Ethics; 'In consideration of the love he bears.' Apprenticeship in the nineteenth century, and the development of professional ethics in dentistry. Part 2. Hippocrates' long shadow

This two part paper takes a look at the ancient institution of apprenticeship. As stated in the introduction to the first part,(1) it regards the conventions of the scheme as having had a positive influence on the morality, legal identity, and professional allegiance of dentists during the ethical development of their profession in the nineteenth century. The first paper looked at the particular application of apprenticeship through the evidence of indentures in the BDA museum. This second paper enlarges on the view that the wider social institution of apprenticeship was at least in part responsible for the development of the ethics of the dental profession.

Ethics; 'in consideration of the love he bears.' Apprenticeship in the nineteenth century, and the development of professional ethics in dentistry. Part 1. The practical reality

This paper takes a look at the ancient institution of apprenticeship. In doing so it regards the conventions of the scheme as having had a positive influence on the morality, legal identity, and professional allegiance of dentists during the ethical development of their profession in the nineteenth century. Two important effects can be detected from the records available. One is general, since the moral ground of apprenticeship derived from, and spread throughout, society, and the other is particular to the development of dentistry as a profession, as those who were apprenticed to dentists acquired a natural loyalty to their dentist Masters in person, and to their craft.

Incidence of cervical dyskaryosis in Ireland: report of a five-year audit

The implementation of a national cervical screening programme in Ireland will require agreement on achievable standards in reporting cervical cytology similar to those published by the NHS cervical screening programme. Due to the opportunistic nature of screening in the Republic of Ireland, national incidence figures for uterine cervical disease are not available. An audit of our practice was performed to find the incidence of human papilloma virus related cervical disease in our population. Our laboratory reported 158,066 cases from 1996-2000. The overall rate of dyskaryosis increased from 3.6% to 7.9%, mostly due to increased low grade dyskaryosis (up from 2.3% to 6.0%). High grade dyskaryosis also increased (from 1.3% to 1.9%), particularly in the under-25 year age group who account for a growing proportion of high grade dyskaryosis (from 15.4% of all high grade diagnoses in 1996 to 23.0% in 2000). The positive predictive value of a diagnosis of high grade dyskaryosis remained stable between 76.0 and 79.5%. While opportunistic screening data may not be directly applicable to the entire screening population it is hoped that these data may form a foundation on which to estimate national incidence figures and define achievable standards for cervical screening cytology in Ireland.

Adequacy of oophorectomy at the time of gynecologic surgery

OBJECTIVES

To determine the incidence of incomplete ovarian removal during gynecologic surgery and correlate the risk of inadequate removal with the procedure chosen.

METHODS

This is a prospective observational study. Ovaries received during a 4-month period in the participating institutions were independently histologically evaluated. Gross inspection of the ovarian capsule, infundibulopelvic ligament, hilum and utero-ovarian ligament was assessed. Grossly close margins were confirmed histopathologically. Any margin with histologically confirmed ovarian tissue at the margin was interpreted as incompletely removed. Details of each surgical procedure were recorded for comparison.

RESULTS

Ovaries (n=174) from 94 patients were collected and 155 were evaluable. The overall incidence of incomplete ovarian removal was 6.5%. Of the 125 ovaries removed abdominally, 23 were laparoscopically assisted and 7 were vaginal; inadequate removal was documented in 5%, 9% and 29%, respectively (P=0.04). There was no relationship of inadequate resection by underlying pathologic diagnosis (P=0.25) or by institution (4.6% university hospital vs. 8.8% community hospital; P=0.29).

CONCLUSIONS

Incomplete ovarian removal occurs and is related to surgical approach. A larger study is warranted to evaluate the role of pelvic pathology or surgeon experience as a risk for incomplete oophorectomy.

Ethics--the early division of oral health care responsibilities by Act of Parliament

The question of how the profession of dentistry became what it is today, an independent and vigorous one, is an absorbing study. In this analysis of the legislation of the mid-sixteenth century and its effect on modern oral health care delivery, two Acts in particular are notable for their importance in the development of the self-determining practise of dentistry as we now enjoy it in the United Kingdom. The first of these is the 1540 Act uniting the Barbers' and Surgeons' Companies, and the second is one dating from two years later; 'A Bill that Persons, being no common Surgeons, may minister Medicines, notwithstanding the Statute.' Apart from a brief period of 35 years extending from the Dentists Act of 1921 to the Dentists Act of 1956, when the Dental Board of the United Kingdom (which after 1956 became the General Dental Council), was subject to the over-riding control of the General Medical Council, the delivery of oral health care in England has enjoyed an independence which is here identified as having its origin in these Acts 450 years ago in the reign of Henry VIII.

