Magister Scientiae Dentium - MSc(Dent) / Aim To analyze the demographic profile, clinical data and radiographs of patients who had third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape over a 10 year period. Introduction Minor oral surgical procedures are carried out by Maxillofacial and Oral Surgeons daily. The surgical removal of third molars is a large part of Minor Oral Surgery which is common throughout the world. The general impression of third molar surgery performed by experienced professionals is the ease of the operation, however no-matter how experienced one may be, a simple procedure should never be underestimated (Carvalho and Do Egito Vasconselos, 2011). New surgical techniques, as well as extensive training, skill and experience have led to the evolution of oral surgery and allowed this procedure to be carried out in a less traumatic manner. Certain factors precipitate third molar surgery to be performed in theatre as opposed to the dental clinic setting. These factors will be discussed in this research report.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成24年3月26日 櫛山泰規氏の博士論文として提出された

Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief spinning episodes that occur with a rapid change in head position. Although considered benign, BPPV can have many personal, social, health, and financial implications. Yet, providers in a variety of settings are frequently mismanaging the condition leading to incomplete resolution of symptoms, decreased quality of life, reduced productivity, and increased healthcare spending. This study sought to better understand why providers fail to follow current evidence-based BPPV guidelines and the impact BPPV-specific education could have on improving their practices. Questionnaires assessing BPPV-specific knowledge as well as inquiring about provider barriers to following guidelines were distributed to 11 providers in a rural Colorado mountain town. A 45-minute education session was then presented to providers in order to update them on current recommendations. Following the education, similar questionnaires reassessing provider knowledge of BPPV guidelines were disseminated. Results showed an improvement in provider knowledge as evidenced by an increase in the percentage of correct response scores following the education session compared to pre-education. Additionally, providers identified difficulty in interpreting nystagmus patterns as well and remembering how to perform the various maneuvers as major barriers to guidelines adherence. Future BPPV education should focus on these two barriers to ensure better guidelines adherence. In order to evaluate long-term practice changes following the intervention, a 16-month retrospective chart analysis was performed in a small rural emergency department where three of the participating providers from the education session worked. Results from the chart analysis were inconclusive due to a scarcity of patient encounters during the post-intervention period. Future studies should be performed with a larger participation pool and longer analysis period to better evaluate the effectiveness of BPPV-specific education on improving provider practices. The ultimate goals of providing BPPV education are to promote a quicker resolution of patient’s symptoms, improve their quality of life, reduce unnecessary healthcare spending, while still allowing for appropriate provider compensation.

No description available.

Introduktion: Paroxysmal nokturn hemoglobinuri (PNH) är en kronisk, förvärvad, mycket sällsynt sjukdom som kännetecknas av komplementmedierad intravaskulär hemolys och är potentiellt livshotande. Sjukdomen börjar med en störning hos en hematopoetisk stamcell vilket leder till att patienter med PNH får röda blodceller som är känsliga för aktiverat komplementsystem och membranattackkomplexet (MAC). PNH kan ge symtom som exempelvis anemi, trombos och trötthet. PNH kan behandlas med komplementhämmare som förhindrar komplementaktivering och därmed komplementmedierad intravaskulär hemolys. Den först utvecklade komplementhämmaren eculizumab är en C5-hämmare som kontrollerar intravaskulär hemolys. Många patienter visar dock tecken på extravaskulär hemolys under behandling med eculizumab. Därför utvecklades det en C3-hämmare pegcetacoplan som ska även blockera extravaskulär hemolys. Syfte: Syftet med detta arbete var att studera pegcetacoplans effektivitet i komplementhämmare-naiva patienter och effektivitet i jämförelse med eculizumab vid behandling av PNH. Syftet var även att analysera skillnader i effektivitet mellan pegcetacoplan och eculizumab vid behandling av PNH. Metod: Detta examensarbete var ett litteraturarbete där sex vetenskapliga artiklar inkluderades baserat på inklusions- och exklusionskriterier. Inklusionskriterier var klinisk studie som analyserade pegcetacoplans effektivitet hos patienter med PNH. Exklusionskriterier var bland annat post hoc-analyser och fallrapporter. Artikelsökning gjordes i databasen PubMed med sökorden ”paroxysmal nocturnal hemoglobinuria pegcetacoplan”. Resultat: Pegcetacoplan-behandling ledde till och/eller bibehöll förbättringar gällande bland annat hemoglobinnivåer och LDH-nivåer hos patienter med PNH i alla sex studier. I PHAROAH och PADDOCK/PALOMINO visades en ökning av klonal distribution av typ II och typ III röda blodceller och minskning av C3 på typ II och typ III celler, vilket tolkades som att pegcetacoplan skyddar dessa celler från extravaskulär hemolys. I PRINCE var pegcetacoplan överlägsen kontrollgruppen med stödjande behandling gällande flera utfallsvariabler. I PEGASUS visade både eculizumab och pegcetacoplan effektivitet gällande bland annat LDH-nivåer men pegcetacoplan visade bättre effektivitet än eculizumab gällande hemoglobinnivåer och retikulocytantal. I uppföljningsstudien till PEGASUS och i förlängningsstudien OLE upprätthöll pegcetacoplan de tidigare uppnådda förbättringarna. Diskussion och slutsatser: Resultatet från dessa studier tyder på att pegcetacoplan är ett effektivt läkemedel med ihållande effektivitet vid behandling av PNH gällande kontroll av både intravaskulär och extravaskulär hemolys oavsett tidigare behandling med komplement-hämmare eller inte. Blockering av extravaskulär hemolys var den viktigaste skillnaden i effektivitet mellan pegcetacoplan och eculizumab. Dock skulle trovärdigheten av dessa slutsatser kunna förstärkas om det gjordes fler studier utan påverkan av Apellis Pharmaceuticals. / Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is a chronic, acquired, rare disease characterized by complement-mediated intravascular hemolysis and is potentially life-threatening. The disease begins with a disorder of a hematopoietic stem cell, which results in patients with PNH having red blood cells that are sensitive to complement activation and the membrane attack complex (MAC). PNH can cause symptoms such as anemia, thrombosis and fatigue. PNH can be treated with complement inhibitors that prevent complement activation and thereby complement-mediated intravascular hemolysis. The first complement inhibitor developed, eculizumab, is a C5 inhibitor that controls intravascular hemolysis. However, many patients show signs of extravascular hemolysis during treatment with eculizumab. Therefore, a C3 inhibitor pegcetacoplan was developed that should also block extravascular hemolysis. Aim: The aim of this study was to evaluate the efficacy of pegcetacoplan in complement inhibitor-naïve patients and efficacy in comparison with eculizumab in the treatment of PNH. The aim was also to analyze differences in effectiveness between pegcetacoplan and eculizumab in the treatment of PNH. Method: This thesis was a literature review in which six scientific articles were analyzed. Inclusion criteria were clinical trial analyzing the efficacy of pegcetacoplan in patients with PNH. Exclusion criteria included post hoc analyzes and case reports. An article search was made in the PubMed database with the keywords "paroxysmal nocturnal hemoglobinuria pegcetacoplan". Results: Pegcetacoplan treatment led to and/or maintained improvements in, among other things, hemoglobin levels and LDH levels in patients with PNH in all six studies. In the PHAROAH and PADDOCK/PALOMINO studies, an increase in the clonal distribution of type II and type III red blood cells and a decrease in C3 on type II and type III cells were shown, which was interpreted as pegcetacoplan protecting these cells from extravascular hemolysis. In PRINCE, pegcetacoplan was superior to the supportive care control group on several outcome variables. In PEGASUS, both eculizumab and pegcetacoplan showed efficacy regarding, among other things, LDH levels, but pegcetacoplan showed higher efficacy than eculizumab regarding hemoglobin levels and reticulocyte count. In the follow-up study to PEGASUS and in the extension study OLE, pegcetacoplan maintained the previously achieved improvements. Discussion and conclusions: The results from these studies suggest that pegcetacoplan is an effective drug with sustained efficacy in the treatment of PNH regarding the control of both intravascular and extravascular hemolysis regardless of previous treatment with complement inhibitors or not. Blockade of extravascular hemolysis was the main difference in efficacy between pegcetacoplan and eculizumab. However, the credibility of these conclusions could be strengthened if more studies were conducted without the influence of Apellis Pharmaceuticals.

