Mandibular bone structure, bone mineral density, and clinical variables as fracture predictors: a 15-year follow-up of female patients in a dental clinic

ObjectiveTo compare three mandibular trabeculation evaluation methods, clinical variables, and osteoporosis as fracture predictors in women.Study designOne hundred and thirty-six female dental patients (35-94 years) answered a questionnaire in 1996 and 2011. Using intra-oral radiographs from 1996, five methods were compared as fracture predictors: (1) mandibular bone structure evaluated with a visual radiographic index, (2) bone texture, (3) size and number of intertrabecular spaces calculated with Jaw-X software, (4) fracture probability calculated with a fracture risk assessment tool (FRAX), and (5) osteoporosis diagnosis based on dual-energy-X-ray absorptiometry. Differences were assessed with the Mann–Whitney test and relative risk calculated.ResultsPrevious fracture, gluco-corticoid medication, and bone texture were significant indicators of future and total (previous plus future) fracture. Osteoporosis diagnosis, sparse trabeculation, Jaw-X, and FRAX were significant predictors of total but not future fracture.ConclusionClinical and oral bone variables may identify individuals at greatest risk of fracture

Gender differences in care-seeking behavior and health care consumption after work-related whiplash injuries injuries: Arthur Tenenbaum

Background: The aim was to study gender differences in care-seeking behaviour regarding type of facility, time span and type of treatment after work-related motor vehicle trauma (WRMVT) and to investigate the incidence of WRMVT. Methods: - Design: Cross-sectional retrospective study. - Setting: A population-based register in a Swedish county from 1999 to 2008. - Participants: A cohort of 820 persons, 18-65 years of age, involved in traffic accidents, either working at the time of the trauma, or on their way to or from work, resulting in a clinical whiplash diagnosis. Results: Women sought care at primary health care units more often than men, who sought care mainly at hospitals (p = 0.0048). Four percent of the injured persons were treated at hospital. Twelve percent of all patients involved in WRMVT sought care with a delay of at least three days. Women sought care later than men (p = 0.011). There was no difference in gender regarding type of treatment after trauma. Ninety-one percent were treated and discharged and six percent were sent home untreated after examination. Fifty-two percent of the injured persons sought care at primary care units. The annual incidence of WRMVT decreased from 68/100 000 to 43/100 000. Conclusion: The incidence of WRMVT in the rural and urban county declined during 1999-2008. Women sought care at primary care units more often then men. Women sought care later then men after the trauma which may reduce especially women's probability of getting workers compensation. Key messages: • Gender differences exist in WRMVT, women seek primary health care more often, and later than men do which may affect insurance outcomes for women. • The annual incidence of acute whiplash disorders due to WRMVT decreased from 68/100 000 to 43/100 000 inhabitants annually between 1999 to 2008

Lung cancer research and its citation on clinical practice guidelines.

BACKGROUND: The impact of medical research is usually judged on the basis of citations in the serial literature. A better test of its utility is through its contribution to clinical practice guidelines (CPGs) on how to prevent, diagnose, and treat illness. This study aimed to compare the parameters of lung cancer research papers with those cited as references in lung cancer CPGs from 16 countries, and the Cochrane Collaboration. These comparisons were mainly based on bibliographic data compiled from the Web of Science (WoS). METHODOLOGY: We examined 7357 references (of which 4491 were unique) cited in a total of 77 lung cancer CPGs, and compared them with 73,214 lung cancer papers published in the WoS between 2004 and 2018. RESULTS: References used by lung CPGs were much more clinical than the overall body of research papers on this cancer, and their authors predominantly came from smaller northern European countries. However, the leading institutions whose papers were cited the most on these CPGs were from the USA, notably the MD Anderson Cancer Center in Texas, the Memorial Sloan Kettering Cancer Center, New York, and the Mayo Clinic in Rochester, Minnesota. The types of research cited by the CPGs were primarily clinical trials, as well as three treatment modalities (chemotherapy, radiotherapy and surgery). Genetics, palliative care and quality of life were largely neglected. The median time gap between papers cited on a lung CPG and its publication was 3.5 years longer than for WoS citations. CONCLUSIONS: Analysis of the references on CPGs allows an alternative means of research evaluation, and one that may be more appropriate for clinical research than citations in academic journals. Own-country references show the direct contribution of research to a country's health care, and other-country references show the esteem in which this research has been held internationally

