Overstuffing the patellofemoral compartment in total knee arthroplasty: a systematic review.

Purpose: To systematically review and analyze the data available in the literature to evaluate the role of patellofemoral overstuffing in affecting clinical outcomes following primary total knee arthroplasty. Methods: A systematic literature review was conducted following the PRISMA guidelines. Only studies including primary total knee arthroplasty in the setting of osteoarthritis with a quantifiable method of measuring patellofemoral overstuffing using pre- and post-operative x-rays or advanced imaging, as well as reported subjective and/or objective patient outcomes in relation to patellofemoral overstuffing were included. Extracted data included patellofemoral overstuffing quantitative measurement method, outcome measurements, follow-up, patient demographics, author, and publication details. Descriptive analysis was provided for the available literature. Results: There were six included articles with a total of 2325 TKAs assessed. All papers found no significant effect on clinical outcomes when the amount of PFJ overstuffing was within reason. Conclusion: The amount of overstuffing that routinely takes place seems to be within tolerable limits and does not create a significant difference in clinical outcomes. Nevertheless, it is recommended to recreate the anatomic dimensions of the PFJ in order to best obtain a joint that is within this safe margin of error.

Public Opinion Leadership in Nursing Practice: A Rogerian Concept Analysis.

In the Dutch nursing context, work remains in strengthening the voice of nurses serving as frontline health care providers and board members alike. Conceptual clarity of Public Opinion Leadership (POL) in nursing practice is needed to provide attributes, antecedents and consequences for nurses and nurse leaders so they can contribute in the public debate and policy making processes. Using Rodgers' method of evolutionary concept analysis and the key words "POL," "lobbying" and "public affairs," we searched PubMed (including MEDLINE), CINAHL, PsycINFO and Cochrane Library for articles written in English, published between January 1999 and May 2020, which resulted in a final selection of seven studies. In addition, transcripts of an expert panel discussion regarding POL were analyzed. Attributes of POL are credibility, accessibility, altruism, dynamic networking and sense of systemness. Antecedents are a clinical background, authentic authority, policy and political awareness and strategic skills. The main consequences of POL entail influencing those who are involved in policy making processes, a new generation of public opinion leaders, and the raising of bottom-up political leaders. POL is a relatively new concept for nursing, with increasing interest given the need to ensure quality of care by increasing the use of evidence in clinical practice. POL in nursing practice is defined as the action of influencing public debate regarding policy making processes by maintaining dynamic (social) networks, having a high sense of systemness, and being (clinically) credible, altruistic and accessible to peers and a wide variety of stakeholders.

Workers' recovery from concussions presenting to the emergency department.

BACKGROUND: The emergency department (ED) is the first point of care for many patients with concussion, and post-concussion syndrome can impact vocational outcomes like successful return to work. Evaluation of concussion in general adult populations is needed. AIMS: To document the occurrence and outcomes of work-related concussion presenting to the ED for treatment. METHODS: This study enrolled adults presenting with concussion to three urban Canadian EDs. Baseline ED interviews, physician questionnaires and patient phone interviews at 30 and 90 days documented work-related events, ED management, discharge advice, patient adherence and symptom severity. Work-related injury and return to work were modelled using logistic or linear regression, as appropriate. RESULTS: Overall, 172 enrolled workers completed at least one follow-up. Work-related concussions were uncommon (n = 28). Most employees (80%) missed at least 1 day of work (median = 7; interquartile range: 3-14). Most (91%) employees returned to work within 90 days, while 41% reported persistent symptoms. Manual labour and self-reported history of attention deficit hyperactivity disorder were associated with work-related concussion, while days of missed work increased with marital status (divorced), history of sleep disorder and physician's advice to avoid work. CONCLUSION: Work-related concussions are infrequent; however, most workers who sustain a concussion will miss work, and many return while still experiencing symptoms. Work-related concussion and days of missed work are mainly affected by non-modifiable factors. Workers, employers and the workers' compensation system should take necessary precautions to ensure that workers return to work safely and successfully following a concussion.

