Data Collection for Adverse Events Reporting by US Dental Schools.

OBJECTIVES: Accreditation of US dental schools requires a formal system of quality assessment of clinical adverse events (AE). There is no universal system to collect, record, interpret, or release findings or trends pertaining to AEs. The objective of this study was to compare similarities and differences among the AE reporting forms used at US dental schools. METHODS: Sixteen (24%) dental schools responded to a query to provide copies of their AE forms. The forms were analyzed to identify unique AE items. A total of 69 unique AE items were identified, grouped, and ranked according to frequency. Methods of AE data collection were also noted. RESULTS: The forms were different in organization, form, and content. The 69 AE items represented a wide variety of information, with no standardization of the type of information, how it was collected, or by whom. We identified 9 most requested AE items and 4 least requested AE items. The schools differed in how the information was obtained: 2 schools used a menu, 8 schools used free response, and 6 schools used a hybrid of both methods. CONCLUSIONS: We found that dental school clinic AE reporting forms are not standardized in structure, organization, or content. We conclude that a hybrid form containing both guided responses and free responses would ensure that proper information is being reported to fully understand why/how an AE occurred. In addition, dental schools need to develop a standardized method of collecting and assessing AE data which will allow for quality improvement and increased patient safety.

A prospective, randomized, within-subject study of ALA-PDT for actinic keratoses using different irradiation regimes.

BACKGROUND: Photodynamic therapy (PDT) can be used to treat large fields of actinic keratoses (AKs) with high clearance rates. A notable downside is the amount of pain that accompany the treatment. This study aimed to optimize the illumination protocol during conventional PDT in order to reduce pain without compromising treatment effectiveness. METHODS: In this prospective, randomized study with a split-face design, patients with, symmetrically distributed AKs were included. All patients were treated using a ALA 78 mg/g gel. One side was illuminated with the Aktilite® CL-128 lamp and the other side with the RhodoLED® lamp in which the light intensity gradually increased to a maximum of 60%. Both sides received a total light dose of 37 J/cm2 . Pain during the treatment was measured using a visual analogue scale. The clinical effectiveness of the 2 treated sides was assessed after 12 weeks. RESULTS: Twenty-nine patients with 399 AKs were included. Illumination with the gradually increasing light intensity resulted in a decrease in the median visual analogue scale score by 1.1 points. Clearance rates were similar between the 2 lamps. CONCLUSION: Minimizing the light intensity during the illumination phase of PDT reduces pain, while still preserving a high clearance rate of AKs.

Evaluation of electrical impedance spectroscopy as an adjunct to dermoscopy in short-term monitoring of atypical melanocytic lesions.

BACKGROUND: Early detection of melanoma is vital for treatment outcome and survival. Short-term sequential digital dermoscopic monitoring (ST-SDDM) involves the capture and assessment of dermoscopic images of one or more atypical melanocytic lesions (AMLs), at baseline and after four months, in order to detect early morphologic changes. Electrical impedance spectroscopy (EIS) is a diagnostic tool with high sensitivity for the detection of malignant melanocytic lesions. OBJECTIVES: The aim of this study was to assess whether EIS, in addition to ST-SDDM, could improve the selection of AMLs requiring surgery. METHODS: In this retrospective descriptive study, 22 AMLs in 19 patients were monitored with both ST-SDDM and EIS. A modified EIS decision-making algorithm was established. AMLs were excised if any dermoscopic changes were seen and/or if the EIS score had increased significantly at follow-up. Statistical analyses were made including sensitivity, specificity, PPV and NPV. RESULTS: A total of seven lesions (32%) were excised. Four lesions (57%) were excised solely because of dermoscopic changes including a 0.4 mm-thick melanoma and three benign nevi. Three benign lesions (43%) were excised because of increased EIS scores without any dermoscopic changes. The EIS scores at follow-up showed high variability as compared to the initial scores. CONCLUSION: The addition of EIS to ST-SDDM did not identify additional malignant lesions. There was no correlation between dermoscopic changes seen with ST-SDDM and increased EIS scores. Three histopathologically benign lesions were needlessly excised. Moreover, the low reproducibility and the possible interoperator variability of the method raised concerns.