Search PubMed⌕ Search

Biomedical subjects

S Richmond

Publications and source records attributed to S Richmond.

At least 37 records · Page 2Linked to original sources
PubMed2001

The relationship between Index of Complexity, Outcome and Need, and patients' perceptions of malocclusion: a study in general dental practice.

AIM: To examine the relationship between the Index of Complexity, Outcome and Need (ICON) and the subjective opinions of patients attending for routine dental care. MATERIALS AND METHODS: This study was undertaken at two general dental practices in Cardiff and Bedford. 50 patients aged between 11-14 years and 50 patients aged 30-40 years presenting for routine dental treatment were selected in each. The subjects were assessed objectively using the ICON guidelines by two examiners trained and calibrated in the use of this index. The scores were recorded directly from the patient. Subjective assessments were obtained from the patients by means of a questionnaire consisting of four simple questions addressing aesthetics, function, speech and treatment need using a five point Likert scale. RESULTS: The mean ICON scores for the different genders and age groups participating in this study were; 11-14 year old males 58.4 (SE 3.17); 11-14 year old females 51.8 (SE 3.51); 30-40 year old males 51.2 (SE 2.70); 30-40 year old females 45.3 (SE 2.56). There were statistically significant differences in ICON scores between the younger and older groups (P = 0.024) and females and males (P = 0.04). Adult patients were more likely to reject treatment than younger patients. Analysis of the professional scores in relation to subjective assessments, using the Spearman rank correlation coefficient, for 11-14 and 30-40 year olds, and for the male and female genders, revealed that the ICON has a significant correlation with patients' perceptions of aesthetics, function, speech and treatment need (r2 = 0.01 to 0.28). The only exceptions were patients' perceptions of speech in the 30-40 year old group, and function in the female gender, which did not show a statistically significant correlation to the professional assessments. CONCLUSION: In this study, the ICON was found to correlate with patients' opinions of aesthetics, function, speech and treatment need. The strength of association, however, was low. It can be concluded that the ICON alone is not necessarily a suitable predictor for appearance, function, speech or treatment need for those individuals attending general dental practice for routine dental care. In combination with a simple question to assess the patients desire for treatment, the shared decision for any particular individual to enter the treatment process can be determined.

Adolescent↗
PubMed2001

Challenges with studies investigating longevity of dental restorations--a critique of a systematic review.

OBJECTIVES: A systematic review is a method of evaluating the published and unpublished literature relating to a specific area or topic. The objectives of this paper are to identify and discuss problems encountered in synthesising the available literature; and to make recommendations for the future conduct and reporting of clinical trials that aim to determine the longevity of dental restorations. DATA SOURCES: Studies were identified by a wide search of published and unpublished material in any language using a large number of general and specialist data bases, hand searching of key dental journals and searching of abstracts from conference proceedings. STUDY SELECTION: Pre-defined inclusion criteria based on objective outcome measures of restoration longevity and study designs were applied to determine study selection. CONCLUSIONS: A review of the longevity of dental restorations completed recently encountered substantial problems in designing an appropriate protocol to address this issue. The review found that many of the factors reported previously as affecting restoration longevity could not be confirmed using the agreed systematic review protocol that incorporated an objective study design. Further, the multiplicity of study designs, and reporting methods found in the literature made meta-analyses impossible. A proforma is proposed in order to aid the design of future research into the longevity of restorations.

Dental Materials↗
PubMed2001

European Resuscitation Council Guidelines 2000 for Newly Born Life Support. A statement from the Paediatric Life Support Working Group and approved by the Executive Committee of the European Resuscitation Council.

The European Resuscitation Council (ERC) last issued guidelines for the resuscitation of the newly born infant in 1999 [1]. This was an "Advisory Statement" of the International Liaison Committee on Resuscitation (ILCOR). Following this, the American Heart Association and the Neonatal Resuscitation Programme Steering Committee of the American Academy of Paediatrics and representatives of the World Health Organisation, together with representatives from ILCOR, undertook a series of evidence-based evaluations of the science of resuscitation which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" in August 2000 [2,3]. The Paediatric Life Support Working Party of the European Resuscitation Council has considered this document and the supporting scientific literature and presents the ERC Newly Born Guidelines in this paper. Readers will find few changes to the ILCOR Advisory Statement recommendations as the new evidence that has emerged since its publication in 1999 has been confirmatory of the ILCOR recommendations.

