Monday, 31 August 2015

I Amsterdam: City Break

A couple of travel posts coming up soon, but first instalment is about my recent city break to Amsterdam with my mother.



Surprisingly before this trip, I had never been on a break with just me and my mum! We were looking for a city close by which wasn't too expensive and luckily there was a 2 night deal on Lastminute.com so we went for it!

What language is spoken there?
Dutch but almost everyone can speak English to a very good standard and signs and menus are usually in both languages.

What is the currency?
Euro. At the moment, it's around 1.3 Euros to the Pound

How do I get around?
Amsterdam is the easiest city to get around! I found it easier than London (and I'm a Londoner!). Trams, buses and trains are all easily numbered with maps to help you know where to get off but a lot of the central part of the city is easily accessible by foot or bicycle. We bought the I Amsterdam card for 2 days which gave us unlimited travel plus free entry or discounts to some attractions. See their website for more information.

We spent two days in the city which I thought was a decent amount of time to see most attractions, although there are so many different museums from the Van Gogh to Anne Frank Huis to the Cow museum! If you wanted to visit them all I think you'd be there for months!

Here is what we got up to:

Day 1

Van Gogh Museum

Top attraction in Amsterdam according to the Lonely Planet. Like most museums in the city, just turning up without a discount card or pre-booked ticket could result in hour long queues. Our I Amsterdam cards gave us free entry to the museum so we had to queue for a mere 20 minutes or so. 

We didn't spend too much time in the museum, it was quite crowded especially around his most famous paintings such as the Sunflowers and the collection wasn't too extensive and it included a whole section on his life and family as well as artists who were influenced by his style.

Heineken Experience

This was probably the attraction I enjoyed most in Amsterdam. Even if you're not a massive beer drinker I would still go. As well as showing you how the beer is made and the history of the company, there were parts that were focused on the events and sports that Heineken sponsored (see the picture of me and my mum 'winning' the Champion's League below). 

There was an interactive 4D motion ride and you are taught how to drink the beer in the correct way as well as how to pull your own perfect pint. The ticket admission included 3 drinks of Heineken (or a soft drink) and there was plenty of cool memorabilia at the gift shop at the end!

Winning the Champions League!


Twenty Third Rooftop Bar

After our few beers we decided to find a rooftop bar and we stumbled on one at the top of the Hotel Okura. Drinks were London prices but the cocktails we had were yummy and they gave us some well needed bar snacks to nibble on whilst overlooking the city. You can see all the planes landing into Schiphol airport too so we got a great view at sunset (despite the rain!). 

To see more, take at look at their website


Day 2


Canal Cruise

Our cards also included a canal cruise with one of the many river cruise companies. There were plenty of cruises that you can choose from: beer and burger cruise, hop on and off cruise, cocktail cruise. We went on the 1 hour cruise around the city. 

We chose to sit inside the boat (it was pretty chilly outside) but you still saw plenty and it was a good way to get your bearings of the city. 


View from the cruise boat of one of the many canals

Artis Royal Zoo

Another attraction included in our card, this zoo situated in the middle of the city used to a botanical garden and it's a very unique zoo. It does feel like you're strolling through a park and not a place full of cages. There are a big variety of animals from lions to penguins as well as an impressive aquarium, planetarium and insectarium. You could probably spend a whole day there if the weather was good.

To see more, check out their website

Red Light District

You can't visit Amsterdam and not check out the famous Red Light District! We walked through the area in the evening so it wasn't that busy and there weren't a lot of girls in the windows (remember no photos unless you want your camera thrown in the canal!).

There are several museums in the area related to the history of Prostitution in the country and the surrounding area is full of Coffee shops and China town is also just around the corner. On some days you can get guided tours through the area and there are pub crawls that go through the district most nights. 

The area is a good place to visit for souvenirs, cheese shops and patisseries selling waffles and macaroons.   


Have you been to Amsterdam? Any places you would recommend? Please leave your comments in the section below!



Thursday, 27 August 2015

Loopy about my Loupes: Review of Optiloupes

It's been a while since my last post and I've had a bit of a break from dentistry before I start my DCT post next week. But as promised, here is the review of the new Loupes I got through in July!

My OptiLoupe through the lens titanium Loupes, magnficiation x3 with mounted illumination

Do I really need Loupes?

Every young dentist has probably had the Loupe chat with someone but are they really that essential when practising dentistry or is it just another expensive cost we have to add to our other gadgets? 

As an undergraduate, I never had the chance to work under magnification unless I was on the endo clinic (and even then I only used the microscope twice). I've managed crown preps, endos, cavity preps perfectly well before without magnification so are Loupes just for those who are short sighted?