Ethics--dentistry and tooth-drawing in the late eighteenth and early nineteenth centuries in England. Evidence of provision at all levels of society

The popularity of caricature at the end of the eighteenth century allows a researcher to observe the social as well as the technical side of dentistry as it was then available throughout the kingdom. The value of these caricatures is further enhanced by the unconscious inclusion of everyday objects which a narrative account would not think it worthwhile including, even if such narrative account had existed.

A nurse-led pulmonary rehabilitation programme for patients with COPD

A pulmonary rehabilitation programme set out to improve quality of life for patients with COPD by providing education and improving exercise tolerance. Progress was measured and outcomes monitored, the results indicating that such programmes could have a big impact, particularly on patients who are identified in the early stages of the disease.

Ethics--dental registration in the seventeenth and early eighteenth century

In the histories of dentistry, some mention is made of the licensing of tooth-drawers, and those who provided dental healthcare before the term Dentist started to become general in the late eighteenth and early nineteenth centuries. One of the most striking references to licensing appears in a little piece of doggerel printed under a 1768 print by Dixon after Harris.

Developing a nurse-led service for COPD patients

A rise in the rate of hospital admissions for patients with COPD has led to the development of nurse-led home care. A study in which a nurse-led team provided domiciliary treatment with ongoing follow-up, was found to be cost-effective and reduced the need for hospital care.

Rare presentation of actinomycosis as an abdominal mass: report of a case

PURPOSE

The purpose of this article was to report an unusual presentation of abdominal actinomycosis masquerading as a tumor.

METHODS

The patient was a 54-year-old male who presented with vague abdominal discomfort and a palpable left lower quadrant mass defined on CT scan. Multiple intraoperative core biopsies were nondiagnostic, and he underwent en bloc resection of the mass and adjacent organs for a presumed tumor.

RESULTS

Examination of tissue from deep within the excised specimen revealed sulfur granules diagnostic for actinomycosis.

CONCLUSION

Abdominal actinomycosis is an extremely rare infection that can mimic multiple disease processes and requires accurate diagnosis for successful therapy. This novel presentation and a review of the literature are reported.

Dental caries and treatment experience of adults from minority ethnic communities living in the South Thames Region, UK

OBJECTIVE

To describe the dental caries and treatment experience of groups of adults from minority ethnic communities living in the South Thames Region of England.

DESIGN

Cross-sectional clinical study.

SETTINGS

Community, religious and educational centres for adults from minority ethnic communities.

PARTICIPANTS

Snowball sample of 928 adults from 44 ethnic groups including: Black Caribbean (141), Black African (134); Pakistani (123); Indian (190); Bangladeshi (78); Chinese/Vietnamese (143) and 119 from other groups.

RESULTS

More participants were dentate or had 18 or more sound and untreated teeth than adults living in the same area (Todd and Lader, 1991). Duration of residence in the United Kingdom predicted caries or treatment experience in the sample as a whole and in Chinese/Vietnamese people. Increased DMFT was predicted by age and by history of visiting a UK dentist in the sample as a whole and in the Black African group.

CONCLUSIONS

Effect of duration of UK residence on presence and extent of caries suggests that oral health may be better among adults from these ethnic minority groups than among the general population. However, the differences can also be attributed to sampling bias and old comparison data. Better sampling strategies are required for research of this type.

Fine Needle Aspiration Cytology and Histologic Findings of Granular Cell Tumor of the Breast: Review of 19 Cases with Clinical/Radiologic Correlation

Granular cell tumors (GCTs) are rare lesions in the breast of putative schwannian origin. These tumors are found in multiple sites throughout the body and have a characteristic histologic appearance. Recognition of these usually benign tumors is important since clinically, radiologically, and grossly GCTs of the breast often mimic carcinoma. The literature on these lesions in the breast is confined to isolated case reports. We describe the epidemiologic, cytologic, pathologic, and radiologic findings in 19 GCTs of the breast in 16 patients diagnosed at the University of Texas Southwestern Medical Center between 1991 and 1997.