Advanced Cardiac Life Support↗
PubMed2001

A 2-center comparison of orthodontist's perceptions of orthodontic treatment difficulty.

The aim of this study was to determine which factors correlate with easy and difficult treatments and to assess the use of the Index of Complexity, Outcome & Need (ICON) as an indicator for treatment difficulty. The study was conducted at 2 centers using a retrospective cross-sectional questionnaire-based design. The participants were specialist orthodontic practitioners in Dresden, Germany and Cardiff, UK. Sixteen specialist orthodontists participated. Each supplied 10 completed cases--5 they regarded as being easy and 5 as being difficult. The specialist orthodontists completed a questionnaire and stated up to 5 reasons why they considered the case easy or difficult. Two examiners were calibrated in the use of the ICON. Logistic regression analysis using a forward conditional systematic model with complexity of case (ie, easy or difficult) as the dependent variable demonstrated statistical significance of the following patient-related factors: pretreatment ICON score, number of appointments, and age. Chi-squared testing demonstrated statistical significance of the following factors: cooperation, extent of overbite, presence of dysfunction, extent of overjet, anchorage, angulation of teeth, presence of crossbite, center-line shift, nonextraction treatment, age at start of treatment, compliance during the course of treatment, oral hygiene level. This study indicates that the main distinguishing factors between easy and difficult cases appear to be pretreatment age, number of appointments, and pretreatment ICON score. However, the odds ratios were not sufficiently high for these factors to be strong predictors of difficulty.

Age Factors↗
PubMed2001

Early diagnosis of congenital heart disease.

Routine examination of apparently healthy newborn babies detects less than half of those with congenital cardiac malformations because they are asymptomatic and without signs. More severe cardiac malformations are not detected more easily. A normal clinical examination does not exclude serious congenital cardiac malformation. Left heart obstruction is easily overlooked but often causes serious deterioration in less than 3 weeks. It is important to arrange early echocardiography of babies with signs and to consider cardiac malformation in a sick baby even if a previous routine examination was normal. All babies with Down syndrome should have early expert cardiological assessment.

Diagnosis, Differential↗
PubMed2001

Foods found in the wild around nuclear sites: an evaluation of radiological impact.

Habit surveys were carried out around four licensed nuclear sites to identify people who collect foodstuffs from the wild (so-called 'free foods'). In total, around 800 collectors were readily identified, most of whom collected more than one free food. The data indicated that estimates of higher than average doses could reasonably be based on the three foodstuffs of most importance. Foods were selected for further study on the basis of either the number of collectors or the amount consumed. The radionuclides of interest were identified using published information on the discharges from each site. The resultant average and higher than average doses were estimated using the site-specific habit data. For all sites, doses from the consumption of free foods were low and of no radiological importance. Assessments based solely on data for cultivated foods would not therefore have underestimated radiological impact significantly. However, given the wide utilisation of free foods found in this study, for rigorous assessments it would be prudent to take account of the consumption of foods from the wild.

England↗
PubMed2001

Hypernatraemic dehydration and breast feeding: a population study.

As part of a population based regional review of all neonatal readmissions, the incidence of dehydration with hypernatraemia in exclusively breast fed infants was estimated. All readmissions to hospital in the first month of life during 1998 from a population of 32 015 live births were reviewed. Eight of 907 readmissions met the case definition, giving an incidence of at least 2.5 per 10 000 live births. Serum sodium at readmission varied from 150 to 175 mmol/l. One infant had convulsions. The sole explanation for hypernatraemia was unsuccessful breast feeding in all cases. The eight cases are compared with the 65 cases published in the literature since 1979. Presentation, incidence, risk factors, pathophysiology, treatment, and prevention are discussed.

Breast Feeding↗
PubMed2001

The time-factor in orthodontics: what influences the duration of treatments in National Health Service practices?