There are 2 massive advantages to using Loupes in your day to day life as a dentist:
  1. Improves your posture to prevent back pain, a major problem for a lot of dentists
  2. Improves the quality of your dentistry as you can see much more with magnification (seems obvious!)

What magnification should I go for?

Magnification varies from x 2.5-x 6

I have been recommended to start off at a low magnification so that the learning curve is less steep when using them: x 2.5 -x 3, I chose to buy x 3 so that I got good amount of magnification that I could get used to using without getting headaches. 

What is the Field of View and Depth of Field?

Field of view is how much you can see through your Loupes - a good FoV in low magnification Loupes is around 10cm.

Depth of Field is the depth distance that is focused through the Loupes - this is related to the working distance. 

Bear in mind that with increased magnification, the DoF and FoV decrease and therefore the Loupes are more difficult to get adjusted to using. 

How do I assess the quality of my Loupes?

You should look for 3 qualities when testing out Loupes:
  1. Resolution - how defined is the image?
  2. Chromatic aberration - has the colour of the image changed?
  3. Spherical aberration -  has the image been distorted?
A good tip that Reena Wadia gave in her tips for young dentists (see a summary of her talk here), is to look at a ruler through the Loupes to make sure the lines on the ruler are straight, clear and the same colour. 

My Loupes


I ordered my Loupes at the BDA conference in May (see my post about the conference here) and it did take about 10 weeks for them to be delivered to me but apparently this was due to having a huge amount of orders from the conference to deal with!

As I've said before, I chose x 3 magnification, through-the-lens titanium frames. I chose through-the-lens as I found the flip down Loupes bulky and heavy.  And of course, I also invested in a light as what's the point in getting a high magnification and not being able to see in the dark!?

The question most of you will probably be thinking is how much are they? Loupe prices can vary massively from a few hundreds to a few thousands. Buying Loupes at a conference supposedly gets you a discount off the normal rate, but I also got another £200 off that price for being a DF1 and also because there was 3 of us who were buying them - so altogether my Loupes plus the light came to £900.

Not cheap but definitely worth it. After working with them for 2 weeks I must say that I don't know how I did some dentistry without them before. The first root canal I did when I had my Loupes was so much easier! Being able to see where you are putting your files instead of poking around blindly not only speeds up the procedure, but it makes it much less stressful and more enjoyable! 

I found adjusting to the magnification surprisingly easy, only poking my first patient a couple of times when bringing instruments in and out of my field of vision (luckily he was a dental nurse who I had told I had not used my Loupes before!). I haven't experienced any headaches using them even though I had to switch to putting my contact lenses in instead of wearing my glasses - I didn't bother getting my prescription in my Loupes as my prescription has changed quite a bit recently. 



So if you are thinking about investing in yourself definitely buy some Loupes! If you are at a conference or have a rep coming round to your practice here are some questions you should ask before you buy your set!
  • What's the magnification/FoV/DoF?
  • Flip ups vs. through-the-lens
  • How long are they guaranteed for? (I have a life time guarantee for mine)
  • How long is the battery life for the light and how long does it take to charge?
  • Can I put my prescription in the lens?
  • Is there a cooling off period?
  • Can I pay in instalments?
  • What if they need adjusting?

I hope this helps when it comes to buying your own set of Loupes. Please leave your experience of Loupes or any questions in the section below!




Friday, 7 August 2015

A Pop-up Up on the 34th Floor: BT Tower Revolving Restaurant

Anyone who follows me on Instagram will have noticed my spamming of views of London on Tuesday night. If you're still unsure where I was, I was at the top of the BT tower

One of the views form the top

It's the BT tower's 50th anniversary this year and in celebration, they've opened back up the revolving restaurant at the top! 

The restaurant hasn't been open since 1980 and since I see the tower everyday from my terrace I was eager to get the chance to go up to the top! Public access is usually only limited to private events and the tower is currently mostly used as a television network switching centre. 

Luckily one of my friends managed to win the ballot that was opened (apparently over 60,000 people applied for only 1400 spots!), so we were whisked up to the 34th floor for a 7 course meal.


Our evening. Clockwise from top left: Cauliflower foam starter, Chocolate Custard, Hake with tomatoes olives and basil, Slow cooked hen's egg and charred lecture, Lemon posset, Post dinner tea, The indulgent cheese trolley, Spiced duck breast main and the night time view from the restaurant.