No description available.

Benign paroxysmal positional vertigo (BPPV), characterized by a history of brief attacks of intense positional vertigo and rotary nystagmus, results from otoconial migration into the semicircular canals, making the sensory structures in the canal gravity sensitive. Treatment methods include positioning maneuvers, which return the otoconia back into the otolith, and typically include a variety of activity limitations for the subsequent 24-48 hours. Previous studies suggest BPPV treatment can be successful without any limitations of the patient post- therapy. The purpose of this study was to determine the necessity of post-maneuver restrictions on BPPV patients treated with the Canalith Repositioning Maneuver. Twenty participants were identified as having BPPV of the posterior canal and treated with the Canalith Repositioning Maneuver. During post-maneuver instruction, the ten participants assigned to the restricted group were provided with typical instructions. Ten participants assigned to the non-restricted group were given no post-maneuver restrictions. At the one-week post-treatment follow-up, all patients were free of vertigo and/or nystagmus. Results indicated that given two groups of subjects matched for age, gender, and symptoms, post-maneuver restrictions are not necessary for successful outcome using the CRM to treat posterior-canal BPPV.

Benign paroxysmal positional vertigo (BPPV) is a specific type of short-duration vertigo that is provoked by changes in head position and usually lasts less than one minute. It is a common vestibular pathology that can have significant effects on patient safety, quality of life, and medical costs. Therefore, it is crucial that medical students are educated and trained to facilitate and coordinate care of patients who may have undiagnosed BPPV. Because there is evidence to suggest that physicians—specifically primary care physicians—may not be properly equipped in their education to manage patients with BPPV, the purpose of this study was to investigate medical students’ evaluations of their preparedness to provide evidence-based care in the diagnosis and treatment of BPPV. An anonymous survey was administered via email to medical students in their fourth and final year of medical school at East Tennessee State University’s Quillen College of Medicine. This survey includes statements about the evidence-based Clinical Practice Guideline on BPPV provided by the American Academy of Otolaryngology. Respondents rated the degree to which they agreed or disagreed with how prepared they felt to address each item using a 5-point response scale from “strongly disagree” to “strongly agree.” Of the 70 students in the current fourth year class, 41 (59%) completed the survey. Students felt prepared for some aspects of diagnosing and treating BPPV, especially with regard to their general knowledge of BPPV, its impact on patients’ lives, and the options available to manage it. They felt less prepared to know when or if it is appropriate to recommend additional testing, imaging, or medication. They did not feel confident in their ability to perform the maneuvers to diagnose and treat BPPV. Overall, these results suggest medical students have a good foundation in their knowledge of BPPV. These results also propose topics to support more specialized training during their residencies to build upon the foundational knowledge obtained during their didactic training and optimize diagnosis and management of BPPV.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23104号 / 医博第4731号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 渡邉 大, 教授 林 康紀, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

付記する学位プログラム名: 充実した健康長寿社会を築く総合医療開発リーダー育成プログラム / 京都大学 / 新制・課程博士 / 博士(医科学) / 甲第23816号 / 医科博第137号 / 新制||医科||9(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 伊佐 正, 教授 林 康紀, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM