Effect of post preparation on the apical seal of teeth obturated with plastic thermafil obturators

The effect of post canal preparation on the apical seal of endodontically obturated teeth with plastic Thermafil obturators was studied in vitro. Fifty-four extracted human maxillary anterior teeth were divided into four experimental and two control groups. Two groups were obturated with lateral condensation or plastic Thermafil obturator techniques; this was followed by post space preparation. Two groups were obturated as described above except that post space was not prepared. Apical leakage was determined with the use of 2% methylene blue dye solution at an absolute pressure of 75 mm Hg. There were no statistically significant differences between any of the groups. The clinical implication of these findings is discussed.     

An in vitro comparison of thermoplasticised gutta-percha obturation techniques with cold lateral condensation

This study compared the apical sealing ability, obturation time and extrusion of gutta-percha and sealer when root canals were obturated using either cold lateral condensation or one of the three methods using thermoplasticised gutta-percha (Alpha Seal, Thermafil or JS Quick Fill) in vitro. One hundred and thirty-one root canals from 78 extracted human teeth were used; 116 canals were divided into five groups so that they were balanced with respect to prepared canal anatomy, and the remaining 15 canals were used as positive and negative controls. The canals in the first four groups were prepared with hand files using the step-down technique to a standard apical size and flare. The last group was prepared using engine-driven rotary nickel-titanium files (McSpadden) to a similar apical size and flare. One of the four obturating techniques was used to fill the canals in each of the first four groups. The fifth group was obturated using the Alpha Seal technique. The roots were immersed in india ink, demineralised and rendered transparent to assess the extent of maximum lincar dye penetration. The Alpha Seal groups had the highest number of specimens without any leakage. There was a significant difference in the proportions of specimens that did not leak when the Alpha Seal (P < 0.01) and cold lateral condensation groups (P < 0.05) were compared with JS Quick Fill. Cold lateral condensation had a higher proportion of specimens with leakage in canals with curvature greater than 20 degrees than in canals with curvatures less than 20 degrees (P < 0.05). The curvature of canals had no effect on the sealing ability of the other techniques. The method of canal preparation had no effect on the sealing ability of Alpha Seal. Alpha Seal, Thermafil and JS Quick Fill were significantly quicker to perform than cold lateral condensation.     

Risk factor model for suicide assessment and intervention.

Psychologists are faced with the challenge of how to apply the growing knowledge about suicide in their clinical practice. A practical and easy-to-use model for integrating this knowledge is proposed, one which psychologists can use to guide their suicide risk assessments and clinical decision making. This model is based on known risk factors for suicide that are categorized as historical, personal, psychosocial–environmental, and clinical and are dichotomized into acute and chronic states. The model includes protective factors that are categorized as temporary and permanent. An example of how to use this model in clinical practice is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heparin-bonded circuits: clinical outcomes and costs

The aim of this study was to use meta-analysis to combine the results of numerous studies and examine the impact of heparin-bonded circuits on clinical outcomes and the resulting costs. Heparin-bonded circuits, both ionically and covalently bonded, are examined separately. The results of the study provide evidence that heparin-bonded circuits result in improved clinical outcomes when compared to the identical nonheparin-bonded circuits. These improved clinical outcomes result in subsequent lower costs per patient with their use. However, differences are apparent in the significance and magnitude of these outcomes between ionically and covalently bonded circuits. Covalently bonded circuits provide a greater magnitude and significance of improvement in clinical outcomes than ionically bonded circuits. Total cost savings can be expected to be three times greater with covalently bonded circuits ($3231 versus $1068). It was concluded that the choice regarding the use of a heparin-bonded circuits and the type of heparin-bonded circuit used has the potential to alter clinical outcomes and subsequent costs. Cost consideration cannot be ignored, but clinical benefits should be the main rationale for the choice of cardiopulmonary bypass circuit. This analysis provides evidence that clinical benefits and cost savings can both be derived from use of the same technology-covalently bonded circuits.     

Contribution of clinical pharmacists to patient care

Literature reports of the contributions of clinical pharmacists to patient care are reviewed. The topics covered are: clinical pharmacist functions in the drug use process, specific clinical activities of clinical pharmacists, and specialty areas of clinical pharmacy practice. It is concluded that more research needs to be done on the effectiveness and legal basis of clinical pharmacy services, and that adequate methods of payment for clinical pharmacy services must be developed.     

Single-case designs and clinical biofeedback experimentation

Rigorous evaluation of the effects of biofeedback with clinical populations is necessary, but practical problems often preclude utilization of between-groups experimental designs involving large numbers of clients with clinically relevant problems. Single-case experimental designs provide a viable alternative for answering most research questions. In addition, single-case designs possess several distinct advantages for biofeedback research, including a focus on clinical significance, the use of variability as data not error, unique procedures for establishing generality of findings, and an ability to deal with ethical concerns in clinical research. Basic procedures in the use of single-case experimental designs are described and illustrations in clinical biofeedback research are provided.     

"Normal" personality inventories in clinical assessment: General requirements and the potential for using the NEO Personality Inventory.

Issues pertaining to the use of "normal" personality inventories in clinical assessment are discussed. The basic tasks of a clinical evaluation are outlined, and the ability of normal measures of personality such as the NEO Personality Inventory (NEO–PI) to contribute to clinical assessment is considered. The authors conclude that normal personality tests should not be used as stand-alone measures in a clinical evaluation and that currently there is insufficient evidence to support the use of the NEO–PI for the differential diagnosis of psychopathology. The authors note that normal measures of personality show the greatest potential for contribution to clinical assessment in identifying stable personality characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical criteria for the use of a decision-making framework for the medically compromised patient: hypertension and diabetes mellitus

In this article, clinical criteria for the staging of disease severity in patients with hypertension and diabetes mellitus are presented. This paper is intended to supplement a previous article by the authors on the use of clinical criteria for the classification of patients with ischemic heart disease and chronic obstructive pulmonary disease and the use of a decision-making framework for the medically compromised patient. Hypertension and diabetes mellitus are discussed in terms of pathophysiology, risk factors, clinical manifestations of disease and disease progression. The article will allow practitioners to stage patients with hypertension and diabetes mellitus and to apply this staging to the previously established clinical decision-making framework for medically compromised patients.     

The use of mobile telephones as adjuncts to cognitive behavioral psychotherapy.

Despite the rapid proliferation of technological adjuncts in cognitive behavior therapy (CBT), much of this development appears to have occurred on an ad hoc basis and in many cases has resulted in applications that are beyond the resources of most practicing clinicians. The authors delineate the specific areas in which CBT can be augmented through use of technology and outline the characteristics of an ideal therapy augmentor. Mobile telephones are identified as a low-cost and accessible device whose use has been largely untapped to date. The existing literature on use of the mobile phone is reviewed, and potential areas for its application in CBT are examined. The authors conclude with clinical guidelines for its use and the recommendation that use of mobile phones in CBT is a promising avenue for both clinical practice and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of hematopoietic growth factors in transfusion medicine

Recombinant human growth factors are expected to have a significant impact on the use of allogeneic blood components. For example, recombinant human erythropoietin has had a significant impact on blood transfusion in renal dialysis patients. Likewise, myeloid growth factors have reduced infections and hospital stay by promoting hematologic recovery after high-dose ablative chemotherapy. The high costs of these agents mandate that their use be limited to settings where they are clinically indicated. This review discusses the emerging clinical data to help establish guidelines for the use of hematopoietic growth factors. Comments regarding the myeloid growth factors are restricted to their emerging role in stem cell transplantation, because this clinical setting is anticipated to have the greatest impact in the use of allogeneic blood components in oncology.     

Use and abuse of the benzodiazepines

Since chlordiazepoxide was introduced in 1961, the benzodiazepines have had many important roles in the pharmacotherapy of various disorders. This drug class for the central nervous system has been considered one of the safest in use for 35 years, especially when the benzodiazepines are compared with the barbiturates they often replaced. The objective of this article is to provide an update on the availability and distribution of benzodiazepines around the world and to discuss their most common clinical applications. Adverse effects of benzodiazepines, observed after long-term therapeutic use and after overdoses, are also presented. Triazolam is discussed because this benzodiazepine was removed from the market by regulatory authorities in the United Kingdom in 1991. Benzodiazepines will continue to have an important role in clinical medicine. Their clinical use, however, should be monitored more closely because of the greater awareness of their adverse effects after long-term use and because of the potential for misuse and abuse.     

The use of biological markers as predictive early-outcome measures in epidemiological research

One of the possible uses of biomarkers in epidemiological research is as early-outcome measures to predict the occurrence of clinical disease and to elucidate the biological mechanism of pathogenesis. This use is conceptually less straightforward than the well established use of biomarkers to improve or extend exposure assessment or to study interindividual variations in disease susceptibility. In principle, this form of use could accelerate or otherwise facilitate etiological research. However, in practice, the recent review literature suggests that this mode of biomarker use, especially in cancer epidemiology, is the least clear-cut and the least well developed. The recurrent problem is identifying biomarkers that: (1) are on the causal pathway, (2) have a high probability of progression to clinical disease, and (3) account for all or most of the cases of the specified clinical outcome. Such biomarkers would be most useful if they conferred a long lead-time relative to clinical disease occurrence.     

