RESUMEN
OBJECTIVES: To determine the prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and periodontal pocketing (PPD) in young European adults. MATERIALS AND METHODS: This is a secondary analysis using data collected from 350 UK participants enrolled in a European cross sectional study of 3187 young adults. GR, BOP, PPD, DH (participant and clinician assessment) and BEWE were recorded. A questionnaire assessed demographics, oral hygiene and lifestyle habits. RESULTS: 349 participants completed the study. GR, BOP and PPD showed the same pattern of distribution, prevalence increasing from incisors to molars in upper and lower arches for buccal and palatal scores. Every participant exhibited recession affecting at least 1 tooth, 42% having a maximum recession of 4-8â¯mm. There was a significant and linear association demonstrating an increase in maximum recession with age. DH and BEWE produced a similar pattern to buccal periodontal indices, the premolars being most affected. Maximum recession correlated significantly with maximum DH (participant and Schiff), PPD, BOP, BEWE (scores of 2/3), BMI (≥25â¯kg/m2) and unsystematic brushing motion. 94% of the study population exhibited some BOP at one or more sites. 5% of the population had periodontal pocketing ≥4â¯mm, 46% had DH and 80% BEWE 2/3. CONCLUSION: Widespread recession and gingivitis with minimal periodontal disease was observed. Every participant exhibited at least one tooth with recession. Many teeth did not exhibit DH despite prevalent recession and severe erosive toothwear. Recession correlates to a number of oral and lifestyle variables. CLINICAL SIGNIFICANCE: Recession in young adults is multifactorial and highly prevalent. It can result in DH and consequential increase in demand for treatment relating to both pain and aesthetics. Further research is needed to understand the underlying aetiology to prevent recession occurring.
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Recesión Gingival , Estudios Transversales , Recesión Gingival/epidemiología , Gingivitis/epidemiología , Humanos , Prevalencia , Reino Unido/epidemiología , Adulto JovenRESUMEN
AIM: To determine if the number of abnormal nodes seen on preoperative axillary ultrasound (AUS) is a predictor of the number of positive nodes at histology for women with needle-biopsy-proven positive nodes. MATERIALS AND METHODS: This prospective multicentre cohort study included consecutive patients with early breast cancer who had needle-biopsy-proven positive nodes on AUS and underwent axillary lymph node dissection (ALND) between October 2015 and July 2016. The number of abnormal nodes at preoperative AUS was recorded by breast radiologists or radiographers. RESULTS: One hundred and twenty-three patients were included in the study. The median age of the women was 62 (range 30-93) years. Fifty-four of the 123 (44%) women had one abnormal node, whereas 69 (56%) had multiple abnormal nodes on AUS. Forty of the 123 (33%) women had two or fewer nodes with metastases at histology after ALND. Tumours ≤20 mm (p<0.001) and one abnormal node on AUS (p<0.001) were associated with two or fewer nodes with metastases at ALND. Both remained significant in logistic regression analysis. The likelihood of at least three metastases based on the combination of these two factors had 95% sensitivity (79 of 83), 35% specificity (14 of 40), a negative predictive value of 78% (14 of 18), and a positive predictive value of 75% (79 of 105). CONCLUSION: Among women with needle-biopsy-proven positive nodes, around three in four women (78%) with an invasive tumour ≤2 cm and one abnormal node on AUS have two or fewer positive nodes at ALND. These women are overtreated by upfront ALND and can be offered sentinel node biopsy (SNB).
