Pain management procedures used by dental and maxillofacial surgeons: an investigation with special regard to odontalgia

BACKGROUND: Little is known about the procedures used by German dental and maxillofacial surgeons treating patients suffering from chronic orofacial pain (COP). This study aimed to evaluate the ambulatory management of COP. METHODS: Using a standardized questionnaire we collected data of dental and maxillofacial surgeons treating patients with COP. Therapists described variables as patients' demographics, chronic pain disorders and their aetiologies, own diagnostic and treatment principles during a period of 3 months. RESULTS: Although only 13.5% of the 520 addressed therapists returned completely evaluable questionnaires, 985 patients with COP could be identified. An orofacial pain syndrome named atypical odontalgia (17.0 %) was frequent. Although those patients revealed signs of chronification, pain therapists were rarely involved (12.5%). For assessing pain the use of Analogue Scales (7%) or interventional diagnostics (4.6%) was uncommon. Despite the fact that surgical procedures are cofactors of COP therapists preferred further surgery (41.9%) and neglected the prescription of analgesics (15.7%). However, most therapists self-evaluated the efficacy of their pain management as good (69.7 %). CONCLUSION: Often ambulatory dental and maxillofacial surgeons do not follow guidelines for COP management despite a high prevalence of severe orofacial pain syndromes

Likely country of origin in publications on randomised controlled trials and controlled clinical trials during the last 60 years

BACKGROUND: The number of publications on clinical trials is unknown as well as the countries publishing most trial reports. To try to examine these questions we performed an ecological study. METHODS: We searched the 454,449 records on publications in The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, Issue 3, 2005 (CD-ROM version) for possible country of origin. We inspected a random sample of 906 records for information on country and type of trial. RESULTS: There was an exponential growth of publications on randomised controlled trials and controlled clinical trials since 1946, but the growth seems to have seized since 2000. We identified the possible country of origin of 210,974 publications (46.4%). The USA is leading with about 46,789 publications followed by UK, Germany, Italy, the Netherlands, Canada, and France. Sweden becomes the leader with 891 publications per million inhabitants during the last 60 years followed by Denmark (n = 864), New Zealand (n = 791), Finland (n = 781), the Netherlands (n = 570), Switzerland (n = 547), and Norway (n = 543). In depth assessment of the random sample backed these findings. CONCLUSION: Many records lacked country of origin, even after the additional scrutiny. The number of publications on clinical trials increased exponentially until the turn of the century. Rather small, democratic, and wealthy countries take the lead when the number of publications on clinical trials is calculated based on million inhabitants. If all countries produced the same number of trials as these countries, this could mean thousands of new effective treatments during the next 60 years

Enhancing access to reports of randomized trials published world-wide – the contribution of EMBASE records to the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library

<p>Abstract</p> <p>Background</p> <p>Randomized trials are essential in assessing the effects of healthcare interventions and are a key component in systematic reviews of effectiveness. Searching for reports of randomized trials in databases is problematic due to the absence of appropriate indexing terms until the 1990s and inconsistent application of these indexing terms thereafter.</p> <p>Objectives</p> <p>The objectives of this study are to devise a search strategy for identifying reports of randomized trials in EMBASE which are not already indexed as trials in MEDLINE and to make these reports easily accessible by including them in the Cochrane Central Register of Controlled Trials (CENTRAL) in <it>The Cochrane Library</it>, with the permission of Elsevier, the publishers of EMBASE.</p> <p>Methods</p> <p>A highly sensitive search strategy was designed for EMBASE based on free-text and thesaurus terms which occurred frequently in the titles, abstracts, EMTREE terms (or some combination of these) of reports of trials indexed in EMBASE. This search strategy was run against EMBASE from 1980 to 2005 (1974 to 2005 for four of the terms) and records retrieved by the search, which were not already indexed as randomized trials in MEDLINE, were downloaded from EMBASE, printed and read. An analysis of the language of publication was conducted for the reports of trials published in 2005 (the most recent year completed at the time of this study).</p> <p>Results</p> <p>Twenty-two search terms were used (including nine which were later rejected due to poor cumulative precision). More than a third of a million records were downloaded and scanned and approximately 80,000 reports of trials were identified which were not already indexed as randomized trials in MEDLINE. These are now easily identifiable in CENTRAL, in <it>The Cochrane Library</it>. Cumulative sensitivity ranged from 0.1% to 60% and cumulative precision ranged from 8% to 61%. The truncated term 'random$' identified 60% of the total number of reports of trials but only 35% of the more than 130,000 records retrieved by this term were reports of trials. The language analysis for the sample year 2005 indicated that of the 18,427 reports indexed as randomized trials in MEDLINE, 959 (5%) were in languages other than English. The EMBASE search identified an additional 658 reports in languages other than English, of which the highest number were in Chinese (320).</p> <p>Conclusion</p> <p>The results of the search to date have greatly increased access to reports of trials in EMBASE, especially in some languages other than English. The search strategy used was subjectively derived from a small 'gold standard' set of test records and was not validated in an independent test set. We intend to design an objectively-derived validated search strategy using logistic regression based on the frequency of occurrence of terms in the approximately 80,000 reports of randomized trials identified compared with the frequency of these terms across the entire EMBASE database.</p

