Improvements in Survival and Clinical Benefit With Gemcitabine as First-Line Therapy for Patients With Advanced Pancreas Cancer: A Randomized Trial.

PURPOSE: Most patients with advanced pancreas cancer experience pain and must limit their daily activities because of tumor-related symptoms. To date, no treatment has had a significant impact on the disease. In early studies with gemcitabine, patients with pancreas cancer experienced an improvement in disease-related symptoms. Based on those findings, a definitive trial was performed to assess the effectiveness of gemcitabine in patients with newly diagnosed advanced pancreas cancer. PATIENTS AND METHODS: One hundred twenty-six patients with advanced symptomatic pancreas cancer completed a lead-in period to characterize and stabilize pain and were randomized to receive either gemcitabine 1,000 mg/m2 weekly x 7 followed by 1 week of rest, then weekly x 3 every 4 weeks thereafter (63 patients), or to fluorouracil (5-FU) 600 mg/m2 once weekly (63 patients). The primary efficacy measure was clinical benefit response, which was a composite of measurements of pain (analgesic consumption and pain intensity), Karnofsky performance status, and weight. Clinical benefit required a sustained (> or = 4 weeks) improvement in at least one parameter without worsening in any others. Other measures of efficacy included response rate, time to progressive disease, and survival. RESULTS: Clinical benefit response was experienced by 23.8% of gemcitabine-treated patients compared with 4.8% of 5-FU-treated patients (P = .0022). The median survival durations were 5.65 and 4.41 months for gemcitabine-treated and 5-FU-treated patients, respectively (P = .0025). The survival rate at 12 months was 18% for gemcitabine patients and 2% for 5-FU patients. Treatment was well tolerated. CONCLUSION: This study demonstrates that gemcitabine is more effective than 5-FU in alleviation of some disease-related symptoms in patients with advanced, symptomatic pancreas cancer. Gemcitabine also confers a modest survival advantage over treatment with 5-FU.

Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients.

OBJECTIVE: To determine UK orthodontic consultants' attitudes to the provision of orthodontic advice to general dental practitioners by electronic means. DESIGN: Questionnaire. SETTING: Conducted by email and surface mail as appropriate in August 2000. SUBJECTS: All those UK NHS orthodontic consultants contained in the membership lists of the Consultant Orthodontists Group of the British Orthodontic Society. OUTCOME: An 86 per cent response was obtained from the 231 consultants. RESULTS: More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility. Provided this was mediated through their GDP, only 26% would oppose consultant advice being given electronically from a centralized source. CONCLUSIONS: A majority of UK orthodontic consultants support the concept of using teledentistry to make their advice more accessible to dentists and patients.

The impact of communication technology on dental services and dental education.

In this paper, the author reviews the scope, and probable future impact, of information technology in dentistry.

Orthodontic teaching practice and undergraduate knowledge in British dental schools.

AIM: The aim was to survey current orthodontic teaching practice in the undergraduate syllabus at British dental schools and to test the abilities of undergraduate students according to the requirements of the GDC regulations. MATERIALS AND METHODS: Information collected by means of a questionnaire sent to each dental school in 1998 was compared with similar data from 1994. The orthodontic knowledge and treatment planning ability of students was assessed by a multiple-choice examination paper completed by a random 10% sample of students from each dental school. RESULTS: In 1998 on average 195 curriculum hours were devoted to orthodontics and each student treated five patients. The teaching of fixed appliances had increased considerably between 1994 and 1998. The average MCQ score was 58% (range 39-72%). Students scored well on questions that tested basic knowledge but much less well when they were required to apply that knowledge. Only three schools felt that it was realistic to expect undergraduates to formulate orthodontic treatment plans, as they are required to do by the GDC. CONCLUSION: Results support the view that undergraduate orthodontic training should concentrate on diagnosis and recognition of problems rather than on providing limited exposure to treatment techniques.

The management of supernumerary teeth in childhood--a retrospective study of practice in Bristol Dental Hospital, England and Westmead Dental Hospital, Sydney, Australia.

This study compared the treatment provided for patients with supernumerary teeth in Bristol Dental Hospital with those in Westmead Dental Hospital, Sydney, Australia. The records of 63 children referred for removal of a supernumerary tooth in Bristol and 96 children in Westmead were examined, involving a total of 215 supernumerary teeth. Differences in the treatment provided for these patients were found not only between the two centres but also within one centre. There appeared to be no standardised route by which these patients were seen and therefore no standardised pattern of treatment. Contact with all UK Dental Schools indicated that no formal treatment protocol existed for the treatment of children with supernumerary teeth. In addition, a permanent incisor associated with a conical supernumerary tooth was twice as likely to erupt spontaneously as one associated with a supernumerary of tuberculate form. The location of the supernumerary tooth also influenced the likelihood of spontaneous eruption of the associated permanent incisor. There is a need for a prospective randomised controlled trial in the future in order to develop a formal treatment protocol for the management of patients with supernumerary teeth. A multicentre trial is under development.

