Personal learning plans for general dental practitioners: a Scottish perspective. Part 2.
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Attitude of Health Personnel↗
Biomedical subjects
J S Rennie
Publications and source records attributed to J S Rennie.
Personal learning plans for general dental practitioners, a Scottish experience. Part 1.
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Attitude of Health Personnel↗
Facing the challenges of competency-based assessment of postgraduate dental training: Longitudinal Evaluation of Performance (LEP).
CONTEXT: The evaluation of competence in the health professions is of great importance to the public and professionals alike. Recent efforts to design dependable and accurate systems of assessment for demanding clinical roles are increasingly attempting to focus on all-round competence of practitioners. Many challenges are faced in this field as a balance between robust assessment methodology and feasibility in practice is crucial to implementation and adoption. OBJECTIVES: The authors discuss some of the challenges faced by educators and clinicians involved in the development of systems of assessment for the health professions, and describe a method which aims to address these issues in the assessment of postgraduate dental training in Scotland. DISCUSSION: Three of the major challenges facing educators and clinicians involved in the design of competency-based systems of assessment are considered: the requirement for evaluation in different areas of competence; the importance of association of assessment with the training objectives, and the types and focus of the assessment introduced. Issues around the use of formative and summative assessment, and the perception that these must always remain completely separate, are discussed in detail. SOLUTIONS: A proposal is made for the introduction of a method of assessment which has been designed keeping these challenges in mind. The rationale behind this assessment method is described.
Clinical Competence↗
The development of an assessment system for dental vocational training and general professional training: a Scottish approach.
The role of competencies in postgraduate dental education and training has been a major topic of interest in recent years. Concerns have been voiced from all sides of the profession about how the competence of trainees and the quality of training can be assured so that high standards of patient care can be maintained. A three year project which seeks to develop a competency-based assessment system for general professional training is underway which hopes to answer some of the concerns and provide an evidence-based system of assessment for the early postgraduate years. This paper looks at the reasoning behind the project, its aims, and the progress made to date.
Clinical Competence↗
Scottish consortium for development and education in dental primary care.
A national consortium for dental primary care in Scotland has been formed as a result of integrated planning by groups involved in managing and delivering postgraduate dental education in Scotland. In 1998 a partnership was formed with representatives from the Scottish Council for Postgraduate Medical and Dental Education (SCPMDE) and the three Scottish dental institutions at Dundee, Edinburgh and Glasgow Universities. The principal aim of the Consortium is to promote evidence-based dental care through postgraduate education and research. The activities of the Consortium will provide a broadly based adjunct to current postgraduate provision with partner institutions contributing in different ways. Since its inception the Consortium has focused on two main areas: 'Higher Training' for Primary Care. Scottish Dental Practice Based Research Network.
Dental Research↗
Young dentists--work, wealth, health and happiness.
OBJECTIVE: To determine the relationships between working conditions for new dental graduates and their mental and physical health. DESIGN: A cross-sectional postal survey. SUBJECTS: Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%). SETTING: The cohorts came from all Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad. MEASURES: Measures included a wide range of conditions at work: number of patients seen, pace of work, hours worked, attitudes to work, financial arrangements, alcohol consumption, sickness-absence, physical and mental health. RESULTS: There were significant differences between those working in general practice and those in hospital in terms of the hours, numbers of patients seen, feelings of competence and senior support. Methods of payment for treatment in general practice also revealed differences in perception of work: most pressure at work was associated with part NHS and part private funding. Mental health and alcohol consumption were equivalent to age-matched junior doctors, but increased psychological symptoms in female dentists were significantly associated with the number of units of alcohol consumed. CONCLUSION: Selected working conditions are associated with reported competence, stress and health among young dentists.
Absenteeism↗
Careers and patterns of work of Scottish dental graduates: 1991 and 1994.
OBJECTIVE: To describe current patterns of employment, career intentions and factors that influence career choice in young graduates. DESIGN: A cross-sectional postal survey. SUBJECTS: Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%). SETTING: The cohorts all came from Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad. MEASURES: A questionnaire which had been piloted, applied to medical graduates and then adapted for dentists, was used. RESULTS: The most common post held was that of Associate in General Dental Practice (61% of the sample) and the majority (85%) were working full-time. Only small numbers indicated that they wished to undertake a career in academia (6) or the hospital dental service (17). In choosing a career, males were more influenced by financial factors (P = 0.009) and women by the availability of part-time employment (P = 0.000). CONCLUSION: Despite the recent adverse publicity about general dental practice, most young dentists see their future in this sector of the profession. More worrying is the comparatively small number who wish to work within the hospital service or in academia. Results also indicate the need to develop schemes to retain women in the workforce.
