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PubMed1992

The how and why of the ADA's evaluation program for dental therapeutic products.

Since 1930, the Council on Dental Therapeutics of the American Dental Association has been evaluating dental drug products for safety and efficacy through its Acceptance Program. To date, numerous products have been evaluated, and many hundreds have received the council's seal of acceptance. Acceptance criteria are rigorous, and the council relies on expert consultants to evaluate the supporting data. There are no manufacturer fees involved with the Acceptance Program. When a product has been awarded the seal, it means that adequate data have been submitted, and that the product is safe and does what it says it will do. This paper describes, in detail, how the Acceptance Program works.

American Dental Association↗
PubMed1991

Innovative bridging program for overseas trained doctors.

Most overseas trained doctors wishing to practise in Australia are required to sit for examinations set by the Australian Medical Council (AMC) before they can seek registration through State medical boards. In 1989, the South Western Sydney Area Health Service, which is responsible for the delivery of health services to 650,000 people, initiated a bridging program with the joint aim of providing overseas trained doctors with the opportunity to undertake a comprehensive program of study and facilitating the recruitment of doctors into the area. The program comprises two integrated components, each extending over five months. Stage 1 relates to the AMC's multiple choice questionnaire (MCQ) examination; stage 2 prepares candidates for the clinical examination. In addition, provision is made for developing awareness of professional responsibility, standards and ethical bases for the practice of medicine in Australia. Participants are also required to study English and communication skills throughout the program. Acceptance into the program is based on a number of criteria including successful completion of a screening test and an interview. Progression to the Clinical Course requires that candidates pass the MCQ Course and undertake to work in the area. The program has been funded jointly by State and Commonwealth Government bodies. Results obtained by program participants in the MCQ and clinical examinations conducted by the AMC have been well ahead of the national average.

Australia↗
PubMed1986

Posterior composite resins. Council on Dental Materials, Instruments, and Equipment.

Information on the long-term clinical performance of composite resins in posterior restorations is still very limited. The council has classified some composite resins as "provisionally acceptable" for permanent teeth on the basis of information submitted under the guidelines for the acceptance program for composite resins for occlusal Class I and Class II restorations. This classification, however, does not imply their unlimited use as routine restorative material in stress-bearing areas in all situations. No justification exists to extrapolate the performance data to situations in which there are limited documented results. Also no justification exists to extrapolate the performance of one composite resin to other composite resins. The guidelines of the acceptance program were established on the basis of information available in 1981. Information is emerging that suggests that these limits do not necessarily provide a critical evaluation of the long-term performance of composite resins in posterior restorations. The guidelines are being reviewed and revised. The profession is advised to be cautious in the manipulation and application of composite resins as they are sensitive to technique. A composite resin should not be handled like an amalgam. Slight deviations from the proper technique may result in postoperative sensitivity, secondary caries, and clinical performances different from those reported in clinical studies. The cavity preparation should be conservative, and the restoration should be subjected to minimal occlusal stresses. The use of a rubber dam is essential. The profession should be aware that composite resins do have occlusal wear. Proximal contacts are difficult to establish.(ABSTRACT TRUNCATED AT 250 WORDS)

Composite Resins↗
PubMed1985

Noble metal alloys for metal-ceramic restorations.

A review of the comparative characteristics and properties of noble metal alloys used for metal-ceramic restorations has been presented. Selection of an alloy for one's practice should be based on long-term clinical data, physical properties, esthetic potential, and laboratory data on metal-ceramic bond strength and thermal compatibility with commercial dental porcelains. Although gold-based alloys, such as the Au-Pt-Pd, Au-Pd-Ag, and Au-Pd classes, may appear to be costly compared with the palladium-based alloys, they have clearly established their clinical integrity and acceptability over an extended period of time. Other than the relatively low sag resistance of the high gold-low silver content alloys and the potential thermal incompatibility with some commercial porcelain products, few clinical failures have been observed. The palladium-based alloys are less costly than the gold-based alloys. Palladium-silver alloys require extra precautions to minimize porcelain discoloration. Palladium-copper and palladium-cobalt alloys may also cause porcelain discoloration, as copper and cobalt are used as colorants in glasses. The palladium-cobalt alloys are least susceptible to high-temperature creep compared with all classes of noble metals. Nevertheless, insufficient clinical data exist to advocate the general use of the palladium-copper and palladium-cobalt alloys at the present time. One should base the selection and use of these alloys in part on their ability to meet the requirements of the ADA Acceptance Program. A list of acceptable or provisionally acceptable alloys is available from the American Dental Association and is published annually in the Journal of the American Dental Association. Dentists have the legal and ethical responsibility for selection of alloys used for cast restorations. This responsibility should not be delegated to the dental laboratory technician. It is advisable to discuss the criteria for selection of an alloy with the technician and the thermal manufacturer or supplier. Once an alloy is selected, the specific alloy name should be written on all laboratory prescriptions as well as in patients' charts. Maintenance of accurate dental records is necessary from a legal point of view, and it also allows the clinician to determine the longevity of specific metal-porcelain systems.

