Evidence-based care through clinical practice

A rater agreement study on measurements in cross-sectional CBCT images exploring the association between alveolar bone morphology and craniofacial height

Objectives

To investigate rater agreement regarding measurements of height and width of the maxilla and mandible using cross-sectional images from CBCT examinations. Furthermore, to explore the association between vertical craniofacial height and alveolar bone morphology.

Methods

Pre-treatment CBCT scans from 450 patients referred for treatment to a private clinic for orthodontics and oral surgery in Scandinavia were available and of these, 180 were selected. Lateral head images were generated from the CBCT volumes to categorise subjects into three groups based on their craniofacial height. Cross-sectional images of the maxillary and mandibular bodies at three locations in the maxilla and mandible, respectively, were obtained and measured at one height and two width recordings by five raters. One-way analysis of variance with a Tukey post hoc test was performed. A significance level of 5% was used.

Results

Rater agreement was mostly excellent or good when measuring height and width of the maxilla and mandible in cross-sectional CBCT images. For height (of the alveolar bone/bodies), there were statistically significant differences between the low- and the high-angle groups for all the observers when measuring in the premolar and midline regions, both in the maxilla and in the mandible.

Conclusion

The high agreement found ensures a reliable measurement technique and confirms the relation between craniofacial height and alveolar bone height and width.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11282-020-00493-4.

Evidence-Based Practice and Occupational Therapy

Occupational therapists, like other health care professionals, are constantly being asked to confront major changes in the way health and social care services are structured and, in turn, how their working practices are organised. In order for the market-driven National Health Service to function, it requires detailed information on whether services are clinically effective. The use of evidence-based practice has been widely advocated as one way to meet these demands.

This article focuses on evidence-based practice as an approach, and considers its implications and relevance for occupational therapists. First, a short history of the background of evidence-based practice is given, followed by a discussion of recent social and political developments which have increased demands for its wider use. A number of key issues associated with evidence-based practice are then considered, including implementing research findings into practice; the nature of evidence itself; time; the accessibility of research findings; and skills required for evidence-based practice. Practical suggestions are also offered to enable therapists to make the most appropriate use of evidence-based practice. The aim of this article is to stimulate debate about evidence-based decision making for practitioners.

Use of the Trendelenburg Position as the Resuscitation Position: To T or Not to T?

• Objective To review the literature on use of the Trendelenburg position as a position for resuscitation of patients who are hypotensive.

• Methods PubMed online, cited bibliographies, critical care textbooks, and Advanced Cardiac Life Support guidelines were searched for information on the position used for resuscitation. Because of the heterogeneity of the data, only pertinent articles and chapters were summarized.

• Results Eight peer-reviewed publications on the position used for resuscitation were found. Pertinent information from 2 critical care textbooks and from the Advanced Cardiac Life Support guidelines was included in the review. Literature on the position was scarce, lacked strength, and seemed to be guided by “expert opinion.”

• Conclusion The general “slant” of the available data seems to indicate that the Trendelenburg position is probably not a good position for resuscitation of patients who are hypotensive. Further clinical studies are needed to determine the optimal position for resuscitation.