Adult↗
Studies on effects of nutritional factors on bone structure and osteoporosis in laying hens.
1. A modern hybrid strain of laying hen (Hisex) was fed from point of lay to 68 weeks on a control diet and diets containing oystershell, fluoride, 1,25-dihydroxycholecalciferol, ascorbic acid, a lower concentration of phosphorus and a combination of a lower concentration of crude protein and higher concentration of vitamin K. Hens from a much older strain (Brown Leghorn J-line) were fed on the control diet. 2. Plasma variables were measured during lay. End-of-lay trabecular and medullary bone volumes in the proximal tarsometatarsus and free thoracic vertebra were measured by histomorphometry. 3. The majority of Hisex hens were considered to be osteoporotic by the end of lay. In contrast, none of the J-line were osteoporotic. 4. None of the nutritional treatments affected trabecular bone volumes. Medullary bone volumes were increased significantly by feeding oystershell or fluoride. 5. There was no phenotypic correlation between egg production and trabecular bone volume in the Hisex hens. 6. The experiment provided evidence that osteoporosis in laying hens, as assessed by trabecular bone volumes, is not caused by calcium deficiency and could not be prevented by any of the nutritional treatments studied.
Animal Nutritional Physiological Phenomena↗
Developments and challenges for postgraduate dental education in Scotland.
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Education, Dental, Graduate↗
Unusual leiomyomatous hamartoma of the hard palate: a case report.
Harmartomas of the head and neck are common lesions, often taking the form of melanocytic nevi or vascular malformations such as hemangiomas and lymphangiomas. Hamartomas composed of other tissue types are much rarer and within the oral cavity are usually located on the tongue near the foramen cecum or on the anterior hard palate near the incisive papilla. Although most occur as isolated phenomena, a small number may be associated with other local developmental defects or with a syndrome complex. A normal 5-year-old girl had a 1 cm soft sessile swelling in the vault of the hard palate on the left side. Histopathologic examination showed bundles of smooth muscle embedded in fibrovascular stroma and accompanied by abundant mature fat and a small amount of salivary tissue. The features were regarded as those of a leiomyomatous hamartoma and could be distinguished from a smooth-muscle tumor, teratoma, and benign mesenchymoma by virtue of the clinical and histopathologic features. No recurrence has been seen after excision.
Child, Preschool↗
Effectiveness of dietary 25- and 1-hydroxycholecalciferol in combating tibial dyschondroplasia in broiler chickens.
1. Three experiments were carried out to determine the effects of feeding diets containing different concentrations of cholecalciferol, 1 alpha-hydroxycholecalciferol (1-HCC), 25-hydroxycholecalciferol (25-HCC), 1,25-dihydroxycholecalciferol (1,25-DHCC) and ascorbic acid on the incidences and severities of tibial dyschondroplasia (TD) at 3 weeks of age in male broiler chicks. 2. In experiment 1, replacing 75 micrograms cholecalciferol/kg with the same weight of 25-HCC decreased significantly (P < 0.01) the incidence of TD from 65 to 10%. 3. In experiment 2, the incidence of TD in the control group was lower, but feeding amounts of 25-HCC up to 250 micrograms/kg had a linear effect on the incidence of TD that was significant at P = 0.06. There was no effect or interactions with dietary addition of 250 mg ascorbic acid/kg. Dietary addition of 5 micrograms 1-HCC/kg decreased TD incidence from 21 to 5%, though the effect was not significant (P > 0.1). 4. TD incidence in experiment 3 was too low to determine an effect of25-HCC or 1,25-DHCC on TD incidence, though in this, as in both other experiments, the severities of TD lesions were always lower with diets containing cholecalciferol metabolites. 5. Hypercalcaemia was not observed after feeding up to 250 micrograms 25-HCC/kg in either experiments 2 or 3. 6. It is concluded that 25-HCC may be an effective practical means of improving broiler leg health by alleviating the incidence and severity of TD.
Animals↗
In vivo and in vitro effect of 1,25-dihydroxyvitamin D3 and 1,25-dihydroxy-16-ene-23-yne-vitamin D3 on the proliferation and differentiation of avian chondrocytes: their role in tibial dyschondroplasia.
