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We describe the formation of the BAPRAS Innovation Group, the first ever specialty-specific innovation group designed to foster innovation among its members and provide an environment for innovation to flourish. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare associated infections (HAI), such as Meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. Diff) are estimated to cost the NHS £1 billion and contribute to 5000 deaths/year in the UK. To date the main emphasis to reduce HAIs has been on hand hygiene. However environmental microbial load and compliance limits the efficacy of hand washing alone. Cultures from tourniquets have demonstrated contamination by pathogens including MRSA. Consequently, many UK trusts are introducing disposable tourniquets as policy. The use of most disposable tourniquets is still limited, as few are able to maintain patient comfort, ease of use and cost effectiveness. This study compares patient and phlebotomist experiences of the single-use tourniquet, Tournistrip™, with currently available disposable and re-usable alternatives. Methods: The trial was performed in on patients attending two West London teaching hospital outpatient phlebotomy departments, over a four week period. After Tournistrip™ use, the patients were invited to fill in an anonymous questionnaire, covering comfort and appearance. A separate questionnaire was filled in by the phlebotomists. Results: Ninety five percent of patients found the Tournistrip™ professional looking, with 54% preferring it to the current re-usable alternatives. One hundred and seventy eight of the 227 patients found Tournistrip™ comfortable. Overall, 85% of patients found Tournistrip™ at least as good, if not better than re-usable tourniquets. All of the phlebotomists found the Tournistrip™ professional looking, and none preferred previously used disposable alternatives. Ninety-five percent found it as easy to use as a re-usable and none found previous disposables better to use. Discussion: The Tournistrip™ was designed to match the comfort and ease of use of the re-usable tourniquet, whilst maintaining cost efficacy. This clinical trial shows the Tournistrip™ is viewed as a superior tourniquet to the current generation of disposables and a viable replacement to the re-usable tourniquet in the continuing challenge to reduce HAIs. [ABSTRACT FROM AUTHOR]

Background: We performed a cross sectional study to determine the attitudes of surgical trainees and medical students towards virtual reality (VR) simulation in surgical training. A survey was devised through an iterative process before distribution to surgical trainees, foundation year doctors and medical students through online platforms., Methods: The survey was disseminated within the United Kingdom through social media and email correspondence, in co-operation with national surgical organisations. 91 trainees responded from a variety of clinical specialities., Results: VR technology in surgical training was viewed positively, with 91.3% of trainees agreeing that VR should be both an adjunct in surgical training as well as a competency-based assessment tool. Barriers to access were present, with access notably more challenging for senior surgeons., Conclusion: Virtual reality surgical simulation in surgical training is beginning to emerge as a genuine high-fidelity, low-risk solution to the lack of surgical case volume trainees are currently experiencing.

Introduction: The World Health Organization (WHO) surgical safety checklist (SSC) has had an overall positive impact; however, it has not completely prevented adverse events and compliance with the checklist varies. The aviation industry is considered to have better engagement with their safety checklists, reporting not only safety improvements, but also a cultural shift in their checklist philosophy over recent years., Methods: We explored the personal attitudes of pilots working in the aviation industry to identify principles of an effective checklist philosophy that could be transposed to the healthcare setting to empower more effective, consistent and ultimately successful implementation of the WHO SSC. A questionnaire was developed by the authors. Three airline pilots were interviewed via telephone, and asked questions regarding the logistics of and attitudes to checklists in the aviation industry., Results: Several key factors for successful checklist implementation were identified. These include regular training and education on human factors and the checklist's purpose, and institution of an atmosphere that is receptive, engaged and welcoming. Much can be learned from the aviation industry, where not only has the incidence of adverse events decreased, but the attitudes of people working in the industry have also transformed., Conclusion: The WHO SSC is an invaluable tool used in healthcare settings worldwide. However, it is not a standalone commodity. To be effective, it necessitates steadfast engagement from the team members involved in its implementation. Human and checklist must work in partnership, using each other's strengths and fallibilities, to optimise outcomes and prevent risks to patient safety.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: A team of authors in Oxford are attempting to pursue a similar adaptation to help with the aforementioned personal protective equipment (PPE) shortages. They have been performing the necessary fit testing and have submitted an option to an independent notification body for the necessary extensive testing in order to be certified as PPE and cleared for safe clinical use. The authors do not recommend its use prior to getting said certifications and write this correspondence purely for informative purposes.

