To accept, or not to accept? A service evaluation to appraise complexity assessment of orthodontic patients referred into a secondary care setting.

Introduction Commissioners in England use the Commissioning for Quality and Innovation (CQUIN) payments mechanism to encourage the best provision of orthodontic treatment. However, CQUIN only use the patient's orthodontic need as a measure of complexity, rather than the levels outlined in the orthodontic commissioning guide published by NHS England. A service evaluation was designed to ascertain a secondary care setting's compliance with the commissioning complexity levels, as a new comparator for CQUIN case-mix assessment.Materials and methods A prospective evaluation was conducted for all new patients referred to the Mid Yorkshire NHS Trust orthodontic department in a 12-month period, using the levels categorised by the commissioning guide. A standard was set to accept no fewer than 80% level 3b patients.Results Of patients accepted for orthodontic treatment, 89.9% were of the highest level 3b complexity. This was compared to only 69.8% of patients having an Index of Orthodontic Treatment Need, Dental Health Component, 5.Conclusion The findings support a recommendation that commissioners should consider complexity based on the commissioning guidance, rather than orthodontic need alone; it is important that the economic drivers of commissioning implementation fairly reflect the specialist work being carried out by the workforce.

Comparison of luminescence ADP production assay and radiometric scintillation proximity assay for Cdc7 kinase.

Several assay technologies have been successfully adapted and used in HTS to screen for protein kinase inhibitors; however, emerging comparative analysis studies report very low hit overlap between the different technologies, which challenges the working assumption that hit identification is not dependent on the assay method of choice. To help address this issue, we performed two screens on the cancer target, Cdc7-Dbf4 heterodimeric protein kinase, using a direct assay detection method measuring [(33)P]-phosphate incorporation into the substrate and an indirect method measuring residual ADP production using luminescence. We conducted the two screens under similar conditions, where in one, we measured [(33)P]-phosphate incorporation using scintillation proximity assay (SPA), and in the other, we detected luminescence signal of the ATP-dependent luciferase after regenerating ATP from residual ADP (LUM). Surprisingly, little or no correlation were observed between the positives identified by the two methods; at a threshold of 30% inhibition, 25 positives were identified in the LUM screen whereas the SPA screen only identified two positives, Tannic acid and Gentian violet, with Tannic acid being common to both. We tested 20 out of the 25 positive compounds in secondary confirmatory study and confirmed 12 compounds including Tannic acid as Cdc7-Dbf4 kinase inhibitors. Gentian violet, which was only positive in the SPA screen, inhibited luminescence detection and categorized as a false positive. This report demonstrates the strong impact in detection format on the success of a screening campaign and the importance of carefully designed confirmatory assays to eliminate those compounds that target the detection part of the assay.