The evaluation of evidence-informed changes to an internationally educated nurse registration process.

AIM: To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. BACKGROUND: Little research exists to inform registration policy for internationally educated health professionals. INTRODUCTION: Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian-educated nurses, but differences in health systems, education and practice create challenges. METHODS: The study setting was a Canadian province. We used a mixed methods approach, with a pre-post-quasi-experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre- and post-implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non-parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders. FINDINGS: The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence. DISCUSSION: Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff. CONCLUSION: Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy. IMPLICATIONS FOR NURSING POLICY: These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence.

Impact of Selection Bias on Treatment Effect Size Estimates in Randomized Trials of Oral Health Interventions: A Meta-epidemiological Study.

Emerging evidence suggests that design flaws of randomized controlled trials can result in over- or underestimation of the treatment effect size (ES). The objective of this study was to examine associations between treatment ES estimates and adequacy of sequence generation, allocation concealment, and baseline comparability among a sample of oral health randomized controlled trials. For our analysis, we selected all meta-analyses that included a minimum of 5 oral health randomized controlled trials and used continuous outcomes. We extracted data, in duplicate, related to items of selection bias (sequence generation, allocation concealment, and baseline comparability) in the Cochrane Risk of Bias tool. Using a 2-level meta-meta-analytic approach with a random effects model to allow for intra- and inter-meta-analysis heterogeneity, we quantified the impact of selection bias on the magnitude of ES estimates. We identified 64 meta-analyses, including 540 randomized controlled trials analyzing 137,957 patients. Sequence generation was judged to be adequate (at low risk of bias) in 32% ( n = 173) of trials, and baseline comparability was judged to be adequate in 77.8% of trials. Allocation concealment was unclear in the majority of trials ( n = 458, 84.8%). We identified significantly larger treatment ES estimates in trials that had inadequate/unknown sequence generation (difference in ES = 0.13; 95% CI: 0.01 to 0.25) and inadequate/unknown allocation concealment (difference in ES = 0.15; 95% CI: 0.02 to 0.27). In contrast, baseline imbalance (difference in ES = 0.01, 95% CI: -0.09 to 0.12) was not associated with inflated or underestimated ES. In conclusion, treatment ES estimates were 0.13 and 0.15 larger in trials with inadequate/unknown sequence generation and inadequate/unknown allocation concealment, respectively. Therefore, authors of systematic reviews using oral health randomized controlled trials should perform sensitivity analyses based on the adequacy of sequence generation and allocation concealment.

The nursing profession in Sri Lanka: time for policy changes.

AIM: We address issues and challenges in nursing in Sri Lanka with the aim of identifying where and how policy changes need to be made. BACKGROUND: Increased global interconnectivity calls for professional leadership, research, education, and policy reform in nursing as these are identified as enhancing health workforce performance and professionalization, thereby improving health systems. SOURCES OF EVIDENCE: We draw on first-hand knowledge of health care and nursing in Sri Lanka and a recent survey of nurses at a large urban government hospital in Sri Lanka, followed by discussion and proposed action on themes identified through analysis of published and unpublished literature about the nursing profession. DISCUSSION: Policy and action are needed to: (a) establish mandatory nurse licensure in the public and private healthcare sectors; (b) implement realistic policies to further develop nursing education; (c) develop a professionalization process to support nursing autonomy and voice; and (d) promote systematic processes for educational accreditation, curriculum revision, continuing professional development, evidence-based practice, research, leadership, and information systems. CONCLUSION: There is a policy vacuum that requires careful analysis and strategic planning by formal nurse leaders. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Implementing change will require political and professional power and strategic, innovative, and evolutionary policy initiatives as well as organizational infrastructure modifications best achieved through committed multidisciplinary collaboration, augmented research capacity, bolstered nursing leadership, and promotion of partnerships with policy makers.

2013 President's Plenary International Psycho-oncology Society: embracing the IPOS standards as a means of enhancing comprehensive cancer care.