Introduction: There is a reduction in Foundation trainee applications to speciality training and this is attributed to an administrative job role, with subsequent fears of burnout. This pilot study presents the findings of a real-time self-reporting tool to map a group of Foundation doctors' elective activities. Self-reporting is efficient, low cost to run and allows for repeated measures and scalability. It aimed to example how a time-map could be used by departments to address any work imbalances and improve both well-being and future workforce planning., Method: Foundation doctors', at a busy District General Hospital, were asked to contemporaneously report their work activities over an 'elective' day. Outcomes measures included the mean duration per task and the time of day these were performed., Results: Nine Foundation doctors' returned 26 timesheet days. Foundation doctors' time was split between direct patient tasks (18.2%, 106.8 min per day), indirect patient tasks (72.9%, 428.6 min per day) and personal or non-patient activities. Indirect tasks were the most frequent reason for Foundation doctors leaving late. No clinical experience was recorded at all and only an average of 4% (23.4 min per day) of a Foundation doctors' time was spent in theatre., Conclusions: This particular cohort performed a high proportion of indirect tasks. These have been associated with burnout. Time-mapping is a low-cost, acceptable and seemingly scalable way to elucidate a clearer understanding of the type of activities Foundation doctors may perform. This methodology could be used to modernise the traditional Foundation doctor job description., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The nipple-areola complex (NAC) is important aesthetically and functionally for both sexes. Methods for positioning the NAC in males are less well established in the literature compared to females but are just as important., Objectives: This study aims to determine the normal parameters for the male NAC, to review literature, and to present a reliable method for preoperative placement., Methods: Normal male patients, with no prior chest wall conditions, were prospectively recruited to participate. General demographics and chest wall dimensions were recorded-sternal notch to nipple (SNND), internipple (IND), anterior axillary folds distances (AFD), NAC, and chest circumference were measured. Comparisons were made using t test and ANOVA., Results: One hundred and fifty-eight patients were recruited (age range, 18-90 years); mostly (86.7%) with normal or overweight BMI. The IND averaged 249.4 mm, the SNND averaged 204.2 mm, and the AFD averaged 383.8 mm. Areola diameter averaged 26.6 mm and for the nipple, 6.9 mm. The IND:AFD ratio was 0.65. There was no statistical difference in the IND:AFD ratio, SNND, or NAC parameters comparing different ethnic groups. The SNND increased with greater BMI (P ≤ 0.001). Using these data, we suggest ideal NAC dimensions and devised a simple method for positioning of the NAC on the male chest wall., Conclusions: This is the largest study, with the widest range in age and BMI, to date on this topic. Although fewer men than women undergo surgery to the breast, there is a growing awareness for enhancing the appearance of the male chest wall.

The return of genetic research results after death in the pediatric setting comes with unique complexities. Researchers must determine which results and through which processes results are returned. This paper discusses the experience over 15 years in pediatric cancer genetics research of returning research results after the death of a child and proposes a preventive ethics approach to protocol development in order to improve the quality of return of results in pediatric genomic settings., (© 2015 American Society of Law, Medicine & Ethics, Inc.)

Purpose: Articulation paper mark size is widely accepted as an indicator of forceful tooth contacts. However, mark size is indicative of contact location and surface area only, and does not quantify occlusal force. The purpose of this study is to determine if a relationship exists between the size of paper marks and the percentage of force applied to the same tooth., Materials and Methods: Thirty dentate female subjects intercuspated into articulation paper strips to mark occlusal contacts on their maxillary posterior teeth, followed by taking photographs. Then each subject made a multi-bite digital occlusal force percentage recording. The surface area of the largest and darkest articulation paper mark (n = 240 marks) in each quadrant (n = 60 quadrants) was calculated in photographic pixels, and compared with the force percentage present on the same tooth., Results: Regression analysis shows a bi-variant fit of force % on tooth (P<.05). The correlation coefficient between the mark area and the percentage of force indicated a low positive correlation. The coefficient of determination showed a low causative relationship between mark area and force (r(2) = 0.067). The largest paper mark in each quadrant was matched with the most forceful tooth in that same quadrant only 38.3% of time. Only 6 2/3% of mark surface area could be explained by applied occlusal force, while most of the mark area results from other factors unrelated to the applied occlusal force., Conclusion: The findings of this study indicate that size of articulation paper mark is an unreliable indicator of applied occlusal force, to guide treatment occlusal adjustments.

