Articaine in dentistry: safety, efficacy, practitioner perception and evidence-based practice

Erica Martin researched articaine in dentistry. She found that although articaine is safe and efficacious for all routine dental treatment, forty percent of dental practitioners avoided its use for inferior alveolar nerve blocks. Her research points to a discrepancy in evidence-based dental practice that needs furthers clarification

Hormonal suppression of mini-puberty in a neonate with mosaic 45X/46XY disorder of sexual development

Disorders of Sex Development (DSD) are some of the most controversial and challenging conditions that pediatric urologists treat. This may be especially true in mosaic 45X/46XY DSD, due to the inability to ascertain in the neonatal period which gender identity will best suit a given child with this condition. It has therefore been proposed to forgo any irreversible surgical interventions. In order to address the concern of early testosterone production in a nonsurgical manner we describe a case in which we treat a patient with a GnRH agonist to block the early physiologic rise in testosterone during the neonatal mini-puberty

Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union.

BACKGROUND: Research suggests that since the collapse of the Soviet Union there has been a sharp growth in the use of complementary and alternative medicine (CAM) in some former Soviet countries. However, as yet, comparatively little is known about the use of CAM in the countries throughout this region. Against this background, the aim of the current study was to determine the prevalence of using alternative (folk) medicine practitioners in eight countries of the former Soviet Union (fSU) and to examine factors associated with their use. METHODS: Data were obtained from the Living Conditions, Lifestyles and Health (LLH) survey undertaken in eight former Soviet countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine) in 2001. In this nationally representative cross-sectional survey, 18428 respondents were asked about how they treated 10 symptoms, with options including the use of alternative (folk) medicine practitioners. Multivariate logistic regression analysis was used to determine the factors associated with the treatment of differing symptoms by such practitioners in these countries. RESULTS: The prevalence of using an alternative (folk) medicine practitioner for symptom treatment varied widely between countries, ranging from 3.5% in Armenia to 25.0% in Kyrgyzstan. For nearly every symptom, respondents living in rural locations were more likely to use an alternative (folk) medicine practitioner than urban residents. Greater wealth was also associated with using these practitioners, while distrust of doctors played a role in the treatment of some symptoms. CONCLUSIONS: The widespread use of alternative (folk) medicine practitioners in some fSU countries and the growth of this form of health care provision in the post-Soviet period in conditions of variable licensing and regulation, highlights the urgent need for more research on this phenomenon and its potential effects on population health in the countries in this region

Articaine: dental practitioner use, basis of perception and evidence-based dentistry — a cross-sectional study

Background Limited data exist on dental practitioner use and perceptions of articaine. This study is a cross-sectional survey of dental practitioners from January, 2021 to ascertain the extent of their use of the dental local anaesthetic, articaine, the basis of their perceptions about articaine and whether current practices are in line with recent evidence regarding articaine safety and efficacy. Method An anonymous survey was designed using the SAP Qualtrics Core XM software platform and a survey link was disseminated from December 2020 to January 2021 via social media. The survey was designed as a five minute, anonymous, online questionnaire including a plain language information sheet, request for participant consent and 14 questions. Data were entered onto a Microsoft™ Excel spreadsheet and analysed qualitatively, isolating the answers into recurrent themes. Results Sixty percent of the surveyed dental practitioner used articaine as their preferred dental anaesthetic. Twenty-three percent of the dental practitioner surveyed used articaine for all of their dental procedures including inferior alveolar nerve blocks, while 40% of respondents used articaine for all their dental procedures except inferior alveolar nerve blocks. The predominant basis of dental practitioner uses and perception of articaine were their countries dental guidelines. Conclusion Despite the latest findings that articaine is as safe and more efficacious as lidocaine for all routine dental treatment, 40% of survey respondents avoided articaine use for inferior alveolar blocks. Our study recognises a discrepancy between reported clinical practice and current research evidence. Further research and clarifications are needed to achieve ubiquitous practice of evidence-based dentistry

How fences communicate interspecies codes of conduct in the landscape: toward bidirectional communication?

