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1,464 records · Page 82Linked to original sources
PubMed2006

Endodontics and implants, a catalog of therapeutic contrasts.

Dentists may be faced with the choice to retain a tooth by performing endodontic therapy and restoration or to extract the tooth and replace it with an implant and restoration. The purpose of this study was to catalog areas where implant and endodontic therapies differ so as to assist dentists in making treatment decisions and in identifying areas deserving of future research. Differences in diagnostic procedures and prognostic indicators were listed. With respect to treatment outcomes, study designs, success criteria, treatment results, systematic reviews, complications, clinician expertise, and the use of patient-based measures were discussed. The need for clinically applicable consensus statements and treatment protocols was noted. It was concluded that at this time, choices between implant and endodontic therapies cannot be solely based on outcomes measurement evidence; that different modes of outcome measure frustrate direct comparison; that endodontic and implant therapies profoundly differ in many ways; that although rigorous and clearly defined outcome measures have been proposed for use in endodontic and implant outcomes studies, they are very rarely used; that long-term, large, clearly defined studies, with simple and clear outcome measures, for example survival in combination with defined treatment protocols, are needed to measure the clinical performance of endodontic and implant therapies; and it was recognized that broad outcomes data may not be sufficiently specific to directly impact clinical decision making.

Consensus↗
PubMed2005

Specificity and overlap in gene segment-defined antibody repertoires.

BACKGROUND: To date several studies have sought to catalog the full suite of antibodies that humans naturally produce against single antigens or other specificities (repertoire). Here we analyze the properties of all sequenced repertoires in order to better understand the specificity of antibody responses. Specifically, we ask whether the large-scale sequencing of antibody repertoires might provide a diagnostic tool for detecting antigen exposure. We do this by examining the overlap in VH-, D-, and JH- segment usage among sequenced repertoires. RESULTS: We find that repertoire overlap in VH-, D-, and JH-segment use is least for VH segments and greatest for JH segments, consistent with there being more VH than JH segments in the human genome. We find that for any two antigens chosen at random, chances are 90 percent that their repertoires' VH segments will overlap by less than half, and 98 percent that their VDJH combinations will overlap by < or =10 percent. We ran computer simulations to test whether enrichment for specific VDJH combinations could be detected in "antigen-exposed" populations, and found that enrichment is detectable with moderate-to-high sensitivity and high specificity, even when some VDJH combinations are not represented at all in some test sets. CONCLUSION: Thus, as large-scale sequencing becomes cost-effective for clinical testing, we suggest that sequencing an individual's expressed antibody repertoire has the potential to become a useful diagnostic modality.

Algorithms↗
PubMed2005

Satellog: a database for the identification and prioritization of satellite repeats in disease association studies.

BACKGROUND: To date, 35 human diseases, some of which also exhibit anticipation, have been associated with unstable repeats. Anticipation has been reported in a number of diseases in which repeat expansion may have a role in etiology. Despite the growing importance of unstable repeats in disease, currently no resource exists for the prioritization of repeats. Here we present Satellog, a database that catalogs all pure 1-16 repeat unit satellite repeats in the human genome along with supplementary data. Satellog analyzes each pure repeat in UniGene clusters for evidence of repeat polymorphism. RESULTS: A total of 5,546 such repeats were identified, providing the first indication of many novel polymorphic sites in the genome. Overall, polymorphic repeats were over-represented within 3'-UTR sequence relative to 5'-UTR and coding sequence. Interestingly, we observed that repeat polymorphism within coding sequence is restricted to trinucleotide repeats whereas UTR sequence tolerated a wider range of repeat period polymorphisms. For each pure repeat we also calculate its repeat length percentile rank, its location either within or adjacent to EnsEMBL genes, and its expression profile in normal tissues according to the GeneNote database. CONCLUSION: Satellog provides the ability to dynamically prioritize repeats based on any of their characteristics (i.e. repeat unit, class, period, length, repeat length percentile rank, genomic co-ordinates), polymorphism profile within UniGene, proximity to or presence within gene regions (i.e. cds, UTR, 15 kb upstream etc.), metadata of the genes they are detected within and gene expression profiles within normal human tissues. Unstable repeats associated with 31 diseases were analyzed in Satellog to evaluate their common repeat properties. The utility of Satellog was highlighted by prioritizing repeats for Huntington's disease and schizophrenia. Satellog is available online at http://satellog.bcgsc.ca.

3' Untranslated Regions↗
PubMed2003

Methodological and statistical techniques: what do residents really need to know about statistics?

