Quality assurance, benchmarking, assessment and mutual international recognition of qualifications.

The aim of this report is to provide guidance to assist in the international convergence of quality assurance, benchmarking and assessment systems to improve dental education. Proposals are developed for mutual recognition of qualifications, to aid international movement and exchange of staff and students including and supporting developing countries. Quality assurance is the responsibility of all staff involved in dental education and involves three levels: internal, institutional and external. Benchmarking information provides a subject framework. Benchmarks are useful for a variety of purposes including design and validation of programmes, examination and review; they can also strengthen the accreditation process undertaken by professional and statutory bodies. Benchmark information can be used by institutions as part of their programme approval process, to set degree standards. The standards should be developed by the dental academic community through formal groups of experts. Assessment outcomes of student learning are a measure of the quality of the learning programme. The goal of an effective assessment strategy should be that it provides the starting point for students to adopt a positive approach to effective and competent practice, reflective and lifelong learning. All assessment methods should be evidence based or based upon research. Mutual recognition of professional qualifications means that qualifications gained in one country (the home country) are recognized in another country (the host country). It empowers movement of skilled workers, which can help resolve skills shortages within participating countries. These proposals are not intended to be either exhaustive or prescriptive; they are purely for guidance and derived from the identification of what is perceived to be 'best practice'.

Thymosin in the treatment of HBeAg-negative chronic hepatitis B.

Chronic hepatitis B virus (HBV) infection, which can lead to cirrhosis and hepatocellular carcinoma, is a major health threat worldwide. Classic patients with chronic hepatitis B are positive for hepatitis Be-antigen (HBeAg) and HBV-DNA. In the Mediterranean basin, 30-80% of patients with chronic hepatitis B (CHB) are HBeAg-negative, in contrast to Northern European countries and the US, where only 10-40% of CHB patients are lacking HbeAg. HBeAg-negative CHB usually runs a progressive course. The greatest problem with the treatment of HBeAg-negative CHB is the high relapse rate. Their end treatment response rates are similar to those of classic CHB patients, but after discontinuation of treatment most of them relapse. All the data available in the literature show that more than 80% of patients with HBeAg-negative CHB do not respond to the current approved therapies. A literature review and our experience with thymosin indicate that the combination of IFN alpha2b and T-alpha1 is better tolerated and more likely to induce a sustained response in HbeAg-negative chronic hepatitis B patients when compared to other currently available therapies. As thymosin-alpha1 treatment is relatively free from adverse effects, future controlled trials are needed, with a longer follow-up, in order to fully evaluate the role of the combination therapy of thymosin-alpha1 with other emerging therapeutic agents.

Functional dyspepsia: relationship between clinical subgroups and Helicobacter pylori status in Western Turkey.

The etiology of functional dyspepsia is not known. The objective of the present study was to determine the characteristics of functional dyspepsia in Western Turkey. We divided 900 patients with functional dyspepsia into three subgroups according to symptoms: ulcer-like (UL), 321 (35.6%), motility disorder-like (ML), 281 (31.2%), and the combination (C) of these symptoms, 298 (33.1%). All patients were submitted to endoscopic evaluation, with two biopsies taken from the cardia and corpus, and four from the antrum of the stomach. All biopsy samples were studied for Helicobacter pylori (Hp) density, chronic inflammation, activity, intestinal metaplasia, atrophy, and the presence of lymphoid aggregates by histological examination. One antral biopsy was used for the rapid urease test. Tissue cagA status was determined by PCR from an antral biopsy specimen by a random sampling method. We also determined the serum levels of tumor necrosis factor-alpha (TNF-alpha) and gastrin by the same method. Data were analyzed statistically by the Kolmogorov-Smirnov test and by analysis of variance. Hp and cagA positivity was significantly higher in the UL subgroup than in the others. The patients in the ML subgroup had the lowest Hp and cagA positivity and Hp density. The ML subgroup also showed the lowest level of Hp-induced inflammation among all subgroups. The serum levels of TNF-alpha and gastrin did not reveal any difference between groups. Our findings show a poor association of Hp with the ML subgroup of functional dyspepsia, but a stronger association with the UL and C subgroups.

Functional dyspepsia: relationship between clinical subgroups and Helicobacter pylori status in Western Turkey

The etiology of functional dyspepsia is not known. The objective of the present study was to determine the characteristics of functional dyspepsia in Western Turkey. We divided 900 patients with functional dyspepsia into three subgroups according to symptoms: ulcer-like (UL), 321 (35.6 percent), motility disorder-like (ML), 281 (31.2 percent), and the combination (C) of these symptoms, 298 (33.1 percent). All patients were submitted to endoscopic evaluation, with two biopsies taken from the cardia and corpus, and four from the antrum of the stomach. All biopsy samples were studied for Helicobacter pylori (Hp) density, chronic inflammation, activity, intestinal metaplasia, atrophy, and the presence of lymphoid aggregates by histological examination. One antral biopsy was used for the rapid urease test. Tissue cagA status was determined by PCR from an antral biopsy specimen by a random sampling method. We also determined the serum levels of tumor necrosis factor-alpha (TNF-alpha) and gastrin by the same method. Data were analyzed statistically by the Kolmogorov-Smirnov test and by analysis of variance. Hp and cagA positivity was significantly higher in the UL subgroup than in the others. The patients in the ML subgroup had the lowest Hp and cagA positivity and Hp density. The ML subgroup also showed the lowest level of Hp-induced inflammation among all subgroups. The serum levels of TNF-alpha and gastrin did not reveal any difference between groups. Our findings show a poor association of Hp with the ML subgroup of functional dyspepsia, but a stronger association with the UL and C subgroups

Cystatin C and creatinine after successful kidney transplantation in children.

