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Biomedical subjects

N René

Publications and source records attributed to N René.

15 recordsLinked to original sources
PubMed1999

On denture marking.

During the last decades in Sweden dentures have been permanently marked with a stainless steel metal band incorporated into the acrylic and containing the patient's birth date, a special number, and "S" for Sweden. The last recommendation issued by the National Board of Health and Welfare states that "the patients shall always be offered denture marking and be informed about the benefit thereof. Denture marking is not permitted if the patient refuses it". Requirements for denture markers have been that they should be biologically inert (when incorporated into the denture), not be expensive, be easy to inscribe, be possible to retrieve after an accident, and survive elevated temperatures for a reasonable time under normal circumstances. Although the frequency of edentulousness has decreased in recent years due to the improvement in oral health there remains a need to address the issue of marking of complete dentures, because there is a large variation in the oral status of populations in different countries. Given that only one marked denture can reveal the identity of a deceased person when all other methods fail to do so, makes it worthwhile. Furthermore, denture marking is important in long-term care facilities. We have investigated the issue of denture marking in Europe and in the United States. The results from the European survey show that denture marking is, to our knowledge regulated by law only in Sweden and Iceland. In the US denture marking is so far mandatory in 21 states while New York State requires dentures to be marked if the patient requests it and several other states impose the obligation to mark dentures on long-term care facilities. Since there is no international consensus regarding the issue of denture marking it is important to address it. A survey from the Nordic countries has shown that if denture marking was in general use, the contribution to the establishment of identity by forensic odontology in cases of fire would increase by about 10%. This means that about 25 more individuals could have been identified if their dentures were marked. Increased international collaboration is needed to solve the issue of denture marking for clinical and forensic purposes.

Aged↗
PubMed1998

Treatment injuries in dentistry--cases from one year in the Swedish Patient Insurance Scheme.

Eight hundred and fifty-one claims submitted to the Swedish Patient Insurance Scheme were studied and analysed. The most frequent claim referred to root fractures of roots with posts, and to root perforations also related to root posts. Other relatively frequent claims referred to pulpal complications in connection with fixed prosthodontics, root perforations related to endodontic treatment, and dysaesthesia. The mean latency time (the time from the actual treatment to the diagnosis of the injury) was for root fractures 10.6 months, and the mean latency time for root perforations that were not directly observed during preparation was 15.9 months. Pulpal complications of teeth treated with crowns or fixed partial dentures had a mean latency time of 7.6 months. Injuries with a low frequency were, for example, fracture of vital abutments for crowns or fixed partial dentures, damage to tissue by electrosurgery or to the floor of the mouth by drilling, or perforations to the antrum. Two cases of particles dropped into the patient's eye were also reported.

Crowns↗
PubMed1996

Frequency of edentulism and identification marking of removable dentures in long-term care units.

There were two aims of this study. First, the frequency of edentulism and denture wearers among 464 residents in long-term units in Göteborg, Sweden, was evaluated. Second, the dentures were examined to determine whether they were marked correctly for identification. Of the subjects, 46% were edentulous in both jaws, and 13% in one jaw. Among complete denture wearers, 47% of the patients had at least one identification-marked denture. Removable partial dentures, worn by 26 subjects, were marked to a lesser extent (32%). Since there are many edentulous people among the elderly in most parts of the world we suggest that removable dentures are marked with the patient's name or identification number.

Age Factors↗
PubMed1995

Quality evaluation of 10 years patient records in forensic odontology.

In forensic odontology, accurate detailed and complete recording of ante-mortem information is essential as the basis for odontological identification. Earlier studies on malpractice cases in Sweden indicated that the quality of the recording procedure was not always acceptable. Therefore, the aim of this retrospective study was to investigate the quality of ante-mortem records and its possible implications for identification work. All forensic odontology cases referred to the Department of Forensic Medicine in Göteborg between 1983 and 1992 were studied with regard to the instructions for dental records from the National Board of Health and Welfare. Information on dental characteristics, normal anatomical findings and restorative treatment was complete in 43 (68%) of the cases, incomplete in 17 (27%) and missing in 3 (5%). Registration of previous therapy was missing in about 75 (94%) of the records. It was possible to identify patient radiographs in only 16 of the 40 records where radiographs were available. In spite of this, the inaccuracies in the records did not seem to hamper the identification procedures in this study which could be explained by the character of the cases and the availability of medical and circumstantial information.

Dental Materials↗
PubMed1994

Knowledge among Swedish dentists about rules for patient records.

Some Swedish dentists chosen at random answered a questionnaire in 1992. The aim was to find out if the knowledge among dentists as a whole about patient record matters is as bad as patient records in disciplinary cases imply. The knowledge was good and better than expected. Specialists have a better knowledge than private practitioners and they also more often have a secretary to handle the patient records. Time of licensation and the dentist's age were of no importance. If the standard of knowledge in a few formal matters corresponds to a high standard in the observance of the rules will be investigated in the second part of this investigation (Rasmusson et al 1994), which will scrutinize patient records from the same dentists who answered the questionnaire.

Adult↗
PubMed1994

Quality evaluation of patient records in Swedish dental care.

