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Biomedical subjects

C D Stephens

Publications and source records attributed to C D Stephens.

At least 19 recordsLinked to original sources
PubMed1998

Orthodontic auxiliaries--a pilot project.

AIM: To undertake a pilot study to determine a possible training programme for orthodontic auxiliaries. DESIGN AND SETTING: Trainee hygienists who had been accepted onto a 2-year programme were asked to attend the Bristol Dental School well before their course was due to begin in order to participate in a pilot orthodontic assistant auxiliary training programme. METHODS: A modular course of one month's duration was constructed based on the programme at the University of British Columbia. This aimed to teach skills such as impression taking, bond placement, debracketing, band cementation as well as core knowledge relevant to these procedures. RESULTS: At the end of the course all participants were judged to be performing the tasks they had been taught competently and safely. CONCLUSION: UK dental nurses can be trained to fill the role of an orthodontic auxiliary. It would appear that an introductory clinical skills course of one week followed by an orthodontic skills training of three weeks is sufficient for a qualified dental nurse of above average abilities such as typifies those who are currently applying for places on UK dental hygiene courses. It is estimated that a further period of nine months supervised training will be necessary for those who have successfully completed such a training to develop clinically useful speeds when delivering these skills.

Cementation↗
PubMed1998

Phase I trial of paclitaxel and gemcitabine administered every two weeks in patients with refractory solid tumors.

PURPOSE: Paclitaxel and gemcitabine possess broad spectra of clinical activity, distinct mechanisms of cytotoxicity, and are differentially affected by mutations in cell-cycle regulatory proteins, such as bcl-2. This phase I trial was designed to identify the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of paclitaxel and gemcitabine when both drugs were given together on a once-every-two-week schedule in patients with solid tumors. PATIENTS AND METHODS: A total of 37 patients were treated at nine different dose levels ranging from paclitaxel 75-175 mg/m2 administered over three hours followed by gemcitabinc 1500-3500 mg/m2 administered over 30-60 minutes. Both drugs were administered on day 1 of a 14-day cycle. Dose escalation was performed in a stepwise manner in which the dose of one drug was escalated while the dose of the other drug was kept constant. RESULTS: Dose limiting toxicity (DLT) was observed at dose level 9: paclitaxel 175 mg/m2 and gemcitabine 3500 mg/m2 in the form of grade 4 neutropenia lasting for > or = 5 days (one patient) and grade 3 elevation of alanine aminotransferase (AST/SGPT) (one patient). An analysis of delivered dose intensity (DI) over the first three cycles revealed that higher dosages of both drugs were delivered at dose level 7, paclitaxel 150 mg/m2 and gemcitabine 3000 mg/m2 dose level, than at the MTD, dose level 8, paclitaxel 150 mg/m2 and gemcitabine 3500 mg/m2. Partial responses were confirmed in two patients with transitional cell carcinoma (one of the bladder, one of the renal pelvis) and in one patient with adenocarcinoma of unknown primary. CONCLUSIONS: Paclitaxel and gemcitabine is a promising drug combination that can be administered safely and repetitively on an every-other-week schedule. Using this drug administration schedule, the recommended phase II dose is paclitaxel 150 mg/m2 and gemcitabine 3000 mg/m2.

Adult↗
PubMed1998

Task Group for Orthodontics Report.

The UK Specialist Review Group of the General Dental Council's Education Committee has been charged with taking forward the recommendations in the Chief Dental Officer's report 'UK Specialist Dental Training'. The Specialist Review Group has, in turn, established a number of specialty task groups. This report is from the Task Group for Orthodontics. It was submitted in May 1996.

Certification↗
PubMed1997

Phase II study of flutamide as second line chemotherapy in patients with advanced pancreatic cancer.

Androgen receptors are present in both pancreatic cancer tissue and cell lines. Flutamide is a potent antiandrogen widely used in clinical practice for patients with metastatic prostate cancer. This Phase II trial was undertaken to evaluate the impact of flutamide in patients with advanced pancreatic adenocarcinoma who had developed progressive disease following therapy with one 5-FU-based regimen. Fourteen patients were treated with flutamide, 250 mg orally three times per day. Therapy was generally well tolerated. No patients achieved objective tumor response. No patient had improvement in tumor-related symptoms as measured by improvement in pain intensity, analgesic requirement, performance status, or nutritional status. Median survival was 4.7 months. We conclude that flutamide is ineffective second line therapy for patients with advanced pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1997

A survey of the opinions of orthodontic specialist trainees in the U.K.

A questionnaire survey was carried out to ascertain a profile of orthodontic postgraduates in training in the United Kingdom during 1993. Information about the postgraduates, their programmes and their career plans was collected. Eighty-nine questionnaires were distributed to those enrolled in 13 of the training programmes in the U.K. at that time from which the response rate was 64 per cent. The results can be compared with a similar survey carried out in the United States of America in 1992 (Keith and Proffit, 1994).

Adult↗
PubMed1997

Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial.

