The development and acceptability of an educational and training intervention for recruiters to neonatal trials: the TRAIN project

BACKGROUND

Suboptimal or slow recruitment affects 30-50% of trials. Education and training of trial recruiters has been identified as one strategy for potentially boosting recruitment to randomised controlled trials (hereafter referred to as trials). The Training tRial recruiters, An educational INtervention (TRAIN) project was established to develop and assess the acceptability of an education and training intervention for recruiters to neonatal trials. In this paper, we report the development and acceptability of TRAIN.

METHODS

TRAIN involved three sequential phases, with each phase contributing information to the subsequent phase(s). These phases were 1) evidence synthesis (systematic review of the effectiveness of training interventions and a content analysis of the format, content, and delivery of identified interventions), 2) intervention development using a Partnership (co-design/co-creation) approach, and 3) intervention acceptability assessments with recruiters to neonatal trials.

RESULTS

TRAIN, accompanied by a comprehensive intervention manual, has been designed for online or in-person delivery. TRAIN can be offered to recruiters before trial recruitment begins or as refresher sessions during a trial. The intervention consists of five core learning outcomes which are addressed across three core training units. These units are the trial protocol (Unit 1, 50 min, trial-specific), understanding randomisation (Unit 2, 5 min, trial-generic) and approaching and engaging with parents (Unit 3, 70 min, trial-generic). Eleven recruiters to neonatal trials registered to attend the acceptability assessment training workshops, although only four took part. All four positively valued the training Units and resources for increasing recruiter preparedness, knowledge, and confidence. More flexibility in how the training is facilitated, however, was noted (e.g., training divided across two workshops of shorter duration). Units 2 and 3 were considered beneficial to incorporate into Good Clinical Practice Training or as part of induction training for new staff joining neonatal units.

CONCLUSION

TRAIN offers a comprehensive co-produced training and education intervention for recruiters to neonatal trials. TRAIN was deemed acceptable, with minor modification, to neonatal trial recruiters. The small number of recruiters taking part in the acceptability assessment is a limitation. Scale-up of TRAIN with formal piloting and testing for effectiveness in a large cluster randomised trial is required.

Clinical outcomes of implant-supported prosthetic rehabilitation of severely atrophic maxilla: A systematic review

Aim

The purpose of this systematic review is to evaluate the clinical outcomes for the various methods of rehabilitation of a severely atrophic maxilla with the help of implant-supported fixed prosthesis.

Materials and Methods

The relevant publications published between 2013 and 2022 and written only in English were identified using an electronic search. The primary research question for this study was developed based on the PICO framework, which stands for population, intervention, control, and outcomes which was "What are the clinical outcomes of implant-supported prosthetic rehabilitation in patients with severely atrophic maxilla?" The relevancy of the articles was confirmed by examining their titles, abstracts, and complete texts to determine whether they satisfied the requirements for inclusion. Utilizing specialized study design-related bias assessment forms, the risk of bias was evaluated.

Results

The database search resulted in 1568 results; however, 1529 of them were eliminated because of insufficient, duplicate, or missing data. Additionally, manual searching yielded 11 articles. After 50 full-text papers were assessed for eligibility, 17 articles were eliminated. Thus, 33 studies in total are included in the current systematic review. Risk of bias analysis and GRADE evidence analysis were performed. Data were found to be heterogeneous and thus meta-analysis could not be done and narrative synthesis is presented.

Conclusion

The patient's condition and the clinician's expertise play a role in taking the decision on choice of technique for the fixed implant-supported rehabilitation of the severely atrophic maxilla. A high success and survival rate is produced by the majority of fixed implant-assisted prostheses despite the biologic and prosthetic problems. A single approach cannot be recommended as the gold standard. The choice is dependent on the patient's biological factors as well as the clinician's expertise. The included studies were assessed using GRADE criteria. The quality of evidence is low-medium. Therefore, to better comprehend the clinical effectiveness of the treatment alternatives, more well-designed randomized controlled trials with longer follow-up period are required.

A comparative study of rectal volume variation in patients with prostate cancer: A tertiary care center study

INTRODUCTION

Every day variations in rectal filling in prostate cancer radiotherapy can significantly alter the delivered dose distribution from what was intended. The goal of this study was to see if the time of treatment delivery affected the rectal filling.