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Neoplasias de la Mama/patología , Escisión del Ganglio Linfático/estadística & datos numéricos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Carga Tumoral , Adulto , Anciano , Anciano de 80 o más Años , Axila , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Metástasis Linfática , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
BACKGROUND: The sensitivity of axillary ultrasonography (AUS) has increased in recent years, enabling detection of even low-volume axillary nodal metastases. The aim here was to evaluate the axillary tumour burden in women with a fine-needle aspiration/core biopsy-proven positive node on AUS and in those with a positive sentinel node biopsy (SNB). METHODS: This retrospective cohort study included all patients with early breast cancer who had AUS and axillary lymph node dissection (ALND) between 2011 and 2014. RESULTS: A total of 332 patients who had ALND were eligible for the study, 191 (57·5 per cent) in the AUS-positive group and 141 (42·5 per cent) in the SNB-positive group. Patients in the AUS-positive group were older at diagnosis (P = 0·018), more likely to have larger tumours (P = 0·002), higher tumour grade (P = 0·005), positive human epidermal growth factor 2 status (P = 0·015), and negative oestrogen receptor status (P < 0·001). The AUS-positive group also had a larger number of lymph nodes with macrometastases (P < 0·001) and were more likely to have extranodal invasion (P < 0·001). In the AUS-positive group, 40·3 per cent of patients (77 of 191) had only one or two nodes with macrometastases identified at histology after ALND. Tumour size no larger than 20 mm, invasive ductal or lobular histology and breast-conserving surgery were associated with the presence of two or fewer macrometastases at ALND. Only tumour size and tumour histology remained significant in multiple logistic regression analysis. CONCLUSION: Patients with AUS-detected metastases had a higher axillary tumour burden than those with SNB-detected metastases. Around 40 per cent of patients with AUS-detected nodal disease had one or two nodes with macrometastases and were thus overtreated by ALND.
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Axila , Biopsia con Aguja Fina , Neoplasias de la Mama/patología , Biopsia Guiada por Imagen , Metástasis Linfática , Biopsia del Ganglio Linfático Centinela , Ultrasonografía Intervencional , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/patología , Carcinoma Lobular/cirugía , Estudios de Cohortes , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Persona de Mediana Edad , Micrometástasis de Neoplasia , Estudios RetrospectivosRESUMEN
OBJECTIVES: To investigate the abrasive effect of the tongue on human enamel loss with and without a prior dietary acid challenge in an in situ model. METHODS: A single centre, single blind, randomly allocated, split mouth, four treatment regimen, in situ study in healthy adult volunteers was undertaken. Twenty four subjects wore two lower intra-oral appliances each fitted with 4 human enamel samples 6h/day for 15 days. The samples were treated with either 50ml orange juice or water for 5min ex vivo 4x/day; prior to being licked or not licked with the subject's tongue for 60s. There were 2 samples per group per subject. Surface loss was measured by contact profilometry. RESULTS: 23 subjects completed the study with no adverse events. The mean loss of enamel at 15days was: 0.08µm for water without licking, 0.10µm with water and licking; 1.55µm with orange juice alone, 3.65µm with orange juice and licking. In the absence of erosive challenge, licking had no detectable effect on enamel loss p=0.28. Without licking, orange juice had a highly significant effect on loss compared to water, p<0.001. Erosive challenge followed by licking more than doubled the loss of enamel p<0.001. CONCLUSIONS: When enamel was exposed to orange juice prior to licking, tissue loss as a result of tongue abrasion of the eroded surface was increased, and double that of the erosive challenge alone. Licking enamel with the tongue had no perceptible effect on enamel loss in the absence of the erosive challenge. CLINICAL SIGNIFICANCE: Enamel wear resulting from tongue abrasion on tooth surfaces softened by acid challenge, can be an unavoidable consequence of oral function. This may account for the pattern of erosive toothwear on palatal and occlusal tooth surfaces, reinforcing the importance of restricting the frequency of dietary acid challenge in susceptible individuals.
