Abstract Introduction The aim of this study was to compare the cyclic fatigue resistance of 3 nickel-titanium (NiTi) endodontic instruments from ProTaper, WaveOne (WO), and Twisted Files (TF). ...Methods Cyclic fatigue testing was conducted by operating instruments from ProTaper F2, WO 25 .08, and TF 25 .08. A total of 184 instruments were rotated in 4 curved artificial canals with different angles and radius of curvature. The time and cycles to failure were calculated. The data were compared for differences by using 2-way analysis of variance ( P < .05). Results In general, WO was the most resistant to fatigue failure of the tested instruments, and TF showed a higher number of cycles to failure than ProTaper. Conclusions Reciprocating movement of WO showed a longer cyclic fatigue life than conventional rotary movement of TF and ProTaper. The new manufacturing twisting process of TF produced NiTi rotary instruments more resistant to fatigue than ProTaper instruments produced with the traditional NiTi grinding process.
From a political and governance perspective Spain is a decentralized country with 17 states comunidades autónomas resulting in a governmental structure similar to a federal state. The various state ...regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.
For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it ...correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector.
To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept.
A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug.
The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis.
The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article.
The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0–27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7–16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4–11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001).
There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations.
There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation.
It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.
The objective was to evaluate the efficiency of ProTaper Gold (PTG) and Reciproc Blue (RB) NiTi files in obturation material removal from straight root canals assessed by micro-computed tomography.
...Fifty-two anterior human teeth were shaped with a PTG rotary system until F2 (25/.08). Specimens were obturated with a continuous wave of condensation technique. For retreatment, specimens were randomly distributed in two experimental groups: PTG group (F4 file) and RB (R40 file). Micro-CT scans were performed before and after retreatment procedures. The percentage of the remaining obturation material compared to the original volume was calculated, as well as the retreatment time. The presence of separated files was recorded. A descriptive analysis was carried out, and nonparametric tests were employed.
The mean percentages of remaining obturation material in the PTG group and the RB group were 4.14 ± 4.30% and 4.18 ± 4.29%, respectively. The mean retreatment times for the PTG and RB groups were 144 ± 51 and 163 ± 88 s, respectively. There were no statistically significant differences, neither in removal efficiency (
> 0.05) nor in retreatment time (
> 0.05), between the two groups. The coronal and middle thirds presented significantly more remaining obturation material than the apical third (
< 0.05). No file separation occurred.
ProTaper Gold and Reciproc Blue present with comparable efficiency in removing the obturation material, with a similar mean retreatment time.
Background The analysis of how people search and "navigate" the internet to obtain health-related information and how they communicate and share this information can provide valuable knowledge about ...the disease patterns behaviour and health habits of populations. Objective To determine the population's interest in drug-related problems through information search trends. Method A descriptive ecological correlational study, based on obtaining Google Trends data. Variables studied: relative search volume (RSV), evolution over time, milestones and seasonality. Results The most searched topic was drug overdose, with mean RSV of 56.25 + or - 0.65. The highest increase occurred in the contraindication topic (R.sup.2 = 0.87, p < 0.001). The main milestone was observed in the drug overdose topic in July 2018 (RSV = 100). A very close relationship was found between adverse drug reaction and contraindication (R = 0.89, p < 0.001). Slight seasonality was noted in the adverse drug reaction (augmented Dickey-Fuller test ADF = -1.96), contraindication (ADF = -2.66) and drug interaction (ADF = -1.67) topics, but did not show an epidemiological trend. Conclusions The greatest public interest was found in the drug overdose and contraindication topics, which showed a stronger upward trend, although the seasonality study did not show any very notable data or demonstrate epidemiological information search behaviour. The main milestone observed was due to media factors related to the consumption of narcotics. There was a clear difference in English-speaking countries in the use of the drug overdose topic. A correlation between the adverse drug reaction and contraindication topics was confirmed. Graphical Keywords: Access to information, Internet access, Information-seeking behaviour, Medication errors, Drug interactions, Drug overdose, Drug-related side effects and adverse reactions, Contraindications, drug
The aim of this study was to perform a 8-year prospective clinical investigation on the survival rate of feldspathic ceramic veneers, as well as analyse the influence of the occlusal splint in ...patients with parafunctional bruxism.