METHODS

This is a retrospective study which included 50 patients with localized prostate cancer treated with volumetric modulated arc therapy (VMAT) to the primary and regional lymph nodes. Cone Beam Computed Tomography (CBCT) image-sets were done for all patient's daily setup verification. The radiation therapist contoured the rectum on all CBCT image sets. The rectal volumes delineated on CBCT and the planning CT image sets were compared. The change in rectal volumes between morning and afternoon treatments were calculated and compared.

RESULTS

A total of 1000 CBCT image sets were obtained on 50 patients in the morning and afternoon. The percentage variation of the CBCT rectal volumes over the planning CT scan was 16.57% in the AM group and 24.35% in the PM group.

CONCLUSION

The percentage change in rectal volume was significantly lesser in AM group compared to PM group and therefore morning treatments may result in dose distribution that is close to the intended dose distribution.

IMPLICATIONS FOR PRACTICE

In prostate cancer radiotherapy our study suggests that a simple technique of changing the time of treatment from afternoon to morning can help to reduce the rectal volume.

Comparative in vitro evaluation of remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars: a systematic review

PURPOSE

The aim was to compare the remaining dentine thickness (RDT) following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars. Research question was 'Is there any difference between the remaining dentine thickness following instrumentation with hand and rotary endodontic files during pulpectomy in primary molars?'.

METHODS

Electronic Databases like MEDLINE PubMed, Cochrane Library, EBSCOhost, Google scholar and grey literature were searched between January 1, 2006 and August 31, 2022 for in vitro and ex vivo studies that compared hand and rotary endodontic instrumentation to evaluate the RDT in primary molars. Articles published in English or which could be translated into English were searched. Two reviewers independently selected studies, extracted data, assessed risk of bias using the Revised, validated version of MINORS criteria.

RESULTS

Twelve studies were included in qualitative analysis. All included studies showed low risk of bias. Six studies showed more RDT with rotary instrumentation compared to manual instrumentation. Whereas, five studies showed variable results for RDT with manual and rotary instrumentation at different levels of root canals. One study showed no significant difference between manual and rotary instrumentation. In view of methodological heterogeneity of the findings, a meta-analysis was not conducted.

CONCLUSION

High quality of evidence based on low risk of bias was found in all the included studies. Statistically, rotary instrumentation showed more RDT than manual instrumentation according to majority of studies. Despite the shortcomings of this systematic review, it is possible to infer that the use of rotary instrumentation provides more RDT and thus there is considerable conservation of tooth structure.

Effect of Ball and Bar Attachment Type on Patient Satisfaction Using Two-Implant-Retained Mandibular Overdenture: A Crossover Randomized Clinical Trial

Background

Considering the two-implant-retained overdenture as a first treatment of choice for edentulous mandible, patients using the overdentures need to be satisfied with the type of attachment used. The purpose of this study was to determine level of patient satisfaction with two-implant-retained mandibular overdentures opposing conventional maxillary complete denture using ball-socket and bar-clip attachments.

Materials and Methods

In this within-subject crossover randomized clinical trial, total 20 edentulous patients were given conventional complete dentures for 3 months to use. All completed a satisfaction questionnaire before implant placement. They were randomly assigned to receive an overdenture retained by either ball or bar attachment. After 3 months satisfaction questionnaires were repeated, and crossover was done by changing the attachments. After use of 3 months of alternate attachments, patients were asked to complete the final questionnaires and asked to choose their preferred type. The patient satisfaction scores were recorded after using 3 months of conventional complete denture, 3 months of first attachment and 3 months of second attachment. Data were analyzed using Wilcoxon signed rank test. The P values were adjusted using Bonferroni multiple testing correction, and P < .05 were considered as statistically significant.

Results

There was no significant difference in patient satisfaction between ball and bar attachments. However, patient satisfaction improved significantly between baseline and either-attachment-retained prosthesis. At the end of the comparative crossover experiment, 11 patients voted for the ball attachments and 9 for the bar attachments, thereby indicating them as their preferred attachments.

Conclusions

Among ball and bar attachment, there was no statistically significant difference in satisfaction scores. Neither ball nor bar attachment was chosen as a preference over the other.