The purposes of this study were to evaluate systematically five patient records each from randomly selected dentists in different regions of Sweden in 1992, and to see whether the good knowledge of some record-keeping rules, noted earlier, was reflected in practical observance of the rules as a whole. Observance was generally poor: in nearly 40% of the variables investigated, the documentation did not follow the rules. Patient history, status, diagnosis, therapy plans and other important information were often missing among the records from the general practitioners. The specialists' records, however, were in general very accurate. As a whole, Swedish dental patient records constitute poor antemortem material for forensic odontology. The dentist's age is related to the quality of the records. The standard of the patient records must be improved.

Adult↗
PubMed1993

Complaint and disciplinary systems in dentistry in Sweden: a presentation and discussion of their efficacy in preventing malpractice.

The Swedish systems for complaints and supervision with many possibilities of claiming on different levels may lead to prevention of future problems in medical and dental care. The systems are corrective, preventive and compensatory, and are important in the process of quality assurance. However, some elements need improvement. The present paper gives as a background an overview of the Swedish systems and discusses a few cases. Comparisons with systems in other countries, especially the USA, are made, and new measures are discussed. There is a need for smooth, preventive measures as well as strong, punitive and corrective measures. Recidivist doctors/dentists must be stopped.

Cross-Cultural Comparison↗
PubMed1992

Prosthodontic claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme includes a guarantee insurance for prosthetic treatment. Retreatments of failures, up to 2 years after cementation of fixed prosthodontics and 1 year after delivery of removable prosthodontics, are covered by the guarantee insurance scheme. Almost all private practitioners were included in this scheme at the time of the study in 1989. During a specific period all claims were studied at the time of reporting, when annexed radiographs and so forth could be analyzed. One hundred and thirty-six claims were recorded with regard to treatment injury, reasons for remake, latency times from cementation or delivery to diagnosis, and details about the teeth or constructions involved in the claim. The dentist's opinion of the cause of the failure was also recorded. The reports covered treatment injuries, most of them root perforations during preparation for a post. The guarantee claims for single crowns concerned porcelain fractures, loss of retention, and root fractures as the most frequent failures. For fixed partial dentures the failures were recorded as loss of retention, porcelain fractures, tooth or root fractures, and metal framework fractures in that order. The dentist gave information about his/her opinion of the reason for the failure in only 38.5% of the claims. There were, however, no clear findings about the reasons for the failures.

Crowns↗
PubMed1992

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.

Humans↗
PubMed1991

Improved bioavailability of a new oral preparation of medroxyprogesterone acetate.

Medroxyprogesterone acetate (MPA) is widely used in the hormonal therapy of breast cancer. So far, oral formulations of MPA commercially available present a very low bioavailability, with a less than 10% extent of oral absorption. A new oral preparation of MPA has been recently developed. Based on a pilot study, an open, randomized, crossover trial has been performed on 22 breast and endometrial cancer patients to evaluate the relative bioavailability of this new oral formulation (200-mg sachet, twice daily) as compared with a standard formulation (Farlutal, 500-mg tablet, twice daily). The bioavailability evaluation was mainly based on the area under the curve measured between two administrations at steady state, after 15 days of continuous therapy. Wide interpatient variability of MPA plasma levels after oral MPA administration was confirmed. The MPA plasma levels were higher in patients treated with the new formulation than in patients treated with Farlutal. The relative bioavailability of the new preparation was 3.5 times higher than that of the standard. This new formulation represents a great improvement in the extent of oral absorption of MPA and could lead to better management of hormone-responsive tumors by hormonal therapy.

Administration, Oral↗
PubMed1991

Malpractice reports in prosthodontics in Sweden.

Prosthodontics is the branch most often involved in dental malpractice cases in Sweden. The number of cases has increased with the growing production of fixed prosthodontics after the introduction of the National Dental Insurance Scheme and the increase in the number of dentists. Prosthodontic treatment accounted for one-third of the working hours of private practitioners but two-thirds of the sanctions during the period 1974-78. The patients' complaints are often justified in some parts. The most common faults are elementary and have been similar throughout the whole period 1947-1988. Bridges (2-4 units), complete dentures and single crowns are the constructions most often involved in complaints. The maxillary frontal and premolar regions are in this order the regions most often involved. There are no differences between different age groups of dentists concerning the quantity of faults, but there is probably concerning the quality of faults because older dentists get more severe sanctions than younger.

Adult↗
PubMed1991

Dental malpractice in Sweden.

This study reports and analyses the handling of malpractice cases by the Swedish authorities from an odontological and legal point of view, in order to find explanatory factors and create a basis for prevention and discussion of the principles for processing such cases. Women report their dentists more often than men. The main reasons for complaint are "faulty management/performance of treatment," "unsatisfactory technical/esthetic quality," and "wrong diagnosis/indication." Many cases concern elementary and well-known clinical principles for investigation, treatment planning, and clinical management. Private practitioners from the Stockholm region are most often involved in malpractice cases, and most of the complaints concern prosthodontic treatment. Poor record keeping is not uncommon.

Adolescent↗
PubMed1991

Dental claims in the Swedish Patient Insurance Scheme.

The Swedish Patient Insurance Scheme covers treatment injuries and guarantees the replacement of failed removable prostheses for 1 year and fixed prostheses for 2 years after fitting. In this paper, 573 dental cases are analysed for a 3-month period in 1986, during which crowns and bridges formed the vast majority of failed treatments that were reported.

Adult↗