Cobalt↗
PubMed1977

[Global program of smallpox eradication. 1. Smallpox in the world before acceptance of the program of its eradication by the World Health Organization].

Despite a considerable success in control smallpox in a number of countries reached as a result of vaccination the problem of eradication of this infection could not be solved without uniting the efforts of all the countries in the world. Guided by humanity principles the delegation of the USSR suggested in 1958 a program of smallpox eradication in the whole world. World smallpox morbidity is analyzed in this work.

Africa↗
PubMed1978

Applied anthropology and the concept of the underdog: implications for community mental health planning and evaluation.

Medical anthropologists have long been involved in health-program evaluation and have studied factors related to program acceptance in target communities. However, assessing the reasons for the success or failure of a program should not be an end in itself, but should be a process that generates guidelines for the development of similar programs elsewhere and more general suggestions about the appropriate roles that applied anthropologists can fulfill. This paper briefly summarizes the research of an anthropological team who investigated the apparent failure of a respite home facility for retarded children in a suburban neighborhood to generate requisite community support. The team was able to develop a series of recommendations in aid of a plan to establish such centers elsewhere in the county, and in the state of Florida as a whole. However, the paper is more broadly concerned with applied anthropological attempts to define the nature of target or client communities and at delineating the appropriate anthropological perspective on health care delivery transactions. New roles for the anthropologist as evaluator will be considered.

Anthropology, Cultural↗
PubMedDate not supplied

Screening to control infectious diseases: evaluation of control programs for gonorrhea and syphilis.

Gonorrhea and syphilis serve as models for the definition of criteria for the evaluation of screening programs for detection of disease. Mass screening and selective screening are distinguished from individual screening (case finding). Important characteristics of screening tests are sensitivity, specificity, efficiency, precision, accuracy, and acceptability. Program evaluation includes process evaluation and outcome evaluation. Major criteria to consider in the evaluation of mass screening programs are prevalence and incidence of disease, predictive value of tests used, yield, available screening tests, acceptance, follow-up services, costs and benefits, and control over the spread of infection. All forms of screening programs should be evaluated by available methods so that they will operate with maximal efficiency and so that nonproductive programs can be discarded.

Communicable Disease Control↗
PubMed1980

An evaluation of behavioral techniques reinforced with an anorectic drug in a double-blind weight loss study.

Sixty obese outpatients participated in a double-blind comparison of diethylpropion hydrochloride and placebo in conjunction with a behavior modification program for weight reduction. Assessments of efficacy and program acceptance included total weight loss, percent of initial (baseline) weight loss, percent excess weight lost, effectiveness of overall program, and helpfulness of medication. Diethylpropion was significantly better than placebo in all five assessments. An added behavioral technique, a substantial refundable deposit of money, reduced the attrition rate of all study entrants from 50% to 10%; thus patient compliance was greatly enhanced.

Adult↗
PubMed1989

Evaluation of a phenytoin dosage regimen design and adjustment computer program.

A computer program for phenytoin (PHT) dosing was developed containing seven different menus: two for drug-naive patients, one using an empirical equation, the other using means for Vmax and Km; two for patients in whom either one or two dose rates and steady-state concentrations are available; two for patients with hypoalbuminemia, and uremia, respectively; and one menu that optimizes Vmax and Km from available steady-state concentrations. The program accepts or converts PHT and sodium PHT, and makes blood level correction for the concomitant administration of 25 different drugs. The evaluation of the program was done by retrospective analysis using data from three study pools: group I involved 47 patients from the University Hospital, group II relied upon 29 patient data supplied from a collaborative Veterans Administration study, and group III involved 26 patients from the Children's Hospital. Predictions were made and compared with found data to be within a range of +/- 15, 20, or 25%. For study group III, many individual blood samples were less than 8 micrograms ml-1; hence, saturation kinetics may not have been involved. It is suspected that saturation kinetics in infants may begin at higher levels. Compliance seems to still be a major problem in PHT monitoring and dosage regimen adjustment. Accepting the data as they are, using one or two dose rates with the corresponding blood concentrations resulted overall in 73-86% achieving blood levels within +/- 25% of the predicted value.

Adolescent↗
PubMed1986

Problems in notification and screening of workers at high risk of disease.

Current and former workers who have been occupationally exposed to hazardous substances have unique medical and social needs. Few programs recognize and accommodate the needs of these workers. Consequently, screening and medical surveillance assume a pivotal role in a system that inadequately deals with the needs of workers identified and notified of occupational disease risks. In some cases, screening programs, ineffective in altering survival patterns, are established because they represent surrogates for other kinds of support programs that do not exist. Where screening techniques are effective and available, there still are problems in getting them funded and established in acceptable programs. This paper details these problems and argues for increased research to enhance the efficacy of screening, not only in preventing disease, but also in improving the quality of life for workers at risk.

Humans↗