UNLABELLED: This study aimed to elucidate factors associated with duration of orthodontic treatment. METHODS: Retrospective analysis of a systematic 2% sample of cases completed in National Health Service practices in England and Wales. Records were collected during 1991. Characteristics of practitioners, patients, malocclusions, treatment variables and outcomes were evaluated. Data were submitted to multivariate analysis, with Log10 Time in Treatment as the dependent variable. RESULTS: Data were available for 1506 cases. The (geometric) mean time in treatment was 13 months. A model was found that explained 41% of the variance. Factors found to increase duration were fixed appliances, multiple stages in the treatments, premolar extractions, and correction of antero-posterior buccal occlusion. Age, buccal segment malocclusion, DHC (Dental Health Component of the Index of Orthodontic Treatment Need) grade 5 and orthodontically qualified practitioners were also associated with slightly longer treatments. CONCLUSIONS: Whilst briefer treatments may be attractive to purchasers, providers and recipients, it should be remembered that thorough treatment, and treatment of more complex malocclusions, tends to take longer. Economic pressures on practitioners to produce high turnovers of cases may be counterproductive in the quest for better outcomes.

Adolescent↗
PubMed2001

Issues and dilemmas of developing a new faculty practice plan.

Due to changes in health care and increased knowledge of the public concerning health care, faculty need to assume a more active role in practice settings. Faculty involvement in the practice of their disciplines allows them to remain on the "cutting edge" as well as be models for their students. Most faculty practice plans will provide some external funding but more importantly will allow additional educational opportunities for the students as they work with the faculty. These plans allow faculty to interact with the community and strengthen the ties of the community and the academic institution. However, there are dilemmas in establishing faculty plans, for the quality of teaching cannot be threatened, and most universities expect their faculty also to be involved in scholarly activities. This article discusses 1) the process used in planning and developing a faculty practice plan; 2) details of the plan, to include faculty incentives, administrative cost, etc.; and 3) strategy for implementation.

Faculty↗
PubMed2001

Orthodontic treatment standards in a public group practice in Sweden.

The aim was to assess the orthodontic treatment service provided by 6 orthodontists in a group practice in Malmö. One hundred cases were randomly selected from the model store. The Index of Complexity, Outcome and Need (ICON) was used to assess the need, complexity of the problem, outcome, the degree of improvement and whether the completed case was acceptable or not. The reliability of the examiner using the ICON was assessed using Root Mean Square. Logistic regression analysis was employed to explore the variables related to acceptability of the finish and duration of treatment. The younger the patient at the start of treatment the lower initial ICON score, with short treatment duration were associated with an acceptable finish. Three out of 100 cases were deemed as not requiring orthodontic treatment and 36 cases were classified as very difficult to treat. Nevertheless, 71 cases out of the 100 exhibited acceptable finishes with 27 indicating substantial or great improvement. 6 cases finished treatment with ICON scores greater than 43 indicating need for orthodontic treatment. The treatment on average took 22 months. An objective appraisal of the quality of orthodontic care in a group practice in Malmö has been undertaken. Seventy-one cases were completed with acceptable occlusions. The Index of Complexity, Outcome and Need appears to be a valuable tool to assess the multiple facets of orthodontic provision.

Adolescent↗
PubMed2000

The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech, and orthodontic treatment need.

The aim of this study was to determine the relationship between patients' perceptions of orthodontic treatment need and need as determined with professionally derived indexes, namely the dental aesthetic index and the index of orthodontic treatment need. This study was undertaken at orthodontic offices in San Francisco, Calif. The pretreatment study casts of 50 consecutive patients, presenting for orthodontic treatment, were objectively assessed with these indexes by 2 examiners trained and calibrated in their use. Patients were asked to complete a questionnaire consisting of 4 questions addressing appearance, function, speech, and treatment need, using either a 5-point Likert scale or a yes/no response. The professionally derived indexes showed that statistically significant correlations existed between the aesthetic component and dental health component (r = 0.46; P <.01), the aesthetic component and dental aesthetic index (r = 0.54; P <.01), and the dental health component and dental aesthetic index (r = 0.46; P <.01). Statistically significant correlations were also found for subjective assessments between biting/chewing and speech (r = 0.31; P <.05), between speech and the aesthetic component (r = -0.39; P <. 01) and the dental aesthetic index (r = 0.34; P <.05), and between the aesthetic component and appearance (r = -0.28; P <.05). Logistic regression analysis after dichotomization (treatment/no treatment need) confirmed that the aesthetic component was the only statistically significant factor (odds ratio, 0.57; 95% confidence limits 0.34 to 0.97).

