Home About us Contact
|
Home About us Contact | ||
|
|
||
Specialist Treatment (specialist + treatment)
Selected AbstractsAssessment of traumatic injuries to primary teeth in general practise and specialized paediatric dentistryDENTAL TRAUMATOLOGY, Issue 2 2010Carl Gösta Rasmusson Materials and methods:, A total of 323 children with traumatic injuries, 184 boys and 139 girls aged 7,83 months, participated in the study. All the children had first presented at a Public Dental Service clinic where they were examined by general dentists who decided, based on the severity of the trauma, to assign each child to one of the following two groups: Group A , recommended for treatment at the general practise (166 children with 257 traumatized incisor teeth). Group B , recommended for referral to a specialist in paediatric dentistry (157 children with 261 traumatized incisor teeth). Even in Group A, the specialist controlled the treatment decisions. The clinical diagnose and follow-up followed the recommendations presented by Andreasen & Andreasen. Results:, The distribution of trauma by age was similar in both groups, with about 60% occurring between 1 and 3 years. More injured teeth were extracted in children in Group B (n = 111) than in Group A (n = 33). A higher percentage of intruded primary incisors were recorded in Group B (24%) compared with Group A (16%). Similarly, the percentage of concussions/subluxations, lateral luxations and complicated crown fractures was higher in Group B than in Group A. Conclusions:, The group referred for specialist treatment had more severe injuries and needed more complicated treatment than the group recommended for care by general dentists. However, the rate of sequelae in permanent successors was the same in both. [source] Eating disturbance and severe personality disorder: outcome of specialist treatment for severe personality disorderEUROPEAN EATING DISORDERS REVIEW, Issue 2 2006Fiona Warren Abstract Objective To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance. Method Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up. Results There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response. Conclusion Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] An Approach to Interdisciplinary Training in Postgraduate EducationEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2006P Brodin Aims, A primary goal for clinical graduate training is to provide the student with the expertise required for specialist treatment in the actual discipline. At the same time there is an increasing need for a broader perspective on specialist care and the students should be aware of the limitations inherent in own specialty. In order to plan treatment in the best interest of the patient, and to be prepared to take part in treatments involving other specialties, the students should be exposed to interdisciplinary cooperation throughout the training. An approach to joint academic and clinical training with the purpose of providing graduate students with a broader perspective on specialist care is described and discussed. Material and methods, During their first year graduate students in the 7 different disciplines complete a joint Core Curriculum consisting of 8 different courses to stimulate a scientific approach to their profession and understanding of basic biologic mechanisms. To create a learning environment focusing on the development of interdisciplinary competence, a joint clinic has been established. Teams of students from different disciplines have been organized in order to establish ,partnership' for the treatment of patients with complex problems. The students also take part in the sessions held by a faculty Team of experts for assessment and treatment planning of referred patients with complex problems. Furthermore, faculty members conduct courses and seminars for students from other disciplines and students also participate in selected parts of the regular program in other disciplines. Results, Formal evaluation has so far been conducted for the Core Curriculum. Most students respond that they are satisfied with the courses, and the curriculum has also been adjusted based on the comments. The students report that treatment of patients in need of interdisciplinary treatment has been facilitated by having ,partners' in other disciplines. Participation in the Team of expert's sessions has been appreciated, and the attendance at interdisciplinary courses and seminars has been good. Conclusions, Based on the experience over the last 5 years, the interdisciplinary aspects of graduate training should be expanded to stimulate a holistic approach also to specialist treatment. [source] A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatmentEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2002Rod Moore Outcomes of hypnotherapy (HT), group therapy (GT) and individual systematic desensitization (SD) on extreme dental anxiety in adults aged 19,65 yr were compared by regular attendance behaviors, changes in dental anxiety and changes in beliefs about dentists and treatment after 3 yr. Treatment groups were comparable with a static reference control group of 65 anxious patients (Dental Anxiety Scale ,,15) who were followed for a mean of nearly 6 yr. After 3 yr, 54.5% of HT patients, 69.6% of GT patients and 65.5% of SD patients were maintaining regular dental care habits. This was better than the 46.1% of the reference group, who reported going regularly to the dentist again within the cohort follow-up period, and 38.9% of a control subgroup with observation for 3 yr. Women were better regular attenders than men at 3 yr. Specialist-treated regular attenders were significantly less anxious and had more positive beliefs than regular attenders from reference groups. There were few differences between HT, GT and SD after 3 yr. It was concluded that many patients can, on their own, successfully start and maintain regular dental treatment habits with dentists despite years of avoidance associated