Clinical communication in orthodontics: Any questions?

OBJECTIVE To measure patient-perceived standards of clinician communication and identify elements of deficient performance. Good communication can improve the quality of care, patient satisfaction and compliance with treatment. DESIGN Cross-sectional questionnaire service evaluation. SETTING Two university dental hospital orthodontic departments. PARTICIPANTS Any patients aged 10 years and over attending the orthodontic department for treatment or consultation were eligible for inclusion. Patients who required third-party translation services were excluded. METHODS Clinicians provided the modified 15-item Communication Assessment Tool (CAT) to up to five patients in a clinical session. A front sheet for clinician characteristics was used and anonymised with a unique identifier. Univariable logistic GEE models examined associations among responses and clinician characteristics. RESULTS There were 55 clinicians with 204 patient responses. The overall percentage of '5=excellent' ratings was 88% (SD 0.16). The lowest scoring item was 'encouraged me to ask questions' (55.8%). Based on clinician characteristics, there were lower odds of an excellent response for certain CAT items. There were higher odds of an excellent response if English was not the clinician's first language (1.05; 95% confidence interval = 1.00-1.09; P=0.03). CONCLUSION There is a high standard of patient-clinician communication in the hospital orthodontic setting. Key areas of communication that require attention include encouraging patients to ask questions, talking in terms they can understand, recognising their main concerns and involving them in the decision-making process. The results of this study can be used to inform communication skills training and be replicated in similar dental settings (primary and secondary care) as part of quality improvement

Examining Cardiomyocyte Dysfunction Using Acute Chemical Induction of an Ageing Phenotype

Much effort is focussed on understanding the structural and functional changes in the heart that underlie age-dependent deterioration of cardiac performance. Longitudinal studies, using aged animals, have pinpointed changes occurring to the contractile myocytes within the heart. However, whilst longitudinal studies are important, other experimental approaches are being advanced that can recapitulate the phenotypic changes seen during ageing. This study investigated the induction of an ageing cardiomyocyte phenotypic change by incubation of cells with hydroxyurea for several days ex vivo. Hydroxyurea incubation has been demonstrated to phenocopy age- and senescence-induced changes in neurons, but its utility for ageing studies with cardiac cells has not been examined. Incubation of neonatal rat ventricular myocytes with hydroxyurea for up to 7 days replicated specific aspects of cardiac ageing including reduced systolic calcium responses, increased alternans and a lesser ability of the cells to follow electrical pacing. Additional functional and structural changes were observed within the myocytes that pointed to ageing-like remodelling, including lipofuscin granule accumulation, reduced mitochondrial membrane potential, increased production of reactive oxygen species, and altered ultrastructure, such as mitochondria with disrupted cristae and disorganised myofibres. These data highlight the utility of alternative approaches for exploring cellular ageing whilst avoiding the costs and co-morbid factors that can affect longitudinal studies

Which White Wire? A Multi-centre Randomised Controlled Trial on Alignment Efficiency and Colour Performance

AIMS: To evaluate the alignment efficiency and colour performance of four coated nickel-titanium aligning archwires over an eight-week period. The aim was to establish whether the latest aesthetic archwires have dispelled their reputation. SUBJECTS AND METHOD: One hundred and twenty participants requiring fixed appliance orthodontic treatment had each dental arch randomly allocated to one of four interventions: (1) Forestadent® BioCosmetic® 0.017 inch (2) Forestadent® Titanol® Cosmetic 0.016 inch (3) TP Orthodontics Aesthetic 0.014 inch (4) Ortho Organizers® Tooth Tone® 0.016 inch. The archwires were ligated and remained in situ for an eight week period. Changes in Little's Irregularity Index were measured on dental casts using digital callipers and retrieved archwires were measured for colour change (ΔE) and coating loss. Colour assessments were made using digital photography and Adobe® Photoshop®, with ΔE values computed using the CIE L*a*b* system. Coating loss was measured by analysing digitally scanned images and using Autodesk® AutoCAD®. RESULTS: One hundred and nineteen patients (74 females, 45 males) completed the trial. Significant alignment was achieved in all groups, however, one-way ANOVA showed no difference in alignment efficiency among the four groups. All four archwires showed significant mean colour change and coating loss after clinical use. One-way ANOVA showed a statistically significant difference between the archwires for ΔE (P = 0.001), with Titanol Cosmetic showing the greatest statistically significant colour change. There was no statistically significant difference between the archwires for coating loss. CONCLUSION: There was no difference in alignment efficiency amongst the coated archwires used, however there was appreciable colour change and coating loss after clinical use of coated aligning archwires. The aesthetic properties of these coated archwires are not ideal

Broken Hearts in Juvenile Dementia: investigating cardiac myocytes in CLN3 disease

CLN3, also called Batten Disease or Juvenile Dementia, is an early onset lysosomal storage disorder. It manifests with blindness at ~8 years of age, followed by seizures and decline of cognitive and motor functions, leading to the patient’s death in the third decade. A co-morbidity of CLN3 is declining cardiac function, including arrhythmias, hypertrophy and echocardiogram abnormalities (Reske-Nielsen E 1981; Michielsen et al. 1984; Tomiyasu et al. 2000; Ostergaard JR 2011; Polychronis Dilaveris 2014). The cardiac dysfunction may result from structural or electrical remodelling of cardiomyocytes. However, although lipopigment accumulation, which is characteristic of CLN3, has been observed in cardiomyocytes, there is limited research into how the heart is altered in CLN3 patients (Reske-Nielsen E 1981; Staropoli et al. 2012). CLN3 is a lysosomal membrane protein that is implicated Ca2+ signalling and homeostasis. Cells expressing a mutated form of CLN3 that is commonly found in patients (CLN3Δex7/8) show increased sensitivity to thapsigargin-induced autophagy and an increased lysosomal Ca2+ concentration (Chandrachud et al., 2015). Although the sarcoplasmic reticulum is the main Ca2+ store in cardiomyocytes, it has been shown that Ca2+ release from lysosomes via two-pore channels is important for modulation of Ca2+ signals following beta-adrenergic stimulation and the triggering of isoproterenol-induced arrhythmias (Capel et al., 2015, Nebel et al., 2013). The CLN3 protein is therefore expressed within cardiomyocytes in a critical homeostatic/signalling location. Using iPSC-derived cardiomyocytes from CLN3 patients and healthy donors we are investigating alterations in Ca2+ signalling and structure associated with CLN3 mutation

Braket self-ligating pada ortodontik:konsep & teknik terbaru

xi,260 hlm

Braket self-ligating pada ortodontik:konsep & teknik terbaru

xi,260hlm

Braket self-ligating pada ortodontik:konsep & teknik terbaru

xi,260 hlm