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Biomedical subjects

R L Braham

Publications and source records attributed to R L Braham.

At least 19 recordsLinked to original sources
PubMed1996

A study of the sedative effect of home-administered oral diazepam for the dental treatment of children.

This study investigated the effects of oral diazepam administered at home to fearful child patients prior to dental treatment. Twenty-five healthy, uncooperative children, mean age 3 years 8 months (+/- 1 year 3 months), requiring at least three visits for the treatment of dental caries, were studied. Each child's behaviour was assessed during three treatment sessions: (i) control, with no diazepam or placebo; (ii) with diazepam; and (iii) with a placebo. Each child acted as his/her own control, being initially assigned to the control session. Subsequently each was randomly assigned to receive either diazepam or placebo for the second session and the other for the third session. The diazepam and placebo were administered by the parents at home approximately 60 minutes before treatment. Each patient's behaviour was assessed on a scale of 1 (definitely positive) to 4 (definitely negative) by two calibrated examiners who were blind to the medications given and independent of the treatment. Vital signs were monitored at 5-minute intervals. Behaviour was significantly better with diazepam than with the placebo or with neither. No significant differences were observed between the placebo and control sessions. At no time were any adverse effects noted, such as vomiting or respiratory depression. It was concluded that oral administration of 0.3 mg/kg diazepam at home by the parent is an effective and safe technique for preoperative sedation of fearful child patients.

Administration, Oral↗
PubMed1995

Inverted impaction of second premolar: two case reports.

This report documents two patients with inversion and impaction of the second premolar tooth. Family and personal histories of both patients were unremarkable with no abnormalities in general growth and development nor any history of trauma. Patient 1 was a 10-year-old female with inversion and impaction of the mandibular right second premolar. Fifteen months previously, pre-operative radiographic examination prior to extraction of the mandibular right second primary molar revealed a normal direction and eruptive pattern of the tooth in question. However, following extraction of the mandibular right second primary molar, the developing succedaneous premolar was seen to be inverted. This was suggestive of inversion resulting from an iatrogenic force during tooth extraction. The second patient was a 9-year-old male with inversion and impaction of the maxillary right second premolar. Radiographic examination 3 months prior to the initial visit at our hospital showed an existing inversion of this tooth. This pointed to a developmental abnormality in the location of the original tooth bud.

Bicuspid↗
PubMed1994

Factors associated with the use of screening mammography in a primary care setting.

Despite consensus recommendations the use of screening mammography remains low. We examined physician and patient related variables associated with requests to undergo screening mammography in a primary care setting, in order to assess current barriers to screening mammography at the level of the physician-patient interaction. A sample of 261 women over the age of 50, whose primary care was provided by resident physicians in a large, urban, academic medical center were examined. Data concerning patients and physicians demographic and clinical characteristics were abstracted. The data were analyzed by Chi-square and stepwise logistic regression. Forty-five percent of the patients were offered screening mammography within the study year and 53% were offered mammography over the preceding two years. Variables significantly associated with a request for screening included a previous history of breast disease (p < .001) and the severity of the patient's overall medical condition. Patients with an overall medical condition rated as mild were more likely to be requested to undergo screening than patients rated as moderately or severely ill (p < .01). Patients with higher educational levels were also more likely to be offered screening (P = .06). First year postgraduate (PGY 1) physicians requested more mammograms than PGY 2 or PGY 3 physicians (P < .05). A multivariable model utilizing logistic regression confirmed the association of the significant variables above with screening requests. Physicians were more likely to request mammography in patients at higher risk for developing breast cancer and less likely to request it in patients who had co-morbid illness. Increasing physician understanding of the importance and benefits of mammography and further investigation of strategies to ensure physician compliance with mammography recommendations are necessary to increase utilization.

Aged↗
PubMed1994

Clinical evaluation of a light-cured glass ionomer lining cement.

This study was a clinical evaluation of a light-cured glass ionomer lining material (Fuji Lining LC) applied to prepared cavities in 45 primary teeth of children aged 3-5 years. The overall assessment, based on clinical and radiographic findings, was 'good' in 42 cases and 'fair' in the other three cases. The material had no effect on the shade of the composite resin restorative material that was used. The findings indicate that Fuji Lining LC has significant value in clinical practice.

Child, Preschool↗
PubMed1994

The sedative effects of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 2: optimal concentration of intranasal midazolam.

