Evaluation of the effectiveness of a tailored mobile application in increasing the duration of wear of thermoplastic retainers: a randomized controlled trial.

BACKGROUND: The 'My Retainers' mobile application is a patient-informed intervention designed to enhance removable retainer wear and associated patient experiences during the retention phase. OBJECTIVES: To evaluate the effect of receiving the 'My Retainers' application on objectively assessed thermoplastic retainer (TPR) wear time, stability, periodontal outcomes, patient experiences, and knowledge related to retainers. MATERIALS AND METHODS: Eighty-four participants planned for removable retention with TPRs were assigned either to receive the 'My Retainers' application or to control not receiving electronic reminders during the 3-month period. Randomization was based on computer-generated random numbers and allocation was concealed using opaque, sealed envelopes. The primary outcome was objectively assessed retainer wear recorded using an embedded TheraMon® micro-electronic sensor. Secondary outcomes, including irregularity of the maxillary and mandibular incisors, plaque levels, bleeding on probing and probing depth, were assessed at baseline and 3-month follow-up; and analysed using a series of mixed models. Experiences and knowledge related to orthodontic retainers were recorded using questionnaires. The outcome assessor was blinded when possible. RESULTS: Receipt of the mobile application resulted in slightly higher median wear time (0.91 hours/day); however, this difference was not statistically significant (P = 0.56; 95% confidence interval [CI]: -2.19, 4.01). No significant differences were found between the treatment groups in terms of stability (P = 0.92; 95% CI: -0.03, 0.04), plaque levels (P = 0.44; 95% CI: -0.07, 0.03), bleeding on probing (P = 0.61; 95% CI: -0.05, 0.03) and probing depth (P = 0.79; 95% CI: -0.09, 0.07). Furthermore, similar levels of patient experiences (P = 0.94) and knowledge related to retainers (P = 0.26) were found. However, marginally better levels of knowledge were identified in the intervention group. No harms were observed. LIMITATIONS: A relatively short follow-up period with the study confined to a single-center in a university-based hospital. CONCLUSIONS: Provision of the bespoke 'My Retainers' application did not lead to an improvement in adherence with TPR wear over a 3-month follow-up period. Further refinement and research are required to develop and investigate means of enhancing adherence levels. CLINICAL REGISTRATION: NCT03224481.

The reliability of thermoform retainers: a laboratory-based comparative study.

AIM: Despite a very significant increase in the use of thermoform retainers, within orthodontics, to date, there is no evidence regarding the quality of fit between the dental cast and retainer. The current study aims to compare the fit of different thermoform retainer materials, under laboratory standardized conditions. MATERIALS AND METHODS: A prospective, laboratory-based study design was adopted to compare the fit of four different commercially available thermoform retainer materials. A master dental cast was fabricated in dental stone, to which three and five specific reference points were located on the central incisors and upper first molars, respectively. The master cast was then duplicated to produce a total of 40 such dental casts. The performance of the following four test materials was investigated: ACE, C+ (Raintree Essix Glenroe), True Tain (True Tain Inc.), and Iconic Clear (DB Orthodontics). For each material, 10 thermoform retainers were fabricated within the dental laboratory. Subsequent scanning and analysing of the casts and thermoform retainers was performed in a dedicated area, using the co-ordinate measuring machine, in order to calculate their respective fit at the incisor and first molar regions. RESULTS: At all eight recorded landmark points, the mean values for the following thermoform materials: ACE, True Tain, and Iconic Clear, a similar trend was observed. At all eight points, there was a significant difference between the performance of the four different materials (P < 0.001), with the greatest difference observed in the mean values in relation to material C+. CONCLUSION: Statistically significant differences were observed in the fit behaviour of all four thermoform materials being tested.

Family-centred care during resuscitation events.

Caring for families of critically ill patients is part of emergency nurses' role, but there is a difference of opinion about whether families should be present during resuscitation attempts. This article reports on an opinion survey conducted at two health and social care trusts in Northern Ireland, in which 160 emergency nurses were asked for their views on holistic family-centred care during and after resuscitation. Most participants said that, although they have a duty to provide such care, they are often prevented from doing so by lack of staff and time, and by inadequate education. In light of this finding, the article suggests that staff should take part in debriefing sessions and follow-up programmes should be made available for families after resuscitations have been attempted.

Family-centred care: review of opinions among staff.

The sudden admission to an emergency department (ED) of a patient requiring resuscitation can be a traumatic experience for families, who often require a great deal of support from ED staff. The needs of such staff must be considered too, if the care of patients and families during resuscitation attempts is to be improved. This article discusses the findings of a systematic review of the literature on family-centred care during and after resuscitation attempts, and reveals that, although families appear to favour witnessed resuscitation, the practice remains controversial among healthcare professionals. Chaotic workloads, time restraints, lack of education and poor coping abilities all appear to affect wider implementation of the practice in EDs.

Application of a column selection system and DryLab software for high-performance liquid chromatography method development.

This paper describes a strategy for the development of chromatographic methods for drug candidates based upon the use of simple MS compatible mobile phases and optimization of the chromatographic selectivity through variations of the stationary phase and mobile phase pH. The strategy employs an automated column selection system and a series of HPLC columns, varying in hydrophobicity and silanol activity, in combination with DryLab software to develop chromatographic methods for the separation of mixtures of bupivacaine and its metabolites; acidic, basic, and neutral compounds; and atenolol, nitrendipine, and their degradation products.

Determination of local tissue concentrations of bupivacaine released from biodegradable microspheres and the effect of vasoactive compounds on bupivacaine tissue clearance studied by microdialysis sampling.

PURPOSE: Incorporation of bupivacaine, a short acting local analgesic, into injectable microspheres provides a long acting formulation. Co-incorporation of dexamethasone into the microspheres results in extended activity. The purpose of this study is to compare tissue concentrations of bupivacaine resulting from the two types of microspheres and to determine if the observed sustained tissue concentration of bupivacaine is due to changes in its tissue clearance. METHODS: Microdialysis probes were implanted into rat muscle. Following microsphere injection, bupivacaine tissue concentration was monitored (HPLC-UV), and the tissues histologically examined. The effect of vasoactive compounds on the tissue concentration of bupivacaine, not formulated in microspheres, was monitored. RESULT: Hind muscle histology showed significant granulomatous reactions around the probe and both types of microspheres. A higher, prolonged bupivacaine concentration was observed from microspheres. A higher, prolonged bupivacaine concentration was observed from microspheres with co-incorporated dexamethasone relative to those without dexamethasone. Addition of vasoconstrictors to the perfusate containing bupivacaine resulted in decreased bupivacaine delivery compared to bupivacaine alone, whereas the addition of a vasodilator increased bupivacaine delivery. CONCLUSIONS: The longer lasting effect of microspheres with co-incorporated dexamethasone results from higher, prolonged tissue concentrations of bupivacaine. Dexamethasone, a vasoconstrictor, decreases the clearance rate of bupivacaine from the tissue resulting in a higher, prolonged tissue concentration of bupivacaine.