with phobic or extreme anxiety. However, it also appears that these patients had less success in reducing dental anxiety and improving beliefs about dentists long-term than did patients who were treated at the specialist clinic with psychological strategies. [source] Latest news and product developmentsPRESCRIBER, Issue 3 2007Article first published online: 14 MAR 200 PPIs and hip fracture Treatment with a PPI may increase the risk of hip fracture, with longer use associated with higher risk according to a study in UK patients (J Am Med Assoc 2006;297:2947-53). The case control study compared use of PPIs by 13 556 patients with hip fracture and 135 386 controls in the UK General Practice Research Database. Use of a PPI for more than one year was associated with an increase of 44 per cent in the odds of hip fracture. The risk was higher for longer- term use (59 per cent after four years) and at higher doses (more than doubled with long-term high doses). The mechanism for this possible effect may be impaired calcium absorption associated with hypochlorhydria and reduced bone resorption. CHD NSF Statin prescribing has increased by 30 per cent every year since the publication of the Coronary Heart Disease NSF, the Department of Health says. The estimated number of lives saved attributable to statins had risen to 9700 in 2005. The proportion of patients with acute MI who were given thrombolysis within 30 minutes of admission has increased to 83 per cent. Flu jabs cut pneumonia deaths A US study suggests that flu vaccine protects against death during the flu season in patients admitted with community-acquired pneumonia (Arch Intern Med 2007;167:53-9). Nineteen per cent of patients admitted with pneumonia during the winters of 1999-2003 were known to have been vaccinated against flu. Their risk of death during their hospital stay was 70 per cent lower than that of nonvaccinated individuals. After adjustment for antipneumococcal vaccination and comorbidity, the odds of death were still 39 per cent lower. Model to predict admissions The King's Fund, together with New York University and Health Dialog, has published a model that predicts the risk of emergency hospital admission (see www.kingsfund.org.uk). The model is intended for use by PCTs and draws on data from secondary and primary care to define clinical profiles, allowing patients whose condition is deteriorating to be identified before they need admission. Problem drinking The National Treatment Agency for Substance Misuse (NTA), a special authority within the NHS, has published a critical appraisal of the evidence for various treatments for alcohol problems (www.nta.nhs.uk). The 212-page document estimates that over seven million hazardous or harmful drinkers may benefit from brief interventions by any health workers, and over one million dependent drinkers may benefit from specialist intervention. It concludes that cognitive behavioural approaches to specialist treatment are most effective and that treatment probably accounts for about one-third of improvements made in problem drinking. of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. Stopping anti-TNFs Discontinuation of treatment with anti-TNF agents is more common in clinical practice than in clinical trial populations, a French study has found (J Rheumatol 2006;33:2372-5). The retrospective analysis of a single centre's experience of treating 770 patients with etanercept (Enbrel), infliximab (Remicade) or adalimumab (Humira) found that fewer than two-thirds of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. There were no statistically significant differences between the three agents but there was a trend for infliximab to be least well tolerated. Generic statin savings The Department of Health has estimated that prescribing simvastatin and pravastatin generically would save £85 million per year. Its analysis of the ,Better care, better value' indicators (see www.productivity.nhs.uk) shows that statin prescribing has increased by 150 per cent in the past five years, with costs totalling £600 million in 2005. The Department says that if every PCT prescribed pravastatin and simvastatin by generic name in only 69 per cent of cases ,the level achieved by the top quarter of trusts ,the savings would be over £85 million a year. Herceptin reporting Press reports of a two-year trial of trastuzumab (Herceptin) were generally accurate in reporting its effectiveness but few reported an increased risk of adverse effects, according to the NHS National Library for Health (www.library.nhs.uk). The Herceptin Adjuvant (HERA) trial (Lancet 2007;369:29-36) found that, after an average follow-up of two years, 3 per cent of women treated with trastuzumab died compared with 5 per cent of controls; estimated three-year survival rates were 92.4 and 89.7 per cent respectively. All four press articles reported these findings accurately, but only two mentioned the increased risk of adverse effects. Updated guidance on CDs The Department of Health has published updated guidance on the strengthened governance requirements for managing controlled drugs, taking into account new regulations that came into force on 1 January (seewww.dh.gov.uk/asset Root/04/14/16/67/04141667.pdf). Statin adherence lowers MI mortality Patients with acute myocar- dial infarction (MI) who take their statins as prescribed are significantly more likely to survive for two to three years than those with low adherence (J Am Med Assoc 2007;297: 177-86). The four-year observational study of 31 455 patients with acute MI found that, compared with those who had taken at least 80 per cent of prescribed daily doses, the risk of death in those with less than 40 per cent adherence was 25 per cent greater over 2.4 years. For individuals with intermediate adherence (40-79 per cent), the risk was 12 per cent greater. Both differences were statistically significant after adjustment for potential confounding factors. The authors believe their finding is explained by differences in