The fence provides two functions in wildlife management. First, it physically blocks, deters or impedes wild animals from access to protected areas or resources. Second, the fence signals impassability, danger, pain or irritation to animals through both of these pathways: the actual blockade and the signal of no access both communicates to wild animals that they should stay away, producing area effects which constrain animal mobility. The mere presence of a fence, while imperfect and potentially passable, can come to establish an area effect of avoidance. In this regard, fences are part of an inter-species communication on the basis of mutually understood signals in the landscape. In this paper, we consider how fences, both physical, such as walls, and virtual, such as ‘biofences’ that use sensory deterrents, signal danger or no access to wildlife, and with what practical and conceptual limitations. Through a framework of ecosemiotics, the communication of signals between wildlife and humans, we discuss the communica-tive role fences play in human–wildlife interactions. First, we outline the way in which ecosemiotics may be leveraged to manage human–wildlife conflicts by utilizing fences as signals. Then we explain miscommunication, and how this impacts the success of fences. Finally, we discuss the normative problems of attempting to signal to wildlife how to behave and where to be, and raise the need for bidirectional communication across species, such that wild animals are also seen as participants in negotiating space and access around humans.publishedVersio

Antibiotic prescriptions upon hospital discharge: A blind spot of antimicrobial stewardship

Background: Transitions of care are a known source of patient vulnerability. The incidence of medication errors during transitions of care is well-documented.1 Discharge from the hospital has proven to be one area where antimicrobial stewardship is absent or lacking and can result in: poor clinical outcomes, adverse drug events, and emergence of multidrug resistant organisms. In one study, 53% of cases reviewed found antibiotics prescribed at discharge were inappropriate.1 Large discrepancies exist between guideline recommendations and antimicrobials prescribed upon hospital discharge.2 At this time, no prior study at OSU Medical Center has analyzed the impact of antimicrobial stewardship at hospital discharge.Methods: This study will be a retrospective chart review based on a report of patients age 18 years and older discharged from OSUMC from 7/1/2018 to 6/30/2019 with CAP or uncomplicated UTI. This data will be used to determine whether optimal antibiotic therapy was prescribed upon hospital discharge. Optimal therapy is defined as: prescription in accordance with nationally-approved guidelines for the management of CAP and UTI; effective and narrowest spectrum of activity; correct dose for indication, organ dysfunction, and medication allergies; and correct duration of therapy. This study will also the assess antibiotic classes most frequently involved in errors, as well as the most commonly occurring types of errors (incorrect drug, dose, or duration). Patients with multiple types of infection will be excluded from the study. Data collected will be organized and evaluated using REDCapTM. The following data will be obtained: date of discharge, days of optimal inpatient antibiotic therapy, discharge antibiotics regimen, infection type (CAP vs. uncomplicated UTI), pertinent laboratory and microbiology data, and bacteria cultured with source and date results finalized.Results: Data collection is still ongoing. At this time, 1402 patient charts have been reviewed, and 168 patient charts met inclusion criteria. Of those included, patients were primarily female (63%) with an average age of 62 (range 21-95), and 43% were discharged on a suboptimal antibiotic regimen. The most common reason for a suboptimal regimen was an inappropriate duration of therapy (92%) followed by an incorrect medication dose (26%).Conclusions: At the time of this writing, duration of therapy far outweighs any other cause for a suboptimal discharge antibiotic regimen. By completing this study, we hope to gain more insight into how we can better serve our institution by educating physicians, reducing errors, and optimizing transitions of care

Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment

OBJECTIVES: To comprehensively review the existing studies of articaine in dentistry and conduct a systematic review and meta- analysis to answer the following Population, Intervention, Comparison and Outcome question: “Is articaine a safe and efficacious local anaesthetic for routine dental treatment compared to lidocaine?” METHODS: Database searches were conducted in Medline Ovid, Medline Pubmed, Scopus, Emcare, Proquest and the Cochrane Central register of Controlled Trials. Inclusion criteria were all existing English, human, randomised controlled trials of interventions involving 4% articaine and 2% lidocaine in routine dental treatment. Twelve studies were included for meta-analysis using Cochrane Review Manager 5 software. Anaesthetic success odds ratios were calculated using a random-effects model. RESULTS: Articaine had a higher likelihood of achieving anaesthetic success than lidocaine overall and in all subgroup analyses with varying degrees of significance. Overall (OR: 2.17, 95% CI: 1.50, 3.15, I2 = 62%) articaine had 2.17 times the likelihood of anaesthetic success of lidocaine (P < 0.0001). For mandibular blocks (OR: 1.50, 95% CI: 1.14, 1.98, I2 = 0%) articaine had 1.5 times the likelihood of anaesthetic success of lidocaine (P = 0.004). For all infiltrations, maxillary and mandibular (OR: 2.78, 95% CI: 1.61, 4.79, I2 = 66%) articaine had 2.78 times the likelihood of anaesthetic success of lidocaine (P = 0.0002). None of the studies reported any major local anaesthetic-related adverse effects as a result of the interventions. CONCLUSIONS: Articaine is a safe and efficacious local anaesthetic for all routine dental procedures in patients of all ages, and more likely to achieve successful anaesthesia than lidocaine in routine dental treatment. Neither anaesthetic has a higher association with anaesthetic-related adverse effects

Breadmaking performance of protein enriched, gluten-free breads

9 pages, 3 figures, 5 tables.-- Published online 19 February 2008.-- The original publication is available at www.springerlink.comSoybean enriched, rice-based gluten-free breads were designed incorporating a structuring agent (hydroxypropylmethylcellulose, HPMC) and a processing aid (transglutaminase, TG). At dough level the effect of increasing amounts of soybean protein isolate (SPI), HPMC and water was studied in the Mixolab. Mixing and thermal characteristics showed the significant effect induced by water, soybean protein isolate, HPMC and TG, allowing the selection of the appropriate amounts for the breadmaking performance of enriched gluten-free breads. The single addition or in combination of 4% HPMC, 13% soybean and 1% TG produced significant changes in the physical properties of the rice-based gluten-free breads. The presence of SPI blended with rice flour produced a significant decrease in the specific volume of the bread, although this detrimental effect was partially counteracted by its combination with HPMC, decreasing also the crumb hardness. The micrographs of the crumb showed the beneficial effect of the HPMC, obtaining a more open aerated structure. Protein enriched, gluten-free breads can be obtained with a combination of SPI, HPMC and TG.This work was financially supported by Comisión Interministerial de Ciencia y Tecnología Project (MCYT, AGL2005-05192-C04-01) and Consejo Superior de Investigaciones Científicas (CSIC). C. Marco gratefully acknowledges the Ministerio de Educación y Ciencia for her grant.Peer reviewe

Transition to Independence: A Phenomenological Study of Foster Care Alumni Pursuing a College Degree

This dissertation explored the experiences of foster care alumni pursuing a college degree and the perceptions and meanings they attribute to those experiences. This phenomenological study explored the conflicts that may impair foster care alumni from achieving postsecondary educational goals. The researcher conducted face-to-face interviews with 10 foster care alumni in the Central Florida area. The findings were based on the following research question: What are the obstacles to postsecondary achievement for foster care alumni who are currently pursuing or would like to pursue a degree at a two-or-four-year university? Scholarly literature and four theoretical frameworks support the analysis of this study’s findings: Burton’s (1990) theory of human needs, Chickering’s (1969) theory of student development, Vygotsky’s (1978) theory on social development and Putnam’s (1993) theory on social capital. The primary essence of this study revealed that foster care alumni who are transitioning from foster care to independence expressed feelings of being alone and having a lack of support. The major sub-themes that exemplified this essence included feelings of isolation, lack of confidence, childhood trauma, gaining life skills, financial conflict, changing perceptions, motivation, communication with faculty, and delays in enrollment. Academic advisors, social workers in child welfare agencies, and researchers in the field of conflict analysis and resolution would benefit from the findings of this study to more effectively address the needs of foster care alumni