Search PubMed⌕ Search

Biomedical subjects

M G Newman

Publications and source records attributed to M G Newman.

At least 37 records · Page 2Linked to original sources
PubMed1996

Improved clinical decision making using the evidence-based approach.

Clinical experience, technical ability, and intuition are indispensable but no longer sufficient as the sole skills necessary to provide the best outcomes from periodontal and implant treatment. This article describes the evidence-based approach, a comprehensive and rigorous literature evaluation process applied by scientists and clinicians. The methodology was used by the participants in The American Academy of Periodontology World Workshop to assess the evidentiary status of periodontal and implant treatment. The major goal of using the evidence-based approach was to improve treatment decisions by increasing the strength of the inference that practitioners can derive from the base of knowledge contained within the literature.

Decision Making↗
PubMed1996

Evidence-based periodontal regenerative therapy.

Periodontal health care has progressed into a new era. It is distinguished by a rapidly expanding volume of literature, rapid influx of new technologies, and need for new skills to perform increasingly complex procedures. Correspondingly, practice management changes are required to adapt to the extensive follow-up care associated with some of these new treatments. This must be accomplished while also acknowledging the deepening concern for escalating costs and increased attention to the quality of care provided. As with most change, clinicians can fight it by continuing to rely on old ways of doing things and hope to keep these issues at bay, but history would say they are unlikely to succeed. Instead, clinicians can embrace these changes and adapt to them by adding new tools, such as evidence-based methodology, to their armamentarium. The evidence-based approach offers a "bridge" from science to clinical practice. It can strengthen the foundation by providing a framework for integrating patient preferences, scientific knowledge, clinical judgment, and personal experience. By adapting the way treatment decisions are made in daily practice to an evidence-based approach, clinicians can deliver the highest quality care to their patients and be in better control of their own destiny. These new challenges can be perceived as problems or as opportunities--it is a choice!

Bibliographies as Topic↗
PubMed1995

Psychophysiological differences between subgroups of social phobia.

Individuals meeting criteria of the revised third edition of Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association, 1987) for social phobia with a fear of speaking in front of people were subdivided into those with (n = 16) and without (n = 14) avoidant personality disorder (APD). These individuals and nonanxious controls (n = 22) spoke in front of a small audience while speaking time, subjective anxiety, fearful thoughts, and electrocardiographic and respiratory measures were recorded. Controls spoke for longer than either social phobia group. Those with social phobia and APD reported more subjective anxiety and more fear cognitions than the other two groups; phobic individuals without APD showed greater heart rates in the phobic situation than either social phobics with APD or controls. The latter two groups did not differ in heart rate. These results indicate incongruent subjective and heart rate responses to the feared situation. A similar pattern of results was found when participants were divided into generalized and specific social phobia groups.

Adolescent↗
PubMed1995

Adjunctive supragingival irrigation with acetylsalicylic acid in periodontal supportive therapy.

To assess the clinical efficacy of adjunctive supragingival irrigation with buffered 0.3% acetylsalicylic acid (ASA), 60 patients with periodontitis receiving supportive periodontal therapy were randomly assigned to 1 of 3 home regimens: (1) 1x daily adjunctive supragingival irrigation with 300 ml water immediately followed by 200 ml of buffered 0.3% ASA; (2) 1x daily adjunctive supragingival irrigation with 500 ml water; or (3) normal oral hygiene alone. Clinical parameters were assessed at baseline and 6 months. Irrigator use was measured by timers built into the irrigator units. Results at 6 months showed that both supragingival irrigation with buffered 0.3% ASA and supragingival irrigation with water significantly reduced gingival index scores (median 0.1 and 0.35, respectively) and pocket probing depths (both median 0.26 mm) compared to the control group. In addition, irrigation with water resulted in a significant reduction in bleeding on probing (median 0.13), whereas irrigation with buffered 0.3% ASA had no significant effect on bleeding on probing compared to the control group. The clinical efficacy of irrigation with either ASA or water was found to be positively correlated to initial disease severity and irrigator use. Thus, frequent supragingival irrigation with either 0.3% ASA or water in addition to regular oral hygiene appears to be a beneficial adjunct to periodontal supportive therapy in patients with moderate to severe signs of periodontitis. However, the use of buffered 0.3% ASA as an irrigant does not seem to enhance the clinical efficacy of supragingival irrigation on periodontal health.

Adult↗
PubMed1995

Evidence-based periodontal treatment. I. A strategy for clinical decisions.

This article is first in a series of reports describing an evidence-based approach for evaluating information associated with periodontal treatment. Two main differences distinguish this approach from the traditional one, which is based largely on clinical experience. The evidence-based approach requires that investigators emphasize the importance of unbiased data (evidence) and use specific rules of evidence to quantify their recommendations. Search, evaluate, and rank are the three steps used for gathering information from the literature. The information (evidence) can then be used to formulate new decision pathways, practice guidelines, and treatment recommendations.

Databases, Bibliographic↗
PubMed1995

Evidence-based periodontal treatment. II. Predictable regeneration treatment.

