A new method for the 3D measurement of postoperative swelling following orthognathic surgery

OBJECTIVE

To describe a new method for measuring facial swelling following orthognathic surgery using a 3D laser-scanning device.

DESIGN

Prospective clinical trial. Setting and Sample Population -- University Dental Hospital, Wales College of Medicine, Biology Life and Health Sciences. Three subjects requiring bi-maxillary orthognathic surgery were recruited for the study.

EXPERIMENTAL VARIABLES

Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with two Minolta Vivid 900 (Osaka, Japan) optical laser-scanning devices assembled as a stereo-pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 s. 3D laser scans were recorded over six time periods (T1 -- pre-surgical scan, postoperatively: T2 -- 1 day, T3 -- 1 week, T4 -- 1 month, T5 -- 3 months and T6 -- 6 months).

OUTCOME MEASURE

Facial scans from different time periods were overlaid onto the baseline (T6) facial scan to determine the reduction and changes in swelling following orthognathic surgery.

RESULTS

The results showed that swelling could be accurately quantified following surgery. Furthermore, there was a significant reduction in the amount of swelling 1 month postoperatively. Furthermore, the facial morphology returned to approximately 90% of the baseline facial scan at 3 months.

CONCLUSION

The 3D laser-scanning device and the method described was a reliable and accurate measure of facial swelling following surgery.

[Orthodontic treatment need: the IOTN, or Index of Orthodontic Treatment Need (part 2)]

IOTN is an index of orthodontic treatment need that has been devised on the basis of the available evidences of the deleterious effects of malocclusion on the aesthetic and health of the dentition. It has two components i.e. an aesthetic component and a dental health component. This index is widely used in epidemiological research and by third party payment for determination of those patients who should benefit from public funding.

Chloroethene biodegradation in sediments at 4 degrees C

Microbial reductive dechlorination of [1,2-14C]trichloroethene to [14C]cis-dichloroethene and [14C]vinyl chloride was observed at 4 degrees C in anoxic microcosms prepared with cold temperature-adapted aquifer and river sediments from Alaska. Microbial anaerobic oxidation of [1,2-14C]cis-dichloroethene and [1,2-14C]vinyl chloride to 14CO2 also was observed under these conditions.

[The need for orthodontic treatment. Justification and methods of evaluation (part 1)]

Most adolescents in developing countries undergo orthodontic treatment. Three main reasons are routinely cited to justify the provision of orthodontic treatment i.e. the improvement of facial and/or dental aesthetic, the preservation of the health and functioning of the dentition. Orthodontic indices have been devised to minimise the subjectivity related to the classic orthodontic diagnosis. These indices can be classified under five headings: nosological, epidemiological, treatment need, outcome and complexity.

The investigation of the changing facial appearance of identical twins employing a three-dimensional laser imaging system

OBJECTIVE

An investigation to determine the changing facial appearance of identical twins.

DESIGN

Clinical study.

MATERIALS AND METHODS

Two Minolta Vivid 900 3D optical laser scanners were placed as a stereo pair to capture the soft tissues of a pair of identical twins. Each scan took approximately 2.5 s. The scanned whole faces were superimposed to determine changes in facial morphologies at different time intervals.

OUTCOME MEASURES

The shell deviations between left and right scans of each patient were recorded and analysed for differences. Furthermore, final merged faces were overlaid to determine the changes in facial morphology over time.

RESULTS

The results showed that changes in height and weight correlated with changes in facial morphology.

CONCLUSION

The 3D laser scanning device is a clinically useful tool in the study of facial growth and facial morphology in a pair of twins.

Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study

AIMS

To study the frequency and associations of early postpartum discharge and infant readmission to hospital.

METHODS

Infants readmitted to hospital during the first 28 days of life in 1998 in the Northern Region of the UK were studied.

