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Biomedical subjects

K D Carter

Publications and source records attributed to K D Carter.

At least 19 recordsLinked to original sources
PubMed2007

Steroid-induced ptosis: case studies and histopathologic analysis.

PURPOSE: The purpose of this study was to review patients who developed ptosis after subtenon's steroid injection and to study the mechanism of steroid-induced ptosis in an animal model. METHODS: Part 1. Twenty-two patients with uveitis who had received posterior subtenon's triamcinolone acetonide injections were retrospectively reviewed. Demographics, type of uveitis, type and number of surgeries, pre and postoperative marginal reflex distance (MRD1), and clinical outcomes were evaluated. Part 2. Study of rabbit levator muscle and aponeurosis histopathology after subtenon's triamcinolone injection was performed. RESULTS: Part 1. The average age was 44.6 years (range: 14-85 years) with a mean follow-up of 14 months. The most common causes of uveitis included uveitis after cataract extraction (five), pars planitis (three), multifocal choroiditis (three), and juvenile rheumatoid arthritis (three). The average time to documented onset of ptosis was 13.9 months (range: 0-49 months). In patients who received only one steroid injection, the average time to ptosis recorded was 2.7 months (range: 0-6 months). Seventeen patients underwent ptosis repair. Part 2. No ptosis was noted in the experimental and control groups. Histopathologic analysis of levator tissues revealed no significant difference in atrophy or degree of inflammation between experimental and control groups. CONCLUSIONS: Ptosis following subtenon's steroid injection ranged from mild to moderate and occurred a few months after steroid injection. Prior studies of muscles and periocular tissues exposed to corticosteroids demonstrated degenerative muscle changes; our studies revealed no histopathologic changes in the levator muscle or aponeurosis.

Adolescent↗
PubMed2005

The oral health assessment tool--validity and reliability.

BACKGROUND: The Oral Health Assessment Tool (OHAT) was a component of the Best Practice Oral Health Model for Australian Residential Care study. The OHAT provided institutional carers with a simple, eight category screening tool to assess residents' oral health, including those with dementia. This analysis presents OHAT reliability and validity results. METHODS: A convenience sample of 21 residential care facilities (RCFs) in urban and rural Victoria, NSW and South Australia used the OHAT at baseline, three-months and six-months to assess intra- and inter-carer reliability and concurrent validity. RESULTS: Four hundred and fifty five residents completed all study phases. Intra-carer reliability for OHAT categories: percent agreement ranged from 74.4 per cent for oral cleanliness, to 93.9 per cent for dental pain; Kappa statistics were in moderate range (0.51-0.60) for lips, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Inter-carer reliability for OHAT categories: percent agreement ranged from 72.6 per cent for oral cleanliness to 92.6 per cent for dental pain; Kappa statistics were in moderate range (0.48-0.60) for lips, tongue, gums, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Intraclass correlation coefficients for OHAT total scores were 0.78 for intra-carer and 0.74 for inter-carer reliability. Validity analyses of the OHAT categories and examination findings showed complete agreement for the lips category, with the natural teeth, dentures, and tongue categories having high significant correlations and percent agreements. The gums category had significant moderate correlation and percent agreement. Non-significant and low correlations and percent agreements were evident for the saliva, oral cleanliness and dental pain categories. CONCLUSION: The Oral Health Assessment Tool was evaluated as being a reliable and valid screening assessment tool for use in residential care facilities, including those with cognitively impaired residents.

Aged↗
PubMed2002

Caries incidence and increments in community-living older adults with and without dementia.

