Telemonitoring of medication adherence in patients with schizophrenia.

Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of resources. The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and service use in patients with schizophrenia. A total of 108 schizophrenia patients were randomized into three equal groups according to the approaches used to assess medication adherence; self-report, pill counting, and telemonitoring. Telementoring was achieved through an innovative new platform called @HOME. This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking. Patient's adherence was observed over an 8-week period, during which patient's clinical status and service use were recorded. In comparison to the other two groups, patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments. The @HOME platform was highly acceptable by patients, caregivers, and professionals, and required minimal training for implementation. The results of the study suggest that the use of telemonitoring in psychiatric settings was both feasible and acceptable and may be associated with significant clinical and service related benefits.

[@HOME is a new Eu-Project in Tele Home care]. / @Home ein neues Eu-Projekt zum Tele Home Care.

@Home is a robust platform for real-time remote monitoring of patients at their home by doctors at the hospital. Health monitoring sensors, which have the capability to measure quick and easy vital parameters such as blood pressure, pulse rate, temperature, oxygen saturation (SpO2), as well as ECG 12 leads are used. Additionally, an advantage of the platform is that all the sensors are wearable and the patient is able to walk around indoors or outdoors. Moreover, the sensors are able to convey the recorded data over Bluetooth, a short-range wireless communication, to any Bluetooth enabled device such as Desktop computer or a Pocket PC.

Image processing for enhanced observer agreement in the evaluation of periapical bone changes.

AIM: The aim of the present study was to evaluate the effect of root canal treatment on periapical lesions by conventional and subtracted digital radiographic images of clinical cases. METHODOLOGY: Eleven patients who exhibited clinical or radiological signs of periapical pathology received root canal treatment. Periapical radiographs were obtained immediately postoperatively and recall radiographs at intervals of 3, 6, 9 and 12 months postoperatively were obtained. Identical exposure geometry was maintained. From the standardized radiographs digitized images were produced. Four experienced practitioners interpreted the radiographs and the digitized images. They assessed 59 pairs of images projected at random using a slide projector. On the left side, there was a reference image with no lesion, and on the right an image either with or without a lesion. Each reader was asked to rate each pair of images on a three-point scale: yes, absolutely sure that gain or loss was present; uncertain, if there was gain or loss; no, absolutely sure that no gain or loss was present. There was no time limit for each decision. Inter- and intra-examiner agreement was analyzed using the kappa-statistic for the diagnosis of periapical bone density changes in the periapical region at the different time points either in conventional pairs of radiographs or using digital subtraction images. RESULTS: The inter-examiner agreement (P < 0.001) and the intra-examiner agreement (P = 0.02) when digital pictures where evaluated were significantly higher than with conventional radiographs. CONCLUSIONS: A highly significantly better observer agreement was achieved by digital subtraction radiography during the evaluation of the outcome of root canal treatment on periapical lesions.

[Dental knowledge and evaluation of school dental care by school graduates in Berne canton]. / Zahnbewusstsein und Stellenwert der Schulzahnpflege bei Schulabgängern im Kanton Bern.

In 1996, a letter was written to 401 High-School level graduates of 20 randomly selected schools in the canton of Berne, Switzerland. Out of these 401, 343 individuals could be interviewed and subsequently be given a clinical examination comprising a plaque revealing test. The average plaque index was 70%. The assessment of the questionnaires showed a comprehensive basic dental knowledge of the students so that reasonable care of their teeth could be expected. Whereas almost everyone used a toothbrush regularly, flossing fell short in the majority of the cases. Outside the class-rooms, concentrated F-preparations were hardly used systematically. Besides parents and the family, dentists and specifically trained auxiliaries (school dental health assistants, SDHA) were found to play a central role in the mediation of theoretical knowledge and in the practical instruction of oral hygiene procedures. They received mostly good grades by the students for their work. The regular teaching staff, however, fell clearly behind the SDHAs. In spite of the obviously big influence on the youth, the dentists play only an insignificant role in some places. Overall, the students consider dental health education as relatively important placing it on the same level as sex education. Since SDHAs do not visit the classes during the last five years any longer, teaching of dental prophylaxis has been reduced in many communities to fluoridation with concentrated F-preparations. Negative consequences such as uncertainty regarding tooth brushing techniques, handling dental floss and questions as to oral hygiene behavior after leaving school have already been registered. With the academic year 2000/01 one visit by an SDHA to the upper level classes (last five years) was reintroduced. This tepid reaction by the Bernese education authority to a massive weakening of public dental health promotion will hardly suffice to keep up the remarkable level of dental prevention reached over the past decades, let alone to warrant substantial progress. The study has also demonstrated that the acquisition of knowledge is based on repetitive efforts. This is the fundamental reason for systematic monitoring and re-instruction of dental hygiene procedures also during the last five classes of mandatory scholarity.

[A retrospective in vivo study of Sonicsys approx restorations]. / Retrospektive In-vivo Untersuchung von Sonicsys-approx-Füllungen.