Adolescent↗
PubMed2000

The development of the index of complexity, outcome and need (ICON).

This paper is based on the winning submission for the 1998 Chapman prize awarded by the British Orthodontic Society for an essay on a subject promoting the interests of orthodontics. The aim of the investigation is to develop a single index for assessing treatment inputs and outcomes. An international panel of 97 orthodontists gave subjective judgements on the need for treatment, treatment complexity, treatment improvement, and acceptability on a diverse sample of 240 initial and 98 treated study models. The occlusal traits in the study models were scored according to a defined numerical protocol. Five highly predictive occlusal traits were identified (IOTN Aesthetic Component, crossbite, upper arch crowding/ spacing, buccal segment antero-posterior relationships, and anterior vertical relationship) and then used to 'predict' the panelist's decisions using regression analysis. Cut-off values were determined for the dichotomous judgements by plotting specificity sensitivity and overall accuracy. Twenty percentile ranges were used to determine 5 grades of complexity and improvement. The index prediction of decisions for treatment need, had specificity 84.4 per cent, sensitivity 85.2 per cent, and overall accuracy 85 per cent. When used to predict treatment outcomes, the new index had specificity 64.8 per cent, sensitivity 70.1 per cent, and overall accuracy 68.1 per cent. The index could explain 75.6 per cent of the variance in the mean casewise complexity score and 63.5 per cent of the mean casewise improvement score. A new orthodontic index is proposed to assess treatment need, complexity, and outcome. It is based on international orthodontic opinion.

Awards and Prizes↗
PubMed2000

Increasing rates of cerebral palsy across the severity spectrum in north-east England 1964-1993. The North of England Collaborative Cerebral Palsy Survey.

OBJECTIVES: To report epidemiological trends in cerebral palsy including analyses by severity. DESIGN: Descriptive longitudinal study in north-east England. Every child with suspected cerebral palsy was examined by a developmental paediatrician to confirm the diagnosis. Severity of impact of disability was derived from a parent completed questionnaire already developed and validated for this purpose. SUBJECTS: All children with cerebral palsy, not associated with any known postneonatal insult, born 1964-1993 to mothers resident at the time of birth in the study area. MAIN OUTCOME MEASURES: Cerebral palsy rates by year, birth weight, and severity. Severity of 30% and above defines the more reliably ascertained cases; children who died before assessment at around 6 years of age are included in the most severe group (70% and above). RESULTS: 584 cases of cerebral palsy were ascertained, yielding a rate that rose from 1.68 per 1000 neonatal survivors during 1964-1968 to 2.45 during 1989-1993 (rise = 0.77; 95% confidence interval 0.2-1.3). For the more reliably ascertained cases there was a twofold increase in rate from 0.98 to 1.96 (rise = 0.98; 95% confidence interval 0.5-1.4). By birth weight, increases in rates were from 29.8 to 74.2 per 1000 neonatal survivors < 1500 g and from 3.9 to 11.5 for those 1500-2499 g. Newborns < 2500 g now contribute one half of all cases of cerebral palsy and just over half of the most severe cases, whereas in the first decade of this study they contributed one third of all cases and only one sixth of the most severe (chi(2) and chi(2) for trend p < 0.001). CONCLUSIONS: The rate of cerebral palsy has risen in spite of falling perinatal and neonatal mortality rates, a rise that is even more pronounced when the mildest and least reliably ascertained are excluded. The effect of modern care seems to be that many babies < 2500 g who would have died in the perinatal period now survive with severe cerebral palsy. A global measure of severity should be included in registers of cerebral palsy to determine a minimum threshold for international comparisons of rates, and to monitor changes in the distribution of severity.

Birth Weight↗
PubMed2000

Temporal variability in birth prevalence of cardiovascular malformations.