RESULTS

A total of 4743 of 11,338 (42%) babies were discharged on or before the first postnatal day. Rates of early discharge varied significantly between hospitals. Infants <2500 g at birth (adjusted odds ratio (AOR) 0.44, 95% CI 0.29 to 0.66), infants 35-37 weeks gestation at birth (AOR 0.65, 95% CI 0.49 to 0.86), and firstborn infants (AOR 0.09, 95% CI 0.08 to 0.10) were less likely to be discharged early. Women from more deprived areas were more likely to be discharged early (AOR 1.37, 95% CI 1.12 to 1.67). A total of 907 of 32,015 (2.8%) babies liveborn in the region were readmitted to hospital during 1998. Readmission rates varied significantly by hospital of birth but not by timing of discharge. Babies <2500 g at birth (AOR 1.95, 95% CI 1.16 to 3.28) and babies born at 35-37 weeks gestation (AOR 1.72, 95% CI 1.15 to 2.57) were more likely to be readmitted. Breast fed babies were less likely to be readmitted (AOR 0.69, 95% CI 0.53 to 0.90). Infants initially discharged early were not more likely to be readmitted.

CONCLUSIONS

Early discharge occurred variably in the Northern Region in 1998. It is not associated with readmission to hospital. Breast feeding is associated with lower rates of readmission to hospital.

The feasibility of measuring three-dimensional facial morphology in children

OBJECTIVE

An investigation to determine the feasibility of measuring soft tissue morphology in children using a three-dimensional laser-scanning device.

DESIGN

Prospective clinical trial.

SETTING AND SAMPLE POPULATION

University of Wales, College of Medicine and one secondary school in the South Wales region. Sixty live subjects (30 adults, 30 children) were recruited in the study.

EXPERIMENTAL VARIABLES

Laser scanned images of the subjects were obtained under a reproducible and controlled environment with two Minolta Vivid 900 (Osaka, Japan) optical laser-scanning devices assembled as a stereo-pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 s. These scanned images were processed and merged to form a composite three-dimensional soft tissue reproduction of the subjects using commercially available reverse modelling software.

OUTCOME MEASURE

The shell deviations between left and right scan of each patient were recorded and analysed for differences. These differences determined whether the subjects could remain still during the time of the scans.

RESULTS

The results showed that the mean differences between shell deviations for the adult scans and children scans were 0.25 +/- 0.09 and 0.30 +/- 0.09 mm, respectively. Paired t-tests showed that the mean error between subject groups was 0.05 +/- 0.15 mm indicating that there was no difference between the two subject groups (p = 0.18).

CONCLUSION

The technique as described is clinically reproducible for children and adults and can be used for studies assessing facial changes due to growth or clinical intervention.

Meeting maximum residue limits: an improved screening technique for the rapid detection of antimicrobial residues in animal food products

A rapid, high-throughput antimicrobial screening assay was developed using either a physical fluid extraction or a solvent extraction technique coupled to the commercially available PremiTest. The solvent extraction approach was fully validated for a wide range of tissues and the fluid extraction approach partially validated for porcine muscle. Both procedures can detect a wide range of antimicrobial compounds at or below maximum residue limit concentrations. The use of a solvent extraction provides an enhanced test capable of detecting a wider range of drugs than the fluid extraction approach at or below half maximum residue limit levels in a variety of matrices. Biochemical methods for the class-specific identification of beta-lactams and sulphonamides following initial screening were developed and validated. The approach is a significant improvement on existing methodologies as a tool for residues monitoring in surveillance programmes.

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128]

BACKGROUND

This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly.

DESIGN

The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls. The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.

Evaluating the Cost-Effectiveness of Orthodontic Provision

The assessment of orthodontic provision is important to determine if treatment was necessary and undertaken appropriately. The ICON objectively quantifies orthodontic treatment need, complexity and outcome and is a valuable occlusal index in the assessment effectiveness of orthodontic care. It is possible to develop cost-effectiveness models by analysing the costs and effectiveness of orthodontic treatment. Several methods are illustrated to compare the orthodontic provision of specialist orthodontists.

Borjeson-Forssman-Lehmann syndrome and multiple pituitary hormone deficiency

We describe two brothers with Borjeson-Forssman-Lehmann syndrome and the 22A-->T (Lys8X) PHF6 mutation, who presented with the symptoms and signs of multiple pituitary hormone deficiency. Biochemical investigations and radiology confirmed growth hormone (GH), thyroid stimulating hormone (TSH) and adrenocorticotrophic hormone (ACTH) as well as gonadotrophin deficiency. They were also found to have optic nerve hypoplasia. This family suggests that the BFL gene product may play an important role in midline neuro-development including the hypothalamo-pituitary axis.

