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This book review discusses the biography of Michael Somes, a dancer, director, and choreographer in the Royal Ballet. The author highlights Somes' influence on Frederick Ashton and the careers of many principal dancers in the company. The biography explores Somes' early training, his rise to principal dancer and partner of Margot Fonteyn, and his later roles as repetiteur and assistant director. The review acknowledges Somes' strict discipline and irascible nature, but also emphasizes his generosity, love for the dancers, and dedication to the art of ballet. The author notes that Somes' contributions were privately acknowledged by the company, despite his abrupt dismissal in 1984. The review concludes by praising the book as a fascinating and readable history of English ballet from the 1940s onwards. [Extracted from the article]

Background and Objectives: In 2022, media reports alleged that doctors, particularly general practitioners (GPs), are defrauding Medicare, claiming $8 billion lost through fraud/non-compliance. This study examined Medicare Benefits Schedule billing patterns by consultation length to estimate overcharging or undercharging by GPs, and the cost/savings to Medicare., Method: A subset of data from the Bettering the Evaluation And Care of Health (BEACH) program from 2013 to 2016, which included length of consultation information, was analysed., Results: Of 89,765 consultations, GPs undercharged 11.8% of consultations and overcharged 1.6%. Of the 2760 GPs sampled, 816 (29.6%) overcharged at least once and 2334 (84.6%) undercharged at least once. Of the GPs who overcharged at least once, 85.4% also undercharged. The total effect of GP undercharging and overcharging was a net saving of $351.7 million to Medicare., Discussion: This study shows that GPs undercharging and overcharging saved Medicare over one-third of a billion dollars in 2021-22. The findings of this study do not support the media claims of widespread fraud by GPs.

Background and Objectives: A 2006-16 study investigated rheumatoid arthritis (RA) management by Australian general practitioners (GPs). The aim of this study was to examine: GP-patient encounters for RA management over the decade, treatments provided for RA management (new and continuing), characteristics of patients managed and of GPs providing management, and differences across regional areas and areas of socioeconomic advantage/disadvantage, compared with Australian guidelines., Method: GP self-reported data collected through the Bettering the Evaluation And Care of Health (BEACH) program were analysed for patient and GP characteristics and management actions (medications, referrals, investigations, procedures) nationally, regionally and by socioeconomic advantage/disadvantage levels., Results: Proportions of RA management encounters: remained static across the decade, were higher for female patients, increased with patient and GP age, increased with socioeconomic disadvantage in major cities, were higher for patients from English-speaking backgrounds, and were higher in regional/remote areas., Discussion: GP behaviour indicates equity and uniformity in RA management nationally. The results suggest adherence to current guidelines for total and new RA contacts.

Design Multi-centre randomised controlled clinical trial with two prosthetic intervention arms conducted in 14 dental schools and universities in Germany from October 2000.Case selection Adults aged ≥35 years with bilateral missing molars, both canines and at least one premolar present on each side in one jaw were eligible for inclusion. Participants were randomly allocated to restoration of posterior teeth using a removable partial denture (RPD), or a fixed prosthesis (that is, a bridge) adhering to the concepts of the shortened dental arch (SDA) principles (no replacement posterior to the second molar). Randomisation was completed centrally using randomly permuted blocks stratified by age. Data were collected at baseline (following pre-prosthetic treatment) and patients were followed up at six months, annually for five years, eight years and ten years.Data analysis In total, 215 participants were randomised and allocated to either RPD group (n = 109) or SDA group (n = 106). Intention to treat (ITT) and modified per-protocol analysis were performed on both the RPD group (n = 79) and SDA group (n = 71). Per-protocol analysis was also undertaken on both the RPD group (n = 25) and SDA group (n = 22). The level of significance was set to a two-sided p value of 0.05. The confidence interval was set at 95%.Results When considering the differences in ten-year vertical clinical attachment loss measurements, ITT analysis showed the differences between the RPD and SDA groups were statistically significant (p ≤0.05) in both the study jaw (0.79 mm) and in all teeth (0.69 mm) in favour of the SDA group. Furthermore, the SDA group also performed more favourably in both bleeding on probing and plaque index parameters, with statistically significant changes demonstrated using positive regression coefficients.Conclusions There is evidence of reduced impact on the periodontium from an SDA approach compared to an RPD approach, although the difference is unlikely to be clinically significant., (© 2021. British Dental Association.)

Introduction Oral health promotion interventions should be evidence-based and designed with community involvement. In England, Family Hubs are attended by families from a range of social backgrounds and provide an ideal setting for co-design of health interventions.Aim To co-design and evaluate an animated film for promoting oral health in community settings.Methods Families attended two co-design workshops at a Family Hub in Portsmouth, during which they discussed oral health priorities and commented on the animation design. A before-and-after survey questionnaire assessed its impact on oral health knowledge in another Family Hub in Portsmouth. Qualitative data were analysed using the Framework method, while the survey data were analysed descriptively.Results Families prioritised evidence-based advice for inclusion in the film and contributed to the film storyline. This enabled relevant alterations to ensure the animation was engaging and age-appropriate. Although the survey response rate was low for inferential statistics, descriptive analysis indicated variation in the oral health knowledge of parents and carers.Conclusion Families can offer valuable contributions to the design of health promotion interventions. A co-design method provides an approach for communicating health advice in a form that is relevant and applicable to target audiences.

