The Microleakage of Composite and Compomer Restorations Following Cavity Preparation With an Erbium-YAG Laser

Over the last thirty years there has been a marked decline in the caries experience in children in the United Kingdom. However, the results of recent epidemiological studies have shown that this trend has slowed down considerably, and may even have reversed in some age groups. Furthermore, there is an increasing cohort of children with significant levels of untreated dentinal decay. Anxiety is a major barrier to the uptake of dental care in the United Kingdom, the two most common stressors being cited as the dental drill and the local anaesthetic needle. The use of the hard tissue laser has been proposed as one operative mode of cavity preparation that obviates the use of both of these anxiety-precipitating stimuli. This in vitro study investigated the affect of one such instrument, the Erbium-YAG laser, on the microleakage of standardised Class V cavities at the amelodentinal junction in extracted human premolar teeth. Extracted premolar teeth were selected and randomly divided into three groups (A, B and C). Each tooth hosted one test cavity prepared with one of three laser energies (200 mJ, 240 mJ or 300 mJ with a 100 mJ finish), and one control cavity, prepared with a conventional diamond bur in a high-speed handpiece. The cavities were restored with either a composite resin or a compomer material; groups A and B were restored with a fourth generation bonding agent, Scotchbond Multi-Purpose and Z100 composite resin and were stored in 0.12% thymol solution for 24 hours and three months respectively. Cavities in group C were restored using a fifth generation bonding agent, Compoglass Single Component Adhesive and a polyacid-modified resin, Compoglass and were then stored for three months. Following storage and thermal stressing (eight hours), microleakage was assessed using a dye penetration technique and single section numerical scoring system. The data was then analysed using the Kruskal-Wallis and Mann- Whitney U tests. For the pulse energies used, it was found that the Er:YAG laser varied in its effect on both the enamel and dentine margins when compared to conventional preparation. At the enamel margin, preparation with either of the three pulse energies compared favourably to the use of the diamond bur for both materials. However, optimum cavity sealing was achieved with energies of at least 240 mJ. In comparison, dentine leakage following laser preparation was comparable to that found with conventional preparation for all laser parameters when Compoglass was used. However, there were statistical differences in leakage at the dentine margins of Z100 restorations. Lower energies of 200 mJ or higher with a low finish such as the 300 mJ with 100 mJ finish used in this study provided better long-term marginal adaptation in dentine for this material. Of these two laser energy subgroups, the 300 mJ with 100 mJ finish compared favourably with conventional cavity preparation. It was therefore concluded that, within the constraints of this study, cavity preparation with the Er:YAG laser did not have a deleterious effect on the microleakage of Class V restoration when compared to conventional preparation, providing care was taken with the choice of laser parameters for dentine and enamel for the restorative material used

Erratum to: Providing Patients with Implantable Cardiac Device Data through a Personal Health Record: A Qualitative Study

Erratum to: Providing Patients with Implantable Cardiac Device Data through a Personal Health Record: A Qualitative Study. [Appl Clin Inform. 2017

Preliminary Acceptability of a Home-Based Peripheral Blood Collection Device for Viral Load Testing in the Context of Analytical Treatment Interruptions in HIV Cure Trials: Results from a Nationwide Survey in the United States

Frequent viral load testing is necessary during analytical treatment interruptions (ATIs) in HIV cure-directed clinical trials, though such may be burdensome and inconvenient to trial participants. We implemented a national, cross-sectional survey in the United States to examine the acceptability of a novel home-based peripheral blood collection device for HIV viral load testing. Between June and August 2021, we distributed an online survey to people with HIV (PWH) and community members, biomedical HIV cure researchers and HIV care providers. We performed descriptive analyses to summarize the results. We received 73 survey responses, with 51 from community members, 12 from biomedical HIV cure researchers and 10 from HIV care providers. Of those, 51 (70%) were cisgender men and 50 (68%) reported living with HIV. Most (>80% overall) indicated that the device would be helpful during ATI trials and they would feel comfortable using it themselves or recommending it to their patients/participants. Of the 50 PWH, 42 (84%) indicated they would use the device if they were participating in an ATI trial and 27 (54%) also expressed a willingness to use the device outside of HIV cure studies. Increasing sensitivity of viral load tests and pluri-potency of the device (CD4 count, chemistries) would augment acceptability. Survey findings provide evidence that viral load home testing would be an important adjunct to ongoing HIV cure-directed trials involving ATIs. Survey findings may help inform successful implementation and uptake of the device in the context of personalized HIV care

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

A dentist's dilemma:sharing wellbeing concerns to safeguard Scotland's children

Introduction Over a decade ago, Getting it right for every child (GIRFEC) introduced the 'Named Person' as a central contact with whom professionals could share 'wellbeing' concerns in Scotland, aiming to promote inter-agency working to avoid potential child protection issues. The mandatory 'Named Person' scheme has since been repealed but the professional's responsibility to share concerns at wellbeing level remains. Aims To explore general dental practitioners' (GDPs') understanding of a child's 'wellbeing', along with the investigation of influencing factors on behaviour when sharing concerns at wellbeing level. Methods Qualitative one-to-one semi-structured telephone interviews with GDPs. Themes arising from transcriptions were organised into the Theoretical Domains Framework. Results In total, 11 dentists (five men and six women) participated. Risks to wellbeing included only attending in pain and dental neglect. There was good awareness of the 'Named Person' and triggers to sharing suspicions were identified, which were concern severity, multiple concerns and own intuition. Multiple barriers (eg poor knowledge, fear of consequences, environment) and enablers (eg professional responsibility and influences, positive consequences) influenced decisions to refer. GDPs struggled to differentiate between wellbeing and child protection. Conclusion Barriers and facilitators to sharing wellbeing suspicions are similar to child protection. GDPs may benefit from further training when safeguarding at a wellbeing level.</p