Improving patient experience in a multi-disciplinary clinic: clinical efficiency and patient satisfaction of 400 patients attending the Manchester Hypodontia Clinic.

OBJECTIVE: To assess the efficiency of the Manchester Hypodontia Clinic (MHC) in improving patient experience and satisfaction. SETTING: In January 2010, the University Dental Hospital of Manchester applied a more modern approach to the design of a treatment planning clinic for patients with hypodontia. This brought together all the necessary dental specialties in one multidisciplinary clinic. DESIGN: A questionnaire study of patients attending the MHC between January 2010 and March 2012 was used to monitor each patient's journey through the clinic. SUBJECTS: 400 patients attended the MHC between January 2010 and March 2012. METHOD: Patient satisfaction was assessed before and after attending the clinic via questionnaires in an attempt to understand more about patient expectations and satisfaction with the structure and management of the clinic. RESULTS: Ninety-nine percent of patients received a clear explanation of why they had been invited to attend the clinic and 98% felt that they had been directly involved in their treatment planning and were fully informed of the decisions made regarding their future treatment. Almost all patients (99%) felt that attending the MHC had been worthwhile. Nearly a third of patients rated their experience as good and over two-thirds of patients (69%) rated their experience as excellent. CONCLUSIONS: The results prove that by designing the service around the patients' needs it is possible to run an efficient clinic and achieve high levels of patient satisfaction.

Evaluation of left ventricular performance during supine exercise by transoesophageal M-mode echocardiography in normal subjects.

In order to evaluate left ventricular function during dynamic exercise transoesophageal M-mode recordings of the left ventricle were carried out with a newly developed transducer gastroscope system. Twelve healthy subjects performed a graded supine bicycle exercise test. Stable and good quality images of the left ventricle at rest and during exercise at different steps up to a maximum workload of 100 watts were obtained in all patients. Isotonic maximum exercise resulted in a significant increase in fractional shortening of the left ventricle, peak shortening rate, and peak lengthening rate of the left ventricular minor axis. Left ventricular end-diastolic dimension decreased significantly. With increasing workload the pressure rate product increased significantly. It is concluded that transoesophageal M-mode echocardiography is a useful method of evaluating left ventricular performance during dynamic exercise.

Multiple and synergistic deregulations of apoptosis-controlling genes in pancreatic carcinoma cells.

Inability to die by apoptosis is one of the reasons for the deregulated growth of tumour cells and the frequently observed failure of chemotherapy. In this study we thought to identify the common and functionally important characteristics responsible for the apoptosis resistance of pancreatic tumour cells. We analysed cell surface expression level of death receptors CD95 and TRAIL-R1-4 as well as the expression profile of sixteen apoptosis-relevant proteins in five pancreatic carcinoma cell lines Capan1, Colo357, PancTuI, Panc89 and Panc1. These data were evaluated in the context of sensitivity towards anti-CD95 and TRAIL-mediated apoptosis. Here we report that except for resistant Panc1 cells, which only marginally expressed CD95, all other cell lines showed comparable levels of CD95 and TRAIL receptors irrespectively of their apoptotic phenotype. Interestingly, we found that the elevated expression of FLIP, Bcl-x(L) and IAP in parallel with a downregulation of FADD and Bid was common for the resistant cell lines. Consequently, stable overexpression of XIAP, Bcl-x(L) or dominant negative FADD in sensitive cells significantly reduced the death receptor mediated apoptosis while the overexpression of Bid rendered the resistant cells sensitive.