Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI)

Randomised controlled non-inferiority trial of primary care based facilitated access to an alcohol reduction website (EFAR-FVG)

Introduction There is a strong body of evidence demonstrating effectiveness of brief interventions by primary care professionals for risky drinkers but implementation levels remain low. Facilitated access to an alcohol reduction website constitutes an innovative approach to brief intervention, offering a time-saving alternative to face to face intervention, but it is not known whether it is as effective. Objective To determine whether facilitated access to an alcohol reduction website is equivalent to face to face intervention. Methods Randomised controlled non-inferiority trial for risky drinkers comparing facilitated access to a dedicated website with face to face brief intervention conducted in primary care settings in the Region of Friuli Venezia-Giulia, Italy. Adult patients are given a leaflet inviting them to log on to a website to complete the AUDIT-C alcohol screening questionnaire. Screen positives are requested to complete an online trial module including consent, baseline assessment and randomisation to either standard intervention by the practitioner or facilitated access to an alcohol reduction website. Follow up assessment of risky drinking is undertaken online at 1 month, 3 months and 1 year using the full AUDIT questionnaire. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. The trial is being undertaken as an initial pilot and a subsequent main trial. Results 12 practices have participated in the pilot, and more than 1300 leaflets have been distributed. 89 patients have been recruited to the trial with a one month follow-up rate of 79%. Discussion The findings of the pilot study suggest that the trial design is feasible, though modifications will be made to optimize performance in the main trial which will commence in January 2014. Plans are concurrently underway to replicate the trial in Australia, and potentially in the UK and Spain

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

Background: Brief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application offers a novel alternative to face-to-face intervention, but its relative effectiveness is unknown.Methods: Primary care-based, non-inferiority, randomised controlled trial comparing general practitioner (GP) facilitated access to an interactive alcohol reduction website (FA) with face-to-face BI for risky drinking. Patients screening positive on the short Alcohol Use Disorders Identification Test (AUDIT-C) were invited to participate in the trial. Assessment at baseline, 3 months and 12 months was carried out using AUDIT and EQ-5D-5L questionnaires. Findings: 58 participating GPs approached 9080 patients of whom 4529 (49.9%) logged on, 3841 (84.8%) undertook screening, 822 (21.4%) screened positive and 763 (19.9%) were recruited. 347 (45.5%) were allocated to FA and 416 (54.5%) to BI. At 3 months, subjects in FA group with an AUDIT score of ≥8 reduced from 95 (27.5%) to 85 (26.8%) while those in BI group increased from 123 (20.6%) to 141 (37%). Differences between groups were principally due to responses to AUDIT question 10. Analysis of primary outcome indicated non-inferiority of FA compared with BI, and prespecified subgroup analysis indicated benefits for older patients and those with higher levels of computer literacy and lower baseline severity. Additional analyses undertaken to take account of bias in response to AUDIT question 10 failed to support non-inferiority within the prespecified 10% boundary.Interpretation: Prespecified protocol-driven analyses of the trial indicate that FA is non-inferior to BI; however, identified bias in the outcome measure and further supportive analyses question the robustness of this finding. It is therefore not possible to draw firm conclusions from this trial, and further research is needed to determine whether the findings can be replicated using more robust outcome measures.Trial registration number NCT01638338; Results

Eva Vacuum-Formed Alternative Splinting of Alveolar Fractures in Primary Dentition: A Case Report

Alveolar fractures treatment includes repositioning of displaced segments and splinting. In children, splinting procedures may occasionally present clinical problems resulting from fewer teeth available for splinting or presence of occlusal disturbances. An alternative clinical approach for splinting in alveolar fractures of primary dentition is described. Clinical case: A 4.5-year-old girl was referred to our clinic 8 hours after a fall accident. Clinical examination revealed mandibular alveolar process segmental fracture in the right canine area with frontal dislodgement of the labial cortical bone resulting to occluding inability. The area was anaesthetized, cleaned and the dislodged bone was manually repositioned, followed by an EVA copolymer splint for fixation as a result of patient's deep bite impeding regular wire-composite splint. The cap splint that was fabricated on a cast made after an alginate impression, was set on the mandibular dentition and immobilized in the primary molars with acid-etch adhesive and flowable resin composite. Following splint removal after 4 weeks and follow-up visits, successful healing was observed clinically and radiographically with no pathological signs and symptoms. Conclusion: The described alternative splinting method in alveolar fractures of primary dentition is a valuable clinical tool for peediatric dentists, easily accepted by children in cases where regular splinting methods cannot be used.</jats:p

Fissure sealants on permanent molars using two different materials: a five-year prospective survival study.

To evaluate the survival of 915 fissure sealants on first and second permanent molars over a five years period using two different materials, a resin-based fissure sealant (RBS) and a flowable composit