adherence rather than healthier behaviour because the excess risk of low adherence was less marked with beta-blockers and not significant for calcium-channel blockers. Improving community medicines management Mental health trusts need to improve medicines management by their community teams and improve information sharing with GPs, the Healthcare Commission has found (www.healthcare commission.org.uk). Its national report revealed limited evidence of pharmacist involvement in community mental health teams, even though 90 per cent of patients were cared for in the community. Only 11 per cent of assertive outreach patients had the tests necessary to ensure safe use of their medicines. Medication reviews found that 46 per cent of patients in mental health trusts and 12 per cent of those in acute trusts were not taking their medication appropriately. The Commission also reported that acute trusts received a complete drug history from GPs for fewer than half of audited patients when they were admitted to hospital, and only 30 per cent of PCTs reported that GPs received adequate information on patients' medicines on discharge. Copyright © 2007 Wiley Interface Ltd [source] Costs of accessing surgical specialists by rural and remote residentsANZ JOURNAL OF SURGERY, Issue 9 2001Sarah L. Rankin Introduction: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. Methods: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. Results: An estimated saving of AU$1077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. Conclusion: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available. [source] Young people who attend specialist alcohol treatment: who are they and do they need special treatment?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2008Devon Indig Abstract Objective: Patterns of drinking in adolescence and young adulthood may have major short term impacts and influences on later drinking, yet little is known about the characteristics of young people who seek help for alcohol problems. Here we examine the characteristics of treatment episodes for adolescents and young adults who present to specialist alcohol treatment in New South Wales (NSW). Methods: The NSW Minimum Data Set for Alcohol and Other Drug Treatment Services was examined for all alcohol-related treatment episodes (N=21,012) reported between July 2004 and June 2005. We compared treatment episodes for adolescents aged 12-19 years, young adults aged 20-29 years and clients aged 30 years or more for their demographics, drug use and service delivery characteristics. Results: Clients aged under 30 years were significantly more likely to be referred into specialist treatment by a police, court or criminal justice diversion program compared with older clients (adolescent: OR=3.7, 95%CI: 3.1-4.4; young adult: OR=2.2, 95%CI: 1.9-2.4). Concern about cannabis use was significantly higher among younger clients (adolescents: OR=2.8 95%CI: 2.3-3.3; young adults: OR=2.1, 95%CI: 2.0-2.4) than those aged 30 years or more. Younger clients were also more likely to be of Indigenous origin or seen in a rural setting. Conclusions: Adolescent and young adult alcohol treatment clients include a higher proportion of clients who are Indigenous, legally coerced, and who have concerns with polydrug use. Service providers should seek to tailor their treatment programs to better meet these unique needs and to better attract young people into voluntary treatment. [source] THE PATIENT TRANSIT ASSISTANCE SCHEME: A CONSUMER'S PERSPECTIVEAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2000Pam McGrath ABSTRACT: This article presents findings from State-wide research in Queensland on experiences with the Patient Transit Assistance Scheme (PTAS) from the point of view of patients with a haematological malignancy who travelled for specialist treatment. The findings indicate that the PTAS is of crucial importance to patients and their families and goes some way to buffering the financial hardship incurred from relocation. However, there are also strong indications that there is insufficient community awareness of the scheme, with the consequence that it is not appropriately accessed by those in need. The results confirm previous research that points to the hardship, both financial and emotional, associated with the experience of relocation for specialist treatment. [source] 3461: Lacrimal gland: non-neoplastic and neoplastic lesions in Denmark 1974-2007ACTA OPHTHALMOLOGICA, Issue 2010S HEEGAARD Purpose To evaluate patient characteristics and incidence of lacrimal gland lesions in Denmark during the period 1974-2007. Methods All biopsied/surgically removed lacrimal gland lesions collected by the Danish pathological departments during the period 1974-2007 were identified by SNOMED codes. In each case age, gender, symptoms, clinical findings, treatment and follow-up were registered. All tumours were re-classified according to latest guidelines from WHO. Results 229 lacrimal gland lesions from 209 patients were identified during the 34-year period. In the study period 7 cases/year were registered (1.3 cases/million/year). Non-neoplastic lesions predominated with a total of 114 (50 %) with the most frequent being inflammation 63 (55%), normal lacrimal gland tissue 28 (25%) and dacryops 23 (20%). Benign tumours comprised a total of 45 (20%) with the most frequent tumour being pleomorphic adenoma 31 (69%). Malignant tumours constituted a total of 70 (31%). 52 (74%) of these were primary tumours, 9 (13%) were secondary invading tumours, 8 (11%) were local recurrences and 1 (1%) was a distant metastasis. Primary malignant tumours comprised malignant lymphoma 25 (48%) and malignant epithelial tumours 27 (52%). The most frequent malignant tumour was adenoid cystic carcinoma comprising 14 (27%) of the primary malignant tumours. Conclusion Lacrimal gland lesions are rare and primarily benign. Treatment of malignant lacrimal gland tumours should be considered a specialist treatment. [source] | ||||||||||