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Citrus sinensis/efectos adversos , Esmalte Dental/efectos de los fármacos , Jugos de Frutas y Vegetales/efectos adversos , Lengua/fisiopatología , Abrasión de los Dientes/etiología , Erosión de los Dientes/complicaciones , Adolescente , Adulto , Bebidas/efectos adversos , Esmalte Dental/patología , Suplementos Dietéticos , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Método Simple Ciego , Propiedades de Superficie , Factores de Tiempo , Erosión de los Dientes/patología , Agua , Adulto JovenRESUMEN
OBJECTIVES: Investigation of early enamel erosion using replica impressions to compare changes in enamel surface topography in vivo prior to and over a 24 h period following acid challenge. METHOD: A single treatment, blinded, enamel replica clinical study was undertaken in 20 healthy subjects. Replica tooth impressions were taken at baseline, following acid challenge and 2, 4, 7 and 24 h post challenge. Subjects consumed 500 ml of acidic soft drink over 30 min. Scanning electron microscopy of surface tomography was characterised with a descriptive 5 point scale by four judges. Duplicate impressions were taken to assess reproducibility. RESULTS: 18 subjects had scorable sequences. Descriptive analyses showed erosive changes following acid consumption and reparative changes in the subsequent 24 h period. Comparing baseline replica to the 24 h replica, there were no significant differences (p=0.26) in tooth surface characteristics. Comparing the replica taken immediately following acidic challenge with the subsequent replicas at 2, 4, 7 and 24 h, showed clear reduction of erosive effects on the enamel surface at 2 h (p=0.02) and a highly significant reduction at 4, 7 and 24 h (p<0.001). CONCLUSION: This methodology demonstrated the ability to follow the progression and recovery of early erosive enamel lesions over 24 h being accurate and reproducible. This study suggests enamel repair commences within 2 h following a substantial acidic challenge and is completed 4-24 h later. After 24 h, the tooth surface appeared visibly indistinguishable from the original tooth surface, suggestive of a recovery process occurring. CLINICAL SIGNIFICANCE: Healthy erosive lifestyles often culminate in tooth wear. The time taken for enamel remineralisation following acidic challenge is unknown however, this study suggests the repair process is relatively slow following a substantial acidic challenge, and at least 4-24 h should elapse prior to further acidic consumption to allow for recovery.
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Ácidos/efectos adversos , Bebidas Gaseosas/efectos adversos , Esmalte Dental/efectos de los fármacos , Propiedades de Superficie/efectos de los fármacos , Adolescente , Adulto , Técnica de Impresión Dental , Femenino , Voluntarios Sanos , Humanos , Masculino , Microscopía Electrónica de Rastreo , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To analyse the factors affecting the clinical performance and those influencing the survival of resin-retained bridgework provided at a UK dental teaching hospital between 1994 and 2001. DESIGN: A prospective analysis of restorations provided at a single centre using case notes with all patients invited for review to corroborate findings. SETTING: Department of Restorative Dentistry, University of Bristol Dental Hospital and School, Bristol, United Kingdom. SUBJECTS AND METHODS: Between January 1994 and December 2001, data regarding 1,000 consecutive resin-retained bridges provided at Bristol Dental Hospital and School were recorded. Data was available for 805 patients at the time of the study. Following invitation, 621 patients attended for a review appointment. Life table and Kaplan-Meir survival analysis were carried out for all restorations provided. RESULTS: The five-year and ten-year survival rates estimated by the life-table method are 80.8% (95% confidence interval 78.0-83.6%) and 80.4% (95% confidence interval 77.6-83.2%) respectively. The median survival cannot be estimated for this study as the survival probability remains above 80% even at the longest follow-up. Analysis of clinical variables influencing survival revealed that design of the restoration and experience of the operator providing the restoration were significant factors. Resin-retained bridges made with minimal tooth preparation are shown to be superior in terms of longevity than those for which other types of tooth preparation is made. Patient satisfaction with their treatment was high.
