Patient and professional engagement in the procurement of dental services.

OBJECTIVE: To describe the process of patient and professional engagement in the procurement of a specialist dental service. Stakeholder engagement is the practice of interacting with, and influencing, project stakeholders to the overall benefit of the project and its advocates. The successful completion of a project usually depends on how the stakeholders view it. Their requirements, expectations, perceptions, personal agendas and concerns will influence the project, shape what success looks like, and impact the outcomes that can be achieved. An engagement working group developed a work plan and communications strategy. Following initial scoping the engagement method and resources were developed. Engagement included patient and dentist questionnaires, interviews with specialists and hospital consultants, briefing papers and market engagement workshops. OUTCOME: Feedback from stakeholders provided reassurance of good access and quality, with 98% of patients expressing satisfaction with their overall treatment. Challenges included communication and administrative support. Learning points were diffusion of tension, developing a relationship based on trust, ensuring that stakeholder views are seen to be included in decision making and that there is flexibility in the engagement process. CONCLUSIONS: Good stakeholder engagement with an effective communications strategy is important in the procurement of dental services. Stakeholder engagement should aim to inform, involve, consult, collaborate and empower.

Oral health and oral health behaviours of five-year-old children in the Charedi Orthodox Jewish Community in North London, UK.

OBJECTIVE: To report on the oral health status and oral health behaviours of five-year-old Charedi Orthodox Jewish children attending schools in London, UK. BASIC RESEARCH DESIGN: Cross-sectional survey. METHOD: Clinical examinations mirroring the 2015 National Dental Public Health Epidemiology Programme for England for five-year-olds and a parental questionnaire on oral health behaviours. PARTICIPANTS: 137 five-year-olds attending Charedi Orthodox Jewish schools in Hackney, North London. MAIN OUTCOME MEASURES: Prevalence dmft⟩0 (%) and severity (mean dmft) of dental caries. RESULTS: Of these children 58% had experienced dental caries (95%CI 50,67), the mean number of decayed, missing and filled teeth was 2.38 (95%CI 1.90,2.82) and 23% (95%CI 16,30) had caries affecting their incisors. Only 20% reported that their children had their teeth brushed twice a day and 16% of the children started having their teeth brushed between six months and one year of age. CONCLUSIONS: The oral health of five-year-old children in the Charedi Orthodox Jewish community is significantly worse than their counterparts across Hackney, London and England. The establishment of robust baseline data supports the local authority plan to develop targeted oral health improvement programmes tailored to address the health needs and cultural sensitivities of this community.

Intracoronary thrombolysis in acute myocardial infarction: experimental background and clinical experience.

Occlusive intracoronary (IC) thrombosis was produced experimentally in dogs by placement of a copper coil. The thrombus was consistently lysed by application of Thrombolysin (streptokinase and plasminogen) at the site of occlusion, 1 to 6 hours after thrombosis. Thrombolysin has no toxic effect on the coronary artery wall or the myocardium. Reperfusion after 30 to 60 minutes of occlusion frequently resulted in ventricular fibrillation, but gradual reperfusion reduced the probability of ventricular fibrillation. Intramyocardial bleeding was noted after reperfusion in areas of advanced necrosis and was shown to be the consequence, rather than the cause, of necrosis. The reperfused myocardium remained hypocontractile, but in contrast to the occlusion period, its mechanical function could be enhanced by inotropic stimulation. After experimental studies confirmed the feasibility and safety of IC thrombolysis, the technique was applied within 3 hours of onset of pain in 29 patients with evolving acute myocardial infarction (AMI) and showing ST elevations without pathologic Q waves. Nitroglycerin (NTG), 0.1 mg, was injected into the occluded coronary artery to rule out spasm; NTG failed to open the occluded artery. A special, very flexible, radiopaque No. 2 French catheter was advanced through the angiography catheter to the site of occlusion. Thrombolysin was infused at a rate of 4000 to 6000 IU/min until patency was achieved, followed by 2000 IU/min for 60 minutes. Lysis of clot was achieved in 27 of 29 patients. The single death (unrelated to the procedure) occurred subsequently in a patient in whom the artery was not reopened. After successful thrombolysis, 12 patients underwent elective coronary bypass surgery because of multiple stenoses. The need for early reperfusion is emphasized for effective IC thrombolysis therapy in evolving AMI.

Intracoronary thrombolysis in evolving myocardial infarction.

After experimental studies in dogs confirmed the feasibility and safety of rapid intracoronary thrombolysis by local infusion of Thrombolysin (streptokinase and plasmin), intracoronary thrombolysis was attempted in 20 patients with evolving myocardial infarction who were hospitalized within 3 hours from the onset of symptoms during the day and within 2 hours at night. Thrombolysin was infused in the immediate vicinity of the site of coronary occlusion using a 0.85 mm outer diameter catheter advanced through the lumen of the Judkins catheter. Reperfusion was achieved in four patients after an average of 43 minutes of Thrombolysin infusion at a rate of 2000 IU/min and in 15 patients after an average of 21 minutes of Thrombolysin infusion at a rate of 4000 IU/min. The failure to open the artery in one patient may have been caused by our inability to advance the infusion catheter close to the site of occlusion. Rethrombosis occurred in one patient 8 days after reperfusion and 2 days after discontinuation of anticoagulants because of a history of chronic alcoholism. Wall motion and perfusion studies showed improvement following reperfusion. Patency of the artery was achieved an average of 4 hours after the onset of symptoms. The need for earlier reperfusion is emphasized.

Serum immunoglobulins in leprosy.

Serum immunoglobulins were quantitated by radial immunodiffusion in 25 cases each of tuberculoid and lepromatous leprosy. Immunoglobulins estimated from 50 normal healthy adults were the control. Serum IgG was markedly raised in both tuberculoid (mean 2420 mg/dl) and lepromatous leprosy (mean 2493 mg/dl) when compared with the controls (mean 1288 mg/dl) and the difference was significant (p less than 0.01). However the difference in serum IgM and IgA levels in cases as compared to controls were not statistically significant. Serum IgM was slightly raised, the mean values obtained being 222 mg/dl in tuberculoid leprosy, 221 mg/dl in lepromatous leprosy and 202 mg/dl in control. Serum IgA was reduced in lepromatous leprosy (mean 129 mg/dl) as compared to the controls (mean 168 mg/dl) and the cases of tuberculoid leprosy (mean 165 mg/dl). The range of values obtained in both groups of patients showed greater scatter than the controls and a few cases of both forms of leprosy showed very low values of both serum IgA and IgM.