Dehydrated hereditary stomatocytosis with transient perinatal ascites

The case is reported of a mother and baby with dehydrated hereditary stomatocytosis and perinatal ascites, an autosomal dominant condition not previously reported in Britain. Recognition is important for the management of pregnancy and for avoidance of splenectomy which, if performed, can predispose the patient to fatal thromboembolic events.

Routine pulse oximetry in the asymptomatic newborn

OBJECTIVE

To assess the effect of routine measurement of postductal oxygen saturation as an adjunct to routine clinical examination in the asymptomatic newborn.

DESIGN AND SETTING

Prospective study in a district general hospital.

PATIENTS

All 6166 infants inborn between 1 April 1999 and 31 March 2001.

INTERVENTION

Oxygen saturation was measured over two minutes, after the age of 2 hours and before discharge, in one foot of all babies not admitted directly to the neonatal unit. Babies with fractional (as opposed to functional) oxygen saturation (SaO(2)) below 95% were examined by the midwife. If this examination was abnormal or if normal but further measurements were below 95%, an echocardiogram was performed. All babies with cardiac malformations diagnosed by 1 year of age were identified from databases maintained at the regional cardiology referral unit and the regional congenital malformation survey.

RESULTS

Measurements were made in 98% of eligible babies. A fractional SaO(2) less than 95% was found in 5% but persisted in only 1%. Structural cardiac malformations were found in 50 (8.1/1000), 26 of whom had isolated ventricular septal defects. Of the remaining 24 with other cardiac malformations, attention was first drawn to six by low SaO(2), and four more, first noticed for other reasons, also had low SaO(2). Low SaO(2) also first drew attention to 13 other babies ill for other reasons.

CONCLUSION

Newborn babies with important cardiac malformations are often asymptomatic initially and the yield from clinical examination is poor. Measuring postductal saturation routinely in newborn babies before discharge is easy and can alert staff to ill babies.

Orthodontic treatment standards in a public group practice in Sweden

The aim was to assess the orthodontic treatment service provided by 6 orthodontists in a group practice in Malmö. One hundred cases were randomly selected from the model store. The Index of Complexity, Outcome and Need (ICON) was used to assess the need, complexity of the problem, outcome, the degree of improvement and whether the completed case was acceptable or not. The reliability of the examiner using the ICON was assessed using Root Mean Square. Logistic regression analysis was employed to explore the variables related to acceptability of the finish and duration of treatment. The younger the patient at the start of treatment the lower initial ICON score, with short treatment duration were associated with an acceptable finish. Three out of 100 cases were deemed as not requiring orthodontic treatment and 36 cases were classified as very difficult to treat. Nevertheless, 71 cases out of the 100 exhibited acceptable finishes with 27 indicating substantial or great improvement. 6 cases finished treatment with ICON scores greater than 43 indicating need for orthodontic treatment. The treatment on average took 22 months. An objective appraisal of the quality of orthodontic care in a group practice in Malmö has been undertaken. Seventy-one cases were completed with acceptable occlusions. The Index of Complexity, Outcome and Need appears to be a valuable tool to assess the multiple facets of orthodontic provision.

A 2-center comparison of orthodontist's perceptions of orthodontic treatment difficulty

The aim of this study was to determine which factors correlate with easy and difficult treatments and to assess the use of the Index of Complexity, Outcome & Need (ICON) as an indicator for treatment difficulty. The study was conducted at 2 centers using a retrospective cross-sectional questionnaire-based design. The participants were specialist orthodontic practitioners in Dresden, Germany and Cardiff, UK. Sixteen specialist orthodontists participated. Each supplied 10 completed cases--5 they regarded as being easy and 5 as being difficult. The specialist orthodontists completed a questionnaire and stated up to 5 reasons why they considered the case easy or difficult. Two examiners were calibrated in the use of the ICON. Logistic regression analysis using a forward conditional systematic model with complexity of case (ie, easy or difficult) as the dependent variable demonstrated statistical significance of the following patient-related factors: pretreatment ICON score, number of appointments, and age. Chi-squared testing demonstrated statistical significance of the following factors: cooperation, extent of overbite, presence of dysfunction, extent of overjet, anchorage, angulation of teeth, presence of crossbite, center-line shift, nonextraction treatment, age at start of treatment, compliance during the course of treatment, oral hygiene level. This study indicates that the main distinguishing factors between easy and difficult cases appear to be pretreatment age, number of appointments, and pretreatment ICON score. However, the odds ratios were not sufficiently high for these factors to be strong predictors of difficulty.