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Fracaso de la Restauración Dental/estadística & datos numéricos , Dentadura Parcial Fija con Resina Consolidada/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente/estadística & datos numéricos , Estudios Prospectivos , Reino Unido , Adulto JovenAsunto(s)
Aminas/administración & dosificación , Analgésicos/administración & dosificación , Ácidos Ciclohexanocarboxílicos/administración & dosificación , Neuralgia Posherpética/prevención & control , Neuralgia/prevención & control , Ácido gamma-Aminobutírico/administración & dosificación , Anciano , Anciano de 80 o más Años , Dolor Crónico/prevención & control , Femenino , Gabapentina , Humanos , Masculino , Dimensión del Dolor , Estudios RetrospectivosRESUMEN
BACKGROUND: New Start, a structured, validated, multidisciplinary training programme in sentinel lymph node biopsy (SLNB), was established to allow the introduction and rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice across the UK. METHODS: Multidisciplinary teams attended a theory/skills laboratory course, following which they performed 30 consecutive SLNBs, either concurrently with their standard axillary staging procedure (training model A) or as stand-alone SLNB (training model B). SLNB was performed according to a standard protocol using the combined technique of isotope ((99m) Tc-labelled albumin colloid) and blue dye. An accredited New Start trainer mentored the first five procedures in the participant's hospital, or all 30 if stand-alone. Validation standards for model A and B were a localization rate of at least 90 per cent. In addition, for model A only, in which a minimum of ten patients were required to be node-positive, a false-negative rate (FNR) of 10 per cent or less was required. RESULTS: From October 2004 to December 2008, 210 SLNB-naive surgeons, in 103 centres, performed 6685 SLNB procedures. The overall sentinel lymph node (SLN) localization rate was 98·9 (95 per cent confidence interval 98·6 to 99·1) per cent (6610 of 6685) and the FNR 9·1 (7·9 to 10·5) per cent (160 of 1757). The FNR was related to nodal yield, ranging from 14·8 per cent for one node and declining to 9·7, 6·6, 4·7 and 4·1 per cent for two, three, four and more than four SLNs respectively. No learning curve was identified for localization or FNR. CONCLUSION: The programme successfully trained a wide range of UK breast teams to perform safe SLNB and suggested that a standard injection protocol and structured multidisciplinary training can abolish learning curves.
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Neoplasias de la Mama/patología , Educación de Postgrado en Medicina/métodos , Biopsia del Ganglio Linfático Centinela/educación , Neoplasias de la Mama/cirugía , Competencia Clínica/normas , Reacciones Falso Negativas , Femenino , Humanos , Curva de Aprendizaje , Metástasis Linfática , Mastectomía/métodos , Mastectomía/estadística & datos numéricos , Mentores , Estadificación de Neoplasias/métodos , Grupo de Atención al Paciente/normas , Biopsia del Ganglio Linfático Centinela/normas , Carga de Trabajo/estadística & datos numéricosRESUMEN
INTRODUCTION: Ongoing professional education is essential for dental professionals to maintain and update their clinical skills and knowledge. There is a current trend towards mandatory Continuing Professional Development (CPD) for dentists within Europe and beyond. Mandatory CPD will ensure high professional standards and enable mobilisation of the dental workforce within Europe. In 2002, the UK General Dental Council (GDC) implemented a system of mandatory CPD for dentists practicing in the UK. The Wales Deanery is situated in the School of Postgraduate Medical and Dental Education, Cardiff University. It provides verifiable CPD courses for dentists and dental care professionals (DCPs) currently practicing in Wales and has recorded professionals' attendance on these courses since 2001. The project aimed to investigate the CPD activity of dentists in Wales, using these data. METHODS: The Wales Deanery database holds data on the CPD courses undertaken by 1178 dentists working in Wales since 2001. A number of hypotheses were investigated using a variety of statistical methods. RESULTS: Dentists were undertaking significantly fewer hours of CPD in Mid and West Wales compared to the North and South of the principality. Sole practitioners were found to engage in less CPD than those in group practices, but these differences did not reach statistical significance. Dentists who employed a hygienist or therapist completed more hours of CPD than those who didn't employ either. There were no gender differences in engagement in CPD. CPD participation was consistently and significantly higher in mid and late career than in early career. CONCLUSIONS: This study provides a greater understanding of the CPD habits of the dental workforce in Wales. Practice staffing levels, location of practice and time since graduation were found to have the greatest impact on engagement in CPD activity. These findings will be used by the Deanery to inform future education provision for dental professionals in Wales.