BACKGROUND: The second President's Plenary at the 2013 International Psycho-oncology Society's World Congress in Rotterdam, the Netherlands aimed to progress and, where needed, initiate changes to achieve comprehensive cancer care. Recent initiatives have been driven by the need to see psychosocial care as an integrated part of holistic multidisciplinary quality cancer care. The President's Plenary session covered the need for the following: An internationally agreed standard of quality cancer care, which includes psychosocial care for patients and their families and caregivers. An endorsement to assess distress as the 6th vital sign. Psycho-oncology professionals to integrate into a federation promoting better national and international outcomes. CONCLUSION: This overview highlights progress in terms of enhanced communication between and within different professionals groups supporting the implementation of a model of comprehensive patient care that is inclusive of psychosocial support and screening for distress. Tasks and challenges for the future are set out but the primary message is of the importance of collaboration in order to achieve recognition that psychosocial care is integrated into comprehensive cancer care; in this way, patient, family and carer needs can be more appropriately met.

Stakeholder perspectives on transitions of nursing home residents to hospital emergency departments and back in two Canadian provinces.

Major gaps exist in our understanding of transitions in care for older persons living in nursing homes. The purpose of the study was to identify key elements, from multiple stakeholder perspectives, that influence the success of transitions experienced by nursing home residents when they required transfer to a hospital emergency department. This interpretive descriptive study was conducted in two cities in the Canadian provinces of British Columbia and Alberta. Data were collected from 71 participants via focus groups and individual interviews with nursing home residents, family members, and professional healthcare providers working in nursing homes, emergency departments, and emergency medical services. Transcripts were analyzed using constant comparison. The elements contributing to the success of transitions reflected a patient- and family-centered approach to care. Transitions were influenced by the complex interplay of multiple elements that included: knowing the resident; critical geriatric knowledge and skilled assessment; positive relationships; effective communication; and timeliness. When one or more of the elements was absent or compromised, the success of the transition was also compromised. There was consistency about the importance of all the identified elements across all stakeholder groups whether they are residents, family members, or health professionals in nursing homes, emergency departments or emergency medical services. Aspects of many of these elements are modifiable and suggest viable targets for interventions aimed at improving the success of transitions for this vulnerable population.

Is helicopter evacuation effective in rural trauma transport?

Helicopter transport for trauma remains controversial because its appropriate utilization and efficacy with regard to improved survival is unproven. The purpose of this study was to assess rural trauma helicopter transport utilization and effect on patient survival. A retrospective chart review over a 2-year period (2007-2008) was performed of all rural helicopter and ground ambulance trauma patient transports to an urban Level I trauma center. Data was collected with regard to patient mortality and Injury Severity Score (ISS). Miles to the Level I trauma center were calculated from the point where helicopter or ground ambulance transport services initiated contact with the patient to the Level I trauma center. During the 2-year period, 1443 rural trauma patients were transported by ground ambulance and 1028 rural trauma patients were transported by helicopter. Of the patients with ISS of 0 to 10, 471 patients were transported by helicopter and 1039 transported by ground. There were 465 (99%) survivors with ISS 0 to 10 transported by helicopter with an average transport distance of 34.6 miles versus 1034 (99.5%) survivors with ISS 0 to 10 who were transported by ground an average of 41.0 miles. Four hundred and twenty-one patients with ISS 11 to 30 were transported by helicopter an average of 33.3 miles with 367 (87%) survivors versus a 95 per cent survival in 352 patients with ISS 11 to 30 who were transported by ground an average of 39.9 miles. One hundred and thirty-six patients with ISS > 30 were transported by helicopter an average of 32.8 miles with 78 (57%) survivors versus a 69 per cent survival in 52 patients with ISS > 30 who were transported by ground an average of 33.0 miles. Helicopter transport does not seem to improve survival in severely injured (ISS > 30) patients. Helicopter transport does not improve survival and is associated with shorter travel distances in less severely injured (ISS < 10) patients in rural areas. This data questions effective helicopter utilization for trauma patients in rural areas. Further study with regard to helicopter transport effect on patient survival and cost-effective utilization is warranted.

Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis.

Vertebral collapse is a common fracture associated with osteoporosis. Subsequent pain may be severe and often requires medications and bed rest. Several studies have suggested the use of calcitonin for the treatment of fracture pain. We sought to determine the analgesic efficacy of calcitonin for acute and chronic pain of osteoporotic vertebral compression fractures (OVCF). We searched for randomized, placebo, and controlled trials that evaluated the analgesic efficacy of calcitonin for pain attributable to OVCFs. We performed meta-analyses to calculate standardized mean differences (SMDs) using a fixed or random effects model. The combined results from 13 trials (n = 589) determined that calcitonin significantly reduced the severity of acute pain in recent OVCFs. Pain at rest was reduced by week 1 [mean difference (MD) = -3.39, 95% confidence interval (CI) = -4.02 to -2.76), with continued improvement through 4 weeks. At week 4, the difference in pain scores with mobility was even greater (SMD = -5.99, 95% CI = -6.78 to -5.19). For patients with chronic pain, there was no statistical difference between groups while at rest; there was a small, statistically significant difference between groups while mobile at 6 months (SMD = 0.49, 95% CI = -0.85 to -0.13, p = 0.008). Side effects were mild, with enteric disturbances and flushing reported most frequently. Although calcitonin has proven efficacy in the management of acute back pain associated with a recent OVCF, there is no convincing evidence to support the use of calcitonin for chronic pain associated with older fractures of the same origin.

Establishing a multicentre clinical research network: lessons learned.

BACKGROUND: Within many health care disciplines, research networks have emerged to connect researchers who are physically separated, to facilitate sharing of expertise and resources, and to exchange valuable skills. A multicentre research network committed to studying difficult cancer pain problems was launched in 2004 as part of a Canadian initiative to increase palliative and end-of-life care research capacity. Funding was received for 5 years to support network activities. METHODS: Mid-way through the 5-year granting period, an external review panel provided a formal mid-grant evaluation. Concurrently, an internal evaluation of the network by survey of its members was conducted. Based on feedback from both evaluations and on a review of the literature, we identified several components believed to be relevant to the development of a successful clinical cancer research network. RESULTS: THESE COMMON ELEMENTS OF SUCCESSFUL CLINICAL CANCER RESEARCH NETWORKS WERE IDENTIFIED: shared vision, formal governance policies and terms of reference, infrastructure support, regular and effective communication, an accountability framework, a succession planning strategy to address membership change over time, multiple strategies to engage network members, regular review of goals and timelines, and a balance between structure and creativity. CONCLUSIONS: In establishing and conducting a multi-year, multicentre clinical cancer research network, network members were led to reflect on the factors that contributed most to the achievement of network goals. Several specific factors were identified that seemed to be highly relevant in promoting success. These observations are presented to foster further discussion on the successful design and operation of research networks.

Effects of shift length on quality of patient care and health provider outcomes: systematic review.

BACKGROUND: Healthcare providers work increasingly under a variety of shift work systems to cover the continuous care required by patients. However, the effects of shift work on patient and provider outcomes in healthcare settings has not been systematically evaluated. OBJECTIVE: To identify and analyse the available evidence on the effect of shift length (8-h vs 12-h shifts) on quality of patient care and healthcare provider outcomes. METHODS: Systematic searching of eight online databases, key governmental/organisational websites and academic journals with ancestry search of relevant articles (limited to articles published in English and Spanish). RESULTS: Of 562 articles that were retrieved from 20 446 titles identified through database and manual searches, 27 satisfied the inclusion criteria, of which 15 were rejected because of low methodological quality. The 12 final studies included cross-sectional/survey (7), before-after (3) and prospective cohort (2) designs. The main primary outcomes evaluated were: (1) quality of patient care and (2) healthcare provider outcomes. The results were equivocal. With respect to the effect of shift length on quality of patient care, two studies found that errors and near errors were associated with working longer shifts, and another study reported decreased patient complications and length of stay with longer shifts. Specific healthcare provider outcomes such as health complaints, well-being, drug and alcohol consumption, stress and job satisfaction were mostly evaluated by single studies and therefore there was insufficient evidence from which to draw conclusions. CONCLUSIONS: Methodological quality of the studies generally was low and results equivocal with insufficient evidence to determine the effects of shift length on quality of patient care and healthcare provider outcomes. Clearly, robust well-designed studies are needed to examine the effect of shift length on patient and healthcare provider outcomes.