OBJECTIVES: The Oral Health of Older Adults with Dementia was instigated in the late 1990s to quantify and compare coronal and root caries incidence and increments in community-living older Australians with and without dementia. METHODS: A longitudinal design was used to conduct dental inspections at baseline and one-year, for two groups of randomly selected community-living older adults--one group of 116 people with dementia and a comparison group of 116 people without dementia. RESULTS: At one-year there were 103 dementia and 113 (112 dentate) non-dementia participants. Coronal and root surface caries incidence was higher for dementia participants (p < 0.05). Dementia participants had higher coronal and root caries adjusted caries increments (ADJCI) (p < 0.01). Both coronal and root ADJCI were evident in half of dementia participants, compared with one-quarter of non-dementia participants. Dementia participants with higher coronal ADJCI were those who had visited the dentist since baseline, who were taking neuroleptics with high anticholinergic adverse effects, and whose carer had high carer burden score (p < 0.01). Dementia participants with higher root ADJCI were those needing assistance with oral hygiene care and whose carers had difficulties with oral hygiene care (p < 0.05). Baseline characteristics predictive in linear regression for: (1) coronal caries increments among all participants were--dementia participants, those with cognitive testing scores indicative of moderate-severe dementia, those with private health insurance; (2) root caries increments among all participants were--dementia participants, and those who had > or = 1 decayed/filled root surface at baseline. Among dementia participants, being male was the baseline characteristic predictive in logistic regression for coronal caries increments, and having > or = 1 decayed coronal surface was the baseline characteristic predictive for root caries increments. CONCLUSIONS: Coronal and root caries incidence and increments were significantly higher in the community-living older adults with dementia over the one-year follow-up period. Dementia participants had high levels of coronal and root caries increments; characteristics related to high caries increments included sex (males), dementia severity (moderate-severe), high carer burden, oral hygiene care difficulties, use of neuroleptic medication (with high anticholinergic adverse effects) and previous experience of caries.

Age Distribution↗
PubMed2002

The prevalence and experience of oral diseases in Adelaide nursing home residents.

BACKGROUND: The twenty-first century will see the evolution of a population of dentate older Australians with dental needs very different from those of older adults in past years. This study provided comprehensive information concerning oral disease prevalence in older South Australian nursing home residents. METHODS: This paper presents cross-sectional baseline results. RESULTS: Most of the 224 residents, from seven randomly selected nursing homes, were functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults who presented many complex challenges to carers and to dental professionals. Two-thirds (66 per cent) were edentulous with many dental problems and treatment needs. Dentate residents had a mean of 11.9 teeth present, higher than previously reported. The prevalence and experience of coronal and root caries and plaque accumulation was very high in dentate residents; especially males, those admitted more than three years previously, those who ate fewer food types and those who were severely cognitively impaired. These residents had more retained roots, decayed teeth and missing teeth, and fewer filled teeth when compared with data for community-dwelling older adults. CONCLUSIONS: This study highlighted the poor oral health status of these nursing home residents and the great impact of dementia on their high levels of oral diseases.

Aged↗
PubMed2001

Predictive value of the initial quantified relative afferent pupillary defect in 19 consecutive patients with traumatic optic neuropathy.

PURPOSE: To study the predictive value of the initial quantified relative afferent pupillary defect (RAPD) in patients with indirect traumatic neuropathy as it relates to final visual outcome. METHODS: The RAPD was measured and quantified by neutral density filters in patients with unilateral indirect traumatic neuropathy. All patients were treated with megadose methylprednisolone by of the protocol established by the Second National Acute Spinal Cord Injury Study. Patients were followed twice daily during treatment and then at 3-month intervals. RESULTS: Nineteen patients were enrolled over a 23-month period. Patients ranged in age from 12 to 78 years old; 18 of the 19 patients were male. No patient with an RAPD of 2.1 log units or greater had visual recovery to better than hand motion vision. The 7 patients with an initial RAPD of less than 2.1 log units showed improvement in their RAPD and were found to have vision of 20/30 or better during the follow-up period. CONCLUSIONS: In patients treated with megadose methylprednisolone with an initial RAPD of less than 2.1 log units, visual acuity improved to 20/30 or better; however, patients with an initial RAPD of 2.1 or greater showed little visual improvement. The initial quantified RAPD appears to have a predictive value related to final visual outcome.

Adolescent↗
PubMed2001

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes.

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.

Attitude of Health Personnel↗
PubMed1999

Ophthalmic manifestations of allergic fungal sinusitis.

