Root canal morphology of primary maxillary second molars:a micro-computed tomography analysis

Aim Successful endodontic treatment of primary teeth requires comprehensive knowledge and understanding of root canal morphology. The purpose of this study was to investigate the root canal configurations of primary maxillary second molars using micro-computed tomography. Methods Extracted human primary maxillary second molars (n = 57) were scanned using micro-computed tomography and reconstructed to produce three-dimensional models. Each root canal system was analysed qualitatively according to Vertucci's classification. Results 22.8% (n = 13) of the sample presented with the fusion of the disto-buccal and palatal roots; of these, Type V was the most prevalent classification. For teeth with three separate roots (n = 44), the most common root canal type was Type 1 for the palatal canal (100%) and disto-buccal canal (77.3%) and Type V for the mesio-buccal canal (36.4%). Overall, 7% (n = 4) of mesio-buccal canals were 'unclassifiable'. Conclusion The root canal systems of primary maxillary second molars were not only complex but had a range of configurations that may contribute to unfavourable clinical outcomes after endodontic treatment

Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?

BACKGROUND: The continuation of preventive drugs among older patients with advanced cancer has come under scrutiny because these drugs are unlikely to achieve their clinical benefit during the patients' remaining lifespan. METHODS: A nationwide cohort study of older adults (those aged ≥65 years) with solid tumors who died between 2007 and 2013 was performed in Sweden, using routinely collected data with record linkage. The authors calculated the monthly use and cost of preventive drugs throughout the last year before the patients' death. RESULTS: Among 151,201 older persons who died with cancer (mean age, 81.3 years [standard deviation, 8.1 years]), the average number of drugs increased from 6.9 to 10.1 over the course of the last year before death. Preventive drugs frequently were continued until the final month of life, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics. Median drug costs amounted to $1482 (interquartile range [IQR],$700-$2896]) per person, including$213 (IQR, $77-$490) for preventive therapies. Compared with older adults who died with lung cancer (median drug cost, $205; IQR,$61-$523), costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference,$13; 95% confidence interval, $5-$22) or gynecological cancers (adjusted median difference, $27; 95$18-$36). There was no decrease noted with regard to the cost of preventive drugs throughout the last year of life. CONCLUSIONS: Preventive drugs commonly are prescribed during the last year of life among older adults with cancer, and often are continued until the final weeks before death. Adequate deprescribing strategies are warranted to reduce the burden of drugs with limited clinical benefit near the end of life

From miracle to crisis? The German economy at the end of the twentieth century

SIGLEAvailable from British Library Document Supply Centre-DSC:4363.4443(96/2) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

SolCos model-based individual reminiscence for older adults with mild to moderate dementia in nursing homes : a randomized controlled intervention study

Aim: To investigate the effect of a standardized individualized intervention based on the SolCos transformational reminiscence model on depressive symptoms (primary outcome), cognition and behaviour (secondary outcomes) for older people with mild to moderate dementia, performed by trained nursing home volunteers as facilitators. Background: Because of limited pharmacological treatment options for older adults with dementia relevant physical, sensory, psychological or social interventions offer alternative opportunities. Method: Randomized controlled trial (ISRCTN74355073) was set up in two nursing homes with 29 and 31 residents in the intervention and the control groups respectively. Eighteen nursing home volunteers were trained to perform the reminiscence therapy. Various assessment scales were measured pre- and post-sessions. Results: Linear regression analysis showed an impact on depressive symptoms. However, no impact was identified on cognition and behaviour. Facilitators experienced the sessions as useful and pleasant, and study participants were, in general, attentive, open and collaborative. Discussion: Study results showed that organizing standardized individual reminiscence therapy with nursing home volunteers was feasible and study participants' attention and participation were overall good. Further study initiatives to explore the potential of individual reminiscence therapy within a person-centred framework are recommended in order to improve care in nursing homes