Three hundred and sixty-four veneers fabricated using conventional feldspathic ceramic were provided in 64 patients. The patient sample included 40 individuals with bruxism. During the follow-up period, the effect of wearing the occlusal splint on the incidence of failure (fracture and/or debonding) in patients with bruxism was also assessed. The survival rate of veneers was determined using the Kaplan-Meier estimator. Statistical significance was set at p < 0.05 with a confidence interval of 95%.
The occurrence of fracture for the feldspathic veneers tested in this study was 7.7%, while only 1.9% of the total number of veneers debonded. The overall survival rate was 93.7% after 3 years, 91% after 5 years, and 87.1% after 8 years. Patients with bruxism using an occlusal splint showed a survival rate of 89.1% after 7 years, while the survival rate in patients with bruxism using no occlusal splint was 63.9% (p < 0.05).
This study confirmed that feldspathic veneers may represent a suitable clinical solution for indirect aesthetic restorations. Such a treatment may be an option also for those patients affected by bruxism, as long as they regularly wear an occlusal splint. However, patients with bruxism using no occlusal splint may still present a potential high-risk of failure and/or debonding.
Background
There is little information regarding the community pharmacy blood pressure (CPBP) measurement method and their differences with home (HBP) or ambulatory BP (ABP). The aim of this study ...was to measure such differences and their variation over successive visits.
Method
Cross-sectional study carried out in eight pharmacies in Gran Canaria (Spain). The study included 169 treated hypertensive patients. BP was measured at the pharmacy (four visits), at HBP (4 days) and 24-h ABP monitoring. We defined pharmacy white-coat effect (PWCE) as differences between CPBP and HBP (home PWCE) or daytime ABP (ambulatory PWCE).
Results
The overall (pooled values for all visits) ambulatory PWCE was not significantly different from zero for systolic BP (SBP) (−0.4mmHg (95% confidence interval (CI): −1.8 to 1.1)), but greater than zero for diastolic BP (DBP) (3.4mmHg (95% CI: 2.3 to 4.6)). The overall home PWCE was not significantly different from zero, both for SBP (1.2mmHg (95% CI: −0.1 to 2.6)) and DBP (0.1mmHg (95% CI: −0.7 to 1.0)). The ambulatory and home PWCE on the first visit were greater than zero (P < 0.001) (SBP/DBP): 3.5/4.8 and 1.9/1.5mmHg, respectively; but showed important reductions at the second visit and became not significantly different from zero, except the ambulatory PWCE in DBP, which persisted until the last visit.
Conclusion
The trend in the PWCE decreased over the successive visits to the pharmacy. Only the ambulatory PWCE in DBP proved to be statistically greater than zero after the second visit. Repeated CPBP measurements could be a useful alternative to assess the response to antihypertensive treatment.
American Journal of Hypertension, advance online publication 21 April 2011; doi:10.1038/ajh.2011.68
An oxamato‐bridged CoIICuII chain compound has been obtained via the self‐assembly of mononuclear bis‐bidentate copper(II) anionic building blocks and cobalt(II) cations. It is the first example of a ...heterobimetallic ferrimagnetic chain that incorporates slow magnetic relaxation behavior (see Figure).
The coordinating properties of
N,
N′-bis(coordinating group substituted)oxamides have been thoroughly investigated both in aqueous solution and in the solid state. The easy
cis–
trans isomerization ...equilibria that they exhibit together with the great variety of
N,
N′-substituents which can be used to play on the overall charge, complexing ability and polarity, make them very suitable ligands in designing homo- and heterometallic species. The knowledge of their complex formation in aqueous solution by potentiometry and using the hydrogen ion concentration as a probe, allowed us to settle the basis of a rational design of oxamidate-containing polynuclear species whose nuclearity can be easily tuned. Concerning their electronic properties, the strong basicity of the deprotonated amide–nitrogen atoms stabilizes high oxidation states of late first-row transition metal ions. Finally, one of the most appealing aspects of this type of ligands is the remarkable efficiency they exhibit to mediate strong antiferromagnetic interactions between paramagnetic centres when acting as bridges but in order to maintain the present work within a rational length, we have omitted this last point which deserves a further review.
Summary
What is known and Objective
Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative ...outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided.
Methods
This descriptive, cross‐sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts.
Results and Discussion
Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood‐forming organs.
What is new and Conclusion
A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.
Distribution of the severity of the negative outcomes associated with medication by categories (necessity, effectiveness and safety). NOAM, negative outcomes associated with medication. This figure shows that there was a high percentage of serious NOAM (classified as severe and fatal) in every category (necessity, effectiveness and safety) in patients with chronic atrial fibrillation who present at the emergency department.
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