PURPOSE: To highlight allergic fungal sinusitis as a cause of ophthalmic and sinus problems by identifying the profile of the patient with allergic fungal sinusitis and presenting a successful treatment approach. METHODS: Six consecutive cases of patients with ophthalmic manifestations of allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus involvement, mycology, immune response, imaging studies, and treatment were examined. The characteristics of this patient group with ophthalmic manifestations of allergic fungal sinusitis were compared with those of the general group of patients with allergic fungal sinusitis. RESULTS: All six patients had proptosis. One had symptomatic diplopia and one had visual loss. Imaging studies, fungal characterization, and immune profiles were similar to the reported allergic fungal sinusitis population. After treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow-up of 34 months (range, 8 to 48 months). There were no complications of treatment. CONCLUSIONS: Initial diagnosis of allergic fungal sinusitis requires suspicion on the part of the ophthalmologist. Proptosis is the most common ophthalmic sign. Differentiation from invasive forms of fungal sinus disease is crucial, because systemic antifungal medication and extensive surgical tissue debridement are not required in allergic fungal sinusitis. Treatment consists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids.

Adolescent↗
PubMed1999

Combined-approach orbital decompression for thyroid-related orbitopathy.

Surgical treatment of thyroid-related orbitopathy can be accomplished by transorbital or endoscopic techniques. Transorbital surgery has advantages in the orbital floor and lateral wall, and endoscopic decompression is best suited to the medial orbital wall. We describe a retrospective review of 16 orbits (10 patients) treated with surgery, combining endoscopic decompression of the medial wall and a transorbital approach to the floor and lateral wall. Follow-up averaged 20.8 months. Vision and field defects improved dramatically in compressive optic neuropathy cases. Hertel measurements improved, on average, 4.9 mm. Two patients with severe preoperative diplopia required strabismus surgery after decompression. Combined-approach decompression is a safe and efficacious operation with conceptual advantages over current surgical techniques.

Adolescent↗
PubMed1999

Clinical factors influencing periocular surgical defects after Mohs micrographic surgery.

PURPOSE: To determine if the surgical defect after excision of periocular skin cancers can be predicted preoperatively. METHODS: Review of medical records of patients who underwent excision of periocular skin cancers between 1990 and 1995. RESULTS: Two hundred sixty-four patients (157 men, 107 women) with a total of 281 malignant tumors were treated. Basal cell carcinoma accounted for 92.2% of the tumors, whereas squamous cell carcinoma constituted 6.4% of lesions. The lower eyelid and medial canthus were the most frequent sites of involvement. Data analysis was conducted on tumor size, cell type, location, and the Mohs stages and sections that were required for cure. Morpheaform basal cell carcinomas required the most Mohs stages and sections and resulted in the largest excisional defects when compared with clinical tumor dimensions. The lateral canthus had the fewest tumors, but lesions in this area resulted in the largest excisional defects (mean, 9.5 cm2) when compared with lesions of the medial eyelid (p = 0.35). The average size of the defect after Mohs excision of basal cell carcinoma was 4.2 to 4.6 times the original clinical tumor size. For morpheaform basal cell carcinoma, however, the average excisional defect was 6.1 times larger. Conversely, the average defect after excision of squamous cell carcinoma was only 2.6 times as large as the original clinical tumor size. CONCLUSIONS: These data are useful in predicting the size of a defect after Mohs excision of periocular skin cancer, based on the original clinical tumor size.

Adolescent↗
PubMed1999

New techniques for surgical decompression of thyroid-related orbitopathy.

Certain cases of thyroid-related orbitopathy may require surgical decompression of the orbit. The purpose of this paper is to highlight new techniques of orbital decompression in thyroid-related orbitopathy. We present two illustrative cases selected from our recent surgical experience. The techniques of combined-approach decompression, transcaruncular approach to the medial orbital wall, drilling reduction of the greater wing of sphenoid and lateral wall lag-screw fixation after lateralization by greenstick fracture are presented. The relative utility of each technique is examined. These techniques expand the surgical repertoire for this condition and allow individualization of treatment for a specific patient's needs.

Adult↗
PubMed1997

The Australian public's perception of mercury risk from dental restorations.

The debate about mercury and dental amalgam has been one of the longest running in dentistry, and shows no signs of abating. This study aimed to investigate perceptions about mercury in dental fillings among a representative sample of the Australian public. A random sub-sample of participants in a national dental telephone interview survey completed a follow-up postal questionnaire which included four items on dental mercury. The postal survey response rate was 85.2%. Concern about mercury in dental fillings was expressed by 37.5%, while 16.2% reported having requested fillings that do not contain mercury. Avoidance of dental care because of concern about mercury in fillings was reported by 5.8%, but only 4.7% reported having had fillings replaced because they contained mercury. The data indicate that there is a substantial degree of concern about mercury and dental amalgam among the Australian public, but that the dental behavioural and treatment-pattern consequences of that concern are infrequent.

