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Biomedical subjects

C D Stephens

Publications and source records attributed to C D Stephens.

At least 37 records · Page 2Linked to original sources
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

[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 the 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 (classified by writing) was recorded as 8.6% among dental students and 17.2% among 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.

Female↗
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↗
PubMed1995

Left handed GDPs.

Explore the source record for details and available documents.

Dentists↗
PubMed1995

The relationship between the index of orthodontic treatment need and consensus opinion of a panel of 74 dentists.

This study looked at the aesthetic and dental health components of the index of orthodontic treatment need in relation to peer assessment of dental health and aesthetic need (panel of 74 dentists). The dental health component had a Spearmans correlation coefficient of +0.64 and the aesthetic component +0.86 when compared with the mean subjective opinion of 74 dentists. It has been proposed to have three categories for both the dental health and aesthetic components in accordance with consensus opinion. The panel of 74 examiners were more likely to regard aesthetics as a greater need for treatment than dental health.

Attitude of Health Personnel↗
PubMed1995

An evaluation of the views of general dental practitioners who have participated in an extended orthodontic training scheme.

A questionnaire was sent to 255 dental practitioners who had participated in an extended orthodontic training scheme, incorporating formal teaching and supervised clinical sessions over a period of not less than 24 months. The response of the practitioners was good; 78 per cent of the forms returned were suitable for analysis. Overall, the practitioners responded favourably to the schemes and felt that they had been of benefit to their clinical practice. The majority undertook more orthodontic treatment as a result and on average, fixed appliances were used in half of these treatments.

Adolescent↗
PubMed1994

An introduction to indices of malocclusion.

Orthodontic indices have been used for many years to assess the severity of a patient's malocclusion and hence determine the need for treatment. Two indices--the Index of Orthodontics Treatment Need (IOTN) and the Peer Assessment Rating (PAR) Index--have recently been developed. The use of indices is likely to become more widespread in the future so that more uniformity is achieved in assessing need for treatment and its success. This article describes how the two indices are applied.

Health Services Needs and Demand↗
PubMed1993

Orthodontics in the general dental service of England and Wales: a critical assessment of standards.

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered.

Analysis of Variance↗
PubMed1993

Consultant opinion on orthodontic treatment plans used by dental practitioners: a pilot study.

Prior to 1987, dental practitioners in England and Wales intending to carry out all but the simplest orthodontic treatment within the National Health Service, were required to submit pretreatment study models, details of the orthodontic assessment and the proposed treatment plan to the Dental Estimates Board prior to starting treatment. Models taken at the end of treatment were required by the Board to enable payment to be made. In this pilot study, the acceptability of orthodontic treatment plans used by practitioners working in the General Dental Services was assessed by eight hospital consultants, using information about 40 cases submitted to the Dental Estimates Board in 1987/88. All consultants considered a high proportion of plans to be unacceptable, but agreement between the consultants was variable and some agreed with one another on very few plans. A single scorer used the weighted PAR (Peer Assessment Rating) index to assess the degree of departure from normal occlusion of both pre- and post-treatment models. Using accepted standards, only nine cases were greatly improved (PAR reduction > 70%) and the mean percentage reduction in PAR score was low. Consultant opinion on the appropriateness of treatment planning was not related to the outcome of orthodontic treatment.

Clinical Competence↗