Revisiting the COVID-19 fatality rate and altitude association through a comprehensive analysis.

The emergence of COVID-19 virus has led to a pandemic with staggering morbidity and mortality. There is evidence showing that pre-existing conditions and environmental factors are associated with worse COVID-19 outcomes. Among these conditions, altitude is of particular interest.

Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging.

Background: Myocardial infarction with non-obstructed coronary arteries (MINOCA) is a distinct entity among patients presenting with troponin-positive acute chest pain. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. There is paucity of evidence on the long-term (> 5 years) clinical outcomes of these patients as graded by their acute CMR diagnosis.

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement.

The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation.

Implementing and evaluating a primary care service for oral surgery: a case study.

Background: A primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. It is important to ensure that standards of quality and safety are similar to those in existing secondary care services, and that the new service is acceptable to stakeholders. The aim of this study is therefore to conduct an in depth case study to explore safety, quality, acceptability and implementation of the new service.

Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging.

Aims: Troponin-positive chest pain patients with unobstructed coronaries represent a clinical dilemma. Cardiovascular magnetic resonance (CMR) imaging has an increasingly prominent role in the assessment of these patients; however, its utility in addition to expert clinical judgement is unclear. We sought to determine the incremental diagnostic value of CMR and the heterogeneity in diagnoses by experienced cardiologists when presented with blinded clinical and investigative data in this population.

'Healthy gums do matter': A case study of clinical leadership within primary dental care.

The Health and Social Care Act 2012 heralded wide reaching reforms intended to place clinicians at the heart of the health service. For NHS general dental practice, the conduits for this clinical leadership are the NHS England local professional networks. In Greater Manchester, the local professional network has developed and piloted a clinician led quality improvement project: 'Healthy Gums DO Matter, a Practitioner's Toolkit'.

Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality, outcomes and value in primary dental care practice a realistic concept?

Background: There is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach.

Prevention in practice--a summary.

Background: This paper is a summary document of the Prevention in Practice Conference and Special Supplement of BMC Oral Health. It represents the consensus view of the presenters and captures the questions, comments and suggestions of the assembled audience.

Methods: Using the prepared manuscripts for the conference, collected materials from scribes during the conference and additional resources collated in advance of the meeting, authors agreed on the summary document.

Subspecialisation in cardiology care and outcome: should clinical services be redesigned, again?

Background: Inpatient management of cardiac patients by cardiologists results in reduced mortality and hospitalisation. With increasing subspecialisation of the field because of growing management complexity and use of technological innovations, the impact of sub-specialisation on patient outcomes is unclear.

Aim: To investigate whether management by subspecialty cardiologists impacts the outcomes of patients with subspecialty-specific diseases.

NHS Health Checks in a primary care dental setting - an opportunity for the profession to maximise uptake for public health partners?

This opinion piece considers an opportunity for primary dental care practitioners to work in partnership with public health teams to maximise the uptake of the NHS Health Check. Public Health England and Local Authority partners remain committed to offering the NHS Health Check to those aged 40-74 years old. The programme previously explored alternative points of delivery - such as community pharmacists.

A qualitative evaluation of a Local Professional Network programme "Baby Teeth DO Matter".

Objective: The objective of this study was to use a qualitative approach to examine the perceptions of dentists who led a health promotion programme entitled "Baby Teeth DO Matter".

Basic Research Design: Semi-structured interviews were undertaken with a variety of participants in a health promotional programme facilitated by a shadow Local Professional Network. These were then recorded and transcribed verbatim.

Estimating the need for dental sedation. 4. Using IOSN as a referral tool.

Objective: In this article we report on the use of the IOSN as a referral tool in primary care and the need for sedation in the referred patient population (as determined by the IOSN score).

Setting: Four centres in the North West of England (primary care) accepting referrals for treatment with the aid of sedation participated in this study.

Design: A service evaluation.

Introducing care pathway commissioning to primary dental care: measuring performance.

Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined.

Imaging cardio-vascular anatomy and function in D-Transposition of the great arteries after mustard procedure.

