Referral patterns of general dental practitioners for oral surgical procedures.

PURPOSE: The health maintenance organizations (HMOs) in the United States continue to be a powerful force in the field of medicine. Their infiltration into dentistry has placed an emphasis on having the primary care provider (general practitioner [GP]) function as the central orchestrator from which patient care cascades. The purpose of this study is to determine the self-perceived threshold and referral tendencies for the GP to a specialist for oral surgical needs. MATERIALS AND METHODS: Six hundred dentists were randomly selected to receive a questionnaire containing 16 clinical cases. These randomly arranged cases consisted of a brief case history and appropriate radiographs. Each case differed in complexity and was grouped according to surgical difficulty as follows: group I--simple dentoalveolar surgery, group II--complex dentoalveolar surgery (including any third molar case), group III--cases requiring placement of an implant, group IV--simple surgery for a medically compromised patient, and group V--complex surgery for a medically compromised patient. RESULTS: Differences in the referral patterns of cases were noted comparing age, gender, and years of practice of the GP. A higher referral rate to the specialist was also observed in patients with remarkable medical conditions. Most general dentists referred the complex dentoalveolar surgery cases. There exists a gender difference in the referral patterns of female dentists compared to their male counter parts in similar age groups and years of clinical practice. Most dentists referred the implants procedures to oral and maxillofacial surgeons or periodontists. Referrals for simple and complex surgical procedures were most often made because of inadequate surgical experience. CONCLUSIONS: When designing dental health policy with regard to exodontia, dentoalveolar surgery and management of the medically compromised patient, insurance companies and public health administrators should consider the existing competencies and level of comfort of the GP.     

Incidental radiation to axilla in early breast cancer treated with intensity modulated tangents and comparison with conventional and 3D conformal tangents

PurposeTo analyze incidental radiation doses to minimally dissected axilla with Intensity modulated radiotherapy (IMRT), 3D conformal radiotherapy (3DCRT) and standard tangents (ST).Methods & materialsWe prospectively evaluated incidental radiation to axilla in fifty cases of early breast cancer treated with breast conservation surgery with sentinel node biopsy alone followed by whole breast irradiation with IMRT. Three plans were devised for each CT dataset, comprising ST, 3DCRT and IMRT tangents. Doses to axillary nodal levels I, II and III were evaluated for mean dose, V95, V90, V80 and V50. Comparisons were made using ANOVA.ResultsThe mean doses delivered to axilla by the three techniques (IMRT, 3DCRT, ST) were: 78% (range 67–90, SD ± 5.2%), 80% (63–95, ±7.5%) and 87% (73–98, ±4.8%) for level I (IMRT vs ST; p = 0.037); 70% (46–89, ±12.4%), 72% (34–93, ±15.5%) and 65% (29–87, ±11.8%) for level II; and 51% (28–76, ±11.1%), 53% (19–86, ±13.7%) and 41% (6–72, ±10.6%) for level III, respectively. V90 values (volume receiving 90% of dose) for the three techniques were 49% (43–53, ±2.7%), 57% (51–65, ±3.1%) and 73% (65–80, ±3.4%) for level I (IMRT vs ST; p = 0.029); 35% (26–42, ±4.7%), 41% (33–50, ±4.2%) and 25% (17–36, ±4.5%) for level II (IMRT vs ST; p = 0.068); and 15% (9–22, ±3.4%), 16% (10–24, ±3.7%) and 8 (5–12, ±3.1%) for level III (IMRT vs ST; p = 0.039), respectively.ConclusionAxillary levels I and II (lower axilla) receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than ST technique.     

Effect of subconjunctival injection with conbercept as an adjuvant to filtration surgery for open angle glaucoma: a prospective randomized interventional 6-month follow-up study

AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil (5-FU) for open angle glaucoma (OAG) patients after filtration surgery. METHODS: As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept (0.2 mL) or 5-FU (0.2 mL) on the 5th day post-operatively. The intraocular pressure (IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS: There were significant differences in IOP between the conbercept and 5-FU groups 1mo (conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo (conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection (conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo (t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d (3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk (3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection (3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group (χ2=4.500, P=0.034). CONCLUSION: Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.     

Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know?

Intracranial incidental findings on magnetic resonance imaging (MRI) of the brain continue to generate interest in healthy control, research, and clinical subjects. However, in clinical practice, the discovery of incidental findings acts as a “distractor”. This review is based on existing heterogeneous reports, their clinical implications, and how the results of incidental findings influence clinical management. This draws attention to the followings: (1) the prevalence of clinically significant incidental findings is low; (2) there is a lack of a systematic approach to classification; and discusses (3) how to deal with the detected incidental findings based a proposed common clinical profile. Individualized neurological care requires an active discussion regarding the need for neuroimaging. Clinical significance of incidental findings should be decided based on lesion’s neuroradiologic characteristics in the given clinical context. Available evidence suggests that the outcome of an incidentally found “serious lesion in children” is excellent. Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population. The study should address this clinical knowledge based review powered by the statistical analyses.     

Spectrum of complicated migraine in children: A common profile in aid to clinical diagnosis

Complicated migraine encompasses several individual clinical syndromes of migraine. Such a syndrome in children frequently presents with various neurological symptoms in the Emergency Department. An acute presentation in the absence of headache presents a diagnostic challenge. A delay in diagnosis and treatment may have medicolegal implication. To date, there are no reports of a common clinical profile proposed in making a clinical diagnosis for the complicated migraine. In this clinical review, we propose and describe:(1) A common clinical profile in aid to clinical diagnosis for spectrum of complicated migraine;(2) How it can be used in differentiating complicated migraine from migraine without aura, migraine with aura, and seizure;(3) We discuss the status of complicated migraine in the International Headache Society classification 2013; and(4) In addition, a common treatment strategy for the spectrum of migraine has been described. To diagnose complicated migraine clinically, it is imperative to adhere with the proposed profile. This will optimize the use of investigation and will also avoid a legal implication of delay in their management. The proposed common clinical profile is incongruent with the International Headache Society 2013. Future classification should minimize the dissociation from clinically encountered syndromes and coin a single word to address collectively this subtype of migraine with an acute presentation of a common clinical profile.     

The impact of treatment intervention on parenting stress in postpartum depressed mothers: a prospective study

The aim of this study was to evaluate whether treatment intervention for postpartum depression impacted maternal parenting stress levels. Twenty-three mothers referred for postpartum mood and anxiety disorder to an outpatient program were included in the study. Statistically and clinically significant decreases in levels of parenting stress were evident at the end of the treatment. Subjects' perceptions of their parenting characteristics were found to be a major contributor to stress levels. In addition to monitoring of depressive symptoms, routine assessment of maternal parenting qualities is recommended to ensure healthy child outcomes.