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Educación Continua en Odontología/estadística & datos numéricos , Competencia Clínica/normas , Demografía , Educación Continua en Odontología/métodos , Femenino , Práctica Odontológica de Grupo/estadística & datos numéricos , Humanos , Masculino , Práctica Privada/estadística & datos numéricos , Ubicación de la Práctica Profesional/estadística & datos numéricos , GalesRESUMEN
OBJECTIVES: The aim of the study was to determine in situ the relative abilities of two desensitising toothpastes to occlude dentinal tubules with or without acid challenge. MATERIALS AND METHODS: The study design was a single centre, randomised, split mouth crossover model examining four treatments over two periods. The primary outcome was the degree of occlusion proffered by two desensitising toothpastes [Sensodyne® Rapid Relief (8% strontium acetate, 1040 ppm sodium fluoride) and Colgate® Sensitive Pro-ReliefTM daily (8% arginine, 1450 ppm sodium monofluorophosphate)], a standard toothpaste (1450 ppm sodium fluoride) and water, after acid challenge. Healthy adult volunteers wore bi-lateral lower buccal appliances each with two dentine sections, receiving two treatments per study period. Samples were brushed twice a day with treatment, with two additional 3-min extra-oral acidic challenges applied ex vivo on days 3 and 4. A secondary outcome was the degree of occlusion attained in the absence of acid challenge. Examiners blinded to the study assessed occlusion by visual score of post-treatment scanning electron microscope images. RESULTS: All 28 participants completed the study. In the absence of acid challenge, occlusion scores for both desensitising toothpastes were similar and significantly better than control scores (p < 0.02). After acid challenge both desensitising toothpastes occluded more effectively than controls; however, occlusion scores for the strontium acetate paste were significantly greater than those of the arginine paste (p < 0.02). CONCLUSIONS: The occluding properties of the strontium acetate toothpaste were significantly more robust after acid challenge than those of the arginine toothpaste. CLINICAL RELEVANCE: Patients with hypersensitivity, regularly imbibing dietary acidic drinks, should be advised that Sensodyne® Rapid Relief provides robust tubule occlusion despite repeated acidic challenges.
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Desensibilizantes Dentinarios/uso terapéutico , Dentina/efectos de los fármacos , Pastas de Dientes/uso terapéutico , Acetatos/uso terapéutico , Adulto , Arginina/uso terapéutico , Carbonato de Calcio/uso terapéutico , Estudios Cruzados , Dentina/ultraestructura , Sensibilidad de la Dentina/prevención & control , Femenino , Fluoruros/uso terapéutico , Estudios de Seguimiento , Humanos , Concentración de Iones de Hidrógeno , Masculino , Microscopía Electrónica de Rastreo , Fosfatos/uso terapéutico , Método Simple Ciego , Fluoruro de Sodio/uso terapéutico , Estroncio/uso terapéutico , Resultado del Tratamiento , Agua/químicaRESUMEN
OBJECTIVES: A product comparison study to compare the short term clinical efficacy of a strontium acetate/silica toothpaste with an arginine/calcium carbonate paste for pain reduction in dentine hypersensitivity. METHODS: The study was examiner blind of two arm parallel design. Eighty healthy adult subjects from general dental practice with ≥2 sensitive teeth but otherwise good oral health, were enrolled and randomised to 1 of 2 toothpaste treatments, schedule provided by the sponsor. Almost equal numbers received each treatment. Tooth sensitivity was measured in three ways; evaporative (Schiff score; Visual Analogue Scale) and tactile stimuli (Yeaple probe), prior to and immediately after subjects' self application of a single pea sized dose of toothpaste, and following subsequent twice daily brushing for three days with the paste. RESULTS: All 80 subjects completed the study. Results confirm that for both treatments, pain was reduced immediately and relief was sustained after 3 days use. For all 3 measures, benefit was similar between the two pastes, with no statistical or clinical difference demonstrated, apart from response to evaporative stimulus at 3 days, where Schiff scores were significantly lower in the arginine group, p=0.02. CONCLUSIONS: It can be concluded that both desensitising, occluding toothpastes provided reduction of pain from dentine hypersensitivity on a short term basis: toothpastes appearing to be clinically similarly effective both after a single subject dab on application and post twice daily brushing for three days. National Research Ethics Service register number 09/H020/57.