"I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

<p>Abstract</p> <p>Background</p> <p>Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors.</p> <p>Methods</p> <p>Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method.</p> <p>Results</p> <p>In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: <it>(a) Pleasure and stimulation</it>. Informants appreciated tutorship and meeting both students and fellow tutors, <it>(b) Disappointment and stagnation</it>. Occasionally, tutors were frustrated and expressed negative feelings, <it>(c) Demands and duty</it>. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, <it>(d) Impact of workplace relations</it>. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and <it>(e) Multitasking difficulties</it>. Combining several duties with those of a tutorship was often reported as difficult.</p> <p>Conclusions</p> <p>It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.</p

The effect of massage for women with breast cancer

ABSTRACT Breast cancer is the most common type of cancer in females. The effect of massage in the field of oncology has been investigated to some extent. The present thesis explored the effect of light pressure effleurage massage in women with breast cancer in six main domains; nausea, anxiety, depression, quality of life, stress and cellular immunity. It also described the experience of massage during chemotherapy. The effect of light pressure effleurage was investigated on nausea, anxiety and depression in women with breast cancer undergoing chemotherapy. Five part-body massage treatments were given during chemotherapy infusion. Massage significantly lowered nausea (p=0.025) compared with control group. No significant differences were shown between study groups on anxiety and depression. The experience of light pressure effleurage during chemotherapy treatment was studied using phenomenology as theoretical framework. The essential meaning of receiving massage during chemotherapy was described as a retreat from the feeling of uneasiness toward chemotherapy. Results revealed five themes: a distraction from the frightening experience, a turn from negative to positive, a sense of relaxation, a confirmation of caring and finally they just felt good. The effect of light pressure effleurage on immunity was investigated in women with breast cancer undergoing radiation. Ten part-body massage treatments, 20 minutes duration, were given during three weeks. Main variables were NK (Natural Killer) and T cells. The effect of massage on cortisol, oxytocin, anxiety, depression and quality of life was also studied. We were not able to demonstrate any significant differences between study groups on any of the variables in this study. The immediate effect of light pressure effleurage on immunity was also investigated. Patients received one full-body massage, 45 minutes duration. Main variable was NK cells, secondary variables cortisol, blood-pressure and heart rate. Massage treatment had significant effect on NK cell function compared with the control group (p=0.03). Furthermore, massage significantly lowered systolic blood-pressure (p=0.03) and heart rate (p=0.04) compared with the control group. No significant effects were demonstrated on cortisol or diastolic blood-pressure. In conclusion, the present thesis demonstrated that light pressure effleurage could be effective in reducing nausea in breast cancer patients during chemotherapy. A single full-body light pressure massage had short term effects on NK cell function, it decreased heart rate and systolic blood pressure significantly compared with visit only. It appears that repeated part-body light pressure massage did not affect cellular immunity during radiation, possibly due to secondary effects of radiation on immunity. Altogether, it might be speculated that the intensity of part-body massage was too low to affect cellular immunity compared with full-body massage. Furthermore, the amount of pressure used might bear impact on results. Patients with breast cancer however, experienced light pressure massage as a retreat from uneasy, unwanted, negative feelings connected with chemotherapy treatment

A new database of the references on international clinical practice guidelines : a facility for the evaluation of clinical research