Hypernatraemic dehydration and breast feeding: a population study

As part of a population based regional review of all neonatal readmissions, the incidence of dehydration with hypernatraemia in exclusively breast fed infants was estimated. All readmissions to hospital in the first month of life during 1998 from a population of 32 015 live births were reviewed. Eight of 907 readmissions met the case definition, giving an incidence of at least 2.5 per 10 000 live births. Serum sodium at readmission varied from 150 to 175 mmol/l. One infant had convulsions. The sole explanation for hypernatraemia was unsuccessful breast feeding in all cases. The eight cases are compared with the 65 cases published in the literature since 1979. Presentation, incidence, risk factors, pathophysiology, treatment, and prevention are discussed.

The relationship between Index of Complexity, Outcome and Need, and patients' perceptions of malocclusion: a study in general dental practice

AIM

To examine the relationship between the Index of Complexity, Outcome and Need (ICON) and the subjective opinions of patients attending for routine dental care.

MATERIALS AND METHODS

This study was undertaken at two general dental practices in Cardiff and Bedford. 50 patients aged between 11-14 years and 50 patients aged 30-40 years presenting for routine dental treatment were selected in each. The subjects were assessed objectively using the ICON guidelines by two examiners trained and calibrated in the use of this index. The scores were recorded directly from the patient. Subjective assessments were obtained from the patients by means of a questionnaire consisting of four simple questions addressing aesthetics, function, speech and treatment need using a five point Likert scale.

RESULTS

The mean ICON scores for the different genders and age groups participating in this study were; 11-14 year old males 58.4 (SE 3.17); 11-14 year old females 51.8 (SE 3.51); 30-40 year old males 51.2 (SE 2.70); 30-40 year old females 45.3 (SE 2.56). There were statistically significant differences in ICON scores between the younger and older groups (P = 0.024) and females and males (P = 0.04). Adult patients were more likely to reject treatment than younger patients. Analysis of the professional scores in relation to subjective assessments, using the Spearman rank correlation coefficient, for 11-14 and 30-40 year olds, and for the male and female genders, revealed that the ICON has a significant correlation with patients' perceptions of aesthetics, function, speech and treatment need (r2 = 0.01 to 0.28). The only exceptions were patients' perceptions of speech in the 30-40 year old group, and function in the female gender, which did not show a statistically significant correlation to the professional assessments.

CONCLUSION

In this study, the ICON was found to correlate with patients' opinions of aesthetics, function, speech and treatment need. The strength of association, however, was low. It can be concluded that the ICON alone is not necessarily a suitable predictor for appearance, function, speech or treatment need for those individuals attending general dental practice for routine dental care. In combination with a simple question to assess the patients desire for treatment, the shared decision for any particular individual to enter the treatment process can be determined.

Issues and dilemmas of developing a new faculty practice plan

Due to changes in health care and increased knowledge of the public concerning health care, faculty need to assume a more active role in practice settings. Faculty involvement in the practice of their disciplines allows them to remain on the "cutting edge" as well as be models for their students. Most faculty practice plans will provide some external funding but more importantly will allow additional educational opportunities for the students as they work with the faculty. These plans allow faculty to interact with the community and strengthen the ties of the community and the academic institution. However, there are dilemmas in establishing faculty plans, for the quality of teaching cannot be threatened, and most universities expect their faculty also to be involved in scholarly activities. This article discusses 1) the process used in planning and developing a faculty practice plan; 2) details of the plan, to include faculty incentives, administrative cost, etc.; and 3) strategy for implementation.

Challenges with studies investigating longevity of dental restorations--a critique of a systematic review

OBJECTIVES

A systematic review is a method of evaluating the published and unpublished literature relating to a specific area or topic. The objectives of this paper are to identify and discuss problems encountered in synthesising the available literature; and to make recommendations for the future conduct and reporting of clinical trials that aim to determine the longevity of dental restorations.