Adolescent↗
PubMed1997

Public perception of cross-infection control in dentistry.

Since the advent of HIV/AIDS at the beginning of the 1980s, concern has generated considerable impetus for change in cross-infection control procedures in dentistry. This process has been hastened partly by media coverage which, in tending to favour sensation over rational discourse, has played a not inconsiderable role in shaping public understanding and expectations. This study aimed to investigate public perceptions of cross-infection control in dentistry in Australia using a postal follow-up to the 1995 National Dental Telephone Interview Survey. The postal survey response rate was 85.2 per cent. Concerns about the procedures used by their dentist to sterilize instruments were reported by 13.3 per cent of respondents overall, and this was greater among non-health-card-holders, individuals who mainly spoke a language other than English in the home, and those who reported a non-routine dental visiting pattern. Avoidance or delaying of dental visits due to the perceived cross-infection risk was reported by an overall 3.6 per cent of people, and this was higher among females and those who expressed concern about cross-infection control. The profession has a responsibility to ensure that information on the measures which have been taken to reduce the risk of cross-infection in dentistry is disseminated as widely and as clearly as possible so that undue public concern and avoidance of dental care are minimized.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Combined endoscopic and subciliary orbital decompression for thyroid-related compressive optic neuropathy.

Compressive optic neuropathy is a feared, although unusual, complication of thyroid-related orbitopathy. A variety of surgical approaches have been described to achieve orbital decompression and alleviate the hallmark apical orbital crowding of this condition. We describe a subciliary anterior orbitotomy approach to the floor combined with an endoscopic medial wall resection. The anterior orbitotomy allows removal of the bones of the orbital floor both medial and lateral to the canal of the infraorbital nerve. The anterior orbital floor is retained for globe support. This combined approach retains the low morbidity of the endoscopic operation while achieving increased apical medial orbital wall and orbital floor decompression. We describe two illustrative cases where this approach produced a dramatic improvement in visual function. The surgical refinements associated with this combined approach offer technical advantages over other operations in the treatment of thyroid-related compressive optic neuropathy.

Aged↗
PubMed1996

Patient mobility in Australian dentistry.

Data on the mobility of dental patients are scarce. The aim of this study was to investigate movement among dentists of a representative sample of the Australian public. A postal questionnaire was completed by a random subsample of 1,010 participants in the 1995 National Dental Telephone Interview Survey. The response rate was 85.2 per cent. Approximately one-third of the 885 dentate respondents reported attending a different dentist to that attended two years previously; this was substantially higher (over half) among those whose last visit was not in the private sector. Most (81.8 per cent) of those who had changed dentist had done so for reasons which were beyond the immediate control of the dental profession, but 15.2 per cent had changed because they were unhappy with the care provided by the previous dentist, and 3.0 per cent had changed because the previous dentist was too expensive. Perceived freedom to change dentist was greater among individuals who used the private sector, spoke English in the home, and who were not holders of health cards. The findings of this study indicate that the Australian public manifests a moderate degree of movement among dental providers, and that such movement is greater among users of public-sector dental services.

Adolescent↗
PubMed1996

Dental anxiety among Australians.

This study aimed to estimate the prevalence of dental anxiety and examine its associations among a representative sample of Australians aged 18 and over. A random sub-sample of participants in a national dental telephone interview survey completed a follow-up postal questionnaire (response rate 85.2 per cent) which included Corah's Dental Anxiety Scale (DAS). The prevalence of dental anxiety (defined by a DAS score of 13 or more) in the sample was 14.9 per cent, with overall severity represented by the mean score of 9.04 (sd, 3.45). The prevalence and severity of dental anxiety were greater among women than men, and in the 35-44 age group. High-anxiety individuals reported more deferring of dental care, and more frequently reported an episodic dental visiting pattern. Although there were no differences in dental anxiety by self-reported dental status, individuals who reported impact from their oral conditions had higher dental anxiety. These associations with social impacts and deferment of care indicate that dental anxiety may be an important dental public health problem in Australia.

Adolescent↗