BACKGROUND: Serum creatinine is commonly used for the monitoring of allograft function following renal transplantation (RTX). Due to lower muscle mass, creatinine production rate is reduced in children, thus decreasing its sensitivity for the detection of allograft dysfunction. In children, the serum concentration of cystatin C, a low molecular weight protein of 13.3 kDa, reflects glomerular filtration rate independent of age, height and body composition. We, therefore, sought to assess the potential of cystatin C as a marker of allograft function in children. METHODS: Cystatin C and creatinine were measured in parallel at least daily in 24 children (14 boys, 10 girls; mean age 10.5+/-5.1 years) during hospitalization after successful RTX. Cystatin was determined immunoturbidimetrically, creatinine enzymatically. RESULTS: Within one hour after RTX, cystatin C (mean+/-SE) almost halved from 6.69+/-0.45 mg/l to 3.69+/-0.38 mg/l while creatinine declined from 862 +/-65.4 to 633+/-62.9 micromol/l. Following a nadir of 1.82+/-0.18 mg/l on day 2, there was a secondary increase in cystatin C concentrations to 2.69+/-0.35 mg/l on day 10. Creatinine concentrations continued to decline until day 9 reaching 80.5+/-13.1 micromol/l. Day-to-day variation at steady-state was comparable. In the course of 9 acute rejection episodes, both parameters rose in parallel, the increase in creatinine concentration being much greater. CONCLUSION: Cystatin C was an early indicator of allograft function following successful RTX in children. It did not prove superior to creatinine for the recognition of acute allograft dysfunction, however.

Time-related wettability characteristic of acrylic resin surfaces treated by glow discharge.

STATEMENT OF PROBLEM: Adhesion and cohesion have important roles in denture retention, and attempts have been made to improve the wettability of the acrylic resin material by surface treatments. PURPOSE: This study examined the initial and subsequent wettability of an acrylic resin denture base material treated under air or argon plasma atmosphere before and after exposure to air or distilled water. MATERIAL AND METHODS: Acrylic resin specimens were treated with plasma under air or argon atmosphere and were either exposed to air or distilled water for up to 60 days. Wettability characteristics of the acrylic resin specimens were determined by contact-angle measurements after 2 hours and after 60 days. Surface composition of the specimens also was analyzed with x-ray photoelectron spectroscopic (XPS) measurements. RESULTS: Statistically significant difference was found between control and each of the plasma treatment groups (P <.05). Although the storage condition and storage period caused statistically significant difference on contact angle values (P <.05), atmosphere type did not have any effect on the results (P >.05). XPS spectra of the plasma-treated specimens differed from control specimens only in the O1s region with a narrower and more intense peak that could be assigned to -COH groups. During 60 days of exposure, the O/C atomic ratios decreased within the first 2 weeks but settled to 0.40 and 0. 32 up to 60 days compared with 0.26 for untreated control specimens. CONCLUSION: Glow discharge plasma altered the surfaces of the acrylic resin and increased thc wettability as shown both by XPS and contact-angle measurements, and plasma treatment seemed to offer a durable (at least up to 60 days) wettability.

Coating of silicone-based impression materials in a glow-discharge system by acrylic acid plasma.

OBJECTIVES: The main purpose of this study was to demonstrate an increase in the wettability of silicone-based impression materials after coating them with a hydrophilic film in a glow-discharge system. METHODS: Two vinyl polysiloxane impression materials, Extrude (Kerr) and Accuflex (GC America Inc.) were used. Impression specimens were treated in a glow-discharge reactor at a radio frequency of 13.56 MHz at different discharge powers (5-20 W) and exposure times (5-60 min). Surface analysis of the specimens was done by FTIR. Surface contact angles were obtained by a captive-bubble method. These results were analyzed by ANOVA and Duncan's Multiple Range test (p < 0.05). The total number of voids on the die stone casts was observed microscopically. Linear dimensional accuracy, detail reproducibility, and surface hardness of the die stone casts were also determined. A Student t-test was performed for statistical analysis of these parameters (p > 0.05). RESULTS: FTIR spectra indicated that the number of hydroxyl groups on the surfaces increased (p > 0.05) because of the glow-discharge treatment. Contact angle measurements showed an increase (p < 0.05) in surface hydrophilicity. Total void formation in the stone casts decreased. There were no significant differences in the linear dimensional accuracy, detail reproducibility, and hardness, before and after glow-discharge treatment (p > 0.05). SIGNIFICANCE: It was concluded that the surface wettability of the impression materials may be increased by plasma deposition, and therefore, the formation of voids was reduced in the stone casts.

[Marginal fit of porcelain-fused-to-metal crowns: a comparative study of metal and porcelain butt margin]. / Metal destekli porselen kronlarda, metalve basamak porseleni marjinal uyumlarinin karsilastirilmasi.

Marginal openings and shoulder fit of porcelain butt margins and metal butt margins of porcelain fused-to-metal crowns have been investigated. Crown restorations were constructed directly onto the prepared teeth with 1 mm. square shoulder. Marginal openings and shoulder fit of labial surface and the cross-section of shoulder area then observed using optical microscope. Marginal fit was found better in porcelain fused-to-metal crowns with porcelain butt margin and also practically invisible neutrally-coloured join between crown and prepared tooth, was achieved with shoulder porcelain.