemotherapy, radiotherapy, drugs, and accessories. Unit cost was used for the costs of laboratory investigations, in-patient and out-patient services. Costs incurred after the first year were discounted at an annual rate of 5%. The benefit was measured as months of life survived. The present study evaluated the patients to 5 years after complete treatment. RESULTS: The CE ratio in the concurrent chemoradiation group was 2,855 and 1,835 Baht/month survived if the chemotherapy was given as in-patient and out-patient respectively. The CE ratio in the radiation group equaled 2,366 Baht/month survived. For the sensitivity analysis, in the situation that chemoradiation was not much better than radiation alone in terms that the recurrent rate from chemoradiation group was not more than 20% lower than the radiation group, radiation therapy alone would be more cost effective even if chemotherapy was given as an out-patient basis. CONCLUSION: Radiation alone was more cost effective than chemoradiation in the treatment of cervical cancer. Nevertheless, if chemotherapy was administered on an out-patient basis, chemoradiation will be more cost effective only if the recurrent rate from the chemoradiation group was more than 20% lower than the radiation group.

Linear Measurement Accuracy of Eight Cone Beam Computed Tomography Scanners.

BACKGROUND: Information regarding linear accuracy is necessary for efficient treatment evaluation, especially for maxillofacial reconstruction or implants. PURPOSE: To investigate the accuracy of linear measurements from multiple cone beam computed tomography (CBCT) devices. MATERIALS AND METHODS: A RANDO® phantom was scanned with eight CBCT scanners (11 modes). The viewing software accompanying each scanner was employed for measurements in mediolateral, anteroposterior, and supero-inferior dimensions by two dentomaxillofacial radiologists. Digital caliper measurements were used as a "gold standard." ANOVA with Scheffé post hoc analysis and intraclass correlation coefficient (ICC) were utilized for statistical analyses. The level of confidence was 95%. RESULTS: Differences from the gold standard among 11 acquisition modes were statistically significant (p < .001). Measurements from one unit were always underestimated compared with all others (p < .001). The range of absolute measurement errors for tested units was -2.56 to 0.54 mm (mean ± SD 0.45 ± 0.71) including the outlier and -0.34 to 0.54 mm (0.16 ± 0.11) excluding the outlier. Slightly more values were underestimated than overestimated (41 of 66 measurements, 7 out of 11 CBCT modes). ICC scores for inter- and intraobserver agreement were perfect (1.000). CONCLUSIONS: Treatment planning from large-volume CBCT was found to be reliable in all except one of the investigated scanners. New CBCT scanners should always be tested for geometric accuracy.