Preformed metal crowns for decayed primary molar teeth

BackgroundPreformed metal crowns (PMCs) are recommended by the British Society of Paediatric Dentistry (BSPD) for restoring badly broken down primary molar teeth. However, few dental practitioners adopt this technique in clinical practice, citing cost and clinical difficulty as reasons for this. Whilst there is a subjective impression by clinical academics that PMCs provide a more durable restoration than filling materials, there appears to be little evidence within the literature to support this.ObjectivesThe primary aim of this systematic review was to compare clinical outcomes for primary molar teeth restored using PMCs compared to those restored with filling materials.Search methodsThe literature was searched using: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); System for Information on Grey Literature in Europe (SIGLE) (1976 to August 2005). Relevant publications' reference lists were reviewed for relevant articles. The most recent search was carried out on 24 August 2005.Selection criteriaRandomised controlled trials (RCTs) that assessed the effectiveness of PMCs compared with filling materials or where there had been no treatment in children with untreated tooth decay in one or more primary molar teeth.Data collection and analysisTwo review authors independently assessed the title and abstracts for each article from the search results to decide whether it was likely to be relevant. Full papers were obtained for relevant articles and all three review authors studied these.Main resultsForty‐seven records were retrieved by the search strategies of which some were duplicates. Of these, 14 studies were scrutinised. No studies met the inclusion criteria and six studies were excluded from the review as they were either retrospective in design or reported as prospective outcomes but not randomised. No data were available for extraction and analysis and therefore, no conclusion could be made as to whether PMCs were more successful than filling materials for restoring primary molar teeth.Authors' conclusionsNo RCTs were available for appraisal. Whilst this technique is recommended by the BSPD for use in clinical practice, the evidence to support this is not strong, consisting mainly of case reports and uncontrolled studies. It is important that the absence of evidence for PMCs is not misinterpreted as evidence for their lack of efficacy.There is a strong need for prospective RCTs comparing PMCs and fillings for managing decayed primary molar teeth. The lower levels of evidence that have been produced, however, have strength in that the clinical outcomes are consistently in favour of PMCs, despite many of the studies placing PMCs on the most damaged of the pair of teeth being analysed

The Effect of the Bribery Act 2010.

Analyses six key effects of the Bribery Act 2010, looking at how the practices adopted in Scotland and the rest of the UK differ. Considers: (1) changes to the substantive law; (2) Ministry of Justice guidance and corporate compliance programmes; (3) the amendment of commercial contracts; (4) prosecutions and convictions; (5) the broadening of the scope of new prosecution policies; and (6) the UK's compliance with international legal obligations

Case note review of community mental health services for children and young people in a UK rural location

PurposeThe aim of the review is to investigate the reasons for referral to this child and adolescent mental health (CAMH) service and determine whether these had been met by the service.Design/methodology/approachThis is a retrospective case note analysis that was conducted of 66 referrals to CAMHS for children and young people serving a rural community of 132,000. Case notes were selected by the NHS CAMHS manager based on referrals during the pre-defined date set. Of the 66 referrals to CAMHS, 19 were not included in the analysis because they had not been accepted into the service. Data were analysed on the remaining 47 cases who were referred, accepted into the service and had been offered an assessment by the service.FindingsGeneral practitioners represented the most frequent health care practitioner to refer to the service (n = 33, 70.2%). Self harm, suicidal intent, thoughts or overdose represented the highest percentage of referrals to the CAMHS service (38.3%); depression, low mood and sadness represented the next highest figure (19%) and anxiety and depression (10.6%) broadly speaking 68% of referrals related to low mood. Out of the 44 cases that were examined, 14/44 (32%) were referred back to the GP and no specific intervention was provided. Interventions provided to five cases were unspecified.Research limitations/implicationsA number of opportunities for developing the service that allowed for a focus on the core business of helping children and young people with low mood were identified. One of the limitations of this retrospective review was the time frame selected because it had been identified as a particularly high period for referral into the service and may not have been representative of the usual trend.Practical implicationsThis informed a training strategy and resource allocation and a redefinition of discrete roles within the service.Originality/valueThis study highlighted the evidence about where the demand was on this service and hence the requirement to focus on their core business. This evidence generated by the review prompted a redirection of resources within the service. Additional reflections and discussion informed the development of a new training strategy and a redefinition of discrete roles within the service

The role of sample pupil responses in problem-solving lessons: perspectives from a design researcher and two teachers

