Sheila E. Fisher

The effects of the carbon dioxide surgical laser on oral tissues

The carbon dioxide laser has become more widely available in recent years and is now employed in many branches of surgery. It is important to understand its biological effect on oral tissues so that the likely response in patients can be predicted. However, little information has been published on the healing mechanism of oral wounds. A study of the healing of laser wounds at various sites in the mouth has been undertaken in a clinically analogous animal model and the results correlated with the findings in patients. A brief description is given of the role of the carbon dioxide laser in the management of oral mucosal disease.

Measuring quality of life in patients with head and neck cancer: Update of the EORTC QLQ-H&N Module, Phase III.

The objective of this study was to pilot test an updated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ‐H&N60).

Development of an advanced database for clinical trials integrated with an electronic patient record system

Secondary use of patient databases is essential in healthcare if clinical trials are to progress efficiently to planned time and target and imperative if the planned UK expansion of research and development (R&D) at point of care is to be achieved. Integration of effective databases primarily designed to facilitate patient care with R&D requirements is needed but represents a complex challenge. We present a system that achieves an integrated approach with online management of complex datasets for clinical trials within care records using a specific study as an example to show functionality in practice; illustrating how this system provides an ideal resource to meet the needs of both clinicians and researchers.

The EORTC QLQ-OH17: A supplementary module to the EORTC QLQ-C30 for assessment of oral health and quality of life in cancer patients

AIMS Assessment of oral and dental problems is seldom routine in clinical oncology, despite the potential negative impact of these problems on nutritional status, social function and quality of life (QoL). The aim was to develop a supplementary module to the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) focusing on oral health and related QoL issues in all cancer diagnoses. METHODS The module development followed the EORTC guidelines. Phases 1&2 were conducted in France, Germany, Greece, Netherlands, Norway and United Kingdom, while seven countries representing seven languages were included in Phase 3. RESULTS Eighty-five QoL-items were identified from systematic literature searches. Semi-structured interviews with health-care professionals experienced in oncology and oral/dental care (n=18) and patients (n=133) resulted in a provisional module with 41 items. In phase 3 this was further tested in 178 European patients representing different phases of disease and treatment. Results from the interviews, clinical experiences and statistical analyses resulted in the EORTC QLQ-OH17. The module consists of 17 items conceptualised into four multi-item scales (pain/discomfort, xerostomia, eating, information) and three single items related to use of dentures and future worries. CONCLUSION This study provides a useful tool intended for use in conjunction with the EORTC QLQ-C30 for assessment of oral and dental problems. The increased awareness may lead to proper interventions, thereby preventing more serious problems and negative impact on QoL. The reliability and validity, the cross-cultural applicability and the psychometric properties of the module will be tested in a larger international study.

Analysis of calvarial bone defects in rats using microcomputed tomography: potential for a novel composite material and a new quantitative measurement

Reconstruction of craniomaxillofacial defects is a challenge for surgeons and has psychological and functional burdens for patients. Undoubtedly, there is a need for improved biomaterials and techniques for craniomaxillofacial reconstruction. We assessed the potential regeneration of bone using three modifications of a novel composite and explored the validity of a new measurement using microcomputed tomography (micro-CT). We placed three different composite samples in calvarial defects in rats and analysed healing with micro-CT. The results showed that polycaprolactone (PCL) with phosphate glass fibre is promising for non-load bearing applications in the craniomaxillofacial region. Also, the new micro-CT measurement of the temporal characterisation of the mineralisation of bone (TCBM) has the potential to evolve into a reliable predictor of bony healing and its quality.

Discriminating normal and cancerous thyroid cell lines using implicit context representation Cartesian genetic programming

In this paper, we describe a method for discriminating between thyroid cell lines. Five commercial thyroid cell lines were obtained, ranging from non-cancerous to cancerous varieties. Raman spectroscopy was used to interrogate native cell biochemistry. Following suitable normalisation of the data, implicit context representation Cartesian genetic programming was then used to search for classifiers capable of distinguishing between the spectral fingerprints of the different cell lines. The results are promising, producing comprehensible classifiers whose output values correlate with biological aggressiveness.

Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000

BackgroundHead and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors.MethodsWe are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires.DiscussionThis large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.

Repair of calvarial defects in rats by prefabricated, degradable, long fibre composite implants

We report results from an initial small animal study designed to provide information on the biocompatibility of a novel biodegradable composite designed for craniomaxillofacial reconstruction. Rat calvarium was chosen as a clinically analogous model, which allowed comparison between experimental groups (PCL alone, PCL/phosphate glass, or PCL/bioglass implants) and control groups (empty defects or bone grafted defects). All animals recovered well from surgery and no clinical complications were observed. Histological assessment indicated a lack of inflammatory response. The amount of new bone formation at the dural aspect of the implant was statistically significantly higher in the PCL/phosphate glass group than the other experimental groups. This study confirms, in a clinically analogous model, the promise of the novel PCL/phosphate glass composite material. Work is planned toward manufacturing scale up and clinical trials.

The configuration of clinics and the use of biopsy and photography in oral premalignancy: a survey of consultants of the British Association of Oral and Maxillofacial Surgeons

Oral dysplastic lesions may have an increased chance of becoming oral squamous cell carcinoma, but to date their management remains controversial. The aim of this survey was to explore the current practical aspects of the management of patients with dysplasia by oral and maxillofacial consultants in the UK. In the survey we asked consultants about the numbers of patients they see with oral premalignant lesions, the frequency and specialty of designated hospital clinics, their use of photographs and biopsy, factors that influence their decision whether to biopsy a lesion at the first appointment, the procedure for treatment and follow-up and their use (if any) of chemopreventive agents. We found a wide variation in the practical aspects of managing patients with dysplasia, and the lack of consistency among clinicians supports the idea of an initiative to establish more robust national guidelines to use as a gold standard in the future.

Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000.

*School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, UniversityHospitals Bristol NHSFoundation Trust, School ofOral andDental Sciences, University of Bristol, Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, School of Social and Community Medicine, University of Bristol, Bristol, UK National Cancer Research Institute Consumer Liaison Group (NCRI CLG), Independent Cancer Patients Voice (ICPV), London, UK **MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and CommunityMedicine, School of Clinical Sciences, University of Bristol, Bristol, Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, Royal Marsden Hospital and the Institute for Cancer Research, London, Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, ***Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK