Traumatic experience interacts with factors in the child and family to contribute to the development of PTSD. Trauma that threatens family integrity appears to make a strong contribution to the development of PTSD. Increased understanding of the factors contributing to PTSD may provide additional opportunities for developing effective interventions.

BackgroundOne of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs.MethodsForty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use.ResultsTwice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation (P < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant (P > 0.05).ConclusionsThe use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.

The judicious application of dose rounding of chemotherapy agents is possible without any negative clinical effect. It is feasible to dose round to the nearest vial for those cytotoxic agents that are available in multiple vial sizes.

Introduction: Operation notes provide an insight into the operative process and stand as a legal document of a surgical procedure occurring. Maintaining accurate, complete and legible notes is fundamental for post-operative patient care and medico-legal purposes. This study aimed at comparing the quality of laparoscopic appendicectomy operation notes prior-to and after the introduction of a procedure-specific proforma consistent with the Royal College of Surgeons of England (RCSEng) guidelines, 2014. Methods: Nineteen parameters based on the RCSEng ‘Good Surgical Practice’ 2014 guidelines were used to audit laparoscopic appendicectomy operation notes. The study consisted of a retrospective audit of 43 consecutive laparoscopic appendicectomy operation notes and a prospective audit of 57 consecutive operation notes following the introduction of a procedure-specific proforma (existing in both hard copy and electronic versions) for laparoscopic appendicectomy. We assessed: (i) the overall compliance with the RCSEng guidelines, (ii) whether each parameter of RCSEng guidelines recommendations were clearly recorded in the operation notes, and (iii) legibility of operation notes. Statistical analysis for difference between the two groups was performed using the independent sample t-test. Results: After introduction of a procedure-specific profroma for laparoscopic appendicectomy, average compliance with RCSEng guidelines increased from 66% retrospectively to 94% prospectively (p < 0.00001). In 8 of the 19 parameters assessed there was significant improvement in adherence to guidelines. Discussion: The implementation of a procedure-specific operation significantly increased compliance with RCSEng guidelines. Such proformas may help reduce variability and standardise operation notes for the same procedure and improve post-operative care. Highlights:

To compare glomerular filtration rate measured by technetium-99m ([Tc 99m ]) DTPA clearance with estimated creatinine clearance (CrCl) (Cockcroft and Gault (C&G) method) in patients with serum creatinine (Scr) levels o0.06 mmol l À1 , and determine the effect of rounding serum creatinine to 0.06 mmol l À1 . Patients with serum creatinine values o0.06 mmol l À1 at the time of [Tc 99m ] clearance determination were identified. Creatinine clearance was calculated by the C&G method using both actual and rounded Scr values. A total of 419 adults had GFR measured by technetium-99m diethyl triamine penta-acetic acid ([Tc 99m ] DTPA) clearance. Out of this group, 26 patients had a serum creatinine value o0.06 mmol l À1 . The C&G estimates of renal function using actual serum creatinine resulted in an overall overestimation of 12.9% when compared to [Tc 99m ] DTPA clearance. When the value of serum creatinine was rounded to 0.06 mmol l À1 , the formula underestimated renal function by À7.0%. Analysis of estimated creatinine clearance for different levels of renal function showed significant differences to [Tc 99m ] DTPA clearance. Rounding up of serum creatinine to 0.06 mmol l À1 improved the predictive ability of the C&G method for the patients with [Tc 99m ] DTPA clearance p100 ml min À1 , but worsened the effect in those 4100 ml min À1 . This work indicates that when bedside estimates of renal function are calculated using the C&G formula actual Scr should be used first to estimate CrCl. If the resultant CrCl is p100 ml min À1, then the Scr should be rounded up to 0.06 mmol l À1 and CrCl recalculated. Further assessment of this approach is warranted in a larger cohort of patients.