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The Consultant in Dental Public Health and the Local Dental Committee in East Lancashire have developed a local system, similar to that being set up for general medical practitioners, to help general dental practitioners whose performance is causing concern. GDPs approved it at an open meeting of practitioners. A Dental Performance and Assessment Group has been set up and one problem has already been resolved to everyone's satisfaction. The model is recommended to dentists in other areas. [ABSTRACT FROM AUTHOR]

On 30 September 2009 at 05:16 pm local time (10:16 am UTC), a major earthquake registering a magnitude M 7.6 occurred off the coast of Padang in West Sumatra. This paper presents the observations from a reconnaissance mission that investigated the performance of structures, infrastructure and geotechnical structures within the affected region. As well as presenting the detailed observations made on the mission, insights as to why structures failed and deficiencies in the construction practices of the region are also presented. Considering the high seismic risk of this area and that seismic gaps suggest another earthquake with a magnitude greater than 8.7 may occur, these observations are particularly significant. One of the vital features of this earthquake was a number of very large and devastating landslides that occurred in the district of Pariaman. These landslides were not only extensive, but had an extremely high lethality. Another key feature of the earthquake was the surprisingly high number of government buildings that collapsed. The paper concludes by presenting a number of recommendations for both the rebuilding of failed structures as well as for hazard assessments of existing structures and geotechnical features. [ABSTRACT FROM AUTHOR]

Summary: The inpatient principal diagnosis in Medicare claims identified 96% of hip fractures in hospitalized nursing home residents with high rates of confirmation by other claims files. Introduction: Hip fracture is typically identified in Medicare claims by examining only the principal diagnosis in the inpatient file, but this simple approach might be inadequate for nursing home residents. Our objective was to examine the impact of varied operational definitions for identifying hip fracture hospitalizations in administrative claims data. Methods: We conducted a retrospective examination of Medicare inpatient and outpatient claims data for dually Medicaid- and Medicare-eligible nursing home residents in 1999 in California, Florida, Missouri, New Jersey, and Pennsylvania ( n = 197,514). We determined the number of hip fractures identified in inpatient (Medicare A) diagnoses codes using differing definitions that varied according to whether or not hip fracture was required to be the principal diagnosis and whether or not confirmatory imaging and procedure codes were required to be found in other (Medicare B) claims files. Results: Hip fractures were found in any inpatient diagnosis position in 4,680 subjects, with 4,479 of these found in the principal diagnosis position. With either approach to diagnosis position, confirmatory imaging and procedure codes were identified for 95% of persons hospitalized with hip fracture. Conclusion: The principal diagnosis alone will identify 96% of hip fracture diagnoses in hospitalized nursing home residents. Such diagnoses are confirmed at very high rates by other sources of claims data. Researchers may be confident using a simple approach to identifying hip fracture hospitalizations in this population, using inpatient claims alone and interrogating only the principal diagnosis position. [ABSTRACT FROM AUTHOR]

Objective: To examine the methods used by policy makers to try to reduce or limit expenditure within the National Health Service.Method: A chronological examination of cost related health care policy and its wider impact on society. Comparison of past developments in the NHS with new methods of health care organisation in the United Kingdom (UK). The experiences of two dental Total Purchasing Pilots are used to describe where the dental profession now stands in relation to current NHS developments.Results: The introduction of Primary Care Groups (PCGs) constitutes part of a continued effort by health care policy makers to control expenditure on health services. In the PCG system, as in Total Purchasing (TP), a group of primary care practitioners control a finite budget. These groups therefore must decide which health care services should be available to the population they represent. Inevitably such systems result in the rationing of health care, but the decisions are instigated by primary health care professionals rather than by government edict.Conclusion: Unless GDPs are allowed, willing and able, to participate in and influence the newly emerging Primary Care Groups and Trusts, dental services may once again be pushed to the fringe of NHS care provision. Without adequate representation, the value of dental care may not be recognised and PCGs may decide to make use of traditional dental resources, to fund other services. [ABSTRACT FROM AUTHOR]