Security was airport like at the tower and we were greeted with a glass of champagne and a 360 view of London. It was great to see the change of light throughout the evening from light, to dusk to night. 

By the end of the amazing 7 courses I was stuffed! I didn't think I would be able to eat everything on the menu, and I almost did (I had to pass on the last few bites of the chocolate pudding!). After a while I forgot that the restaurant was constantly revolving so when it juddered to a stop at the end of the night, it was almost like stepping off a ferry or landing a plane. It also meant that when we got up to go to the bathroom, when you'd re-emerge it took a few seconds to re-orientate yourself and find your table.

Although the evening was pretty expensive (dinner came to almost £80), it was worth it as this sort of thing will not be happening again any time soon. We also were given a certificate and pack on the way out as a souvenir of the night. 


Were you lucky enough to win a spot on the ballot? How did you find it? Let me know in the comments below!

Monday, 3 August 2015

Antimicrobials in Dentistry

Following my post about the talk I presented at the Evidence Based Dentistry conference, I thought I would share some more information about antimicrobial usage in practice. 



One of the requirements of my foundation year was to perform an audit in practice: specifically one on antimicrobial prescribing.

Dentists are responsible for prescribing % of antibiotics in the UK, and it's important to ensure that these prescriptions are appropriate due to the increasing risk of antibiotic resistance. Campaigns such as the Antibiotic Guardian initiative aim to decrease the amount of inappropriate prescriptions as if we continue to prescribe these drugs as freely as they can be now, resistant strains will become very difficult to treat e.g. MRSA.

What guidelines should I use?


The guidelines that we should be following when prescribing antimicrobials are:
  1. FGDP: Antimicrobial Prescribing for Dental Practioners
  2. SDCEP: Drug Prescribing in Dentistry
When prescribing anti-microbials you need to ensure that:
  • The prescription is recorded fully
  • There are clear and appropriate justifications for the prescription
  • Local measures should be taken first if possible e.g. drainage, extraction, extirpation

Recent updates:

  • Amoxicillin should be prescribed at 500mg three times daily (TDS) for 5 days rather than 250mg previously recommended
  • Metronidazole should be prescribed for 3 days only, not for 5 days unless in combination with amoxicillin

Results of the Pan London Audit


The main findings from the first round of audit across London were:
  • All prescriptions were recorded with name of the drug but not always the dose and duration 
  • 52% of prescriptions were appropriate
  • 250mg of amoxicillin was still being prescribed in some cases
  • Pain was used as justification for prescription alone which is not a systemic sign of spread of infection and therefore not an appropriate justifcation
  • Local measure were only taken in 50% of cases

Changes that were made in practice:

  • Prescribe the correct dose, duration of drug and record this
  • Justify the prescription appropriately i.e. systemic sign of spread
  • Local measures to be taken first
In order to facilitate these changes, practices much make sure they made an antimicrobial prescribing protocol to adhere to, to have a thermometer in their practice and to make pain appointments longer in order to allow the dentists to take local measures first.

Re-audit

We performed a re-audit 3 months after the Action plan was implemented and these were our findings:
  1. All prescriptions had drug, dose, duration and frequency recorded
  2. Only 4% of the time 250mg of amoxicillin was still being prescribed (2 instances)
  3. Justifications for prescriptions had generally improved (82%), but pain was still justification in 15% of cases
  4. Local measures were taken in 70% of cases

This shows a general improvement in the prescription of anti-microbials although further training and education may be needed to achieve a gold standard of care.

If you are unsure of how to perform an audit in practice, see my guide here.


Antibiotic prophylaxis


When discussing the use of anti-microbials in practice you cannot ignore the issue of antibiotic prophylaxis prior to dental treatments.

In 2008, NICE issued guidelines which recommended the ceasure of prophylaxis prior to dental treatments, even for those at higher risk of Infective Endocarditis (IE) e.g. prosthetic heart valves, congential heart defects. They recommended this due to the risk of allergy and resistance and the fact that they claimed there was little evidence to support the effectiveness of this treatment. 

This has resulted in a massive reduction in the presciption of antibiotics but according to the Lancet, there has also been an increase in the instances of IE, especially in high risk individuals. At the moment there is no direct causal link, but since the guidelines have been introduced there is a definite spike in the number of IE cases (see the Lancet).

Perhaps this guideline needs to be reviewed, especially since the mortality rate for IE is 40%, although there has been recent confirmation by NICE that these guidelines will remain unchanged. 


I hope this clears up when to prescribe antimicrobials in dentistry. Please let me know in the comments what you think about the NICE guidelines and if antibiotics are being prescribed appropriately in your practice.


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