1,25-Dihydroxyvitamin D3 (1,25(OH)2D3) is regarded as the most biologically active metabolite of cholecalciferol. It prevents tibial dyschondroplasia (TD) in chicks where inhibition of chondrocyte differentiation within the growth plate occurs. However, it is unclear whether its mode of action is through direct interaction with its chondrocyte receptor and its known regulatory role in cell differentiation or is mediated by increased calcium absorption and mobilisation. Synthetic analogues of 1,25(OH)2D3 such as 1,25-dihydroxy-16-ene-23-yne cholecalciferol (RO 23-7553) with increased differentiation properties but reduced calcaemic activity have been synthesised. In this study, the in vitro and in vivo effects of 1,25(OH)2D3 and RO 23-7553 on chick chondrocyte growth and differentiation were examined. In addition, the in vivo effectiveness of these steroids in preventing TD in chicks was assessed. 1,25(OH)2D3 and RO 23-7553 (10(-12)-10(-7) M) displayed biphasic concentration effects and had similar potencies in vitro in regulating chondrocyte proliferation and differentiation. However, while the incidence of TD in birds dosed with 1,25(OH)2D3 was lower (10%) than in control chicks (55%), RO 23-7553 was ineffective (50%). This may be the result of its reduced affinity (1000 times less) for the plasma vitamin D binding protein (DBP) and the chondrocyte receptor in comparison to that of 1,25(OH)2D3. A reduction in calcium supply to the chondrocyte may also result in decreased chondrocyte differentiation but blood ionised and plasma total calcium were normal in birds dosed with RO 23-7553. These data suggest that RO 23-7553 and 1,25(OH)2D3 regulate chondrocyte proliferation and differentiation similarly in vitro but not in vivo. This may be caused by differences in DBP binding and clearance rates of the two steroids in vivo.
Animals↗
Folic acid requirements of broilers.
1. Dietary folic acid requirements of broilers were studied in three experiments using wheat- and maize-based practical diets. Requirements were assessed on the basis of performance and metabolic criteria. 2. Growth and food conversion efficiencies were optimised with supplements of 1.5 mg folic acid/kg added to basal mash starter diets. The dietary folic acid requirement of broilers was estimated to be in the range of 1.7 to 2.0 mg/kg. 3. Red blood cell phosphoribosylpyrophosphate concentrations and dihydrofolate reductase activities did not show consistent changes over the range of dietary folate concentrations studied but plasma folate concentrations responded markedly to dietary folate supplementation. 4. Adding choline to diets in amounts greater than the normal requirement did not spare the requirement for folic acid. 5. It is suggested that minimum folic acid supplements for pelleted practical diets should be in the order of 2.5 to 3 mg/kg.
Animals↗
Interaction between dietary 1,25-dihydroxycholecalciferol and calcium and effects of management on the occurrence of tibial dyschondroplasia, leg abnormalities and performance in broiler chickens.
1. Two experiments were performed to compare the relative effectiveness of feeding 1,25-dihydroxycholecalciferol (1,25-DHCC) in minimising leg abnormalities in broilers with other methods and to investigate interactions between dietary 1,25-DHCC and calcium. 2. Adding 5 micrograms 1,25-DHCC/kg to a diet containing 12 g calcium/kg was more effective than early food restriction or meal feeding in preventing leg abnormalities but was found to cause a growth depression. 3. The second experiment, which had a factorial design, with diets containing 7.5, 10.0 and 12.5 g calcium and 0, 2.0, 3.5 and 5.0 micrograms 1,25-DHCC/kg, showed linear and quadratic interactions between these dietary factors. Diets with higher concentrations of both 1,25-DHCC and calcium resulted in growth depression associated with hypercalcaemia. 4. The incidence of tibial dyschondroplasia (TD) at 3 weeks of age was highest with the basal diet containing 7.5 g calcium/kg and was markedly reduced by addition of 1,25-DHCC and/or calcium. The incidence was very low or non-existent when 1,25-DHCC was fed at 3.5 micrograms/kg or greater. 5. Feeding 5 micrograms/kg 1,25-DHCC had no effect on plasma 1,25-DHCC concentrations, although at the higher dietary calcium contents plasma concentrations of 25-hydroxy- and 24,25-dihydroxy-cholecalciferol were lower in those birds fed 1,25-DHCC. 6. It is concluded that 1,25-DHCC is most effective in preventing TD without accompanying growth depression when it is fed in conjunction with diets containing less than 10 g calcium/kg.
Animal Feed↗
In vivo effect of 1,25-dihydroxycholecalciferol on the proliferation and differentiation of avian chondrocytes.
A combination of immunocytochemistry and in situ biochemistry has been used to determine the in vivo effects of 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] on the proliferation and differentiation of chondrocytes. Chicks were fed a diet supplemented with 1,25-(OH)2D3 (2.5, 5, or 10 micrograms/kg diet) for 3 weeks, and measurements were made in sections of growth plate of chondrocyte proliferation and rate of maturation through the growth plate [using bromodeoxyuridine (BrdUrd) labeling] and also chondrocyte differentiation [assessed by alkaline phosphatase (ALP) activity]. The labeling indices of the control and supplemented chicks were similar (23.1 +/- 1.3 versus 23.2 +/- 1.6%); however, within a 21 h period the BrdUrd-positive cells of the supplemented chicks had moved down the growth plate significantly farther than in the control chicks (71.0 +/- 2.8 versus 52.6 +/- 1.8%). Greater ALP (mean integrated absorbance) activity higher up the growth plate of the supplemented chicks indicated a more differentiated phenotype in cells closer to the epiphyseal junction. Within individual transitional chondrocytes ALP activity in the 10 micrograms/kg supplemented chicks was 26.6 +/- 0.85, which was significantly higher (p < 0.01) than that of the control chicks (19.2 +/- 0.9). These results suggest that 1,25-(OH)2D3 in vivo does not increase the rate of chondrocyte proliferation but accelerates the onset of maturation.
Alkaline Phosphatase↗
Biochemical responses of broiler chicks to folate deficiency.
The effects of folate sufficiency and deficiency in three pathways of folate metabolism were studied in 2-and 3-week-old broiler chicks. Erythrocyte phosphoribosylpyrophosphate concentrations and dihydrofolate reductase (EC 1.5.1.3) activity were significantly elevated in folate deficiency. Percentage incorporation of deoxyuridine into bone marrow DNA was reduced in folate deficiency. There was a trend towards reduced liver dihydrofolate reductase activity in deficient chicks. These studies identify further biochemical criteria that can be used to assess folate status of chicks.
Animals↗
The effect of dietary 1,25-dihydroxycholecalciferol in preventing tibial dyschondroplasia in broilers fed on diets imbalanced in calcium and phosphorus.
Three experiments were carried out to investigate the effects of supplemental dietary 1,25-dihydroxycholecalciferol (1,25(OH)2cholecalciferol) and a low dietary Ca:P ratio on the occurrence of tibial dyschondroplasia (TD) in 3-week-old broilers. Histopathology was used to diagnose TD. In the first experiment, feeding a diet containing 7.5 g Ca and 7.6 g P/kg gave a higher incidence of TD than a control diet containing normal amounts of Ca and P (12 and 6 g/kg respectively). Increasing the dietary supplement of cholecalciferol in the imbalanced diet prevented rickets but did not decrease the incidence of TD. In the second experiment, supplementing the imbalanced diet with 10 micrograms 1,25(OH)2cholecalciferol/kg prevented TD completely but also gave a slight growth depression. In the third experiment the imbalanced diet was supplemented with 0, 2.5, 5 or 10 micrograms 1,25(OH)2 cholecalciferol/kg. The supplement of 2.5 micrograms/kg depressed and the higher supplements prevented the occurrence of TD, this time without a growth depression. Feeding the 10 micrograms/kg supplement for the first week only did not prevent TD. Plasma total Ca, inorganic P and alkaline phosphatase (EC 3.1.3.1) were unaffected by diet but 1,25(OH)2cholecalciferol was higher on the imbalanced than on the control diet. Supplementation of the imbalanced diet with 1,25(OH)2cholecalciferol did not increase plasma levels. It is concluded that 1,25(OH)2cholecalciferol is exerting a powerful biological effect in this model of TD, but the mechanism is unclear.
Animals↗
Defective Down syndrome in chicks is not caused by riboflavin deficiency in breeders.
1. Riboflavin-deficient practical and semi-purified diets were fed to broiler breeder hens. 2. Yolk and albumen riboflavin concentrations were depressed by the deficient diets and cases of curled toes were seen in the chicks. 3. The few instances of defective down did not resemble cases seen in field outbreaks of a condition involving depressed hatchability and a defective down syndrome. 4. It is concluded from observations in this experiment and in the field outbreaks that there is a condition in breeding chickens causing depressed hatchability and defective down that is not attributable to riboflavin deficiency.
Animals↗