Do Greek healthcare users and healthcare providers share cancer care priorities? Analysing the results from two Delphi studies.

Traditionally healthcare providers have determined how healthcare resources should be allocated. However, in recent years, healthcare users have increasingly been invited to identify those priorities important to them. Yet, healthcare users' priorities do not always match the priorities set by healthcare providers. In Greece, there has not been any research to measure the extent of agreement between healthcare providers and users on cancer care priorities. This project aimed to identify the priorities of healthcare users and providers with regards to the areas of cancer care that needed to be developed or improved in Greece and to examine the extent of agreement between the two groups. Two parallel Delphi surveys were conducted to identify the priorities and arrive at a consensus. Thirty participants formed the panel of healthcare providers and 30 participants the panel of healthcare users. The participants identified 18 key cancer care areas that require development or improvement; however, there were significant differences on the prioritisation between the two panels. It is encouraging that 18 key areas were shared by both panels. These areas can form an agenda for further exploration. Healthcare users can participate in developing priorities for cancer care; however, education is required so that they are better able to make informed choices.

Reasons for tooth extraction in four general dental practices in South Wales.

Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

The impact of attendance patterns on oral health in a general dental practice.

OBJECTIVE: The aim of this study was to examine the impact of attendance patterns on oral health in the context of government policy on dental care and registration in the UK. METHOD: The data involved 643 consecutive patient responses to a questionnaire on dental health taken from a survey that was conducted during 1998 in an urban area of Swansea. The survey continued for a period of six months and covered patients of 18 years of age and over, responding to a questionnaire on the subjective oral health status indicators including the pattern of their attendance to dental practices. RESULTS: Regular dental care attendance has a significant positive impact on dental health while its impact on the number of teeth present is insignificant. Regular attendees also suffer significantly less from the severity, prevalence, social and psychological impacts of dental health problems. CONCLUSION: Regular dental attendance is associated with better oral health when regularity of care is defined as a visit within a two-year period. The rationality of a 15 month registration period is therefore debatable in the context of developing equitable services.

Lymphedema as a cause of unilateral leg swelling: a case report with 6-yr follow-up.

OBJECTIVE: To discuss a case of unilateral lower extremity swelling caused by an uncommon condition, lymphedema praecox. An emphasis is placed on diagnostic imaging. CLINICAL FEATURES: A 48-yr-old man suffered from low back and left leg pain. The left leg was swollen with evidence of cellulitis. Orthopedic evaluation separated the low back pain from the leg pain, and a diagnosis of sacroiliac syndrome concurrent with lymphedema was made. Further evaluation led to a diagnosis of congenital lymphedema, specifically lymphedema praecox, because of the age of onset. INTERVENTION AND OUTCOME: Because of active cellulitis, direct treatment of the lymphedema was contraindicated. The patient was advised in techniques to keep the leg clean and to help decrease pooling of lymph by placing the limb in an elevated position. The patient was also referred to a medical facility for antibiotics. The low back pain was addressed using chiropractic. CONCLUSION: Congenital lymphedema is an uncommon condition that causes unilateral limb swelling. The differential diagnosis includes other uncommon entities that should be ruled out so that proper treatment may be administered. Congenital lymphedema is best treated conservatively and only after any cellulitis has been controlled.