Background: The aim of the current study was to determine whether anthropometric data from the New Zealand B4 School Check (B4SC) universal health service assessments are comparable to research grade anthropometric data., Methods: B4SC anthropometric data were obtained for a subsample (n=394) of children who participated in the Prevention of Overweight in Infancy (POI) randomised control trial. B4SC anthropometric measures were compared to POI anthropometric values that had been interpolated to align with the date of the B4SC assessment., Results: Interclass correlation coefficients between values from the two sources (0.93-0.98) suggested that across all these measures, most variation depended on between child effects rather than between source effects. A paired t-test found no evidence for differences between POI and B4SC height values. B4SC weights were a mean of 0.45kg heavier, and BMIs a mean of 0.41kg/m2 greater. Exploratory analyses demonstrated that greater overestimation of weight by the B4SC was associated with assessments on colder days., Conclusion: B4SC measurements of weight were greater than values obtained from interpolating the POI standardised research assessments. Interestingly, this overestimation was inversely associated with the average temperature on the day when the B4SC occurred. These findings suggest that universal health services that monitor growth in children could be improved by including standardised procedures to account for non-removal of clothing., Competing Interests: Nil.

Background: People living with psychosis, bipolar disorder, schizophrenia, major depressive disorders and other delusional disorders, collectively termed ‘severe mental illness’ (SMI), are at increased risk of dying prematurely from cardiovascular disease (CVD). The risk factors associated with this reduced life expectancy are largely modifiable., Objective: The aim of this paper is to provide summative evidence of some of the known effective interventions that may reduce cardiovascular risk in people living with SMI., Discussion: Pharmacological and nonpharmacological interventions are available and can be used in primary care for CVD risk reduction in people with SMI. Trials of pharmacological interventions for weight gain and smoking have shown good effects. Combined pharmacological and lifestyle interventions could support management of other risk factors, but tailored support and engagement strategies are needed. Specific guidance for CVD risk reduction in people with SMI is absent, but evidence indicates that following guidelines for the general population is warranted.

Background: Identifying general surgical patients at risk of poor outcome can be a diagnostic challenge. This study aimed to determine the significance of admission serum acute phase reactants in predicting emergency general surgical outcome., Methods: An electronic database containing all acute general surgical admissions over two years was analysed to correlate admission acute phase reactants (including C-reactive protein (CRP), absolute neutrophil count (ANC) and serum albumin) with outcome. Study endpoints included: cross-sectional imaging, surgery, intensive care admission, in-hospital mortality and length-of-stay (LOS)., Results: A total of 9738 patients were enrolled in the study. Elevated CRP (n= 4635; 47%) was associated with: advanced imaging 17% vs 30% (p=0.0001), surgery 15% vs 28% (p=0.0001), ITU admission 3% vs 7% (p=0.0001) and mortality 0.5% vs 2% (p=0.0001). A cut-off level of >150 mg/L was most significant. Abnormal ANC (n= 4104; 42%) was significant in predicting advanced imaging 15% vs 55% (p=0.0001), surgery 17% vs 27% (p=0.0001), and ITU admission 3% vs 8% (p=0.0001). Hypoalbuminaemia (n= 1392; 14%) was associated with a 12-fold rise in mortality 0.5% vs 6%. Normal CRP, ANC with hypoalbuminaemia was a strong negative predictor of mortality (0.015% vs 1.24%), while an abnormal combination was associated with mortality of 8%., Conclusions: Admission acute phase reactants are useful to enhance acute surgical patient stratification during clinical decision making. An admission CRP above 150 should alert the clinician of a potentially high-risk patient who may require prompt intervention. A combination of abnormal results has the highest in-hospital mortality.

Data sourcesCochrane Central Register of Controlled Trials (CENTRAL), Medline through PubMed, Scopus, Science Direct, ISI Web of Science, Evidence-Based Dentistry, ClinicalTrials.gov, the European Union Clinical Trials Register, the Spanish General University Board database of doctoral theses in Spain (TESEO), the Spanish National Research Council (CSIC) bibliographic databases, and the Spanish Medical Index (IME).Study selectionRandomised controlled trials (RCTs) (with or without placebo) of patients of any age or gender who underwent maxillary or mandibular third molar extractions. Studies were required to have analysed the efficacy of only chlorhexidine in any concentration, formulation or treatment regimen for preventing alveolar osteitis (AO). There was no language restriction.Data extraction and synthesisData extraction was carried out independently by two researchers, and a third researcher was consulted in case of disagreements. When explicit data were not stated in the text, they were calculated using data from the tables where possible. In addition, authors were contacted to obtain any necessary missing information. Datasets were assessed for heterogeneity, and meta-analysis was conducted on homogenous datasets. Publication bias was assessed through funnel plots. The research was conducted and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsTwenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and two split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P<.0001). There was evidence of low heterogeneity (I 2 = 9.3%; P = 0.336 by X 2 test). The number needed to treat was eight (95% CI, 7-11). There were no differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60) for the prevention of AO after third molar extractions. Chlorhexidine did not cause more adverse reactions than placebo.ConclusionsThe use of chlorhexidine, in any formulation (rinse or gel), concentration (0.12% or 0.20%), or regimen (before, during and/or after surgery), is efficacious and effective in preventing AO in patients who have undergone third molar extraction. The findings showed that in order to prevent one case of AO, eight patients would have to be treated with chlorhexidine. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.

The Victorian Country Fire Authority in Australia runs the Community Fireguard (CFG) programme to assist individuals and communities in preparing for fire. The objective of this qualitative research was to understand the impact of CFG groups on their members' fire preparedness and response during the 2009 Australian bushfires. Social connectedness emerged as a strong theme, leading to an analysis of data using social capital theory. The main strength of the CFG programme was that it was driven by innovative community members; however, concerns arose regarding the extent to which the programme covered all vulnerable areas, which led the research team to explore the theory of diffusion of innovation. The article concludes by stepping back from the evaluation and using both applied theories to reflect on broad options for community fire preparedness programmes in general. The exercise produced two contrasting options for principles underlying community fire preparedness programmes., (© 2014 The Author(s). Disasters © Overseas Development Institute, 2014.)

A variety of educational approaches exist within U.K. dental schools, and institutions are constantly striving to improve the quality of their graduates. This study aimed to evaluate the self-reported confidence in, and clinical exposure to, paediatric dentistry at three U.K. dental schools (Liverpool, Manchester and Sheffield) over a three year period. Seventy-five percent of final year BDS undergraduates at the three dental schools completed an anonymous questionnaire capturing student self-reported clinical experience in seven core paediatric dentistry treatment skills, both in hospital and outreach settings. Visual analogue scales were used to record self-assessed confidence levels in aspects of paediatric dentistry and students were also asked to provide a written reflection of both their hospital and outreach placements. The results revealed that despite the variety of educational approaches taken, undergraduates reported very similar levels of clinical experience and confidence. Significant interschool differences in student experience were found with respect to the management of carious primary molars, believed to be a result of individual schools favouring different treatment regimes. Although outreach placements were seen as essential for gaining adequate student experience, the need to improve the consistency of teaching between hospital and outreach centres was highlighted. The study also emphasises the need to take care when using clinical targets in undergraduate teaching and identifies the potential benefits of undergraduate training in inhalation sedation. Finally, despite changes to the paediatric programmes with respect to dental trauma management, students remained lacking in confidence suggesting the need for further development.

Adolescent idiopathic scoliosis is the most common spinal deformity encountered by General Orthopaedic Surgeons. Etiology remains unclear and current research focuses on genetic factors that may influence scoliosis development and risk of progression. Delayed diagnosis can result in severe deformities which affect the coronal and sagittal planes, as well as the rib cage, waistline symmetry, and shoulder balance. Patient's dissatisfaction in terms of physical appearance and mechanical back pain, as well as the risk for curve deterioration are usually the reasons for treatment. Conservative management involves mainly bracing with the aim to stop or slow down scoliosis progression during growth and if possible prevent the need for surgical treatment. This is mainly indicated in young compliant patients with a large amount of remaining growth and progressive curvatures. Scoliosis correction is indicated for severe or progressive curves which produce significant cosmetic deformity, muscular pain, and patient discontent. Posterior spinal arthrodesis with Harrington instrumentation and bone grafting was the first attempt to correct the coronal deformity and replace in situ fusion. This was associated with high pseudarthrosis rates, need for postoperative immobilization, and flattening of sagittal spinal contour. Segmental correction techniques were introduced along with the Luque rods, Harri-Luque, and Wisconsin systems. Correction in both coronal and sagittal planes was not satisfactory and high rates of nonunion persisted until Cotrel and Dubousset introduced the concept of global spinal derotation. Development of pedicle screws provided a powerful tool to correct three-dimensional vertebral deformity and opened a new era in the treatment of scoliosis.

Dementia care costs exceed those of cardiovascular diseases and cancer combined. Milder forms of functionally significant cognitive decline add further to the staggering human, societal and economic costs. However, the underlying mechanisms are poorly understood and few treatments are available. Cumulative exposure to high glucocorticoid levels is a major hypothesis of decline in cognitive function with aging. Current manipulations to maintain low circulating glucocorticoid levels throughout life (adrenalectomy with low-dose corticosterone replacement and neonatal handling), although effective in preventing the emergence of memory deficits with age in rodent models, are not clinically applicable. By contrast, recent data in cells, mice and humans suggest that inhibition of the tissue-selective glucocorticoid-amplifying enzyme, 11β-hydroxysteroid dehydrogenase type 1, may be an effective novel approach.

A young man with schizophrenia had persistent auditory hallucinations which responded well to clozapine but subsequently developed a different pattern of brief, joint visual and auditory hallucinations which were confirmed as being due to complex partial seizures of temporal lobe origin. He had no history of epilepsy prior to taking clozapine and the subsequent hallucinations could be mistaken for a deterioration in the schizophrenia, leading to a further increase in clozapine dose.