Although there are now several bibliographic databases of research publications, such as Google Scholar, Pubmed, Scopus, and the Web of Science (WoS), and some also include counts of citations, there is at present no similarly comprehensive database of the rapidly growing number of clinical practice guidelines (CPGs), with their references, which sometimes number in the hundreds. CPGs have been shown to be useful for the evaluation of clinical (as opposed to basic) biomedical research, which often suffers from relatively low counts of citations in the serial literature. The objectives were to introduce a new citation database, clinical impact (R), and demonstrate how it can be used to evaluate research impact of clinical research publications by exploring the characteristics of CPG citations of two sets of papers, as well as show temporal variation of clinical impactand the WoS. The paper includes the methodology used to retain the data and also the rationale adopted to achieve data quality. The analysis showed that although CPGs tend preferentially to cite papers from their own country, this is not always the case. It also showed that cited papers tend to have a more clinical research level than uncited papers. An analysis of diachronous citations in both clinical impactand the WoS showed that although the WoS citations showed a decreasing trend after a peak at 2-3 years after publication, this was less clear for CPG citations and a longer timescale would be needed to evaluate their impact on these documents

The relation between PhD students and their advisors: how to make it work and how to manage upcoming problems

Aims and rationale: The aim is to describe the experience of PhD supervision from the perspective of advisors and PhD students. PhD supervision is mostly done in a personal style that varies between advisors. For an outside observer it may seem that this works quite well. Can it be done better? The attrition rates and number of websites discussing how to survive your PhD suggests that there might be room for further improvement. Methods: Nine advisors from several university institutions in general practice in UK and Sweden and seven PhD students were interviewed. Principal findings: Three main themes were identified: 1) The good example: Eight house keeping rules were identified to facilitate a good relation between advisors and students. 2) Disagreements: Five areas for potential problems were identified and how these should be managed. 3) Potential consequences of a global trend in changing PhD programs from the former UK model (allowing more student initiative and "finding their way") to the US model (emphasizing low attrition rates and completion in time). Relevance to policy, research and/or practice needs: PhD students in general practice are often older than other PhD students and often do their PhD part time. They rarely fit into the standard PhD frame work made up by the University. This makes it important to clarify what can be done to facilitate research education in general practice

The experience of disagreement between students and supervisors in PhD education: a qualitative study

Background: PhD supervision is mostly individual and disagreement between supervisors and PhD students is a seldom-discussed topic at universities. The present study aimed to describe the experience of disagreement between PhD students and supervisors.\ud \ud Methods: Nine supervisors and seven PhD students from Sweden and England were interviewed using a video recorder. The recorded material was analysed using inductive content analysis.\ud \ud Results: Disagreements in PhD education can be described with the overarching theme: the nature of the disagreements changes over time. Five categories emerged to describe the variations of the experiences: involvement in important decisions, supervisors not being up-to-date, dubious advice from supervisors, mediating between supervisors, and interpersonal relationships.\ud \ud Conclusions: There is a gradual shift in competence where PhD students may excel supervisors in subject knowledge. Early disagreements may indicate immaturity of the student while disagreements later may indicate that the student is maturing making their own decisions. Consequently, disagreements may need to be addressed differently depending on when they occur. Addressing them inappropriately might slow the progressions and result in higher attrition rate among PhD students. The five categories may be elements in future PhD supervisor training programs and should be further evaluated for their importance and impact on PhD education

Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial

Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. \ud \ud Method: We recruited 113 patients suffering from chronic WAD grades I–III and several years’ duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. \ud \ud Results: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR = 15) more than the ET group (median = 0, IQR = 15), p = 0.032, effect size −0.54. Three months after the end of treatment, the BAT group had less bodily pain (m = 17.5, 95% CI 6.9–17.6) than the ET group (m = 4.9, 95% CI −0.1 to 9.8), p = 0.044, effect size −0.4. The BAT group had also increased their social functioning (m = 13.3, 95% CI 6.6–19.9) more than the ET group (m = 3.5, 95% CI −3 to 9.9), p = 0.037, effect size −0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. \ud \ud Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD