Surgical determinants of clinical success of osseointegrated oral implants: a review of the literature

PURPOSE: This article reviews the current knowledge about the influence of surgical factors on implant failure in routine cases and in those where implants have been used in conjunction with bone augmentation procedures. MATERIALS AND METHODS: Clinical reports published in major scientific journals served as the basis for this review. RESULTS: With few exceptions, most clinical reports were on screw-shaped titanium implants. High failure rates are associated with poor bone quality and the use of short implants in the athrophic maxilla, irradiation, and bone-grafting procedures of the athrophic maxilla. Evidence for high long-term failure rates of press-fit cylinders was found. Moreover, limited clinical experience, lack of preoperative antibiotics, and smoking may lead to higher failure rates. CONCLUSION: There is a need for further research to increase the success rates in the severely resorbed maxilla. Because of a lack of proper documentation with respect to the great majority of currently used oral implant designs, the influence of different factors and their long-term results remain unknown.     

The accuracy of clinical versus computerized test interpretations.

Suggests that J. D. Matarazzo's (see record 1986-19878-001) arguments related to the accuracy of clinical vs computerized test reports are inconsistent with the available research on clinical vs mechanical or statistical methods of prediction and interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodological considerations in validating computer-based test interpretations: Controlling for response bias.

Although computer-based test interpretation (CBTI) systems have been operational for nearly 25 years, their availability and adoption in routine clinical practice have grown exponentially in recent years. This article addresses methodological considerations in CBTI validation studies, emphasizing those design issues relevant to customer satisfaction studies. Specifically, issues of response bias are addressed as they relate to selection of raters and test respondents, use of random reports as a "control" for spurious ratings of report validity, and both the format and content of ratings. Deficiencies of various studies from the research literature are reviewed, and advantages and limitations of design alternatives are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computerized clinical psychological test interpretations: Unvalidated plus all mean and no sigma.

Contends that computerized clinical psychological test interpretations offer considerable potential for improving the work of health service providers. However, cost additions associated with this technology have increased the probabilities that legislative, judicial, and administrative restrictions and sanctions will be imposed. Evidence accumulated during the past 2 yrs suggests that psychologists have begun to address scientific, ethical, and professional aspects of the threat that the technology will pose to society and to the profession, if it is left unbridled. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life: Expanding the scope of clinical significance.

Clinical researchers have turned their attention to quality of life assessment as a means of broadening the evaluation of treatment outcomes. This article examines conceptual and methodological issues related to the use of quality of life measures in mental health. These include the lack of a good operational definition of the construct, the use of subjective vs objective quality of life indicators, and the nature of the relationship between symptoms and quality of life judgments. Of special concern is the ability of quality of life measures to detect treatment-related changes. The authors review the application of quality of life assessment across diverse patient groups and therapies and provide recommendations for developing comprehensive, psychometrically sophisticated quality of life measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of the clinical significance of anti-Dob

BACKGROUND: Anti-Dob is an uncommon antibody, and there are few data regarding its clinical importance. In the present case, the patient's transfusion management was based on both in vivo and in vitro assay results. CASE REPORT: A delayed hemolytic transfusion reaction was suspected in a 64-year-old white woman awaiting cardiac surgery when the transfusion of 1 unit of red cells failed to raise her hematocrit. Although direct antiglobulin tests were negative, antibody screening tests on samples drawn 9 days after transfusion were positive, and anti-Dob was identified, reacting to a titer of 4. 51Cr in vivo survival studies with incompatible Do(b+) red cells showed poor survival: 83.2 percent at 1 hour, 43 percent at 24 hours, and 29.6 percent at 48 hours and t1/2 = 19 hours (normal t1/2 = 25-35 days). A monocyte monolayer assay performed with the same incompatible Do(b+) donor red cells also indicated poor survival: 22 percent and 30 percent reactive monocytes, respectively, with and without the addition of complement (normal, 0-3%). The patient was given 4 Do(b-) red cell units without clinical signs or symptoms of a reaction. CONCLUSIONS: This example of anti-Dob was implicated in a delayed hemolytic transfusion reaction. The 51Cr survival studies and monocyte monolayer assay results indicated that the anti-Dob was clinically significant, requiring the use of Do(b-) red cells for transfusion.     

Lengthening contraction and interpretations of active state tension in the isometric twitch response of skeletal muscle

The plateau of tetanic tension in a lengthening contraction of muscle at any given length is always greater than that in an isometric contraction at the same given length. To account for this excess of tension, it is suggested that the contractile machinery is "locked" in a strained condition that might make the muscle capable of bearing a greater tension in a lengthening contraction than it can develop in an isometric contraction. It is proposed that this strained condition also occurs in a lengthening contraction of the twitch response. If this proposal is valid it seems certain that the plateu of tension in the lengthening contraction of the twitch response cannot be equated with the plateau of tension in the isometric contraction of tetanus. The design of the original concept, that the plateau of active state tension in the lengthening contraction of the twitch is equal to the plateau of tension (Po) in the isometric contraction of tetanus, is based upon the assumption that the contractile component is neither lengthening nor shortening during both of these plateaus. This assumption is made without considering the possibility that the plateau in the lengthening contraction might be due to concurrent lengthening of series elastic elements and shortening of the contractile component. To account for the plateau of tension observed after quick lengthening in the early phase of twitch contraction indirect evidence is presented favoring the view that the quick lengthening during stretch is followed by slow lengthening and stress relaxation (decrease of tension) in series elastic elements and simultaneous shortening and increase of tension in the contractile component. When the original concept of active state tension in the twitch response is interpreted in the light of lengthening contraction, it is concluded that the labeled or implied Po for the plateau of the active state tension is unwarranted and confusing. It seems that the primary source of confusion is the assumption that the tension a muscle is capable of bearing in a lengthening contraction is equatable with the tension it can develop in an isometric contraction.     

Similar findings, different interpretations: A response to the commentary by Bootsma et al. (2010).

In this paper, we respond to the commentary by R J. Bootsma, L. Fernandez, A. H. P. Morice, and G. Montagne (2010) concerning our original study on the role of vision during the execution of fast interceptive actions (A. J. van Soest, L. J. R. Casius, W. de Kok, M. Krijger, M. Meeder, and P. J. Beek, 2010), that was inspired by the seminal study of R. J. Bootsma and P. C. W. van Wieringen (1990). Most importantly, we reiterate that the control strategy used in the simulation study (preprogrammed muscle stimulation, triggered at an appropriate time) was adopted on the sole ground that it was the simplest control strategy that allowed us to investigate the role of the visco-elastic properties of muscles. Regarding the visuomotor delay of our participants, we note that the assumption that the visuomotor delay can be reliably identified as the time from the occurrence of a minimum in the coefficient of variation of the relative rate of dilation to the instant of ball contact, is not generally accepted; lacking firm data on the visuomotor delay of our participants, any arguments on the relation between movement time and visuomotor delay are not well grounded. All in all, we believe that our original study added several new–but by no means final–insights to the understanding of the control of fast interceptive actions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes of bone metabolic markers in patients with bone metastases: clinical significance in assessing bone response to chemotherapy

To determine the changes in bone metabolism in response to combined chemotherapy in patients with bone metastases (BM), we examined osteocalcin (BGP), alkaline-phosphatase (ALP), hydroxyproline (HYP), pyridinoline (PYR), and/or deoxypyridinoline (D-PYR) in 25 cancer patients. In patients without BM, serum BGP was normal and not affected by chemotherapy. In patients with BM, however, BGP was often abnormally high or low, and some patients reacted to chemotherapy with a BGP increase at 4 weeks after initiation of therapy. Such an increase was observed in the group of patients who responded favorably to therapy as judged by a decrease in bone pain and tumor-associated biochemical markers. Urine HYP, PYR, and D-PYR were high in patients with BM before therapy; D-PYR decreased transiently at 2 weeks and increased thereafter. We assume that increased bone-resorption markers along with increased bone formation markers after therapy would indicate recovery of coupled bone metabolism, as the deranged bone remodeling is improved by tumor-regression. This study suggests that BGP and D-PYR can be useful early markers to predict favorable bone response to chemotherapy in patients with BM.     

Placental chorioangioma: prenatal diagnosis and clinical significance

We report the prenatal diagnosis of placental chorioangioma in a 32-week intrauterine pregnancy associated with polyhydramnios and enlarged fetal cardiac size that resulted in intrauterine fetal death. Ultrasound appearance, pathophysiology, and clinical significance of this entity are discussed.     

Paradoxical contraction of pelvic floor muscles: clinical significance

Accurate quantification of relative allele frequencies in pooled DNA samples can be carried out for microsatellite markers having a dinucleotide repeat unit, conditional on the absence of overlapping "shadow" bands. This provides a basis for extending DNA pooling to this useful class of DNA marker. Expressions for the standard error of densitometric estimates of allele frequencies from pooled samples are presented, and their statistical application is illustrated in a variety of situations. This enables DNA pooling to be utilized in situations requiring the testing of statistical hypotheses concerning differences in allele frequencies between populations, or samples.     

The clinical utility of quantitative cholescintigraphy: the significance of gallbladder dysfunction

By using an immunoradiometric method with a stated detection limit of < or =1 IU/l (stated normal reference limit in adults 3.7-16 IU/l) we determined EDTA-plasma erythropoietin (EPO) in 58 patients with polycythaemia vera (PV) and 49 patients with essential thrombocythaemia (ET). At the time of blood sampling, 20 of the PV patients were newly diagnosed and untreated, 23 were treated by phlebotomy only, and 30 also received myelosuppressive treatment (with 32P, hydroxyurea or alpha-interferon). Of the ET patients 24 were untreated and 28 received myelosuppressive therapy. For comparison plasma EPO was also determined in 10 patients with pseudopolycythaemia (PP). In this latter group the results for plasma EPO agreed well with the cited normal reference limits. The majority of untreated PV patients (12/20) had undetectable plasma EPO concentration, and the remainder all had values below the lower normal reference limit. Plasma EPO in PV was not significantly influenced by phlebotomy therapy. Twelve of the 24 untreated ET patients (50%) had plasma EPO values below the reference interval (undetectable in 2 patients). The mean EPO concentration was significantly lower in PV patients receiving phlebotomy therapy than in patients with untreated ET. In the total material of PV and ET treated with myelosuppressive agents the PV patients showed significantly lower values for EPO concentration than did patients with ET. The present results support the view that EPO measurements by high-detectability methods are diagnostically useful and should be included in the panel of new criteria for the diagnosis of PV.     

The clinical significance of compliance

The authors deal with a particular type of working alliance, called "compliance", which may be defined as mutual agreement between patient and physician with respect to prevention and therapy. This type of compliance may be influenced by the kind of disease (e.g. low compliance in psychiatric illness), by the mode of referral (verbal or written), by the kind of hospital care (an individual appointment with one particular physician in an outpatient department makes for better compliance) and by medication (intravenous or oral administration and color and size of pills). The number of medicines prescribed is of particular importance for compliance, i.e. the greater the number of drugs prescribed per day, the more the patient tends to be unreliable in taking them. Furthermore, the time spent in the waiting room, the amount of information given to the patient and the clarity of the instructions given by the physician play an important role. Situational factors and interaction in the physician-patient relationship seem to be more relevant than specific personality traits.