PURPOSE: Most patients with advanced pancreas cancer experience pain and must limit their daily activities because of tumor-related symptoms. To date, no treatment has had a significant impact on the disease. In early studies with gemcitabine, patients with pancreas cancer experienced an improvement in disease-related symptoms. Based on those findings, a definitive trial was performed to assess the effectiveness of gemcitabine in patients with newly diagnosed advanced pancreas cancer. PATIENTS AND METHODS: One hundred twenty-six patients with advanced symptomatic pancreas cancer completed a lead-in period to characterize and stabilize pain and were randomized to receive either gemcitabine 1,000 mg/m2 weekly x 7 followed by 1 week of rest, then weekly x 3 every 4 weeks thereafter (63 patients), or to fluorouracil (5-FU) 600 mg/m2 once weekly (63 patients). The primary efficacy measure was clinical benefit response, which was a composite of measurements of pain (analgesic consumption and pain intensity), Karnofsky performance status, and weight. Clinical benefit required a sustained (> or = 4 weeks) improvement in at least one parameter without worsening in any others. Other measures of efficacy included response rate, time to progressive disease, and survival. RESULTS: Clinical benefit response was experienced by 23.8% of gemcitabine-treated patients compared with 4.8% of 5-FU-treated patients (P = .0022). The median survival durations were 5.65 and 4.41 months for gemcitabine-treated and 5-FU-treated patients, respectively (P = .0025). The survival rate at 12 months was 18% for gemcitabine patients and 2% for 5-FU patients. Treatment was well tolerated. CONCLUSION: This study demonstrates that gemcitabine is more effective than 5-FU in alleviation of some disease-related symptoms in patients with advanced, symptomatic pancreas cancer. Gemcitabine also confers a modest survival advantage over treatment with 5-FU.

Adult↗
PubMed1997

Clinical informatics and the dental curriculum. A review of the impact of informatics in dental care, its implications for dental education.

The origins of informatics lie in the development of computers and data processing techniques since the 1950s. The subsequent application of these to the practice of healthcare continues to the present day, so that information technology now holds the potential to revolutionise healthcare through more rapid and efficient management of an ever increasing quantity of clinical information. In dentistry, no less than in medicine, electronic systems can make an extremely valuable contribution to clinical practice. For these systems to be clinically useful, however, they need to be properly understood by clinicians. This review paper outlines the scope of clinical informatics and argues that a grounding in clinical informatics is now essential for today's undergraduates to equip them to meet the challenge of practice in the 21st century.

Computer Communication Networks↗
PubMed1996

Left-handedness in dental undergraduates and orthodontic specialists.

A questionnaire was devised involving a group of dental students (n = 70) and a group comprising all consultant orthodontists in the UK (n = 170) to investigate the prevalence and role of handedness in dental specialisation. Subjects were classified as being pure left-, mixed- or pure right-handed according to responses to a hand preference questionnaire and the results were compared with a very similar previous study of the general population. The prevalence of sinistrality (self-classified by writing) was recorded as 8.6% among dental students and 17.2% amongst orthodontists; this compares with 7.4% among the general population. More mixed-handers presented in both the dental groups compared to the general population. This agreed with the right shift theory of laterality. No significant correlation was noted between handedness and any other variable between the two dental groups.

Dentists↗
PubMed1996

An investigation into the standard of orthodontic treatment carried out by GDPs after completion of a clinical assistant training.

A sample of 172 orthodontic patients treated by 10 general dental practitioners in their practices was assessed in terms of treatment need and standard of treatment provided. The practitioners had been clinical assistants, for a minimum of 2 years, at a District General Hospital before starting any of the cases. Prior to treatment 70% of the cases had a 'clear need' for treatment on dental health grounds and 73% of the cases had a 'moderate' or 'great need' for treatment on aesthetic grounds. Using the Peer Assessment Rating nomogram to assess the treatment standard, 83% of patients could be classed as 'improved' or 'greatly improved' with treatment but 17% were 'worse or no different'. The standard of treatment produced by fixed appliances was found to be superior to that produced by removable appliances alone. When removable appliances were used the best results were obtained when consultant advice was given. The results for the clinical assistant sample are compared with the results for the GDS sample published in 1993. Ways of further improving the treatment standards produced by the general dental practitioners are considered.

Chi-Square Distribution↗
PubMed1996

Discontinued orthodontic treatment in the general dental service and community dental service in England and Wales during the summer of 1991.

This paper reports on two studies which investigated levels of discontinued orthodontic treatment amongst patients under 18 years, who had been treated in the General Dental Service (GDS) and Community Dental Service (CDS) of the National Health Service during June and July 1991. These complement the study of discontinued Hospital Dental Service treatment already reported. The studies indicated that, at the time, the levels were 13.1 per cent in the GDS and 12.5 per cent in the CDS. The figure for the GDS was much lower than that of 20 per cent reported in the Schanschieff Report. There was little difference in the levels of discontinued treatment between those working in the GDS with an orthodontic qualification (12.1 per cent) and those without (13.5 per cent). The results suggest that the levels for discontinued orthodontic treatment in those aged under 18 years of age may be lower than previously reported.

Adolescent↗