In a previous paper, we reported on the effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. The purpose of this study was to compare the clinical and possible adverse effect of doses of 0.2 mg/kg and 0.3 mg/kg midazolam, administered intranasally, and to determine the most appropriate concentration for the drug when administered by this route. Patients were assessed by a behavioral test which consisted of a scale from 1-7 with 3 ranges: markedly effective (1-3), effective (4-5) or ineffective (6-7). Forty-three mentally handicapped patients, aged 5 to 20 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were stratified by age and randomly assigned in a double blind manner to two groups, receiving either 0.2 mg/kg or 0.3 mg/kg midazolam administered intranasally. Group 1, consisting of 22 patients, average age 11 years 8 months, received 0.2 mg/kg. Group 2 consisted of 21 patients, average age 13 years 8 months, each of whom was administered 0.3 mg/kg intranasal midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. Subsequent to intranasal administration of midazolam, no patient rejected the nasal mask nor refused to inhale nitrous oxide/oxygen. The induction of nitrous oxide/oxygen sedation and oral examination were effected smoothly in every case in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1993

The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose.

The purpose of this study was to determine the sedative effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. Twenty-one patients, aged 4 to 21 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were sedated with 0.2 mg/kg midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. After administering the midazolam, each patient was allowed to rest before initiating the dental procedures. Behavioral patterns during the various procedures were rated on a behavioral rating scale of 1-7. Each patient served as his or her own control, comparing behavior with or without intranasal midazolam. The results showed a marked improvement in behavioral patterns after administration of intranasal midazolam. Ratings on a scale of 1-7 were noted as "markedly effective" and "effective" for 69.2% of those patients who received infiltration injection anesthesia, 93.8% under rubber dam, 76.2% during cavity preparation, 84.2% for restoration placement and 87.5% during pulpotomy procedures. The majority of patients were discharged within 150 minutes of intranasal instillation. Further studies are indicated to ascertain the most appropriate dose of intranasally administered midazolam.

Administration, Intranasal↗
PubMed1992

The detection of alcohol problems in a primary care clinic.

The CAGE is a four item questionnaire which is used to help clinicians identify alcohol problems. Charts of 433 primary care patients who were given a medical health form containing the CAGE questions (experimental patients) were compared with charts of 451 patients given a similar form that did not contain the CAGE questions (control patients). Alcohol problems were detected more frequently in the experimental patients (10.6%) than in the control patients (6.7%) (p < 0.05). This difference in detection tended to be most evident for persons with milder alcohol problems (problem drinking) as opposed to more well developed alcohol abuse. Experimental patients (3.7%) also tended to be more likely than control patients (2.9%) to receive active alcohol treatment during their initial medical visit. Medical health screening forms which include the CAGE questions may promote the identification of alcohol problems in primary care.

Alcoholism↗
PubMed1991

Psychological studies of emotional changes in children undergoing dental treatment. 1. Changes in plethysmogram.

This study was designed to examine the influence of children's personality traits and parents' child-rearing attitudes on children's internal behaviors before and after treatment. As an indicator of emotional changes, polygraph data and particularly plethysmograms were compared with psychological analysis data of children's personality traits and parental child-rearing attitudes. The subjects were 40 children with slightly carious primary molars, who were out-patients at Aichi-Gakuin University Dental Hospital. The results show that the emotional changes of children undergoing dental procedures are, in fact, observed at the resting pre-treatment stage, and that they are influenced by various factors, including parental child-rearing attitudes and children's personality traits. More over, in the resting post-treatment stage, these factors impinge upon children's emotions in a more complicated manner.

Behavior Therapy↗
PubMed1990

Bond strengths and pulpal response of light-cured composite resin inlays in primary molars.

The purpose of this study was to: 1) determine the most effective combination of composite resin and adhesive resin cement in the cementation process when fabricating esthetic inlays in severely broken down posterior primary teeth; 2) evaluate the pulpal response to adhesive resin cement in the primary teeth of young dogs. In Part I of the study, P-30 and Dentacolor composite resin inlays were evaluated with regard to their bonding strengths with Panavia-EX and Chemiace adhesive resins. Test samples of the composite resin inlays were prepared in molds according to the manufacturer's instructions. Each sample was polished on a flat, wet surface of 320 grit carborundum until a uniformly flat surface, perpendicular to the long axis of the cylinder was attained. Composite resin plugs, similarly fabricated, were bonded to the test samples using either Panavia-EX or Chemiace adhesive resin cements. A total of 160 samples were divided into four groups. Three of the groups were tested for bonding strength at intervals of 24 hours, 7 days and 30 days. The fourth group was thermocycled through 4 degrees C and 60 degrees C immersion periods. The results were analyzed using Tukey's studentized range test with an alpha (significance level) of 0.05. In Part II of the study, the pulpal response to Panavia-EX as a luting medium was compared with that of HY-Bond polycarboxylate cement. Cavities were prepared in 92 teeth from 8 young dogs and contralateral pairs of teeth were restored with Panavia-EX and HY-Bond polycarboxylate cement respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Clinical evaluation of light-cured composite resin inlays in primary molars.

