Comparing the Efficacy of Scalpel, Electrosurgical, and Laser Gingivectomies for the Management of Gingival Enlargement Following Orthodontic Therapy

Introduction: Gingival enlargement can occur during orthodontic therapy and often may not subside following removal of the orthodontic appliances. It may lead to esthetic concerns, as well as potential reservoirs for bacteria and hinder oral hygiene efforts. Treatment has included nonsurgical debridement alone or in combination with gingival resection using laser, electrosurgery, or conventional scalpel. Objectives: To compare the clinical effectiveness of three resective techniques in the management of gingival enlargement following orthodontic therapy with regards to: Gingival margin position (GMP), probing depths (PDs), bleeding scores, plaque index (PI), gingival index (GI) and patient postoperative discomfort. Materials and Methods: 17 healthy adult patients, who recently completed orthodontic treatment and presented with at least two posterior teeth in each quadrant with 4 mm or greater gingival pocketing were screened. Six qualified for the study. A periodontal evaluation and the GMP were recorded using a customized stent. The patients received initial nonsurgical debridement and were re-evaluated after 4-6 weeks. Two patients dropped during the course of the study (one relocated, and the other no longer had gingival enlargement). The four remaining patients underwent surgical treatment by a Secondary Investigator (experienced periodontist) in a split mouth design. Three quadrants were randomly assigned a surgical treatment (laser, electrosurgery, or scalpel) while the fourth quadrant served as a control, with all quadrants receiving additional nonsurgical debridement during that visit. The Primary Investigator was blind to the surgical treatment and returned after the procedure to measure the GMP. The first follow-up visit was at 1-2 weeks post-surgery during which patients were also asked about postoperative discomfort. Further evaluations were performed at 4-6 and 12-14 weeks post-surgery. Results: Four patients with a total of 61 posterior teeth (29 premolars and 32 molars) completed the study. Three of the four patients reported more postoperative discomfort in the electrosurgery treated regions, while one patient reported the laser treated region causing the most discomfort. All three surgical groups (laser, electrosurgery, and scalpel) showed significantly more reduction in the GMP compared to the control. All subjects had statistically significant reduction in the overall PDs, bleeding scores and PI by the end of the study, while not in the GI. Furthermore, when comparing the three surgical techniques to each other, no statistically significant differences were found for any of the clinical parameters (PD, bleeding, GMP, PI, and GI), however, the laser group had the most reduction in all the evaluated clinical parameters. Lastly, analysis by tooth type revealed that premolar teeth had significantly more reduction than molar teeth in bleeding score, PI, and GI, but not with respect to GMP and PDs. Conclusion: Within the limitations of this study, it was shown that all three resective techniques (laser, electrosurgery, and scalpel) were more effective at reducing gingival enlargement than nonsurgical therapy alone. Most patients reported the electrosurgery treated group as having the most postoperative discomfort, followed by the laser treated group. Although there was no statistically significant difference when comparing the three techniques to each other, the laser had the most reduction in all clinical parameters (GMP, PDs, bleeding score, PI, and GI). Further studies with longer follow-up are recommended to strengthen the evidence in support of their effectiveness

A systematic review of pharmacovigilance systems in developing countries using the WHO pharmacovigilance indicators

BACKGROUND: In the context of the growth of pharmacovigilance (PV) among developing countries, this systematic review aims to synthesise current research evaluating developing countries’ PV systems’ performance. METHODS: EMBASE, MEDLINE, CINAHL Plus and Web of Science were searched for peer-reviewed studies published in English between 2012 and 2021. Reference lists of included studies were screened. Included studies were quality assessed using Hawker et al.'s nine-item checklist; data were extracted using the WHO PV indicators checklist. Scores were assigned to each group of indicators and used to compare countries’ PV performance. RESULTS: Twenty-one unique studies from 51 countries were included. Of a total possible quality score of 36, most studies were rated medium (n = 7 studies) or high (n = 14 studies). Studies obtained an average score of 17.2 out of a possible 63 of the WHO PV indicators. PV system performance in all 51 countries was low (14.86/63; range: 0–26). Higher average scores were obtained in the ‘Core’ (9.27/27) compared to ‘Complementary’ (5.59/36) indicators. Overall performance for ‘Process’ and ‘Outcome’ indicators was lower than that of ‘Structural’. CONCLUSION: This first systematic review of studies evaluating PV performance in developing countries provides an in-depth understanding of factors affecting PV system performance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43441-022-00415-y

A qualitative exploration of pharmacovigilance policy implementation in Jordan, Oman, and Kuwait using Matland’s ambiguity-conflict model