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Desensibilizantes Dentinarios/uso terapéutico , Sensibilidad de la Dentina/tratamiento farmacológico , Dentina/efectos de los fármacos , Pastas de Dientes/uso terapéutico , Acetatos/uso terapéutico , Adulto , Arginina/uso terapéutico , Carbonato de Calcio/uso terapéutico , Cariostáticos/uso terapéutico , Frío , Dentina/ultraestructura , Sensibilidad de la Dentina/prevención & control , Desecación , Femenino , Fluoruros/uso terapéutico , Humanos , Masculino , Dimensión del Dolor , Umbral del Dolor/efectos de los fármacos , Fosfatos/uso terapéutico , Estimulación Física , Dióxido de Silicio/uso terapéutico , Método Simple Ciego , Fluoruro de Sodio/uso terapéutico , Estroncio/uso terapéutico , Tacto/fisiología , Resultado del TratamientoRESUMEN
In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device.
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Técnicos Medios en Salud , Equipos Desechables/estadística & datos numéricos , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/estadística & datos numéricos , Adulto , Estudios Cruzados , Diseño de Equipo , Equipo Reutilizado , Femenino , Humanos , Masculino , ManiquíesRESUMEN
BACKGROUND: Prevalence surveillance methodology is the systematic observation of the occurrence and distribution of healthcare-associated infections (HCAIs) so that appropriate actions can be taken. AIM: The objectives of a prevalence survey with an international validated methodology were to determine the prevalence of HCAIs for the first time in Argentina, and to provide data which could be used for international benchmarking. METHODS: In 2008, an HCAI prevalence survey was carried out in 39 hospitals in seven of 23 provinces in Argentina, with methodology identical to that employed by the Hospital Infection Society in the third prevalence survey of HCAIs in acute hospitals in the British Isles. Data collected were processed and analysed at the Northern Ireland Healthcare-Associated Infection Surveillance Centre at Belfast. FINDINGS: A total of 4249 patients were surveyed; 480 of these had at least one HCAI, resulting in a prevalence of 11.3% of patients. Male prevalence was 13.6% and female 9.0%. The most common HCAIs were pneumonia (3.3%), urinary tract infection (3.1%), surgical site infection (2.9%), primary bloodstream infection (1.5%), and soft tissue infections (1.2%). Among the 1027 patients who underwent surgery, the prevalence of surgical site infection was 10.2%. The prevalence of meticillin-resistant Staphylococcus aureus was 1.1%, accounting for 10.0% of all HCAI isolates. The results for Argentina show higher HCAI rates compared with corresponding findings for England, Wales, Northern Ireland and South Africa. CONCLUSION: This survey will contribute to the prioritization of resources and help to inform Departments of Health and hospitals in the continuing effort to reduce HCAIs.