Clinical experience, technical ability, and intuition are indispensable but are no longer sufficient as the sole clinical skills necessary to provide the best outcomes from periodontal and peri-implant regeneration treatment. This article describes a comprehensive and rigorous methodologic framework to assess the available evidence contained within the literature. This assessment tool is referred to as the evidence-based method. The methodology was used by a series of task forces convened to evaluate three common areas of clinical regenerative treatment. The major goals of these task forces were: (1) to increase the strength of the inference that practitioners can derive from the base of knowledge contained within the literature, (2) to develop algorithms to improve the predictability of regeneration treatment, and (3) to determine methods that can be used to predictably transfer the value of therapy to the patient.

Algorithms↗
PubMed1994

Effectiveness of adjunctive irrigation in early periodontitis: multi-center evaluation.

The purpose of this study was to determine the effect of daily water irrigation versus regular oral hygiene alone on gingival and periodontal health in periodontitis patients receiving supportive periodontal treatment. The study also sought to determine if there are enhanced benefits from using an antiplaque zinc sulfate rinse as an irrigant. One hundred fifty-five patients who have had periodontitis and had been treated either surgically or non-surgically completed the 6-month multi-center multi-national study. Patients with at least two 5 mm sites demonstrating bleeding on probing were assigned to 3 equal groups by balanced randomization. In all centers Group A (n = 57) performed regular oral hygiene only, and Group B (n = 58) irrigated with 500 ml water once daily after regular oral hygiene. Group C (n = 40) patients irrigated with a total of 500 ml once daily; following irrigation with 300 ml water, the patients then irrigated with an additional 200 ml with a zinc sulfate solution. The irrigants were diluted to provide the manufacturer's recommended daily dosage. The supragingival irrigation was performed with a commercially available oral irrigator. Bacterial measurements at baseline, 3 months, and 6 months were taken to determine the effect of irrigation on the target organisms and will be reported elsewhere. Gingival index: irrigation with water (Group B) was significantly better than normal oral hygiene (Group A) and irrigation with zinc sulfate (Group C) (P < 0.05) in reducing gingival inflammation. Bleeding on probing: significant reductions in bleeding on probing occurred for water (Group B) compared to normal oral hygiene (Group A) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Association of clinical risk factors with treatment outcomes.

A patient's decision to accept treatment recommended by his dental health care provider will be strongly influenced by the quality of the information he is given. Estimates of prognosis and treatment predictability must be based on the evidence available from the literature and the practitioners' own experience. Thorough, accurate, and relevant clinical and adjunctive diagnostic data will be a major influence in the development of the patient's individualized treatment strategy. Some clinical findings such as severity of disease for age, deepening pockets accompanied by loss of clinical attachment, frequent bleeding on probing, and bone loss can be considered as risk and prognosis factors. "Hard" data implicating specific clinical or diagnostic findings as risk factors or markers are difficult to find because there are few randomized longitudinal trials available. A new approach which attempts to focus on reducing the risk of undesirable outcomes while improving the probability of successful outcomes following treatment has been referred to as the Treatment Predictability Model. A key feature of this approach is the focus on individual patient circumstances and preferences through the use of decision analysis techniques. A large scale, long-term project utilizing a practice-based research network (PBRN) provided some descriptive information about factors that could distinguish between responders and nonresponder patients undergoing treatment for advanced periodontitis. Bacterial colonization, level of post-treatment plaque control, and smoking were major predictive variables in this group of periodontitis patients. The predictive treatment approach may be one way to develop evidence that will improve the predictability of outcomes for individual patients.

Databases, Factual↗
PubMed1994

A 6-month multi-center evaluation of adjunctive tetracycline fiber therapy used in conjunction with scaling and root planing in maintenance patients: clinical results.

The purpose of this study was to compare the efficacy of scaling and root planing (S and RP) alone versus tetracycline fiber therapy used adjunctively with S and RP in the treatment of localized recurrent periodontitis sites in maintenance patients. A total of 113 patients receiving regular supportive periodontal therapy (SPT) were treated with whole mouth S and RP. Two non-adjacent sites in separate quadrants were selected in each patient for monitoring based on criteria that the sites were 5 to 8 mm deep and had a history of bleeding on probing. The chosen sites were randomly assigned to one of the two treatment groups. Probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) were measured at baseline and 1, 3, and 6 months. At 1, 3 and 6 months, adjunctive fiber therapy was significantly better in reducing PD (P < 0.05) and reducing BOP (P < 0.05) than S and RP alone. At 6 months, fiber therapy was significantly better in promoting clinical attachment gain (P < 0.05) than S and RP alone. Overall, these results indicate that fiber therapy significantly enhanced the effectiveness of S and RP in the management of localized recurrent periodontitis sites, in patients receiving regular supportive periodontal treatment.

Arizona↗
PubMed1994

The influence of supragingival plaque control on clinical and microbial outcomes following the use of antibiotics for the treatment of periodontitis.