OBJECTIVE: To investigate changes over time in the prevalence at live birth of cardiovascular malformations and to compare "anatomical" and "physiological" diagnostic hierarchies within a population. DESIGN: Retrospective and prospective ascertainment of all congenital cardiovascular malformations diagnosed in infancy. SETTING: The resident population of one health region. PATIENTS: All infants live born from 1985 to 1997 with cardiovascular malformations confirmed by echocardiography, cardiac catheterisation, surgery or autopsy. MAIN OUTCOME MEASURES: Year to year variation in prevalence of individual malformations and of "complex", "significant", and "minor" groups. RESULTS: 2671 babies with cardiovascular malformations were confirmed in a denominator population of 477 960 live births (5.6 per 1000). There was no change over 13 years in the birth prevalence of "complex" or "significant" defects, but a highly significant increase in "minor" defects (p < 0.0001), mainly small ventricular septal defects. Termination of pregnancy increased from no cases in 1985 to 16 in 1997 with no demonstrable effect on live born babies with heart defects. A one dimensional "anatomical" diagnostic hierarchy led to under ascertainment of pulmonary atresia by 27%, coarctation of the aorta by 39%, and interruption of the aorta by 100%. CONCLUSIONS: The apparent increase in live born cardiovascular malformations results mainly from improved diagnosis of minor defects. There has been no change over time in birth prevalence of more serious defects. Spontaneous year to year variation in numbers will make it difficult to ascribe any short term changes to any particular intervention. A two dimensional diagnostic hierarchy is offered as a standard.

Abortion, Therapeutic↗
PubMed1999

A closer look at General Dental Service orthodontics in England and Wales. II: What determines appliance selection?

AIM: To elucidate factors that influence choice of appliance type in General Dental Service (GDS) orthodontics in England and Wales. METHOD: Records were obtained for 1527 cases, representing a systematic 2 per cent sample of GDS cases completed during 1990-91. Evaluation involved Discriminant Analysis to find the most influential factors in appliance choice. Factors considered included patient and practitioner characteristics, and features of the malocclusion as assessed by Occlusal Indices. RESULTS: Full data were available for 1217 cases. 24 per cent of treatments included use of dual- and 26 per cent single-arch fixed appliances. Appliance choice was predictable in 55 per cent of cases. Older patients, orthodontically qualified practitioners, high Peer Assessment Rating score at start, permanent dentition, lower grades of the Dental Health Component of the Index of Orthodontic Treatment Need at start, and practitioners with high gross earnings from orthodontics, all tended to be associated with more frequent use of fixed appliances. CONCLUSIONS: Possession of a diploma or membership in orthodontics was associated with more frequent use of both dual- and single-arch fixed appliances. Better appliance selection, and thus more effective treatments in the GDS, may result from a greater availability of practitioners with formal postgraduate training in orthodontics.

Discriminant Analysis↗
PubMed1999

A closer look at General Dental Service orthodontics in England and Wales. I: Factors influencing effectiveness.

OBJECTIVE: To evaluate factors influencing effectiveness in General Dental Service (GDS) orthodontics. DESIGN: Retrospective analysis of systematic 2% sample of GDS (England and Wales) cases. METHOD: Records of cases were collected during 1991. Assessment involved occlusal indices and data from National Health Service forms for 1,411 cases. Multivariate analyses were used with Peer Assessment Rating Index (PAR) score at Finish as the outcome indicator. RESULTS: Dual arch fixed appliances: achieved lower Finish PAR scores than other appliances; only 1.5% of the variance was explained, by treatment time and Dental Health Component of the Index of Orthodontic Treatment Need (DHC). Finish PAR was unaffected by Starting PAR. All other appliances: the model explained 25% of the variance for Finish PAR, which varied with Starting PAR and DHC scores. Social class had effects of little clinical significance, but the data suggested availability of orthodontic treatment was poorer in 'manual class' areas. Orthodontic qualifications, number of arches treated and mixed dentition starts had no significant effects when submitted to multivariate analysis. CONCLUSIONS: The importance of appliance selection is reinforced: dual arch fixed appliances are generally more consistent. Lower social class areas may be poorly provided with orthodontic services.

Age Factors↗