DATA SOURCES

Studies were identified by a wide search of published and unpublished material in any language using a large number of general and specialist data bases, hand searching of key dental journals and searching of abstracts from conference proceedings.

STUDY SELECTION

Pre-defined inclusion criteria based on objective outcome measures of restoration longevity and study designs were applied to determine study selection.

CONCLUSIONS

A review of the longevity of dental restorations completed recently encountered substantial problems in designing an appropriate protocol to address this issue. The review found that many of the factors reported previously as affecting restoration longevity could not be confirmed using the agreed systematic review protocol that incorporated an objective study design. Further, the multiplicity of study designs, and reporting methods found in the literature made meta-analyses impossible. A proforma is proposed in order to aid the design of future research into the longevity of restorations.

European Resuscitation Council Guidelines 2000 for Newly Born Life Support. A statement from the Paediatric Life Support Working Group and approved by the Executive Committee of the European Resuscitation Council

The European Resuscitation Council (ERC) last issued guidelines for the resuscitation of the newly born infant in 1999 [1]. This was an "Advisory Statement" of the International Liaison Committee on Resuscitation (ILCOR). Following this, the American Heart Association and the Neonatal Resuscitation Programme Steering Committee of the American Academy of Paediatrics and representatives of the World Health Organisation, together with representatives from ILCOR, undertook a series of evidence-based evaluations of the science of resuscitation which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" in August 2000 [2,3]. The Paediatric Life Support Working Party of the European Resuscitation Council has considered this document and the supporting scientific literature and presents the ERC Newly Born Guidelines in this paper. Readers will find few changes to the ILCOR Advisory Statement recommendations as the new evidence that has emerged since its publication in 1999 has been confirmatory of the ILCOR recommendations.

Early diagnosis of congenital heart disease

Routine examination of apparently healthy newborn babies detects less than half of those with congenital cardiac malformations because they are asymptomatic and without signs. More severe cardiac malformations are not detected more easily. A normal clinical examination does not exclude serious congenital cardiac malformation. Left heart obstruction is easily overlooked but often causes serious deterioration in less than 3 weeks. It is important to arrange early echocardiography of babies with signs and to consider cardiac malformation in a sick baby even if a previous routine examination was normal. All babies with Down syndrome should have early expert cardiological assessment.

The time-factor in orthodontics: what influences the duration of treatments in National Health Service practices?

This study aimed to elucidate factors associated with duration of orthodontic treatment.

METHODS

Retrospective analysis of a systematic 2% sample of cases completed in National Health Service practices in England and Wales. Records were collected during 1991. Characteristics of practitioners, patients, malocclusions, treatment variables and outcomes were evaluated. Data were submitted to multivariate analysis, with Log10 Time in Treatment as the dependent variable.

RESULTS

Data were available for 1506 cases. The (geometric) mean time in treatment was 13 months. A model was found that explained 41% of the variance. Factors found to increase duration were fixed appliances, multiple stages in the treatments, premolar extractions, and correction of antero-posterior buccal occlusion. Age, buccal segment malocclusion, DHC (Dental Health Component of the Index of Orthodontic Treatment Need) grade 5 and orthodontically qualified practitioners were also associated with slightly longer treatments.

CONCLUSIONS

Whilst briefer treatments may be attractive to purchasers, providers and recipients, it should be remembered that thorough treatment, and treatment of more complex malocclusions, tends to take longer. Economic pressures on practitioners to produce high turnovers of cases may be counterproductive in the quest for better outcomes.

Foods found in the wild around nuclear sites: an evaluation of radiological impact

Habit surveys were carried out around four licensed nuclear sites to identify people who collect foodstuffs from the wild (so-called 'free foods'). In total, around 800 collectors were readily identified, most of whom collected more than one free food. The data indicated that estimates of higher than average doses could reasonably be based on the three foodstuffs of most importance. Foods were selected for further study on the basis of either the number of collectors or the amount consumed. The radionuclides of interest were identified using published information on the discharges from each site. The resultant average and higher than average doses were estimated using the site-specific habit data. For all sites, doses from the consumption of free foods were low and of no radiological importance. Assessments based solely on data for cultivated foods would not therefore have underestimated radiological impact significantly. However, given the wide utilisation of free foods found in this study, for rigorous assessments it would be prudent to take account of the consumption of foods from the wild.