The purpose of this study was to catalog the statistical methods used in six journals two each from the fields of Family Practice, Emergency Medicine, and Obstetrics and Gynecology. We reviewed the quantitative articles from January 1998 through December 2000 from the Journal of Family Practice, the Journal of Family Medicine, the Annals of Emergency Medicine, the Journal of Academic Emergency Medicine. Articles from January 2000 through December 2000 of Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology were also included. Case reports and editorials were not included in this analysis. There were a total of 1828 articles reviewed (666 from Emergency Medicine articles, 380 from Family Practice, and 782 from Obstetrics and Gynecology). The distribution of study types (cross-sectional or survey, retrospective, or prospective) did not differ between the selected journals within Emergency Medicine, Family Practice, or Obstetrics and Gynecology. Pearson's chi-square/Fisher's Exact test was the statistic of choice overall (47.5%) followed by Student's t-test (33.1%). Analysis-of-variance was used in 23.3% of the studies, nonparametric methods (8.1%), linear regression (17.6%), and odds ratios/logistic regression (17.4%). Other statistical procedures were used less than 10% of the time. These results show that a physician who comfortably comprehends the appropriate use of descriptive statistics Student's t-test, Pearson's chi-square/Fisher's Exact test will be able to read and interpret at least 70% of the published medical literature. Educational efforts should focus on appropriate study design and analysis.

Clinical Competence↗
PubMed2002

Reading habits of practicing physiatrists.

OBJECTIVE: Over the past 30 yr, the number of ACGME accredited specialties has quadrupled, and the number of journals cataloged on MEDLINE has doubled. Given this increase of information, this study sought to determine the amount and extent that pertinent journals are read by specialists in the field of physical medicine and rehabilitation. DESIGN: From a randomly selected list of board-eligible physiatrists and diplomates of the American Board of Physical Medicine and Rehabilitation, 1204 resident physicians, fellows, and attending physicians were sent questionnaires concerning their reading habits. The questionnaire contained a list of 36 journals adapted from a list of journals previously published as being pertinent to physical medicine and rehabilitation. Physicians were asked to specify which journals they read over the past year and how extensively these were read. Respondents were also asked to note whether they participated in an academic or private practice and if they read as much as they would like. RESULTS: The results revealed that very few journals were always read thoroughly, with the modal response among the more popular journals being that of "always scanned the table of contents and read the most important articles." Academic physiatrists were noted to read more than their private practice counterparts. Of the subspecialists who replied, 67% read a journal pertinent to their subspecialty. Eighty-three percent of all respondents reported that they did not read as much as they would like. CONCLUSION: Physiatrists are rarely able to completely read the most relevant journals in their field. When reading journals, most physiatrists only scan the table of contents and read the most important abstracts.

Attitude of Health Personnel↗
PubMedDate not supplied

Framework for pharmacy services quality improvement--a bridge to cross the quality chasm. Part I. The opportunity and the tool.

OBJECTIVE: To review the literature on the subject of quality improvement principles and methods applied to pharmacy services and to describe a framework for current and future efforts in pharmacy services quality improvement and effective drug therapy management. BACKGROUND: The Academy of Managed Care Pharmacy produced the Catalog of Pharmacy Quality Indicators in 1997, followed by the Summary of National Pharmacy Quality Measures in February 1999. In April 2002, AMCP introduced Pharmacy's Framework for Drug Therapy Management in the 21st Century. The Framework documents include a self-assessment tool that details more than 250 specific "components" that describe tasks, behaviors, skills, functions, duties, and responsibilities that contribute to meeting customer expectations for effective drug therapy management. FINDINGS: There are many opportunities for quality improvement in clinical, service, and cost outcomes related to drug therapy management. These may include patient safety; incidence of medical errors; adverse drug events; patient adherence to therapy; attainment of target goals of blood pressure, glucose, and lipid levels; risk reduction for adverse cardiac events and osteoporotic-related fractures; patient satisfaction; risk of hospitalization or mortality; and cost of care. Health care practitioners can measure improvements in health care quality in several ways including (a) a better patient outcome at the same cost, (b) the same patient outcome at lower cost, (c) a better patient outcome at lower cost, or (d) a significantly better patient outcome at moderately higher cost. Measurement makes effective management possible. A framework of component factors (e.g., tasks) is necessary to facilitate changes in the key processes and critical factors that will help individual practitioners and health care systems meet customer expectations in regard to drug therapy, thus improving these outcomes. CONCLUSIONS: Quality improvement in health care services in the United States will be made in incremental changes that rely on a structure-process-outcome model. The structure is provided by evidence created from controlled randomized trials and other studies of care and system outcomes that are based on the scientific method. The process portion is created by the application of evidence in the form of clinical practice guidelines, clinical practice models, and self-assessment tools such as Pharmacy's Framework for Drug Therapy Management. Incremental changes in structure and process will result in the desirable outcome of meeting customer needs for more effective drug therapy and disease management.

Guidelines as Topic↗