The purpose of this retrospective study was to determine the longevity and quality of Class II resin composite restorations with Sonicsys approx inserts placed in private practice. In 79 patients 213 composite restorations with margins in enamel and in dentin were evaluated clinically using a modified version of established USPHS-Criteria. The mean time in clinical service was 18+-8 months. The majority of the restorations investigated were rated as "good" (Alpha) or "clinically acceptable" (Bravo). In more than 90% sufficient proximal contact points were evaluated. Seven restorations had no contact to their adjacent tooth. Only one failed after an average period of 18 months in clinical service because of loss of the ceramic insert and was replaced. It is concluded that the composite restoration in combination with Sonicsys insert is an appropriate system for the restoration of Class II lesions in premolar and permanent molar teeth.

[In vivo study of small class II composite fillings]. / In-vivo-Untersuchung von kleinen Klasse-II-Kompositfüllungen.

This clinical trial aimed at studying the medium term performance in routine clinical practice of drop-shaped Class II resin composite restorations. 111 preparations were completed with the Sonicsys micro-tips (KaVo) and filled with either of two light-cured composites (Tetric Flow, Tetric Ceram, Vivadent, Schaan, Liechtenstein) by 11 dentists in a university clinic. The restorations were evaluated after half a year and then annually, using the US Public Health Service criteria. After one to three years of service nearly all restorations were clinically successful and acceptable for continued use. In four cases, incomplete caries excavation was the cause of failure. We conclude that the drop-shaped Class-II-resin composite restoration should be considered a routine operative treatment for small proximal lesions in posterior teeth.

[In vitro study of marginal quality of small approximal composite fillings]. / In-vitro-Untersuchung zur Randqualität von kleinen approximalen Kompositfüllungen.

The aim of the study was to compare different preparation methods and filling techniques for class II microcavities in vitro. The following methods were evaluated: Sonicsys halftorpedo, Sonicsys halfsphere, Sonicsys approx, Siplus, Piezo cavity system and rotating finishing bur. Every cavity type was obturated with a flowable (Tetric flow) and with a hybrid composite (Tetric ceram). One group consisted of prefabricated ceramic inlays (Sonicsys approx) and one group was filled with a three-site light curing technique. This resulted in 128 composite fillings. The evaluation of the quality of the margins under the SEM demonstrated a statistically significant higher percentage of perfect margins for Siplus compared with the PCS-System (88% versus 58% perfect margins). Marginal adaptation before and after thermocycling demonstrated the following results: Bewelled margins showed in general better adaptation than box-shaped cavities. Similar results were found for normal and flowable composites. Microcavities with occlusal access prepared with the sonicsys halfsphere showed in general better marginal adaptation in comparison to the other methods tested. It was concluded that simple obturation techniques can lead to a stable adaptation of the margins.

Preparation and restoration of small interproximal carious lesions with sonic instruments.

Partially diamond-coated oscillating preparation instruments are particularly suited for cutting minute interproximal cavities. This review presents an oscillating preparation system with newly designed working tips for cutting and finishing proximal microcavities. Analysis of the margins of various cavity designs prepared with this instrumentation exhibited outlines that were essentially free of defects. The method and instruments presented allow cutting of minute first intervention cavities of interproximal lesions with defect-related extension. Enhanced margins can be attained without concomitant damage to adjacent tooth surfaces.

Accuracy in detecting bone lesions in vitro with conventional and subtracted direct digital imaging.

OBJECTIVE: To implement direct digital imaging (DDI) in subtraction radiography and compare the accuracy of conventional and subtracted DD images in detecting small bone lesions in vitro. METHODS: Alveolar bone defects were produced in a section of a pig mandible, with slow-speed burs 0.6, 0.7, 0.8, 0.9, 1.0, 1.2, 1.4 mm in diameter. Standardized DD images were subtracted and displayed in black and white, contrast-enhanced and pseudo-colour transformed formats. 370 pairs of slides taken directly from the computer monitor were evaluated by eight observers. RESULTS: The area P(A) under the ROC curve with DDI was 0.67 +/- 0.1. This was significantly lower (p < 0.001) than any of the three modes of subtraction radiography (mean P(A) = 0.88 +/- 0.09). The detection of small lesions (bur diameter 0.6 mm) was significantly better (p < 0.001) with contrast enhancement. Observer agreement was smaller for DDI (chi = 0.22 +/- 0.09) compared with the subtraction images (mean chi 0.64 +/- 0.13) (p < 0.001). CONCLUSION: The diagnostic characteristics of the DDI system were significantly improved by digital subtraction with image processing.

Removal of hard tooth structure by ROOTSHAPE root planing files used with a modified EVA contra-angle.

The results of numerous recent investigations indicate that root contamination with bacteria and endotoxins is limited to the root surface only. Therefore, methods on root surfaces instrumentation that preserve root substance should be focused on. Newly available instruments or treatment systems should be evaluated for their root substance-removing potential. The devices for root planing presented here comprised specific files (Rootshape) (with diamond-coating on their convex working surfaces used in conjunction with a water-spray-cooled contra-angle head transforming rotational movements into translatory oscillations. The substance-removal potential of rigid and flexible files with diamond coatings of 2-4, 15, 25 and 40 microns compared with that of regular hand curettes, was evaluated under various working forces. The results demonstrated, that depending on the grit size of the diamond coating, the Rootshape files removed less and in no instance greater amounts of root surface substance than did hand instruments.