Although supragingival plaque control is essential to successful periodontal therapy, the role of plaque control following systemic antibiotic use in periodontal disease has not been well defined. This study evaluated, following antibiotic use, which clinical and microbial parameters appeared to be influenced primarily by the antibiotics, independent of plaque control, and which outcomes appeared to be dependent on plaque control. Two hundred thirty-six patients (236) with moderate to severe periodontitis were clinically evaluated and microbial samples were taken by their private-practice periodontists. All patients were treated with scaling and root planing and a variety of systemic antibiotics, which were selected based on the microbial and clinical profile of the patient. Three months after therapy, patients were reevaluated and grouped by post-treatment plaque control, as either having very good oral hygiene (LoPl: N = 143; < or = 10% plaque-covered surfaces) or poor oral hygiene (HiPl: N = 93; > or = 25% plaque-covered surfaces). The two groups had different plaque and bleeding scores initially, but similar numbers of pockets probing > 5 mm and similar microbial patterns. Although the LoPl group had a significantly greater reduction in plaque than the HiPl group, bleeding scores and probing depths changed comparably in both groups after antibiotic therapy. Plaque control influenced outcomes significantly, but in a complex manner. The LoPl group exhibited a significantly greater reduction in certain bacteria, for example P. gingivalis. Interactions between plaque control and specific microbial parameters significantly affected clinical outcomes, although neither alone was sufficient to predict outcomes following antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Assessing bacterial risk factors for periodontitis and peri-implantitis: using evidence to enhance outcomes.

This article discusses the use of microbial diagnostics and their relationship to the treatment of periodontal and peri-implant disease. Clinical and microbiologic characteristics are described to help the practitioner recognize patients with periodontitis and peri-implant infections. By using available information (evidence) to guide the choice of therapeutic intervention, the clinician can enhance the outcomes resulting from therapy.

Bacteria, Anaerobic↗
PubMed1994

Contemporary periodontics: view from a researcher/clinician.

Periodontal disease is one of the most common dental health problems in the United States. The treatment and prevention of periodontal diseases are now important aspects of dentistry. An increasing awareness has opened the marketplace for the development of new periodontal products. This article examines two general approaches to periodontal disease treatment, as well as advances in research and therapy.

Humans↗
PubMed1993

The role of infection and anti-infection treatment in regenerative therapy.

Infection associated with regenerative therapy is becoming an increasingly important consideration as the frequency and numbers of regenerative procedures increase. Specific recommendations for antimicrobial treatment associated with membranes, grafts, and implants are presented in the context of establishing general principles of infection management.

Anti-Bacterial Agents↗
PubMed1992

Field testing as clinical trial methodology in periodontics.

In the early 1950s the randomized control trial (RCT) was introduced and became widely accepted as the definitive proof of efficacy of a specific medical treatment. In fact, the acceptance and application of this methodology were instrumental in converting medicine from an unpredictable art to a science. At present no other methodologies exist that allow the evaluation of therapeutic efficacy with confidence comparable to that achieved with randomized controlled trials. In recent years researchers have applied new experimental designs and data analysis techniques to clinical trials conducted in a field trial environment to facilitate the understanding of proper use of new therapeutic agents and procedures. Since many of the new methodologies are still evolving or have only recently been introduced, this review considers some of the major trends and developments, as well as experiences of the authors, in field trial methodology. This manuscript addresses the following questions: 1) are there current clinical trial needs that are not met by RCT? 2) If so, what considerations are necessary for new approaches to have scientific usefulness? and 3) What are the strengths and weaknesses of the field trial's setting relative to an institutional environment?

Bias↗
PubMed1992

E-test: a new technique for antimicrobial susceptibility testing for periodontal microorganisms.

The purpose of the study was to validate the Epsilometer test (E-test) method for antimicrobial susceptibility testing of selected periodontopathic microorganisms using the agar dilution method as a standard. The E-test has been developed to provide a direct quantification of antimicrobial susceptibility of microorganisms. The device consists of a predefined, continuous, and exponential gradient of antibiotic concentrations immobilized along a rectangular plastic test strip. After 48 hours incubation a drop-shaped inhibition zone intersects the graded test strip at the inhibitory concentration (IC) of the antibiotic. Twenty-two subgingival plaque samples from periodontitis sites were plated on trypticase soy agar supplemented with 5% rabbit blood or 5% sheep blood and trypticase soy agar supplemented with vancomycin and bacitracin. A total of 60 strains of key periodontal pathogens (Prevotella intermedia, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Campylobacter rectus, and Capnocytophaga) isolated from 22 sites of 12 patients were studied. The antibiotics tested were clindamycin, metronidazole, tetracycline, ciprofloxacin, cefoxitin, and ampicillin at concentrations above and below the achieved blood or gingival crevicular fluid levels. As a standard reference the minimal inhibitory concentrations (MICs) were determined using the agar dilution method. MICs were compared with ICs determined using the E-test method. The results showed an agreement ranging from 67% to 100%; sensitivity ranging from 75% to 100%; predictability ranging from 56% to 100% and specificity ranging from 33% to 96%. The E-test ICs for ampicillin, cefoxitin, and metronidazole against the Gram-negative capnophilic and microaerophilic rods and the black-pigmented anaerobic rods ICs for ampicillin, clindamycin, metronidazole, and tetracycline showed a high percentage of agreement with the agar dilution MICS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