Objective: Iron deficiency is associated with paediatric sleep disturbances; in particular, restless leg syndrome (RLS) and periodic limb movement disorder (PLMD). Correction of iron deficiency has been shown to improve sleep disordered breathing (SDB) in certain adult populations. We evaluated the iron status of children diagnosed with SDB undergoing adenotonsillectomy., Methods: Consecutive children undergoing adenotonsillectomy for SDB between January 2007 and January 2008 were analysed. Routine blood tests were performed including full blood count and iron studies. Children were grouped according to age; 0-2 years (group A), 2-6 years (group B) and above 6 years (group C). Results were compared to local normal values and published data regarding normal values for paediatric populations., Results: 94 children were included (60 male, 34 female). Mean age was 3.9 years (range 1.2-13.4 years). Iron deficiency was most marked in group A (n=8), with levels of ferritin (12.4), Mean Cell Haemoglobin (MCH) (25.0), iron saturation (16%, normal 20-40%) all below normal and Hb at the bottom of the normal range (11.0, normal 11-14.5). In group B (n=76), ferritin (19.4) and MCH (26.5) were again below normal but were higher than for group A. Average Hb for group B was 11.9., Conclusion: The association between low iron and SDB in children has not previously been described. The results of this study highlighted low iron status in the children undergoing adenotonsillectomy for SDB. This was most severe in children under 6 years old. It is unclear whether low iron levels represent a cause or effect of SDB.

Computerized occlusal analysis is becoming the principal tool available to clinicians with which to understand functional and parafunctional forces of occlusal contact, contact timing sequences, and occlusal surface interface pressures, which arise as teeth mill against each other during mandibular movements. Because recent research on articulating paper has revealed that articulating paper mark size does not measure occlusal forces predictably, the modern clinician needs to employ an occlusal contact measuring device that can reliably determine aberrant occlusal force concentrations and time prematurities. Computerized occlusal analyses can be used to guide the operator as to which tooth contact locations require appropriate occlusal adjustments. When inserting Cerec restorations, computerized occlusal analysis can be employed to target excessive force concentrations and time premature contacts to better preserve the Cerec materials, than can be accomplished with "articulating paper-only" occlusal adjusting. This paper describes the evolution of computerized occlusal analysis, the system attributes, and illustrates its use in case-finishing Cerec bonded lingual guidance veneers.

A computer system has been developed that can accurately record occlusal contact events in real time in a dynamic "movie" form. The literature regarding this computer technology and the currently understood clinical applications in which measurable precise occlusal endpoints can be obtained is reviewed.

Locating the first tooth contact that interferes with freedom of movement in and out of centric relation has been the diagnostic and treatment objective of most occlusal therapies. The centric relation prematurity can be located by various methods, which involve operator-guided mandibular positioning combined with the patient's subjective assessment of his or her perceived first tooth contact. The method known as bimanual manipulation has been widely recognized and accepted as a predictable method of determining and verifying the centric relation position. The first occlusal contact that results when the mandible is closed on a correct centric relation axis is known as the centric relation prematurity. An alternative procedure combines bimanual manipulation with the simultaneous recording of the sequence of resultant tooth contacts using a computerized occlusal analysis system. This alternative offers a significant improvement in the precision of locating the first tooth contact. This article describes a method of identifying the first tooth contact while not relying on the patient's subjective assessment of his or her perceived occlusal feel.

Implant fixture positioning and inclination problems that result from poor osseous height, width, and ridge configuration have created difficult prosthetic tooth replacement scenarios. Options for ameliorating poor angulation are limited to the use of preangled and custom abutments. Overcoming poor angulation has been simplified by using custom vs preangled abutments because preangled abutments are limited by their standardization to a few random angles. Custom abutments can be more predictably formed to re-create the desired supporting preparation orientation and morphology. This facilitates the formation of anatomical gingival topography and coronal contours for prosthetic replacement. Cast, ceramic, and machine-milled titanium abutments have several advantages and disadvantages. A new custom abutment system that uses computer-guided manufacturing technology to machine mill custom abutments from commercially pure titanium is described. These abutments are anatomically correct, have the proper emergence anatomy, proper spatial design at the cervical margins, necessary occlusal reduction, and the proper axial angulation of ideal tooth preparations. A clinical case that illustrates implementation, with respect to the principle of stage 2 guided tissue healing, is presented.

The long-term success of an implant-supported prosthesis is related to the management of occlusal forces upon the restoration. Since implants are not anchored in bone with periodontal ligament proprioceptors, subjective confirmation by the patient is not always an accurate means of determining occlusion. A computerized occlusal analysis system has been developed to determine the timing and nature of the occlusal forces on tooth contacts. This article details the implementation of this system as an aid in the occlusal adjustment procedure of an implant-supported fixed/detachable prosthesis.