[A mathematical model for the treatment of root surfaces with rigid and flexible instruments]. / Mathematisches Modell für die Bearbeitung der Wurzeloberfläche mit starren und flexiblen Instrumenten.

The objective of this study was to assess the accessibility of root surfaces using stiff instruments in order to evaluate the advantages of a new flexible instrument-set for the treatment of periodontally diseased roots. 100 extracted human teeth were sectioned and histologically prepared. They were divided into two groups each containing 50 sections. Group I showing the interproximal, group II the buccal/lingual morphology. Slides were taken of each section under a constant magnification (3.2x) and a selected number of distances and angles were measured on each section. Using trigonometric functions the following parameters were calculated and set in relation with hypothetical probing depths ranging from 0-15 mm: 1.) instrument length; 2.) change of the instrument angulation; 3.) theoretical deflection of the gums. Statistical analysis was performed using Student's t-test. For a given probing depth the instrument length was independent of the sites and the deflection of the gums. When a deflection of the gums was assumed, the instrument angulation was constant; an exponential decrease of the angulation with increasing probing depth was found with gum deflection. The deflection was increasing with increasing probing depth, showing statistically significant differences between interproximal and buccal/lingual sites (p < or = 0.05). In conclusion the instrument length seems not to be an impeding factor for the accessibility of root surfaces in contrast to the instrument angulation and the fact that teeth are encircled by the gum. Due to morphological reasons stiff instruments seem to be inferior to flexible instruments when a non-surgical root treatment is performed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Personnel and instrumental differences in the treatment of root surfaces. A comparison on a phantom model]. / Behandler- und Instrumentenunterschiede bei der Bearbeitung von Wurzeloberflächen. Ein Vergleich am Phantommodell.

The treatment of root surfaces in periodontal lesions with mechanical instruments is becoming more and more popular as an alternative to the conventional treatment with curets. In this in-vitro study a phantom head with a simulated periodontitis was used. The aim of this investigation was to determine the percentage of the subgingival non-treated root surfaces after treatment with different instruments and by different persons. Newly developed mechanical file instruments (Rootshape) were tested. Hand curets served as control group. The treatment of the teeth was carried out by three groups, each including 4 people. Group one were dental hygienists (DH), group two dentists with (Spez) and group three dentist without (Zaz) experience in the therapy of periodontal diseases. They were asked to perform a scaling and root planing on six teeth (16, 21, 24, 36, 41, 44) both with curets and Rootshape files. The size of the non-treated areas was subsequently determined planimetrically and expressed as percentage of the entire subgingival root surface. Independent of the group the percentage after file treatment was significantly lower (mean 9.85 +/- 7.78%) than that after curet-treatment (mean 14.74 +/- 10.20%). Significant differences were found when the three groups were compared after treatment either with files or curets (DH 9.61 +/- 8.02%, Spez 12.11 +/- 8.01%, Zaz 15.18 +/- 11.01%; p < 0.001). Zaz working with files achieved as good results as DH or Spez with curets (p < or = 0.05). The results indicate that the files represent an alternative to hand instruments concerning the accessibility of root surfaces.

[The diagnosis of bone lesions with conventional x-ray images and with a direct digital procedure (RVG). An in-vitro study. RadioVisioGraphy]. / Diagnostik von Knochenläsionen mit konventionellen Röntgenbildern und einem direkt digitalen Verfahren (RVG). Eine In-vitro-Studie.

The purpose of this study was to evaluate the possibility to delineate artificial osseous lesions with direct digital radiography (DDR) in comparison to conventional radiography (Rx). Defined lesions of nine different depths were created on ten mandibular segments of pigs. A conventional and a direct digital radiography was made of each lesion. 400 pairs of images were evaluated by ten dentists on the basis of a 5-point rating scale. The statistical evaluation included the interexaminer agreement and ROC-analyses. The mean interexaminer agreement was low and not significantly different between the two methods (Rx: kappa = 21.87 +/- 5.08; DDR: kappa = 20.25 +/- 3.79; p > 0.05). The ROC-analyses showed no significant differences between the two methods for the smallest lesions (Rx: 0.72 +/- 0.12; DDR: 0.64 +/- 0.12; p > 0.05). Defects between 0.5 mm and 1.0 mm of size were significantly better depicted with conventional radiographs (p > 0.05). Lesions from 1.25 to 2.0 mm were statistically not significantly different (p > 0.05). The diagnosis of lesions of 1.0 mm diameter and less than 1.25 mm depth was better delineated by conventional radiographs than by direct digital radiographs. However, proper diagnostic results were only achieved in lesions bigger than 2.0 mm. During the time this study was conducted many technical improvements were introduced for direct digital equipment with higher spatial resolutions. The presented methodology is proposed for the examination of the diagnostic properties of new imaging tools in comparison to conventional radiography.