Traitement par prothèses sur implant de l’édentement postérieur partiel : suivi à long terme d’une étude prospective

Objective: This paper reports on the long-term outcome of patients with Kennedy Class IV partial edentulism treated in the Implant Prosthodontic Unit (IPU) at the University of Toronto, Toronto, Ontario. Methods: The information for this paper was gathered from the charts of the first 30 consecutive, partially edentulous patients treated at the IPU. These patients all had Class IV edentulism and formed part of the original prospective clinical studies that were initiated in 1983. The patients’ dental history suggested maladaptive experiences with traditional removable prostheses or a reluctance to have intact or quasi-intact teeth prepared as retainers for fixed prostheses. Fifteen men and 15 women treated with 94 Brånemark dental implants, supporting 34 prostheses, were followed until June 2000 (25 patients) or until they were lost to follow-up (5 patients). The multiple missing teeth occurred in 19 maxillae and 15 mandibles. Results: The original prosthodontic treatments were intended to result in 33 fixed partial prostheses and 1 overdenture. At the time of this report, 25 patients with 86 implants supporting 31 fixed prostheses and 3 overdentures had been followed for an average of 12 years (range 7–16 years). The overall survival of implants was 92%. The difference between men (94%) and women (89%) was not statistically significant. Conclusions: This report is an interim update on an ongoing long-term prospective study. The results so far demonstratea high survival rate for Brånemark implants supporting tissue-integrated prostheses for the management of anterior partial edentulism.peer-reviewe

Glycosylated haemoglobin (HbA1c) and cortisol levels on admission to intensive care as predictors of outcome

Objective: To evaluate the predictive value of glycosylated haemoglobin and cortisol on admission, in critical care patients. Design: Prospective, observational, single centre study. Setting: 14 bedded Intensive care unit of a tertiary-level university hospital. Patients: 124 consecutive emergency medical and surgical patients. Methods: Data collected on admission included patient demographics, medical history, medication, diagnosis, type of nutrition, TISS28 score, serum blood glucose, Glycosylated haemoglobin (HbA1c), cortisol, mean arterial blood pressure, and the use of inotropes in the first 24hrs. Daily baseline tests included complete blood count, urea and electrolytes, creatinine, twice weekly liver function tests. The primary outcome measure was intensive care unit mortality. Secondary outcome measures were ITU stay, days of ventilation, peak urea, peak creatinine, lowest platelet count, peak bilirubin, lowest Pa/FiO2, and the number of transfusions. Measurements and results: 124 patients (mean age 56.2 years SD 23.2) were included. Regression analysis was used to identify any potential predictors of outcome: HbA1c levels on admission were not found to be significantly associated with mortality (p=0.51), or any other secondary endpoints listed above. However, subgroup analysis revealed a predictive role of HbA1c with regards to length of ITU stay (p= 0.01) and number of days of ventilation (p=0.007) in those patients with a history of diabetes. Glucose level on admission emerged as an independent marker of mortality (p=0.009). Conclusions: This study suggests that HbA1c may not be a predictor of outcome in the general ITU population but may be of predictive value in diabetic ITU patients. On the other hand, blood glucose levels on admission emerged as a predictor of mortality, whilst no association was found between HbA1c and cortisol levels on admission.peer-reviewe

Aligning governmental and organizational missions: building a model of FE organizations in Malta

Purpose: This thesis proposes a first conceptual model using data gathered in 2012, to delineate the assessed alignment between the Maltese government’s policy for the further education sector (FE) and FE organizations’ missions. Although alignment models exist, no research has been published detailing the FE sector and the usefulness of such models in small island states. Methodology: Since alignment is multifaceted, a complementarity blended approach was used to help uncover its complexities. Data were collected from seven FE vocational and academic organizations via questionnaires to academic staff; interviews with principals and other internal and external stakeholders; content analysis of mission statements. Findings: Assessing alignment to create the conceptual model showed that there is only moderate alignment between organizational mission and government policy while organizational missions in practice differ significantly from organizational mission statements. Due to their brevity, mission statements can only capture a part of such organization mission. There may be occasions where organizational realities exceed the expectations of a mission statement thus turning conventional wisdom on its head. Significance: By utilizing systems theory a new conceptual model based on inputs, outputs, organizational processes and feedback is proposed together with a new metaphor of an operating theatre to add to existing metaphorical explanations of the field. Such an alignment model explains the FE sector in the small island state of Malta. The use of a complementarity blended method may be useful to explain educational alignment in other small states