Force loading of dental prosthesis is generally a guessing game played by the operator with the patient. Relying on a patient is comfort level to adjust occlusion is now being replaced by sound force information provided by the T Scan II. Proper use of the T Scan II when installing a segmental fixed prosthesis gives a more precise, comprehensive occlusion. Porcelain surfaces, solder joints, and the underlying abutment teeth can now be loaded with low-to-moderate forces because the operator can fine-tune the occlusal forces precisely. With proper force loading, greater material and prosthesis longevity is significantly enhanced.

The purpose of this study is to assess what impact shortening disclusion time to less than .5 seconds during right and left mandibular excursions has on myofascial pain(s) symptoms present in a dental student population. Twenty-five dental students, who exhibited symptomatology consistent with myofascial pains patient, were divided into a treatment, control, and an untreated group. They participated in an occlusal adjustment study which measured changes in disclusion time, as well as, myofascial pains muscular symptom remissions resultant from treatment. The treated group of ten subjects received ICAGD occlusal adjustments to shorten their disclusion time to less than .5 seconds per mandibular excursion. The goal of this therapy was to totally disclude the posterior teeth in a measurable time frame of .5 seconds or less. The control group of eight subjects received mock ICAGD with tooth polishing. The goal of this therapy was to simulate ICAGD adjustments for possible placebo effect on symptom remissions. The untreated group had their disclusion times measured but received no treatment to adjust, or to simulate adjustment to their occlusion. The goal of analyzing an untreated group was to attempt to show that mock treatment (performed on the control subjects), or no treatment (performed on the untreated subjects), resulted in no measurable change in the disclusion time in either of these two subject groups. Each subject was recalled for disclusion time measurement four to five times in a one-year period of observation, at which time, they were required to report their myofascial pains symptom status by answering an ordinal scale questionnaire. The results suggest that shortening disclusion time to less than .5 seconds per mandibular excursion can induce remissions of many muscular myofascial pains symptoms. Additionally, mock ICAGD occlusal adjustments did not appear to be a factor in the control subjects treatment response, as this group showed no statistically significant symptom remissions.

A recall study of 102 myofascial pain dysfunction syndrome-temporomandibular disorder (MPDS-TMD) patients, treated with disclusion time reduction therapy from 1983 to 1991, was undertaken to determine the long-term results of this treatment on symptom reductions. The patients were asked to fill out a symptom questionnaire which used ordinal number scales to determine their disease status (frequency and intensity of muscular, joint and dysfunctional symptoms; frequency of medication and appliance use) before and after they were treated with disclusion time reduction. The statistical results indicate that discluson time reduction therapy is a highly effective treatment regimen for MPDS and that it has lasting effects on symptom reduction. In addition, the results of this recall study indicate that occlusion, and more specifically, lengthy pretreatment disclusion time, does play a primary role in the symptomatology, and most probably, in the etiology of MPDS and TMD.

From a pool of 89 patients, 49 patients were classified as having chronic myofascial pain dysfunction syndrome (MPDS), and 40 were classified as asymptomatic or non-MPDS patients designated as the control group for the study. To achieve balanced sample size in both groups, 40 patients were arbitrarily selected from the MPDS group. All patients from each of the two primary groups were then categorized and assigned to one or more subgroups according to the following criteria: (1) jaw classification, (2) open occlusion, (3) previous orthodontic therapy, or (4) no previous orthodontic therapy. A fifth subgroup composed of only MPDS patients and equally divided into those who had or had not experienced orthodontic therapy was established to determine whether mean disclusion time differences occur between orthodontic and nonorthodontic MPDS patients. All 80 patients were evaluated for disclusion time of their right and left mandibular excursions to determine statistical population comparisons. Statistical assessment of right and left disclusion times for women and men in the MPDS and non-MPDS groups was performed separately for each of the five subgroups. Analysis of the comparisons revealed that in all except two of the subgroups, mean disclusion time was significantly longer in the MPDS patient group than in the non-MPDS group. The two subgroups in which this was not apparent were those with open occlusion and orthodontic patients compared with nonorthodontic patients. These findings suggest that lengthy posterior disclusion time may be of diagnostic importance when the differing etiologic factors of chronic MPDS patients are evaluated.