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Infección Hospitalaria/epidemiología , Vigilancia de la Población/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Bacteriemia/epidemiología , Infección Hospitalaria/etiología , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Irlanda del Norte/epidemiología , Neumonía/epidemiología , Sudáfrica/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Infección de la Herida Quirúrgica/epidemiología , Infecciones Urinarias/epidemiología , Gales/epidemiología , Adulto JovenRESUMEN
AIM: To evaluate a disinfection and decontamination dental postgraduate course run by the Wales Dental Postgraduate Deanery between 2008 and 2010. METHODS: Pre- and post-course multiple choice questionnaires were completed by 1177 course attendees. Mean scores before and after participation on the training course were compared and analysed. RESULTS: Mean pre-course score was 45.3%, rising to 87.0% in the post-course assessment, reflecting an improvement of 41.8%. Prior to training, 30.7% achieved a satisfactory score of 13/20 (65%) compared to 98.3% on completion of training. Dental technicians were found to score significantly lower than other occupation groups both before and after course attendance. Decade of graduation had no effect on results. Theoretical microbiology was the question area which showed least improvement. CONCLUSION: Attending the disinfection and decontamination course significantly improved participants' knowledge. Theoretical microbiology, as a topic area, may be targeted for improvements in future courses to improve results further.
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Descontaminación/normas , Desinfección/normas , Educación Continua en Odontología , Contaminación de Equipos/prevención & control , Análisis de Varianza , Evaluación Educacional , Humanos , Evaluación de Programas y Proyectos de Salud , Estadísticas no Paramétricas , Encuestas y Cuestionarios , GalesRESUMEN
OBJECTIVE: To evaluate medium-term knowledge retention of dental personnel following attendance at a postgraduate course in radiation protection. SUBJECTS AND METHODS: Knowledge was measured using identical pre- and post-course validated single best-answer multiple-choice instruments, administered immediately before and after training and at follow-up at 6 or 12 months. These comprise 16 questions each with 5 choices. The range of possible scores was from 0 to 16, and scores were scaled to percentages. Participants were predominantly dental practitioners, but a minority consisted of dental care professionals (dental nurses, hygienists and therapists). Of 285 participants, 272 (95.4%) completed both pre- and post-course questionnaires. One hundred and seventeen (43%) of these also completed the follow-up test, but only 109 (40%) individuals could be linked to the original course. RESULTS: Mean (standard deviation) pre-, post-course and follow-up-corrected percentage scores were 39.1 (16.1), 74.6 (16.9) and 58.9 (22.7), respectively. There was attrition in knowledge at follow-up: the average increase in adjusted score after training was 35.5 points, but only 56% of this was retained at follow-up. Paired t-tests confirmed that the mean score at follow-up was firmly intermediate between the pre- and post-course scores. Of the 109 participants, 7 (6%) achieved a satisfactory score pre-training, 82 (75%) immediately post-training and 41 (38%) at follow-up. There were gross differences between the levels of performance achieved for the eight subject areas tested. CONCLUSION: Immediate post-course assessments have indicated that current postgraduate courses in radiation protection are effective. However, a substantial amount of knowledge is lost by 6-12 months following course attendance. To achieve long-term knowledge retention, early or repeated reinforcement may be necessary.
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Educación Continua en Odontología , Protección Radiológica , Radiología/educación , Educación de Postgrado , Evaluación Educacional , Humanos , Retención en Psicología , Encuestas y Cuestionarios , GalesRESUMEN
In 2006, the Hospital Infection Society was funded by the respective health services in England, Wales, Northern Ireland and the Republic of Ireland to conduct a prevalence survey of healthcare-associated infection (HCAI). Here, we report the prevalence of pneumonia and lower respiratory tract infection other than pneumonia (LRTIOP) in these four countries. The prevalence of all HCAIs was 7.59% (5743 out of 75 694). Nine hundred (15.7%) of these infections were pneumonia, and 402 (7.0%) were LRTIOP. The prevalence of both infections was higher for males than for females, and increased threefold from those aged <35 to those aged >85 years (P<0.001). At the time of the survey or in the preceding seven days, 23.7% and 18.2% of patients with pneumonia and LRTIOP, respectively, were mechanically ventilated compared to 5.2% of patients in the whole study population. Meticillin-resistant Staphylococcus aureus (MRSA) was the cause of pneumonia and LRTIOP in 7.6% and 18.1% of patients, respectively (P<0.001). More patients with LRTIOP (4.2%) had concurrent diarrhoea due to Clostridium difficile compared to patients with pneumonia (2.4%), but this did not reach statistical significance. Other HCAIs were present in 137 (15.2%) of patients with pneumonia and 66 (16.4%) of those with LRTIOP. The results suggest that reducing instrumentation, such as mechanical ventilation where possible, should help reduce infection. The higher prevalence of MRSA as a cause of LRTIOP suggests a lack of specificity in identifying the microbial cause and the association with C. difficile emphasises the need for better use of antibiotics.
