Re-shaping NHS orthodontic provision - the North Wales experience.

The orthodontic service provision within North Wales, in common with many areas of the United Kingdom, was experiencing increasing waiting times for assessment and treatment. Reasons for this included an increasing population, patient demand and fixed NHS contracted orthodontic provision. In addition to these universal challenges, the geography of North Wales contributed to difficulties in accessing care.

Ensuring effective device management.

In an article that first appeared in the August 2013 issue of HEJ's sister magazine, The Clinical Services Journal, John Sandham IEng MIET MIHEEM, discusses the need to put in place effective healthcare technology management policies, and highlights some of the barriers, including lack of management expertise, and insufficient commitment, that are making achieving this goal more difficult and, in the process, may be contributing to hospitals and other healthcare facilities being unable to comply with regulatory standards in this important area.

Determinants of first practice location: among Manitoba medical graduates.

Objective: To help understand physician movement out of Manitoba by determining the factors that influence Manitoba medical graduates' choices about practice locations.

Design: Cross-sectional, within-stage, mixed-model survey.

Setting: Manitoba.

Increasing the enrolment of rural applicants to the faculty of medicine and addressing diversity by using a priority matrix approach to assign values to rural attributes.

In an external review of the admissions process for the Faculty of Medicine, University of Manitoba, Canada, it was suggested that admissions policies be modified to increase the enrolment of students more likely to practise in rural locations, by selecting a cohort of students with attributes reflecting potential for rural practice. A broad-based Working Group devised a framework for scoring personal attributes reflecting a potential for living and working in rural areas. This framework, based on established characteristics reported in the literature, valued applicants who had rural connections, a history of rural employment, a history of rural community service, or a combination of these attributes.

Site-specific tissue inhibitor of metalloproteinase-1 governs the matrix metalloproteinases-dependent degradation of crosslinked collagen scaffolds and is correlated with interleukin-10.

We have previously shown that the foreign body reaction (FBR) against crosslinked collagen type I (Col-I) differs between subcutaneous and epicardial implantation sites; Col-I was quickly degraded epicardially, whereas degradation was attenuated subcutaneously. The current study set out to dissect the nature and regulation of the MMP-based degradation of implanted Col-I in mice during the FBR. Immunohistochemistry showed that MMP-2, MMP-8 and MMP-13 were present in subcutaneous and epicardial implants, whereas only MMP-9 was also present epicardially.

The number, scope and geographic distribution of clinical researchers in Canada.

Purpose: Despite international concerns about declining numbers of clinical researchers, the number of clinical researchers in Canada remains undocumented.

Methods: The number and geographic distribution of clinical researchers in Canada and the scope of their research activities were estimated using, as an indicator, the data on clinical research projects funded by the Canadian Institutes for Health Research (CIHR).

Results: Between fiscal years 1999-00 and 2006-07, 1,041 individual researchers--approximately 130 per year--were principal investigators (PIs) on clinical research grants.

Clinical research lags behind biomedical, population-based health, and health services research at multiple levels.

Purpose: Concerns regarding a decline in clinical research have been raised internationally. In this study, research initiatives and competitiveness of investigators seeking funding for clinical research were compared with those for three other health research themes in Canada, namely, biomedical, population-based, and health services research.

Methods: A retrospective, multi-level descriptive study was conducted using administrative data from the Canadian Institutes for Health Research (CIHR) research grants program.

Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients.

Purpose: The multiple organ dysfunction (MOD) score and sequential organ failure assessment (SOFA) score are measures of organ dysfunction and have been validated based on the association of these scores with mortality. We sought to compare the performance of the SOFA and MOD scores in a large cohort of consecutive multisystem intensive care unit (ICU) patients.

Methods: Prospective automated daily measurements of MOD and SOFA scores were performed in 1,436 patients admitted to a multisystem ICU in the Calgary Health Region over a one-year period.

Study of clinical course of organ dysfunction in intensive care.

Objective: Multiple organ dysfunction is a common cause of death in intensive care units. We describe the daily course of multiple organ dysfunction measured by the Sequential Organ Failure Assessment score in a population-based cohort of critically ill patients.

Design: Prospective cohort study.

A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.

Background: Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality.

Methods: We performed a randomized trial comparing goal-directed therapy guided by a pulmonary-artery catheter with standard care without the use of a pulmonary-artery catheter. The subjects were high-risk patients 60 years of age or older, with American Society of Anesthesiologists (ASA) class III or IV risk, who were scheduled for urgent or elective major surgery, followed by a stay in an intensive care unit.

A 2-year prospective cohort study of cardiac resuscitation in a major Canadian hospital.

Objectives: To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and to identify risk factors associated with survival to the time of hospital discharge.

Design: A 2-year prospective cohort study.

Setting: Foothills Medical Centre, a 700-bed tertiary, academic and regional referral centre for Calgary and southern Alberta.

An investigation into the behavioural characteristics of orthodontic elastomeric modules.

The object of the study was to investigate the behavioural characteristics of orthodontic elastomeric modules with regard to their effect on frictional resistance and their failure load forces, and involved the use of an experimental laboratory-based study. Six cohorts were assembled employing five types of module and two bracket types. Straight lengths of 0.

Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients.

We conducted a prospective, observational cohort study designed to compare intestinal permeability (IP) and development of multiple organ dysfunction syndrome (MODS) in a subset of critically ill patients in an intensive care unit (ICU). All patients with an expected ICU stay of 72 h or more were entered into the study, and IP was determined on a daily basis whenever possible from the urinary fractional excretion of orally administered lactulose and mannitol (LMR). Forty-seven consecutive patients were studied, and 28 developed MODS either at the time of admission or during their ICU course.

Electrothermal debonding of ceramic brackets: an ex vivo study.

The shear forces necessary to remove ceramic brackets from human premolar teeth using mechanical and electrothermal debonding techniques were compared and the post-debond enamel characteristics were evaluated. The temperature rise in the pulp cavity during electrothermal debonding was recorded. The samples were tested sequentially on a shear jig attached to an Instron Universal Testing Machine.

Pulmonary artery catheterization: a narrative and systematic critique of randomized controlled trials and recommendations for the future.

Objective: The purpose of this review is to evaluate the current literature regarding the efficacy of pulmonary artery catheterization, to assess the quality of existing randomized controlled trials and to make recommendations for future studies.

Data Source: A Medline search was conducted of English language studies published between 1970 and 1996 using as search terms "Swan-Ganz catheterization," "pulmonary artery catheterization," and "right heart catheterization."

Study Selection: Randomized controlled trials of pulmonary artery catheterization were selected for review.

Non-completion of active orthodontic treatment.

Over a 1-year period, all patients attending a consultant orthodontist's new patient clinics in North Derbyshire and whose treatment plans involved active appliance treatment, were accepted into a prospective longitudinal study. In all 294 patients were included in the study. Subsequent to the consultant's new patient clinic the patients' active treatments were undertaken in the Hospital, General, or Community Dental Services.