Six of seven women were recalled after 1 year to remeasure their right- and left-side working disclusion times. Before the occlusal adjustment technique known as immediate complete anterior guidance development (ICAGD), these patients presented lengthy mean disclusion times (> 1.0 second) and multiple chronic myofascial pain dysfunction syndrome (MPDS) symptoms. After ICAGD, these patients presented with short mean disclusion times (< 0.7 second) and no chronic MPDS symptoms were observed. At 1-year follow-up, there was no statistical difference between present measurements of disclusion time and those of 1 year earlier. In addition, all six posttreatment patients demonstrated no observed chronic MPDS symptoms. However, the symptom of nocturnal bruxism appeared to recur with some chronic regularity. These results suggest that, for this population, disclusion time was stable over the 1-year period of observation, and the short disclusion time appears to allow normal daily muscle function with significantly lessened appearance of chronic myofacial pain dysfunction symptoms.

Traditional occlusal equilibration has been advocated by numerous authors as a treatment modality for chronic myofascial pain dysfunction syndrome. However, treatment predictability and reliable clinical success has not been reported by all authors. Some report no correlation between occlusal contacts and chronic myofascial pain dysfunction syndrome. Recent publications and manuscripts have described a new occlusal adjustment technique which is aimed at reducing lengthy pretreatment disclusion time in mandibular excursions. This reduction in disclusion time physiologically and rapidly reduces contractile muscle activity in the masseter and temporalis muscles, which leads to the resolution of numerous chronic myofascial pain dysfunction syndrome (MPDS) symptoms. This new occlusal adjustment process is known as Immediate Complete Anterior Guidance Development (ICAGD). The purpose of this article is to describe the important differences in focus, sequence, and theory between traditional occlusal equilibration and ICAGD.

Successful treatment of chronic myofascial pain-dysfunction syndrome by disocclusion time-reduction therapy has been shown to be effective in 1 to 3 months, with the major muscular changes occurring in the first 30 to 40 days following initial therapy. Disocclusion time reductions have been previously reported to quickly reduce or eliminate numerous symptoms of chronic myofascial pain-dysfunction syndrome. Proper modification of an existing occlusal scheme from one that contains lengthy disocclusion time to one with short disocclusion time can be accomplished by implementing the method of occlusal adjustment known as immediate complete anterior guidance development. This paper describes the proper clinical occlusal adjustment methodology using a computerized device that shows the measurement and subsequent reduction of excessive disocclusion time. This directly lessens elevated contractile muscle activity, which leads to rapid muscular recovery of the involved dysfunctional muscle groups.

Seven women patients at Tufts University School of Dental Medicine were evaluated for the subjective symptoms of a myofascial pain dysfunction. Each patient was evaluated by an occlusal analysis of the T-Scan computer to determine posterior disclusion time during excursive movements, and EMG analysis of the masseter and temporalis muscles. Each patient was then treated occlusally by developing immediate complete anterior guidance. This adjustment process involved the removal of all lateral and protrusive interferences prior to habitual closure adjustments. No attempt was made to retrude the mandible in centric relation, and splints were not used to deprogram the musculature before adjustment. In this study, protrusive movements and interferences were not examined, and there was no control group. Posttreatment EMG and T-Scan computer analyses revealed that by shortening disclusion times to less than 0.5 second in any lateral excursions, muscle function returned to normal in all seven patients in approximately 1 month's time. A direct correlation seemed to exist between contractile muscle activity and disclusion time. Lengthy disclusion time leads to excessive muscle activity that introduces spasm and fatigue of the masseter and temporal muscles. These results indicated that a partial explanation of the etiology of MPDS may be the time the molars and nonworking premolars remain in contact during excursive movements--a phenomenon termed "disclusion time."

Fifty-three patients with a diagnosis of chronic myofascial pain-dysfunction syndrome were treated with occlusal equilibration to establish complete anterior guidance. In approximately 5 to 7 days after treatment, most myofascial pain dysfunction symptoms disappeared and complete symptom resolution was usually attained within 3 weeks. The common symptoms all patients had were (1) pain and fatigue in the masseter and temporal muscles, (2) nocturnal bruxism, (3) jaw tension on waking up, and (4) difficulty chewing some foods. All patients had an absence of true anterior guidance with molar interferences in all excursive movements. Many patients had previously undergone orthodontic therapy and had "ideal" vertical tooth relationships. Treatment consisted of occlusal equilibration to remove all posterior interferences and establish anterior guidance. Three appointments, 1 week apart, were alloted for treatment. Major symptom reduction occurred after the first appointment. Four-year follow-ups reveal no recurrence of chronic symptoms after treatment completion.