Psychosynthesis: A Foundational Bridge Between Psychology and Spirituality

Pastoral psychologists have long tried to establish a working model that encompasses the seemingly conflicting disciplines of science and religion. Psychosynthesis, a transpersonal psychology and therapeutic approach, offers such a model of the human personality, in which the psychological and spiritual perspectives can converge. This article explores psychosynthesis psychology and therapy as a theoretical framework for pastoral psychology. Although psychosynthesis psychotherapy relies on an array of techniques, it fundamentally works with the clients’ will while emphasizing, exploring, and cultivating their relationships on all levels—intrapersonal, interpersonal, and with the Higher Self. In addition to the subconscious, psychosynthesis includes a higher psychological plane, called the superconscious, from which our higher ethical, aesthetic, scientific, and spiritual values are derived. This article begins by introducing psychosynthesis concepts and techniques. It then provides qualitative findings showing that psychosynthesis counseling helped to awaken spirituality in three out of eleven clients who had formerly identified themselves as atheists. In addition, testimonies are included that show that psychosynthesis counseling also helped all eleven clients to attain personal growth. Finally, the counselor describes her experience of psychosynthesis as a Christian in the therapeutic setting. The framework of psychosynthesis psychology and its techniques are viable methodologies for anyone searching to incorporate spiritual growth into a psychological working mode

Effect of Color Shading Procedures and Cyclic Loading on the Biaxial Flexural Strength of Zirconia

Purpose: Zirconia is the most preferred ceramic restoration in posterior areas because of its flexural strength. The aim of the study is the evaluation of biaxial flexural strength of different colored zirconium oxide core materials after cyclic loading. Material and Methods: Zirconia discs (12 mm diameter and 1.2 mm thickness) were divided into 6 groups of 12 discs each. Groups were colored according to the Vita Classic shade guide: A3 and D4. One group was not colored and left as control. Each group was randomly divided into subgroups and subjected to mechanical cycling prior to biaxial flexural strength test. Cyclic loading was applied as 50 N loads for 20,000 times for the loaded groups. Samples were subjected to biaxial flexural strength test in a universal testing machine with a crosshead speed of 1 mm/min. Two-way analysis of variance (ANOVA) and Tukey's HSD tests were used for comparisons of the groups. Results: Biaxial flexural strength values did not vary significantly depending on coloring procedure or loading process tested (p&gt;.05). XRD analysis displayed that the monoclinic volume fraction of zirconia was highest in cyclic loaded D4 and was lowest in non-loaded control group. The SEM image revealed that A3 color solution created metallic coloring pigments at grain boundaries. Conclusions: Coloring procedures and cyclic loading did not affect the biaxial flexural strength of zirconia core material; however, microstructural analysis displays changes, which may weaken the zirconia structure on the long term.Keywords: Biaxial flexural strength, coloring, cyclic loading, zirconi