Computing facilities available to final-year students at 3 UK dental schools in 1997/8: their use, and students' attitudes to information technology.

OBJECTIVE: To identify computer facilities available in 3 dental schools where 3 different approaches to the use of technology-based learning material have been adopted and assess dental students' perception of their own computer skills and their attitudes towards information technology. DESIGN: Multicentre cross sectional by questionnaire. SUBJECTS: All 181 dental students in their final year of study (1997-8). RESULTS: The overall participation rate was 80%. There were no differences between schools in the students' self assessment of their IT skills but only 1/3 regarded themselves as competent in basic skills and nearly 50% of students in all 3 schools felt that insufficient IT training had been provided to enable them to follow their course without difficulty. There were significant differences between schools in most of the other areas examined which reflect the different ways in which IT can be used to support the dental course. CONCLUSIONS: 1. Students value IT as an educational tool. 2. Their awareness of the relevance of a knowledge of information technology for their future careers remains generally low. 3. There is a need to provide effective instruction in IT skills for those dental students who do not acquire these during secondary education.

An inference modeling of human visual judgment of sagittal jaw-base relationships based on cephalometry: part II.

In a clinical situation, visual judgment of sagittal jaw-base relationships is described and handled as fuzzy terms, such as "slight" skeletal 3 tendency or "relatively severe" skeletal 2. The purpose of this study was to develop an inference system in order to be able to describe the degree of certainty for sagittal skeletal discrepancy automatically and in a mathematical way. Orthodontic records of 137 adult female patients were judged by 3 orthodontists. Based on these data and the multiple regression model described in Part I of this study, we developed an inference system that consisted of 2 membership functions and 6 incorporating rules. The performance reliability of the system was tested for 175 female adult cases by 7 orthodontic experts. In 97% (170 of 175) of the cases, the orthodontic experts agreed with advice proposed by the inference system. We conclude that the current model is an effective means of deriving the opinion of an experienced clinician from a cephalometric tracing and provides an interesting insight into how orthodontists are influenced by the face when attempting to judge the sagittal relationship clinically. In addition, the current system would be an initial stage in the development of the decision-making system for the orthodontic diagnosis and treatment planning.

An inference modeling of human visual judgment of sagittal jaw-base relationships based on cephalometry: part I.

When there appears to be a contradiction between a cephalometric tracing and what is seen, the clinician tends to place more reliance on the appearance of the face in profile than on a formal cephalometric evaluation of the sagittal jaw relationship. With this in mind, we derived a multiple regression model with cephalometric variables to explain the visual influences that affect the subjective classification of sagittal jaw relationships made by experienced orthodontists. The regression model that showed the highest coefficient of determination, 0.90, was constructed from a linear combination of the angle ANB, the anteroposterior position of gnathion, the SN length, and the mandibular body length. The performance reliability of the inference system has been tested for 175 female adult cases and will be reported in Part II of this article.

Forget the sailboard--let's go whiteboarding!

This paper describes the electronic whiteboard, and discusses its potential as a clinical communication tool and its possible use in dental education.

A survey of the IT skills and attitudes of final year dental students at Bristol University in 1996 and 1997.

Surveys of final year dental students were conducted in 1996 and 1997 to see if there were any detectable differences in students' perception of their own information technology IT skills and attitudes towards information technology following the opening of a dedicated computer-assisted-learning (CAL) room. An increase was seen in students' confidence levels, with fewer assessing themselves as IT "beginners" (1996 = 36%; 1997 = 14%), and more assessing themselves as competent in some basic skills (52%; 41%). Although more students were found to be using basic computer facilities (word processing, email, the World Wide Web), there was little difference in attitudes towards these packages between the 2 years. There was a significant increase in the number of students agreeing or strongly agreeing with the statement "the use of IT had added value to this course for me" (1996 = 39%; 1997 = 67%). The main obstacle which was identified by students as a barrier to using IT was the lack of adequate training. Over half the students in both years felt that insufficient training had been provided to enable them to cope with the course without difficulty.

Orthodontic auxiliaries: the way forward?

Currently two-thirds of European countries employ orthodontic auxiliaries and the UK is therefore unusual in not permitting their use. There is support from the orthodontic specialty for the concept of delegating routine intra-oral tasks to auxiliary personnel. The following describes a pilot project undertaken to determine the possible training structure for orthodontic auxiliaries. The modular course, which took place over a period of 4 weeks, is described and the results and implications are discussed.

Digital cameras and orthodontics: an overview.

The need to record clinical images, for use in documenting treatments, patient education, patient contracting, referral letters and sharing information with colleagues, is increasing. This article reviews the advantages and disadvantages of 35 mm and digital photography.

Task Group for Orthodontics Report.

The UK Specialist Review Group of the General Dental Council's Education Committee has been charged with taking forward the recommendations in the Chief Dental Officer's report 'UK Specialist Dental Training'. The Specialist Review Group has, in turn, established a number of specialty task groups. This report is from the Task Group for Orthodontics. It was submitted in May 1996.