Context: There is agreement that warfarin decreases stroke risk in patients with atrial fibrillation (AF), but prior studies suggest that warfarin is markedly underused, for unclear reasons.Objective: To determine if warfarin is underused in the treatment of patients with atrial fibrillation.Design: Cross-sectional.Setting: Tertiary care VA hospital.Patients: All patients with a hospital or outpatient diagnosis of AF between 10/1/95 and 5/31/98.Data Collection: One or more physician investigators reviewed pertinent records for each patient. When any of the 3 investigators thought warfarin might be indicated, the patient's primary care provider completed a survey regarding why warfarin was not used.Results: Of 1,289 AF patients, 844 (65%) had filled at least 1 warfarin prescription. Of the 445 remaining, 19 had died, 5 had inadequate medical records, and 54 received warfarin elsewhere, leaving 367 patients. Of these, 160 had no documented AF, 53 had only a history of AF, and 49 had only transient AF. Of the remaining 105 patients, 17 refused warfarin therapy and 72 had documented contraindications to warfarin use including bleeding risk or history, fall risk, alcohol abuse, or other compliance problems. The reasons for not using warfarin among the 16 patients remaining included provider oversight (n = 4) and various reasons suggesting provider knowledge deficits.Conclusion: In contrast to prior studies that suggested that warfarin is markedly underused, we found that few patients with AF and no contraindication to anticoagulation were not receiving warfarin. We believe that differing study methodologies, including the use of physician review and provider survey, may explain our markedly different rate of warfarin underutilization, although local institutional factors cannot be excluded. The findings suggest that primary providers may be far more compliant with the standard of care for patients with atrial fibrillation than previously believed. [ABSTRACT FROM AUTHOR]

Objective: To determine, in a representative sample of patients drawn from a variety of hospitals, the degree of adherence to consensus recommendations for anticoagulation among patients with deep vein thrombosis or pulmonary embolism.Design: Cross-sectional review of a population-based random sample.Setting: Twenty-one randomly selected Pennsylvania hospitals.Patients: Of 357 randomly selected Medicare beneficiaries discharged from study hospitals with a diagnosis of deep venous thrombosis or pulmonary embolism during 1992, 43 charts were not reviewed for administrative reasons, 31 were miscoded or not treated with intravenous administration of heparin, and 13 were excluded for other reasons, leaving 270 in the final sample.Measurements and Main Results: Overall, 179 patients (66%, 95% confidence interval [CI] 59%, 72%) received therapeutic anticoagulation (two consecutive partial thromboplastin times more than 1.5 times control) within 24 hours of starting heparin. Platelet counts were checked at least once during the first week of heparin therapy in 66% (95% CI 58%, 74%). At least 5 days of heparin therapy was given to 84% (95% CI 79%, 87%). Among 266 (99%) of the patients receiving warfarin, 193 (72%; 95% CI 63%, 80%) received heparin until the prothrombin time ratio or International Normalized Ratio was therapeutic. Patients who were started on warfarin therapy within 2 days of heparin had decreased length of stay (geometric mean 8.2 vs 9.7 days, p = .003). Compliance varied among hospitals.Conclusions: In a wide variety of hospitals, we found fair, but variable, compliance with consensus recommendations for anticoagulation of patients with venous thromboembolic disease. Simple interventions to improve compliance with these recommendations might improve quality of care and reduce costs. [ABSTRACT FROM AUTHOR]

Objective: To determine whether patient preferences for the use of coronary revascularization procedures differ between white and black Americans.Design: Cross-sectional survey.Setting: Tertiary care Department of Veterans Affairs hospital.Patients: Outpatients with and without known coronary artery disease were interviewed while awaiting appointments (n = 272). Inpatients awaiting catheterization were approached the day before the scheduled procedure (n = 80). Overall, 118 blacks and 234 whites were included in the study.Measurements and Main Results: Patient responses to questions regarding (1) willingness to undergo angioplasty or coronary artery bypass surgery if recommended by their physician and (2) whether they would elect bypass surgery if they were in either of two hypothetical scenarios, one in which bypass surgery would improve symptoms but not survival and one in which it would improve both symptoms and survival. Blacks were less likely to say they would undergo revascularization procedures than whites. However, questions dealing with familiarity with the procedure were much stronger predictors of a positive attitude toward the procedure use. Patients who were not working or over 65 years of age were also less interested in procedure use. In multivariable analysis race was not a significant predictor of attitudes toward revascularization except for angioplasty recommended by their physician.Conclusions: Racial differences in revascularization rates may be due in part to differences in patient preferences. However, preferences were more closely related to questions assessing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed revascularization. Further research should address this issue in patients contemplating actual revascularization. [ABSTRACT FROM AUTHOR]

Congenital nystagmus is an oculomotor disorder in which fixation is disrupted by rhythmical, bilateral involuntary oscillations. Clinically these eye movements have been described with some degree of success in terms of their peak-to-peak amplitude, frequency, mean velocity and waveform shape. However, it has not proved possible to diagnose any underlying pathology from the nystagmus characteristics. Here, we propose a new approach to understanding the nystagmus using dynamical systems theory. Our approach is based on the use of delay embedding techniques, which allow one to relate a time series of scalar observations to the state space dynamics of the underlying dynamical system. Using this approach we quantify the dynamics of the nystagmus in the region of foveation and present evidence to suggest that it is low-dimensional and deterministic. Our results put new constraints on acceptable models of nystagmus and suggest a way to make a closer link between data analysis and model development. This approach raises the hope that techniques originally developed to stabilise chaotic systems, by using small perturbations, may prove useful in the control of nystagmus. [ABSTRACT FROM AUTHOR]