From ‘other’ to involved: User involvement in research: An emerging paradigm

This article has been made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 The Author(s). This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.This article explores the issue of ‘othering’ service users and the role that involving them, particularly in social policy and social work research may play in reducing this. It takes, as its starting point, the concept of ‘social exclusion’, which has developed in Europe and the marginal role that those who have been included in this construct have played in its development and the damaging effects this may have. The article explores service user involvement in research and is itself written from a service user perspective. It pays particular attention to the ideological, practical, theoretical, ethical and methodological issues that such user involvement may raise for research. It examines problems that both research and user involvement may give rise to and also considers developments internationally to involve service users/subjects of research, highlighting some of the possible implications and gains of engaging service user knowledge in research and the need for this to be evaluated

Development and characterization of a stable adhesive bond between a poly(dimethylsiloxane) catheter material and a bacterial biofilm resistant acrylate polymer coating

Catheter associated urinary tract infections (CA-UTIs) are the most common health related infections world wide, contributing significantly to patient morbidity and mortality and increased health care costs. To reduce the incidence of these infections, new materials that resist bacterial biofilm formation are needed. A composite catheter material, consisting of bulk PDMS coated with a novel bacterial biofilm resistant polyacrylate (EGDPEA–co-DEGMA) has been proposed. The coated material shows excellent bacterial resistance when compared to commercial catheter materials but delamination of the coatings under mechanical stress presents a challenge. In this work, the use of oxygen plasma treatment to improve the wettability and reactivity of the PDMS catheter material and improve adhesion with the EGDPEA–co-DEGMA coating has been investigated. Argon Cluster 3D-imaging Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) has been used to probe the buried adhesive interface between the EGDPEA–co-DEGMA coating and the treated PDMS. ToF-SIMS analysis was performed in both dry and frozen-hydrated states and results were compared to mechanical tests. From the ToF-SIMS data we have been able to observe the presence of PDMS, silicates, salt particles, cracks and water at the adhesive interface. In the dry catheters, low molecular weight PDMS oligomers at the interface were associated with poor adhesion. When hydrated, the hydrophilic silicates attracted water to the interface and led to easy delamination of the coating. The best adhesion results, under hydrated conditions, were obtained using a combination of 5 min O2 plasma treatment and silane primers. Cryo-ToF-SIMS analysis of the hydrated catheter material showed that the bond between the primed PDMS catheter and the EGDPEA–co-DEGMA coating was stable in the presence of water. The resulting catheter material was resisted Escherichia coli and Proteus mirabilis biofilm colonization by up to 95 % compared with uncoated PDMS after 10 days of continuous bacterial exposure and had the mechanical properties necessary for use as a urinary catheter

Antifungal therapy in European hospitals : data from the ESAC point-prevalence surveys 2008 and 2009

The study aimed to identify targets for quality improvement in antifungal use in European hospitals and determine the variability of such prescribing. Hospitals that participated in the European Surveillance of Antimicrobial Consumption Point Prevalence Surveys (ESACPPS) were included. The WHO Anatomical Therapeutic Chemical (ATC) classification for ‘antimycotics for systemic use’ (J02) 2009 version was used. Demographic data and information about indications and diagnoses were collected in 2008 and 2009. From 99 053 patients, 29 324 (29.6%) received antimicrobials. Antifungals represented 1529 of 40 878 (3.7%) antimicrobials. Antifungals were mainly (54.2%) administered orally. Hospital-acquired infections represented 44.5% of indications for antifungals followed by medical prophylaxis at 31.2%. The site of infection was not defined in 36.0% of cases but the most commonly targeted sites were respiratory (19.2%) and gastrointestinal (18.8%). The most used antifungal was fluconazole (60.5%) followed by caspofungin (10.5%). Antifungal–antibacterial combinations were frequently used (77.5%). The predominance of fluconazole use in participating hospitals could result in an increase in prevalence of inherently resistant fungi, increasing the need for newer antifungals. Although acknowledging that antifungal prophylaxis in the immunocompromised host needs further exploration, repetitive surveys using ESAC-PPS methodology may help to monitor the effects of interventions set to regulate antifungal use.The ESAC project was supported by a grant from the European Centre for Disease Prevention and Control (ECDC; Grant Agreement 2007/001).peer-reviewe