Use of archival fine-needle aspirates for the allelotyping of tumors

BACKGROUND

Loss of heterozygosity (LOH) analysis (allelotyping) based on polymorphic microsatellite DNA is one of the most powerful molecular tools currently available for studying carcinogenesis. However, allelotyping studies that require archival paraffin embedded tissues are often hampered by technical difficulties related to microdissection and poor DNA quality.

METHODS

The authors compared allelotyping results from 12 paraffin embedded breast carcinoma cases with those from matching alcohol fixed fine-needle aspiration (FNA) cytology slides obtained for routine diagnostic purposes, using 30 polymorphic microsatellite markers at chromosomes 3p, 4p, 4q, 5q, 6p, 8p, 9p, 11q, 17p, and 17q. Cells from the alcohol fixed FNA slides were dissected and processed in three different ways, and DNA dilution experiments were performed to determine the minimum number of cells required for accurate allelotyping.

RESULTS

LOH results were identical for paraffin embedded and alcohol fixed tumors for 97% of 114 polymerase chain reactions (PCR) when 1000-2000 cells were dissected from each FNA slide and DNA from 100 cells was used for each multiplex PCR. However, with lower cell numbers, the discordance rate increased and artifactual LOH was observed. Intratumor allelotype heterogeneity could not be documented.

CONCLUSIONS

The use of alcohol fixed cytology preparations improves the ease of PCR-based allelotyping and greatly expands the range of archival materials available for study. The allelotyping is accurate and reproducible when DNA from >/=25 cells is used in the initial multiplex PCR. Cancer (Cancer Cytopathol)

Allelic losses at chromosome 3p are seen in human papilloma virus 16 associated transitional cell carcinoma of the cervix

OBJECTIVE

Transitional cell carcinomas (TCCs) of the cervix are rare neoplasms of the female genital tract. Although these tumors display urothelial differentiation, there is controversy regarding their histogenetic relationship to squamous cell carcinomas (SCC) of the cervix versus transitional cell carcinomas of the bladder.

METHODS

We performed partial allelotyping of five TCCs of the cervix using 23 polymorphic markers located on chromosomes 3p and 9, which demonstrate frequent and early losses in cervical SCC and urothelial TCC, respectively. Multiplex polymerase chain reaction was used on DNA extracted from archival paraffin-embedded tissue using precise microdissection. Additionally, P53 gene mutation analysis was performed using single-strand confirmation polymorphism (SSCP) and the presence of human papilloma virus (HPV) sequences was analyzed using general and specific (types 16 and 18) primers.

RESULTS

General HPV sequences were demonstrated in all cases, but the oncogenic strain HPV 16 was present in only three (60%) of the five tumors; no HPV 18 was detected in any sample. Three of five TCCs, all harboring HPV 16 sequences, demonstrated concurrent allelic losses at several 3p loci (specifically 3p12, 3p14.2 [the FHIT gene locus], 3p21.3, and 3p22-24.2). LOH at a single locus on 9q32-qter was demonstrated in one tumor; no other deletions were seen on chromosome 9. P53 gene mutations in exons 5-8 were absent by SSCP analysis.

CONCLUSIONS

The infrequent involvement of chromosome 9 in TCCs of the cervix, along with the concurrent presence of 3p LOH and oncogenic HPV 16 in a subset of tumors, suggests a closer histogenetic relationship of this neoplasm to cervical SCCs rather than urothelial TCCs.

Teaching and assessing ethics and law in the dental curriculum

The General Dental Council's recommendations on dental education places a new emphasis on the importance of ethics and law in the dental curriculum, stating that students should have an awareness of moral and ethical responsibilities involved in the provision of care to individual patients and to populations. The duties of care to protect a patient's life and health at all times, to respect their autonomy to make informed choices about what happens to them, and to do this fairly and without prejudice, are widely accepted as the fundamental ethical principles governing all health care. The specifics of these duties of care are detailed in Maintaining Standards: guidance to dentists on professional and personal conduct, published by the GDC.