The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia.

BACKGROUND: Levobupivacaine, the S(-)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia. METHODS: A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and orbicularis oculi function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block. RESULTS: The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (P=0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration vs time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor post-operative adverse event was prolongation of the local anaesthetic block, which was reported by nine patients (four in the levobupivacaine group and five in the bupivacaine group). CONCLUSIONS: Levobupivacaine and bupivacaine are equally successful in achieving clinically satisfactory peribulbar anaesthesia with few adverse effects.

Mycobacterium thermoresistible recovered from a cutaneous lesion in an otherwise healthy individual.

This is the first report of coinfection by Mycobacterium thermoresistible and Mycobacterium fortuitum and only the fifth case of human infection by M. thermoresistible reported in the world literature.

Effect of simulating leg length inequality on pelvic torsion and trunk mobility.

Although techniques such as roentgenograms and magnetic resonance imaging can provide definitive information about leg length inequality, they are not easily implemented for screening purposes. Using relative heights of palpated iliac crests as criteria for determining degree of lateral pelvic tilt, we examined the immediate effect of simulating leg length inequality on pelvic torsion and trunk flexion. In seven healthy men and 22 healthy women, 18-28 years of age, a lift of at least 15 mm was placed under either foot to laterally tilt the pelvis 1.2 degrees or more. In eight subjects with pre-existing lateral pelvic tilts of 1.8 degrees or more, a lift was also used to eliminate the tilt. We examined how this tilting affected torsion between the innominates and mobility of the trunk. The innominate contralateral to the lift became more anteriorly rotated than the ipsilateral innominate and lateral flexion of the trunk increased toward the side of the lift. Both of these effects can be associated with clinical leg length inequality, so a lateral pelvic tilt on the order of 1.2 degrees, if encountered in the clinic, should signal the suitability of more extensive examination for possible lower limb asymmetry.

Emergency staff survey on their role in pediatric injury prevention education-a pilot study.

A pilot study to survey the attitudes of emergency department (ED) personnel regarding their role in injury prevention education in children and parents was conducted at a tertiary care trauma center. The survey consisted of 14 statements, asking staff members their level of agreement (from strongly agree to strongly disagree) on a forced-choice four-point scale. These were followed by two questions asking staff members to rank schools, physician's offices, emergency departments, and public health units on their value in providing injury prevention information to children and parents. Before the intervention (an in-service training program on the importance of documenting the circumstances of injury on a patient's chart), a 50% randomly selected sample of ED staff members was asked in May 1997 to complete the survey. After the data collection prepilot (4 months later), the remaining 50% was asked in September 1997 to complete the same questionnaire. Administration of the preintervention survey resulted in 53 of 62 surveys being returned (85%). The postintervention survey was completed by 35 of the 41 staff members still eligible (85%), those who were employed in the ED during the entire pilot project. There was no statistically significant difference between the pre- and post-pilot groups on any demographic characteristics. Staff members agreed least with the statement that ED physicians and staff members could impact the severity of injuries to children by providing counseling to parents (68.1% preintervention and 64.5% postintervention agreement). Of most significance was the fact that a lower percentage of staff members agreed postintervention that almost all injuries to children were avoidable. The emergency department was the lowest ranked information dissemination venue for both parents and children.

Scene disposition and mode of transport following rural trauma: a prospective cohort study comparing patient costs.