Asunto(s)
Bacterias/aislamiento & purificación , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana/microbiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Bacterias/clasificación , Inglaterra/epidemiología , Femenino , Humanos , Irlanda/epidemiología , Masculino , Persona de Mediana Edad , Irlanda del Norte/epidemiología , Prevalencia , Factores Sexuales , Gales/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Blue dye with or without isotope has been widely used to identify the sentinel lymph node(s) in breast cancer. Patent blue V is used in the UK while its isomer isosulfan blue is used in the US. The allergic potential of isosulfan blue is well documented (1.4% adverse reactions) but that of patent blue V is less clearly defined. METHODS: In this paper we review the adverse reactions of patent blue V in 7,917 patients who participated in the NEW START training programme and the ALMANAC trial. All patients underwent sentinel lymph node biopsy for breast carcinoma using patent blue V in combination with (99m)Tc-albumin colloid. RESULTS: In total, 72 of 7,917 (0.9%) patients experienced adverse reactions : non-allergic reactions were observed in 4 (0.05%) patients, 23 (0.3%) patients had minor grade I allergic skin reactions (urticaria, blue hives, pruritus, or generalised rash) and 16 (0.2%) had grade II reactions (transient hypotension/bronchospasm/laryngospasm). Severe Grade III reactions (severe hypotension requiring vasopressor support and/or change/abandoning of planned procedure and/or HDU/ITU admission) were noted in 5 (0.06%) patients. The type of adverse reaction was not specified in 24 (0.3%) patients. No mortality was recorded. CONCLUSION: The allergic potential of patent blue V dye compares favourably with isosulfan blue however both the surgeon and anaesthetist need to be alert to the risk of allergic reactions.
Asunto(s)
Neoplasias de la Mama/patología , Colorantes/efectos adversos , Hipersensibilidad a las Drogas/epidemiología , Colorantes de Rosanilina/efectos adversos , Biopsia del Ganglio Linfático Centinela/efectos adversos , Femenino , Humanos , Metástasis Linfática , Ensayos Clínicos Controlados Aleatorios como Asunto , Biopsia del Ganglio Linfático Centinela/métodos , Reino Unido/epidemiologíaRESUMEN
AIM: To investigate the quality of periapical radiographic images produced by two digital dental radiography systems, a charge-coupled device (CCD) and a photostimulable phosphor (PSP) image plate system, and to examine the overall radiation exposure when using these systems in a clinical setting. METHODOLOGY: Patients were randomly allocated to both systems and the resultant radiographs rated for quality. The expected radiation exposure for an investigation was calculated. RESULTS: Overall, 98 images were acquired using the CCD system and 108 with the PSP system. The PSP system produced significantly higher quality (P < 0.001) periapical images compared with the CCD system. The CCD system required significantly more (P < 0.001) repeat exposures to obtain a diagnostic image than the PSP system but at a lower expected radiation exposure. CONCLUSIONS: The image quality was superior using the phosphor plate system. Although more repeat radiographs were required using the CCD system, the images were produced with a lower expected radiation exposure.