Stomatognathic Risk Factors and Clinical Manifestations of Temporomandibular Disorders in Indian Population: A Case-control Study

AIM

This study was aimed to compare the risk factors and associated clinical manifestations of patients with temporomandibular disorders (TMDs) in the Indian population.

MATERIALS AND METHODS

A total of 52 patients were explored according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and compared with 48 controls. The mean age of the study group was 30.96 ± 11.60 years, 41% were males and 59% were females. The mean age in the control group was 31.5 ± 9.9 years (37.5% males), measuring differences in TMD risk factors (self-perceived stress, parafunctions, occlusal interferences, history of orthodontic treatment, and/or extraction).

RESULTS

The most common sign observed in the selected subjects was the joint sound (clicking) (42%), followed by mandibular deviation 39% as the second most common sign. Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (n = 40, 76%), followed by disc displacement with reduction (DDWR) (32.1%), arthralgia (30%), and disc displacement without reduction (DDWoR) (7.6%). More than one DC/TMD diagnosis was established in 63.2% of the patients. The risk factors like presence of clenching, stress perception, parafunctions, tooth wear, and occlusal interferences were significantly more frequent in all the cases than in the respective controls.

CONCLUSIONS

In the studied population, the presence of TMD was found to be positively related to factors namely female gender, parafunction, occlusal interferences, psychological stress, and tooth wear. Myofascial pain is the commonest diagnosis (either single or in combination). It is followed by DDWR (either single or in combination with others). Double diagnosis is also common.

CLINICAL SIGNIFICANCE

Temporomandibular disorders showed a female predilection and were found to be positively related to factors, viz., parafunction, occlusal interferences, stress, and tooth wear. Clinicians should also be aware of common clinical manifestations of TMDs and their related stomatognathic risk factors to provide comprehensive oral care and to identify such factors for disease prevention.

Inflammation begets isolated atrioventricular conduction disturbances in young an observation from indian registry data

Background

High grade AV block is less commonly encountered in patients &lt;60 years. The aetiological role of inflammatory conditions is not well studied in this group of patients.

Purpose

To determine the prevalence of myocardial inflammation in young patients presenting with High grade AV block and assess its response to immunosuppression.

Methodology

This is a prospective, registry based, observational study conducted at two centers from Jan 2020 to Dec 2021. Myocardial inflammation was detected using Cardiac PET, and/or histopathological examination. Those with evidence of inflammation were started on graded immunosuppression.

Results

318 patients were enrolled. Mean EF was 55.2±7.0%. Cardiac PET was performed in 87/318 (27.3%). Myocardial inflammation was seen in 57/87 (65%). LV basal septum was most commonly involved. 44/57 (77%) were started on immunosuppressive therapy after excluding indolent tuberculosis.8 patients died during follow-up with all deaths being sudden in nature. 5/44 (11.3%) had reversal of CHB with resolution of cPET findings.

Conclusion

Significant proportion of young patients with High grade AV block have segmental myocardial inflammation. Immunosuppression helps restore AV conduction in some of these patients. Long-term studies are required to assess adverse impact of inflammation on cardiac contractile function.

Funding Acknowledgement

Type of funding sources: None.

Opacifiers on color stability of maxillofacial silicone under aging and Indian weathering conditions: An in vitro study

STATEMENT OF PROBLEM

Resistance to long-term color change is a desirable property for facial prosthetic elastomers. Evidence for the color stability of maxillofacial silicones under aging and hot and humid Indian weathering conditions is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of adding opacifiers on the color stability of maxillofacial silicone under human aging and Indian weather conditions.

MATERIAL AND METHODS

A total of 93 specimen disks were obtained from the A-2186, platinum-based, room-temperature vulcanized, maxillofacial silicone elastomer by using a Ø30×6-mm stainless-steel die. The specimens were divided into 3 main groups (n=30), C (control), T (titanium dioxide), and B (barium sulfate), and 1 additional specimen (n=1) from each group was stored in a closed box and further subgrouped as outdoor weathering (COut, TOut, BOut), acidic perspiration (CAcid, TAcid, BAcid), sebum (CSebum, TSebum, BSebum) (n=10), and visual comparison (CVis, TVis, BVis) (n=1). Baseline L∗, a∗, b∗ values were recorded by using a spectrophotometer and visual perception. The specimens were subjected to human and extraoral aging conditions, and the values were recorded again after 6 months. Data were analyzed statistically by using analysis of variance (ANOVA) and post hoc analysis with the Tukey post hoc test.

