Efeito da redução do tempo de aplicação na permeabilidade dentinária de um adesivo universal em modo etch-and-rinse vs self-etch

Objetivo: Analisar a influência na permeabilidade dentinária da redução do tempo de aplicação do adesivo universal OptiBond Universal® (Kerr), aplicado pela técnica etch-and-rinse e self- etch. Método: Foram selecionados e distribuídos 20 espécimes em dois grupos de estudo: Grupo I – aplicação do adesivo universal durante 5 segundos, pela técnica self-etch; Grupo II – aplicação do adesivo universal durante 5 segundos pela técnica etch-and-rinse. A permeabilidade máxima foi medida após o condicionamento ácido de cada espécime com ácido ortofosfórico durante 15 segundos. De seguida foi aplicado e polimerizado o adesivo, e medida novamente a permeabilidade do espécime. As diferenças na redução da permeabilidade após a aplicação do adesivo foram analisadas com o t-test. Resultados: Verificou-se redução da permeabilidade dentinária após a aplicação do adesivo em ambos os grupos de estudo. A redução do Grupo II (81.7±11.43%) foi superior, comparativamente ao Grupo I (71.8±18.07%). No entanto não se verificaram diferenças estatisticamente significativas entre os grupos estudados (p=0.160). Conclusão: A permeabilidade dentinária não é influenciada pela aplicação de um sistema universal pela técnica etch-and-rinse ou pela técnica self-etch, com a redução do tempo de aplicação para 5 segundos.Aim: To analyze the influence in dentin permeability of the 5-second appliance of OptiBond Universal® (Kerr Corp., Orange, EUA), comparing modes of application, etch-and-rinse and self-etch. Methods: 20 specimes were randomly assigned to 2 study groups: group I – application of the adhesive during 5 seconds by self-etch mode; group II – application of the adhesive during 5 seconds by etch-na-rinse mode. The maximum permeability was measured in each specimen after the application of 37.5% phosphoric acid for 15 seconds. The adhesive was then applied and light-cured, and the permeability measured once more. The differences in permeability reduction after adhesive application were analyzed with the Kolmogorov-Smirnov test, the Levene test and the t-test. Results: Both study groups showed a reduction of permeability after the application of the adhesive. The reduction in Group II (81.7±11.43%) was higher when compared to Group I (71.8±18.07%), although there were no statistical differences between groups (p=0.160). Conclusion: Dentin permeability does not seem to be influenced by the mode of application of the adhesive, whether it is etch-and-rinse or self-etch, when the time of the adhesive application is reduced to 5 seconds

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London