This prospective cohort study was performed from 1994 to 1996 to compare the impact of scene disposition on prehospital and hospital costs incurred by rural trauma patients transported to a trauma center by helicopter or ground ambulance. The study included all rural adult injury victims who arrived at the tertiary trauma center by ambulance within 24 h of injury. Inclusion criteria consisted of inpatient admission or death in the emergency department, and any traumatic injury except burns. Data collected included mortality, mode of transport, Injury Severity Score (ISS), and costs from impact to discharge or death. Of 105 study patients, 52 initially went to a rural hospital, while 53 went directly to the trauma center. There was no significant difference in survival in the two groups. The ISS was significantly higher for patients taken directly to the trauma center from the scene. The ISS of trauma patients transported from the rural hospital was highest for patients sent by ground transport. The prehospital transport costs were significantly more for patients transported to a rural hospital first. The costs incurred at the trauma center were highest for those patients transported directly from the scene. Many severely injured patients were initially transported to a rural hospital rather than directly to the trauma center. At both the scene and rural hospital, consistent use of triage criteria appeared to be lacking in determining the severity of injury, appropriate destination, and mode of transport for trauma patients. Since no significant difference in prehospital helicopter and ground transport costs was demonstrated, the decision on mode of transport should be in the best interest of patient care.

A phase II study of mitomycin C, etoposide, and cisplatin in advanced non-small cell lung cancer.

Standard chemotherapeutic regimens, such as cisplatin and etoposide, may improve quality of life and prolong survival in patients with incurable non-small cell lung cancer (NSCLC). This trial was designed to evaluate the activity and toxicity of a regimen combining three of the most active agents against advanced-stage NSCLC: mitomycin C, etoposide, and cisplatin (MEP). Sixty-eight patients with stage IIIB (pleural effusion) or IV NSCLC received cisplatin 80 mg/m2 i.v. on day 1 and etoposide 80 mg/m2 i.v. on days 1, 2, and 3 every 3 weeks along with mitomycin C 10 mg/m2 i.v. on day 1 of the first and third cycles for a median of four cycles (range, 1-11). Median age was 59 years, and nine patients were enrolled after relapse from previously treated early-stage NSCLC. Eighty-eight percent of patients had stage IV disease, and 14 (21%) had brain metastases at diagnosis. Palliative radiotherapy was given to 10 patients (15%) before MEP and to 17 (25%) concurrent with MEP. The major toxicity of MEP was myelosuppression, with grade 3-4 neutropenia in 74% of patients. Sixteen patients (24%) had documented infections, and there were eight (12%) treatment-related deaths. Partial response was observed in 24 patients (35%) with a median duration of 4.4 months, (range 1.4-13 months). Median survival was 8.1 months (range, 1-34 months), and 1-year survival was 32%. The addition of mitomycin C to cisplatin and etoposide resulted in response and survival rates comparable with those achieved with standard regimens in patients with advanced NSCLC but was associated with substantial hematologic toxicity and unacceptable treatment-related mortality.

Effect of systemic doxycycline on alveolar bone loss after periradicular surgery.

Studies in the periodontic literature have shown an average of 0.5 mm to > 1.0 mm of bone loss after full thickness flap reflection. Similar literature has revealed that the tetracycline family of antibiotics can prevent bone loss. The purpose of this study was to observe the effect of systemic Doxycycline on crestal alveolar bone loss after periradicular surgery in beagle dogs. Five beagle dogs were used in two phases of this study. In the first phase (control sides), after reflecting full thickness flaps in one mandibular quadrant, notches were placed in the enamel of the third and fourth premolar teeth using a one-quarter round bur. Using magnification, measurements were taken from the reference notches to the height of the alveolar crest. After 8 wk, flaps were reflected in the same quadrant and measurements retaken, and the amount of bone loss was then measured. In the second phase (experimental sides), the same procedure was performed on the contralateral mandibular quadrant, but the dogs were placed on 4.4 mg/kg/day of Doxycycline for 10 days after reflections of full thickness flaps. After another 8 wk, the area was reflapped and measured. There was significantly (p < 0.01) less bone loss on the Doxycycline-treated side.