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Biomedical subjects

M Brickley

Publications and source records attributed to M Brickley.

11 recordsLinked to original sources
PubMed1998

Relationship between bone density and osteoarthritis in a skeletal population from London.

To determine whether bone density was related to the presence of osteoarthritis in past populations, bone density was determined directly on bone slices taken from the fourth lumbar vertebra of a series of skeletons from a cemetery in London used from the middle 18th to the early 19th centuries. Eighty male and 57 female skeletons were studied and standard anthropological methods were used to determine age and gender. Osteoarthritis was diagnosed by the presence of eburnation on joint surfaces. The mean bone density in the males was 0.351 (+/-0.071) g/cm2, and in the females 0.332 (+/-0.091); this difference was statistically significant (p = 0.045). There was a significant, negative relationship with bone density and age in females (p = 0.0023), but not males (p = 0.073). Forty-seven of the males and 30 of the females had osteoarthritis, the most commonly affected joints being the facet joints of the spine and the hands. For the males there was no significant difference in bone density in those with or without osteoarthritis, but in females the bone density was significantly lower (p = 0.021) in those with osteoarthritis than in those without. The reasons why this result differs from modern populations in which patients with osteoarthritis tend to have higher bone density are discussed, and it is suggested that the most plausible explanation may relate to differences in nutritional status between past and modern populations.

Adult↗
PubMed1995

The relevance of health state utilities to lower third molar surgery.

A study of the attitudes of 102 arts and science undergraduate students was carried out to establish relative utility values, that is the participants own assessments, for possible outcomes of surgical intervention and non-intervention in lower third molar management. Using a standardised visual analogue scale, respondents were asked to rate 17 outcomes of treatment presented to them by means of short descriptions (vignettes). Ranking of mean utility values showed that post operative complications were considered to be a greater handicap than the sequelae of leaving third molars in situ. The respondents considered that the effects of irreversible lingual and inferior dental nerve damage reduced health to a major degree, and that normally encountered post operative complications such as moderate pain, swelling and trismus were a greater handicap than recurrent mild/moderate pericoronitis.

Adult↗
PubMed1995

Public health aspects of third molar surgery. The effect of surgeons' treatment thresholds on efficiency and effectiveness.

Disease associated with third molars is being recognised increasingly as a public health problem in terms both of rising incidence and of appropriate use of resources. Since minor alterations in treatment philosophy can have a substantial impact on the efficiency and effectiveness of oral surgery services, this study examines the sensitivity and specificity of oral surgeons' decisions and uses Receiver Operator Characteristics (ROC) analysis to investigate their ability to detect and make appropriate judgements about teeth which need extraction according to established criteria. The study shows that the seniority of the surgeon making the treatment decisions had no significant effect on the decisions made and also demonstrated wide variations between the treatment plans made by individual clinicians. It is clear from this study that if an efficient and effective service for the treatment of third molar disease is to be commissioned, policy decisions about criteria for intervention must be made by health service purchasing authorities, adhered to by secondary care providers, and shared with the primary care practitioners who refer patients for treatment.

Decision Making↗
PubMed1993

Comparison of clinical treatment decisions with US National Institutes of Health consensus indications for lower third molar removal.

Treatment decisions about lower third molar surgery have important clinical and cost implications. Although indications for surgery have been the subject of a National Institutes of Health (NIH) consensus conference at which several unambiguous criteria were agreed, no prospective investigations have been carried out to compare clinic treatment decisions with these consensus criteria. Treatment decisions made by six Hospital Service oral surgeons were therefore evaluated for 72 consecutive patients (28 men, 44 women) aged 15-44 years (mean age 25 years), referred for lower third molar assessment. The presence of local disease; recurrent pericoronitis; caries not amenable to restorative measures; follicular cyst formation; internal/external resorption and periodontal disease was recorded by an independent observer immediately after treatment planning had been completed. Of the 139 third molars present, 55 were unerupted, 79 partially erupted and 5 fully erupted. Thirty patients had been scheduled for surgery under general anaesthesia (GA), 36 under local anaesthesia and six patients had not been scheduled for surgery. A total of 42 teeth, according to NIH consensus criteria, had no indications for removal, of which 27 had been scheduled for surgery. These excluded disease-free contralateral teeth that had been scheduled for removal under GA. When a single episode of pericoronitis was excluded as a valid indication, 39 teeth did not meet criteria for removal but had been scheduled for surgery. It was concluded that two-thirds of lower third molars not meeting NIH consensus criteria for surgery had been scheduled for removal. The reasons for this, which may include inappropriate criteria, require further research.

Adolescent↗
PubMed1992

Activity analysis: measurement of the effectiveness of surgical training and operative technique.

All surgical procedures are characterised by a sequence of steps and instrument changes. Although surgical efficiency and training in operative technique closely relate to this process, few studies have attempted to analyse it quantitatively. Because efficiency is particularly important in day surgery and lower third molar removal is a high-volume procedure, the need for which is responsible for particularly long waiting-lists in almost all UK health regions, this operation was selected for evaluation. A series of 80 consecutive procedures, carried out for 43 day-stay patients under general anaesthesia by seven junior staff (senior house officers and registrars: 39 procedures) and four senior staff (senior registrars and consultants: 41 procedures) were analysed. Median operating time for procedures which required retraction of periosteum was 9.5 min (range 2.7-23.3 min). Where these steps were necessary, median time for incision was 25 s (range 10-90 s); for retraction of periosteum, 79 s (range 5-340 s); for bone removal, 118 s (range 10-380 s); for tooth excision, 131 s (range 10-900 s); for debridement, 74 s (range 5-270 s); and for suture, 144 s (range 25-320 s). Junior surgeons could be differentiated from senior surgeons on the basis of omission, repetition and duration of these steps. Juniors omitted retraction of periosteum in 10% of procedures (seniors 23%) and suture in 13% (seniors 32%). Juniors repeated steps in 47% of operations; seniors, 14%. Junior surgeons took significantly more time than senior surgeons for incision, bone removal and tooth excision. No significant differences between junior and senior surgeons were found in relation to the incidence of altered lingual and labial sensation at 7 days. It was concluded that activity analysis may be a useful measure of the effectiveness of surgical training and the efficiency of operative technique.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Decision analysis for lower-third-molar surgery.

The objective of the study was to identify those factors that should affect treatment planning for patients who have lower third molars, using decision-analytic techniques. Utility values based on data from 104 patients indicated that the respondents considered that postoperative complications (except mild pain and temporary paresthesia) reduced health to a greater degree than did complications following non-intervention. A decision analysis indicated that the maximum expected utility of prophylactic third-molar surgery (60.25) was lower than that for non-intervention (76.96). The decision was sensitive to changes in the probabilities of occurrence of recurrent pericoronitis (threshold = 0.52), resorption of an adjacent tooth (threshold = 0.29), loss of an adjacent tooth (threshold = 0.32), and cystic change (threshold = 0.34). These thresholds are much higher than the incidence of problems affecting the lower third molar shown by a concurrent clinical audit and literature review. This study therefore suggests that lower third molars should not be removed prophylactically.

Decision Trees↗