A study was carried out to evaluate the clinical potential of a visible light-cured composite resin inlay (P-30) cemented with an adhesive resin cement (Panavia-EX) in primary molars. The inlays were placed in Class I complex, Class II MO, DO, MOD and more extensive cavity preparations in primary molars. Fifty restorations were placed in 40 patients and evaluated at baseline, 3 months, 6 months, 1 year and 2 years. The evaluations were carried out according to the U.S. Public Health Service Clinical Rating System. The results showed the composite resin inlay cemented with an adhesive resin cement to be a highly effective combination.

Child↗
PubMed1990

Surgical exposure and orthodontic alignment of an unerupted primary maxillary second molar impacted by an odontoma and a dentigerous cyst: a case report.

This report describes the surgical and orthodontic management of a 3-year old girl with an unerupted primary maxillary second molar impacted by an odontoma and a dentigerous cyst. Following surgical removal of the odontoma and dentigerous cyst, further surgical intervention and orthodontic traction were required to bring the primary maxillary second molar into correct occlusion with resultant proper functioning and good periodontal health.

Child, Preschool↗
PubMed1989

Clinical evaluation of the handling properties of Herculite in posterior primary teeth.

This study evaluated the handling properties of Herculite compared to Dispersalloy in primary posterior teeth. The materials were evaluated with regard to differences in packing consistency, adhesion to instruments, ease of insertion, working time and ease of finishing the restoration. A total of 33 restorations (19 composite resin, 12 amalgam) were placed in nine children. The major impression achieved is that both materials have excellent handling properties. However, each material has its own place in the dentist's armamentarium. Posterior composite resins require a highly skilled and demanding clinical technique, which requires an appropriate professional fee and should not be seen as a replacement for the conventional alloy.

Bicuspid↗
PubMed1988

Cost-effectiveness of extracorporeal shock-wave lithotripsy.

A study was done comparing the charges and outcomes for extracorporeal shock-wave lithotripsy (ESWL) with those for percutaneous nephrostolithotomy (PCN), which was the treatment of choice at our hospital for stones of the upper urinary tract when ESWL was introduced. Using a retrospective cohort design, patients were matched for age, sex, physical status index (American Society of Anesthesiologists), stone size, and urinary tract obstruction. Twenty-nine pairs of PCN and ESWL patients with complete data were matched. The groups were not significantly different in the matching parameters. Seventy-two per cent of patients in each group (21/29) were stone-free after the initial hospitalization. PCN patients required more auxiliary procedures per patient than did the ESWL patients; in addition, 5 (17%) of the PCN patients had perforation of the renal pelvis and 5 (17%) required transfusions. On discharge, 48 per cent (14/29) of the PCN patients had nephrostomies compared with none of the ESWL patients. The ESWL group had a shorter mean length of stay (2.9 vs 8.7 days, p less than 0.0005) and lower charges in all categories. Total charges were significantly less for ESWL ($9,290 vs $11,796 for PCN, p less than 0.005) as were physicians' fees ($3,391 vs $5,607, p less than 0.0005), room and board charges ($825 vs $2,164, p less than 0.0005), and operating room fees ($313 vs $1,452, p less than 0.0005). We conclude that ESWL is a cost-effective means for treating stones of the kidney and upper urinary tract.

Cost-Benefit Analysis↗
PubMed1987

Morbidity during hospitalization: can we predict it?

Physicians use the concept of stability to estimate the likelihood that a patient will deteriorate during a hospitalization. To determine whether physicians can accurately predict a patient's risk of morbidity, 603 patients admitted to the medical service during a one month period were rated prospectively as to how stable they were. Overall, 15% of patients had deterioration of already compromised systems, while 17% had new complications, such as sepsis. Eight percent of patients had both. Twelve percent of stable patients experienced morbidity; 39% of the somewhat unstable and 61% of the most unstable. When all of the demographic and clinical variables were taken into account including the reason for admission and comorbid diseases, the residents' estimates of the patient's stability was the most significant predictor of morbidity (p less than 0.001). The judgment that a patient was stable had an 87% negative predictive accuracy, while the judgment unstable had a 46% positive predictive accuracy.

Aged↗