Toward a more clinically valid approach to therapy research.

Despite the advances in psychotherapy outcome research, findings are limited because they do not fully generalize to the way therapy is conducted in the real world. Research's clinical validity has been compromised by the medicalization of outcome research, use of random assignment of clients without regard to appropriateness of treatment, fixed number of therapy sessions, nature of the therapy manuals, and use of theoretically pure therapies. The field needs to foster a more productive collaboration between clinician and researcher; study theoretically integrated interventions; use process research findings to improve therapy manuals; make greater use of replicated clinical case studies; focus on less heterogeneous, dimensionalized clinical problems; and find a better way of disseminating research findings to the practicing clinician. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical quality measurement. Comparing chart review and automated methodologies

OBJECTIVES: This study investigates the use of data from automated systems within a large managed care plan to create indicators of clinical quality. METHODS: Measures from the first year of Health Plan Employer Data and Information Set, HEDIS 2.0, are used to compare chart review and automated analysis methodologies. The contributions of various data systems in creating clinical quality measures are evaluated. RESULTS: Chart review data usually are better for creating clinical quality indicators, although the level of agreement between the two methodologies often is quite high. Computerized patient record systems are found to be the most reliable automated data source, and automated claims are found to be the least reliable. This study's findings suggest that automated encounter systems may provide relatively reliable data. CONCLUSIONS: Managed care plans may not want to rely on automated data alone for clinical quality measurement. The results reported here support the use of combined methodologies such as the "hybrid" method, which utilizes both automated and chart-review data.     

Intoxication syndrome in acute pancreatitis

Methods of ELISA competitive binding and blotting on nitrocellulose membranes were developed for detecting microalbuminuria in diabetic nephropathy. These methods are based on the use of recombinant albumin receptor. They are highly specific and sensitive and are recommended for everyday clinical use.     

Guided tissue regeneration. Absorbable barriers

Over the past 15 years, techniques aimed at regeneration of lost periodontal tissue have become widely used and accepted in clinical practice. Among these techniques are those which use the principles of guided tissue regeneration (GTR), wherein barriers (i.e., membranes) are used to control cell and tissue repopulation of the periodontal wound. A variety of non-absorbable and absorbable barriers have been developed and used for this purpose, with a trend in recent years toward increased use of absorbable GTR materials. This article describes the evolution of absorbable barrier materials and overview materials available for clinical use today. In addition, advantages and disadvantages of these materials are discussed, as well as possible new developments in barrier-based GTR therapy.     

The risks and costs of upper gastrointestinal disease attributable to NSAIDs

NSAIDs, including both aspirin and nonaspirin NSAIDs, are among the most frequently used drugs, and their use may result in serious adverse gastrointestinal outcomes and significant medical costs. The increased risks for adverse upper GI hemorrhage and peptic ulcer disease associated with NSAID use have been demonstrated in observational studies and clinical trials; an overview of these results is presented in this article. The magnitude of these risks should play an important role in clinical decision making and should influence decisions regarding the use of this class of drugs.     

Dentinal bonding agents versus glass-ionomer cements

The long-term bonding of dental material to dentin remains an area of great controversy and the results of in vitro testing do not always reflect those found in vivo. The clinician is faced with a large number of dentinal bonding agents that have had limited testing in vivo and are frequently replaced before any long-term clinical testing has been completed. Glass-ionomer cements, although having a longer history of good adhesion to dentin, are not suitable for use in high-stress-bearing areas. The selection of materials for specific clinical situations has become more and more difficult. This paper gave a personal view of the history and evolution of both resin bonding agents and glass-ionomer cements and their potential in clinical use.     

Introduction to the Special Section on Incremental Validity and Utility in Clinical Assessment.

This special section focuses on the incremental validity and utility of clinical assessment data. The lack of replicated incremental validity research limits the ability of psychologists to establish their assessment practices on a solid empirical footing. The articles in this section deal with conceptual, methodological, and content issues in the development and use of clinical measures. The authors addressed several aspects of incremental validity research, including (a) the evaluation of the magnitude of validity increments, (b) the use of incremental validity data for test development and validation, (c) the costs of assessment, (d) the use of multi-informant and multimethod assessments, and (e) the treatment utility of assessment. Obstacles limiting the use of incremental validity research to inform and guide clinical practice are also emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)