From Springer Nature via Jisc Publications RouterHistory: received 2021-04-06, accepted 2021-08-10, registration 2021-08-12, pub-electronic 2021-08-30, online 2021-08-30, collection 2021-12Publication status: PublishedFunder: Kuwait Ministry of Health; Grant(s): Kuwait Ministry of HealthAbstract: Background: As Arab countries seek to implement the ‘Guideline on Good Pharmacovigilance Practice (GVP) for Arab countries’, understanding policy implementation mechanisms and the factors impacting it can inform best implementation practice. This study aimed to explore the mechanisms of and factors influencing pharmacovigilance policy implementation in Arab countries with more established pharmacovigilance systems (Jordan, Oman), to inform policy implementation in a country with a nascent pharmacovigilance system (Kuwait). Results: Matland’s ambiguity-conflict model served to frame data analysis from 56 face-to-face interviews, which showed that policy ambiguity and conflict were low in Jordan and Oman, suggesting an “administrative implementation” pathway. In Kuwait, policy ambiguity was high while sentiments about policy conflict were varied, suggesting a mixture between “experimental implementation” and “symbolic implementation”. Factors reducing policy ambiguity in Jordan and Oman included: decision-makers’ guidance to implementors, stakeholder involvement in the policy’s development and implementation, training of policy implementors throughout the implementation process, clearly outlined policy goals and means, and presence of a strategic implementation plan with appropriate timelines as well as a monitoring mechanism. In contrast, policy ambiguity in Kuwait stemmed from the absence or lack of attention to these factors. Factors reducing policy conflict included: the policy’s compliance with internationally recognised standards and the policy’s fit with local capabilities (all three countries), decision-makers’ cooperation with and support of the national centre as well as stakeholders’ agreement on policy goals and means (Jordan and Oman) and adopting a stepwise approach to implementation (Jordan). Conclusions: Using Matland’s model, both the mechanism of and factors impacting successful pharmacovigilance policy implementation were identified. This informed recommendations for best implementation practice in Arab as well as other countries with nascent pharmacovigilance systems, including increased managerial engagement and support, greater stakeholder involvement in policy development and implementation, and undertaking more detailed implementation planning

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Impact of balanced scorecard usage on the performance of commercial banks

The study sought to examine the impact of balance scorecard usage on the performance of commercial banks in Kenya. The study location was in Nakuru District, Kenya where a census research design was adopted. Convenient sampling was utilized to select 72 respondents from 18 commercial banks in Nakuru. A likert scale was employed to gauge the degree of response in terms of strength or weakness on a scale of one to five. Descriptive statistics was employed to analyze the data and Pearson's correlation was utilized to test the relationship between two or more variables. The study concludes that the effectiveness of BSC usage lies on the organizations dynamics, execution, monitoring and evaluation procedures adopted. It is recommended that for banks to become more competitive and satisfy the needs of customers they need to develop products and services that have competitive advantage

Perception of civil servants towards promotion on merit

The study sought to determine the perception of civil servants towards promotion on merit and identify factors that affect these perceptions. The study also sought to investigate the opinions of staff towards performance appraisal as a tool of promotion. The study location was in Kakamega Central District, Kenya. A descriptive research design was adopted for the studyanda sample of 320 civil servants selected by stratified sampling. Data was collected using questionnaire and content analysis utilized to analyse qualitative questions. The study found that the civil servants held both positive and negative perceptions towards promotion on merit. The study revealed that certain factors like length of service, academic qualifications and level of employee affect the perception of civil servants

Effectiveness of strategy implementation using the balanced scorecard in local government authorities

This study focuses on two issues; first is to examine how Local Government Authorities (LGAs) implement their strategies and secondly how the Balanced Scorecard is adopted as a tool for measuring effectiveness of strategy implementation in public organizations. In an effort to understand strategy usage in local government authorities, this study adapts the Balanced Scorecard as an approach for assessing an organization's performance and its motion toward the objectives in four major perspectives: Financial perspective, Customer-Market perspective, Internal Processes perspective and Learning & Growth perspective. The research was conducted in five (5) selected local authorities in the Kenyan Coast region. This study gathered data on the extent to which the selected LGAs have achieved their set objectives in the four perspectives of organizational performance using the Balanced Score Card approach. The results suggest that local authorities are successful in achieving their objectives in various degrees

Strengths and weaknesses of the pharmacovigilance systems in three Arab countries:A mixed-methods study using the WHO pharmacovigilance indicators

Using the WHO pharmacovigilance (PV) indicators as a framework, this study aimed to explore the structures, processes, and outcomes of three Arab countries’ (Jordan, Oman, and Kuwait) PV systems to inform recommendations for countries with nascent PV systems. A mixed-methods design involving document review, semi-structured interviews, and a questionnaire was employed. Fifty-six key informants from the three countries’ national PV centres (NPVCs) and pharmaceutical industry were interviewed. The questionnaire collecting quantitative measures was only completed by Oman and Kuwait’s NPVCs. Using the framework, system strengths were attributed to the presence of “core” structural indicators, including a dedicated and officially recognised NPVC, PV legislation, and a national PV advisory committee, as well as “complementary” structural indicators, e.g., a computerised case-report management system. Contrastingly, weaknesses were attributed to the absence of these indicators plus other “core” structural indicators, namely, regular financial provision and adequate staff. Other weaknesses were attributed to low performance in “core” process and outcome indicators including reporting rates, reporter awareness, and signal detection. Greater governmental prioritisation through the provision of legislative enforcements, resources, and expertise as part of a well-structured system is required. More regional coordination efforts are needed to allow for sharing of expertise in order to bolster nascent systems