We used cardiovascular magnetic resonance (CMR) to demonstrate cardio-vascular anatomy and function in a 42 year-old man with a D-Transposition of the great arteries who survived a sudden cardiac arrest.

Estimating the need for dental sedation. 2. Using IOSN as a health needs assessment tool.

Aim: This service evaluation assessed the need for sedation in a population of dental attenders (n = 607) in the North West of England.

Methods: Using the novel IOSN tool, three clinical domains of sedation need were assessed: treatment complexity, medical and behavioural indicators and patient reported anxiety using the Modified Dental Anxiety Scale.

Results: The findings suggest that 5% of the population are likely to require a course of treatment under sedation at some time.

Estimating the need for dental sedation. 1. The Indicator of Sedation Need (IOSN) - a novel assessment tool.

While the control of pain and anxiety is fundamental to the practice of dentistry, the use of conscious sedation in dentistry is very variable among dentists. The need for conscious sedation could be considered by assessing and ranking a combination of information on patient anxiety, medical history and the complexity of the anticipated clinical treatment. By undertaking this systemtic assessment an indication of sedation need may be developed which would act as an aide to decision making and, potentially, referral management.

Improving oral health among schoolchildren - which approach is best?

This opinion piece considers the focus of the coalition government on improving the dental health of schoolchildren. It shows how oral health improvement teams have moved on from approaches which involve the education of children alone. More modern interventions are selected from a palette of evidence-informed options to suit the needs of the local population.

Three-dimensional kinematics of the breast during a two-step star jump.

Anecdotal reports suggest two-step star jumps cause excessive breast movement and discomfort, leading to recommendations for this activity as a diagnostic tool to determine effective breast support in a retail environment. The aim was to investigate multiplanar bare-breast kinematics during the two-step star jump and to establish the relationship between breast kinematics, discomfort and cup size. Thirty-nine females completed five two-step star jumps with no breast support after which breast discomfort was rated.

Introducing care pathway commissioning to primary dental care: the concept.

Care pathways are defined as 'a methodology for the mutual decision making and organisation of care for a well-defined group of patients during a well-defined period'. Although most often used in Europe as a tool to improve the quality of care and to aid the continuity of care between disciplines and settings, care pathways also have an application in underpinning the commissioning process. This paper describes the development of a new model of commissioning for general dental practice services based on a need and risk assessment linked to specified care pathways for preventive care.

The application of fluoride varnish in the prevention and control of dental caries.

Unlabelled: The method of applying fluoride varnish is described and the evidence of its effectiveness in the prevention and control of caries is summarized.The application of fluoride varnish should be an integral part of caries preventive programmes.

Clinical Relevance: This paper describes how to apply fluoride varnish and reviews its effectiveness in preventing caries.

Development of immunoassay for detection of meat and bone meal in animal feed.

An immunoassay system was developed for efficient detection of prohibited meat and bone meal (MBM) in animal feed. Monoclonal antibodies (MAbs) were raised against bovine smooth muscle autoclaved at 130 degrees C for 20 min. Among the 1,500 supernatants of hybridoma cells screened, MAbs 3E1, 1G3, and 3E10 were selected and characterized in this study.

Production of monoclonal antibody for the detection of meat and bone meal in animal feed.

For the detection of prohibited meat and bone meal (MBM) in animal feed, monoclonal antibodies (MAbs) were raised against heat-stable h-caldesmon purified from bovine intestinal smooth muscle. The obtained hybridoma cells were screened against extracts of the bovine MBM and heat-treated smooth muscle, and MAb 5E12 was identified as having the best performance. Antibody 5E12 did not react with animal feed, milk product, plant proteins, and other ingredients used for commercial animal feed except for the gelatin.

A scheme to recruit Pakistani and Bangladeshi trainee dental nurses in a multiethnic area of Greater Manchester.

The primary dental care services in Oldham, Greater Manchester have established an innovative scheme to encourage diversity in primary dental care services. The scheme involves the recruitment of bilingual trainee dental nurses in order to improve accessibility and appropriateness of the services and to improve communication with Pakistani and Bangladeshi patients. The scheme has raised a number of issues for trainees, existing staff and management.