The benefits of learning mathematics by comparing, reflecting on and discussing multiple approaches to a problem are well-known (Silver, 2005). However, teachers using non-routine problem-solving tasks designed to encourage multiple approaches face challenges: understanding how pupils make sense of the problem, especially when pupils use unique or unanticipated approaches and helping pupils make connections between disparate approaches and aligning these with lesson goals. In an attempt to address such challenges an extensive set of problem solving lessons were developed. Each lesson includes a range of sample solution-methods that expose pupils to multiple perspectives. A detailed teacher guide supports each lesson. This paper focuses on the use of these sample solution-methods. It explores their development from initial design to final versions. We analyse the varied interpretations and use made of sample solution-methods, in both US classrooms and by two UK teachers, and reflect on how these interpretations align with the designers’ intention

The role of sample pupil responses in problem-solving lessons: perspectives from a design researcher and two teachers

The benefits of learning mathematics by comparing, reflecting on and discussing multiple approaches to a problem are well-known (Silver, 2005). However, teachers using non-routine problem-solving tasks designed to encourage multiple approaches face challenges: understanding how pupils make sense of the problem, especially when pupils use unique or unanticipated approaches and helping pupils make connections between disparate approaches and aligning these with lesson goals. In an attempt to address such challenges an extensive set of problem solving lessons were developed. Each lesson includes a range of sample solution-methods that expose pupils to multiple perspectives. A detailed teacher guide supports each lesson. This paper focuses on the use of these sample solution-methods. It explores their development from initial design to final versions. We analyse the varied interpretations and use made of sample solution-methods, in both US classrooms and by two UK teachers, and reflect on how these interpretations align with the designers’ intention

Linkage of social care and hospital admissions data to explore non-delivery of planned home care for older people in Scotland

Purpose: As part of a pilot study assessing the feasibility of record-linking health and social care data, we examined patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. We also assessed whether non-delivery was associated with subsequent emergency hospital admission. Design: After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission. Findings: There were 4,170 instances of ‘No Access’ non-delivery among 1,411 people, and 960 instances of ‘Service Refusal’ non-delivery among 427 people. The median number of undelivered visits was two among the one third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding. Research Implications: This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes. Practical Implications: Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance

U–Pb zircon age constraints for the Ordovician Fishguard Volcanic Group and further evidence for the provenance of the Stonehenge bluestones

New U–Pb zircon ages from rhyolite samples of the Fishguard Volcanic Group, SW Wales, confirm a Middle Ordovician (Darriwilian) age for the group. One of the samples is from Craig Rhos-y-felin, which has recently been identified on petrological and geochemical grounds as the source of much of the debitage (struck flakes) at Stonehenge. Analysis of a Stonehenge rhyolite fragment yields an age comparable with that of the Craig Rhos-y-felin sample. Another Stonehenge fragment, thought to come from orthostat (standing stone) 48 and on petrographical grounds to be derived from the Fishguard Volcanic Group (but not Craig Rhos-y-felin), yields an age also consistent with a Fishguard Volcanic Group source. Supplementary material: Details of analytical methods and a table of data are available at https://doi.org/10.6084/m9.figshare.c.3518175

Improving the timeliness of mental health assessment for children and adolescents in a multidisciplinary team

Background: The waiting list for outpatient Child and Adolescent Mental Health Service (CAMHS) appointments exceeded 12 months. This paper discusses the development and implementation of a bespoke mental health assessment process that improved the timeliness of assessments for referred children and adolescents. Aim: To introduce a new system of managing referrals to reduce the waiting list for children and their families. Methods: Action research methodology was used as an approach to engage practitioners and facilitate change within a multidisciplinary CAMHS in the UK. The methods used to generate data about the intervention were semi structured interviews with families referred to the services and with practitioners working in the team, as well as an examination of waiting list data and a survey of referrers to the service. Findings: As a result of the implementation of a triage approach, the waiting time for a referred child to receive an initial CAMHS assessment was reduced from 12 months to all children being assessed within one month of referral. Referrers to the service and families involved valued the quick response from CAMHS. Conclusions: This was a bespoke process that combined a brief clinical interview, the use of psychometric measures and a team review meeting to create an effective mechanism for conducting brief, robust mental health assessments. Implications for practice: It was possible to glean sufficient detail about the nature of a child’s mental health difficulties from a brief assessment or triage process A brief assessment process might be useful in a number of mental health fields to enable screening, triage or a gateway assessment to be conducted Action research was a useful approach to engage practitioners as collaborating partners during organisational change in a way that promoted sustainability for that chang