RESULTS

In group C, the mean color change for COut was 3.69 ±0.49; CAcid, 3.58 ±0.68; and CSebum, 7.53 ±0.22 (P<.001). In group T, the mean color change for TOut was 2.60 ±0.24; TAcid, 2.35 ±0.13; and TSebum, 4.91 ±0.44 (P<.001). In group B, BOut was 1.59 ±0.28, BAcid was 1.46 ±0.28, and BSebum was 4.03 ±0.71 (P<.001). The specimens containing barium sulfate showed the maximum color stability. The least color stability was observed in all specimens exposed to sebum solution and was significantly different (P<.001) from the outdoor weather and acidic perspiration specimens. Visually perceivable color changes were observed in specimens exposed to the sebum solution.

CONCLUSIONS

The addition of titanium dioxide and barium sulfate as opacifiers resulted in clinically acceptable color change when exposed to outdoor weathering and acidic perspiration but not in sebum solution.

AB0610 NORMOCALCAEMIC HYPERPARATHYROIDISM AND BONE HEALTH – WORSE THAN ANTICIPATED?

Background:

Since the formal recognition of normocalcaemic hyperparathyroidism (nHPT) as a distinct entity in 2008, several studies have been published describing the characteristics of these individuals. Controversy exists regarding diagnostics and the role of parathyroidectomy in such cases. A chief reason for lack of consensus is the disagreement among experts regarding the potential complications and a bias towards perhaps benign nature of this condition.

Objectives:

In order to understand the challenges posed by this cohort, we aim to characterise these patients at presentation to our metabolic bone diseases unit with a focus on bone health.

Methods:

We interrogated our departmental database and undertook retrospective analysis of all patients presenting to metabolic bone service at our large university teaching hospital with a catchment population of 350,000. Individuals were included in the survey based on criteria of Vit D >70 nmol/L, normal calcium (2.20-2.60 mmol/L), eGFR>60ml/min and PTH >6.9 pmol/L measured twice at least three months apart.

Results:

Over six months review period, of 134 referrals, 42 (31%) were identified with nHPT. Follow up duration was two years. Mean age was 60 years (25-86). 38 (90%) were women with 31 (81%) post menopause. 34 (80%) were of Caucasian descent. All had comorbidities with median of five (1-14). Polypharmacy (>4 prescribed medicines) was common (36/42, 85%) with mean of seven prescribed medications (0-22). Mean Vit D was 88 (70.4-133.6), calcium 2.43 (2.26-2.58), creatinine 69.8 (48-115) and PTH 8.8 (7.2-14.2). Ten (24%) had already had fragility fractures with mean of two (0-4). 21 had DXA scan with mean T score of -3.78 (-2.1 - -6.0). 13/21(31%) had osteoporosis. Oral and IV bisphosphonates, denosumab and teriparatide were prescribed to 12 (28.5%), 14 (33%), 4 (10%) and one patient respectively.

Conclusion:

Our study suggests high prevalence of nHPT among patients referred to metabolic bone service with confirmed bone health issues. Nearly a third of patients have nHPT in this secondary care setting and a quarter have already suffered fragility fractures. These patients carry high comorbidity, polypharmacy and osteoporosis burden. Management of such patients is challenging owing to complex interplay of various ailments. Bone active agents are required for nearly two-thirds of this group. Though the natural course of nHPT is an area of active research, our data adds to the growing body of evidence that this is not a benign condition with particularly high fracture burden and poor bone quality. nHPT is perhaps responsible for the onset and progression of the similar osseous complications as described in classical PHPT. Further longitudinal studies are required to help devise best management plan to mitigate against the skeletal encumbrance of nHPT.

Disclosure of Interests:

None declared.

