Biologics for psoriatic arthritis: network meta-analysis in review.

OBJECTIVE: A review of network meta-analysis to assess efficacy and safety of biologics for the treatment of psoriatic arthritis (PsA). MATERIALS AND METHODS: A systematic search was conducted on electronic databases to identify Bayesian meta-analysis reporting clinical parameters of efficacy, safety and cost-effectiveness of biologics that are approved for the treatment of PsA patients. RESULTS: We identified 19 studies and included them for review. There is insufficient statistical evidence to demonstrate clear differences in effectiveness between available biologic agents for PsA due to many differences in methods and clinical parameters reported in the studies. Old biologics are reported to be safe. CONCLUSIONS: New molecules approved for the treatment of PsA appear promising treatments but further comparative studies methodologically well-conducted are necessary. It is also necessary to follow strictly international recommendations to conduct NMA to better help physicians and decision-makers in making appropriate decisions.

A siphonotid millipede (Rhinotus) as the source of spiropyrrolizidine oximes of dendrobatid frogs.

Poison frogs of the neotropical family Dendrobatidae contain a wide variety of lipophilic alkaloids, which are accumulated from alkaloid-containing arthropods. A small millipede, Rhinotus purpureus (Siphonotidae), occurs microsympatrically with the dendrobatid frog Dendrobates pumilio on Isla Bastimentos, Bocas del Toro Province, Panamá. Methanol extracts of this millipede contain the spiropyrrolizidine O-methyloxime 236, an alkaloid previously known only from skin extracts of poison frogs, including populations of D. pumilio. Thus, R. purpureus represents a likely dietary source of such alkaloids in dendrobatid frogs.

Comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. A two-year caries clinical trial on children in New Jersey and Puerto Rico.

PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.

Community-based dental programs: University of Medicine and Dentistry of New Jersey-New Jersey Dental School.

The dental school plans to incorporate CODE into the curriculum so that more students have community-based dental educational experiences. Future plans also include increasing standardization of reports, clinical and administrative procedures, resources, and processes across the sites in order to lower managerial overhead. This process will be aided by further enhancement of computerized information systems and electronic links. The major lesson learned is that new extramural programs can be created and sustained by pooling school resources with those from the private and public sectors. Funding sources and opportunities available to one party alone are insufficient. While one-time funding was used to build and furnish the NJDS extramural sites, the clinics were established only after business plans demonstrated the availability of funds to sustain their operations. The Statewide Network of Community Oral Health Care and CODE models are still evolving, but they are replicable not only in dental education but in other types of health services. The details of the partnerships and funding streams will vary from site to site, but through outreach and careful negotiation with potential partners and detailed contracts, the community service and educational missions of a health professions school can have a successful outcome.

Defining predoctoral prosthodontic curriculum: a workshop sponsored by the American College of Prosthodontists and the prosthodontic forum.

Prosthodontic educators participated in a workshop held at The American College of Prosthodontists annual session in Kansas City, MO, in October 1996. Their goal was to review elements of the predoctoral prosthodontic curriculum to establish a consensus on the levels of expected skill and knowledge. Skill components were designated at the competency and exposure levels, while knowledge components were designated at the understanding and familiarity levels. The workshop recommendations were distributed to American and Canadian dental schools and the communities of interest for comments in January 1997. The workshop recommendations were reviewed and finalized at the American Association of Dental Schools annual meeting in Orlando, FL, in March 1997. The recommendations may be used by dental educators to prioritize curricular elements in relation to limited time dedicated to the prosthodontic curriculum. Outcomes assessment methods will be needed to ensure competency in the new dentist.

Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection.

No comprehensive national study has ever been completed on the oral health status of people with disabilities, their patterns of use of oral health services and access-to-care barriers. The authors describe the Special Olympics, Special Smiles program, conducted as part of the New Jersey Summer Special Olympics Games, and assess a pilot-tested model for collecting epidemiologic data. The results of this initial data collection are also compared with the goals of the U.S. Public Health Service, as outlined in the Healthy People 2000 publication.

Implementing and evaluating a patient instructor program.

A Patient Instructor (PI) program designed to improve students' data-gathering and interpersonal skills is evaluated. Each student in two consecutive classes of third-year students (class of 1996, n = 60; class of 1997, n = 72) interviewed four patient instructors (PIs) during a three-hour rotation. Each PI portrayed one of six scenarios. PIs assessed students using content checklists and an abbreviated Arizona Clinical Interview Rating Scale (ACIR). After the interview, each PI gave student constructive feedback regarding interpersonal behavior and ability to identify salient content items from the patient's history. Significant improvement was observed on content checklists (p < 0.01) between the first and second rounds. Significant improvement was also noted on the ACIR (p < 0.01) between rounds one, two and three. The results indicate that data-gathering and interpersonal skills can be enhanced by using patient instructors. Student evaluation of the program was positive.

Impact of quality assurance program: providing practice assessment.

Participation in a self-administered quality assessment (SAQA) program led to changes in New Jersey dentists' perceptions of practice quality. Ninety-four percent indicated they discovered practice deficiencies. This study suggests that using a self-administered quality assessment program, such as the SAQA program, can lead to a better understanding of a practice's strengths and weaknesses.

Teaching ethics, jurisprudence, and risk management at the New Jersey Dental School.

In an attempt to better prepare students for dental practice in a litigious environment with cost-containment pressures, quality assurance requirements, and increased patient expectations, the New Jersey Dental School has begun planning and implementing various programs to teach students and faculty ethics, jurisprudence, and risk management. In addition to formal course work, the New Jersey Dental School is implementing a quality assurance and risk management clinical program.

Alterations of renal cortex and medullary glycosaminoglycans in aging dog kidney.

Age-related changes in renal function have been attributed to alterations in the chemical composition of the kidney tissues. Hence, the glycosaminoglycan composition of the renal cortex and medulla at varying age intervals was investigated. Glycosaminoglycans were isolated from the tissues by means of digestion with collagenase and pronase and purified by ethanol precipitation. Subsequent separation of various polyanions was accomplished by ion exchange chromatography on a Dowex 1-X2 column, using sodium chloride buffers of increasing ionic strengths. The glycosaminoglycans in each fraction were identified and quantitated by digestion with specific enzymes, including hyaluronidase, chondroitinase AC and ABC. The enzyme resistant material was separated and further digested with nitrous acid to quantitate the proportion of heparon sulfate. The results indicate that the glycosaminoglycan content of the renal medulla was much higher than the cortex at all the age intervals studied, and age-induced reduction was mainly cortical. There was a significant reduction in the heparan sulfate content of the cortex in aging. Interestingly, the major glycosaminoglycan content of the medulla was hyaluronic acid, which showed a sharp increase during aging, whereas heparan sulfate declined. Chondroitin sulfate was not altered due to age in either tissue. The molecular weight of hyaluronic acid was determined by column chromatography. Results indicate that the size of hyaluronate in the cortex was small and did not vary with age. In the medulla of the younger age group, a considerable amount of large size hyaluronate was observed. As age increased, the size decreased. The results strongly suggest that alteration in the renal glycosaminoglycans may be partly responsible for the age related protinuria and ionic imbalance.