Exogenous β-cyclocitral treatment primes tomato plants against drought by inducing tolerance traits, independent of abscisic acid

Drought is the most devastating stress for crops. Intensity and duration of drought determine the magnitude of plant damage; similarly, plant ability to counteract drought determines its tolerance capacity. Recent studies revealed that exogenous apocarotenoid treatment confers abiotic stress tolerance to plants. However, much less is known about the role of β-cyclocitral (βCC), the major apocarotenoid, in drought tolerance. Here, we demonstrate βCC's role in improving plants' tolerance against drought stress. Tomato (Solanum lycopersicum L.) plants were independently treated with water and βCC and grown under either water-limited or irrigated conditions. The βCC-treated drought-exposed (BD) and βCC-treated irrigated (BH) plants were analysed for the major drought tolerance associated traits; water-treated drought-exposed (CD) and water-treated irrigated plants (CH) were used as controls. On exposure to drought, unlike controls, βCC-treated plants showed no wilting, higher RWC and stomatal conductance, unchanged ABA levels and stomatal closure. The BD plants had increased photosynthesis, chlorophyll content and enhanced root, but not shoot, growth. In addition, βCC treatment enhanced proline accumulation and activity of SOD in both drought-exposed and well irrigated plants. Taken together, βCC was identified as a potential candidate that improves tomato osmolyte accumulation and superoxide elimination, independent of ABA, and prepares the plant for upcoming drought stress. Our results suggest that βCC can be used to prime crops against drought stress.

The color stability of maxillofacial silicones: A systematic review and meta analysis

Aim

This systematic review aims to identify and interpret results of studies that evaluated the changes in the color stability of maxillofacial prosthetic materials due to chemical instability of silicones and pigments and the effect of exposure to environmental conditions and aging factors on the same.

Settings and Design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA).

Materials and Methods

Relevant articles written in English only, before November 15, 2019, were identified using an electronic search in the PubMed/Medline conducted to identify pertinent articles. The relevancy of the articles was verified by screening the title, abstract, and full text, if they met the inclusion criteria. A total of 42 articles satisfied the criteria, from which data were extracted for qualitative synthesis. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42019124562).

Statistical Analysis Used

Since considerable data heterogenicity was present in all studies except the ones on incorporation of TiO2 for which meta-analysis using random effects model was performed.

Results

The database search resulted in 234 studies, of which 202 articles were excluded due to lack of relevance, duplication, and unavailability of data. The remaining 32 fulltext articles were assessed for eligibility, out of which 2 articles were excluded. Twelve articles were yielded by manual search. A total of 42 studies were included in the present systematic review. Due to heterogeneous data, meta-analysis could be only carried out with the effect of TiO2 nano particle on color stability.

Conclusions

Although there has been extensive amount of research in this field, an ideal maxillofacial silicone exhibiting good color stability in various human and environmental aging conditions is yet to be identified. Human and environmental aging conditions have an adverse effect on the color stability and addition of TiO2 nano particle seems to improve the same.

COVID-19 pandemic and its impact on dental students: A multi-institutional survey

Purpose/objectives

To investigate dental students’ perceptions and concerns regarding the COVID‐19 pandemic, their coping strategies and support resources, and their perceived stress levels.

Methods

A customized 19‐item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress

Results

A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID‐19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went “smoothly with some troubles” for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID‐19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores

Conclusion

Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Evaluation of the educator's portfolio as a tool for self-reflection: Faculty perceptions

Background

Preparing a teaching portfolio to document educational expertise has shown to be useful for both promotion and to stimulate faculty development. This article describes a study of the effectiveness of the Educator's Portfolio (EP) as a stimulus for faculty reflection about educational practice.

Methods

A sensitizing session of thirty faculty from medical, dental, and physiotherapy colleges on the same campus was conducted; faculty members were asked to complete and submit their EPs. Out of 30 members, 25 responded (83%). Semi-structured interviews of 25 faculties who prepared EPs were conducted, and a qualitative content analysis of the resulting protocols was completed to determine how the EP development process had promoted their reflection on education.

Results

All the 25 faculty members indicated that reflection about education had occurred. Four categories of reflection emerged, namely, (a) lack of understanding regarding how to categorize their work; (b) lack of evidence of the effectiveness of educational activities; (c) reformulating educational practice; and (d) source of motivation and self-regulation.

Discussion

The findings indicate that EP preparation serves as a tool for reflection on educational practice, which promotes faculty development.