Assessment of online continuing dental education in North Carolina

BACKGROUND

Dental professionals are discovering the unique advantages of asynchronous lifelong learning through continuing dental education (CDE) opportunities offered online. The purpose of this study was to evaluate both the process and outcomes of online CDE in North Carolina. The assessment was designed to provide a better understanding of practicing dental professionals experiences with online CDE and to determine the effectiveness of this learning strategy.

METHODS

Dental professionals from four North Carolina Area Health Education Centers regions evaluated two pilot online CDE modules in 1998. Thirty-one participants were recruited and subsequently enrolled with 23 completing at least one module. Each module included objectives, a multiple-choice pretest, interactive core material, and a post-test. Participants completed three online surveys measuring individual demographics and computer skill level, module design, and use and overall reaction to online learning.

RESULTS

Most participants agreed that the modules were comprehensive, were pleasing in appearance, provided clear instructions, provided adequate feedback, and were easy to navigate. Most participants agreed that knowledge of the material increased. This was validated by a significant increase in mean pre- to post-test scores (p = .0001). Participants agreed that convenience was a definite advantage, and they would choose online courses again to meet their CDE needs. The least-liked aspects included technical and formatting issues.

IMPLICATIONS

Participants were enthusiastic about online learning and learned effectively with this teaching strategy, but desired much more interactivity than existed in the current design.

An international comparison of early treatment of angle Class-II/1 cases. Skeletal effects of the first phase of a prospective clinical trial

The University of North Carolina at Chapel Hill has established an extensive randomized trial to evaluate early treatment of Class-II/1 cases. As presented in this part of the study, a German treatment group was selected in parallel, based on identical prospective criteria, in the context of international cooperation with the Westfälische Wilhelms-Universität, Münster. One essential aspect of this study is the degree to which initially comparable groups can be established by careful alignment of selection criteria and of compilation and analysis of diagnostic records. Nine skeletal analysis parameters initially indicated that it is possible to select very similar though not absolutely identical groups in the context of international cooperation. The further results of the initial 15-month phase comprising functional orthodontic treatment in severe Class-II/1 cases showed significant mandibular effects in both treatment groups (USA UNC, Chapel Hill: modified Balters appliance; Germany WWU Münster: U-bow activator Type I). The groups were compared to a randomized control group with similar untreated malocclusions, established at Chapel Hill (USA, UNC, Chapel Hill). The results of this cooperative study reveal opportunities for critical evaluation of different treatment methods through international cooperation, utilizing existing prospective randomized studies.

Surgical versus orthodontic correction for Class II patients: age and severity in treatment planning and treatment outcome

Treatment options for Class II malocclusion include orthognathic surgery. Treatment choices are particularly difficult for young patients because of the uncertainty regarding future growth. Surgical treatment has generally been considered necessary for older patients with more severe Class II problems. The treatment records of more than 500 patients with Class II malocclusion were reviewed. Patients were grouped according to their initial treatment plan (surgery or orthodontics) and treatment outcome (overjet [OJ] reduced to < 4 mm or not). Discriminant function analyses using data from the patient's pretreatment cephalogram were used to determine whether age, in combination with malocclusion severity, could predict the choice of treatment, and whether a simple set of pretreatment variables could predict the success or failure of OJ reduction. The derived equations were tested in a similar group of growing Class II children. Although the data showed clinicians use patient's age in determining treatment choice, age did not seem to be associated with treatment outcome. The majority of the variability that determined the success or failure of OJ reduction was not explained by patient's age or malocclusion severity. These findings suggest other factors, including psychosocial variables, need to be explored if we are to gain a better understanding of why treatments succeed or fail.

Patient-centered outcomes in surgical and orthodontic treatment

Patient-centered health care has two characteristics: it is closely congruent with and responsive to the patient's wants, needs, and preferences, and it considers the psychological, social, cultural, and economic dimensions of the patient in addition to physical findings. The ultimate benefit to the patient has always been a primary concern of clinicians providing coordinated orthodontic and orthognathic surgical treatment. However, in the past 10 years, a much greater emphasis has been placed in both medicine and dentistry on the patient as a coparticipant in decision making and the process of treatment. In addition, it has been realized the success of treatment must be defined not just in terms of the objective findings of clinicians, but also in the context of the patient's perceptions of what was achieved. This article discusses the impact of the new emphasis on patient-centered care on clinical practice and research in orthodontics and orthognathic surgery and provides two examples of how patient-centered outcomes can be assessed and used to improve the quality of care in these patients.

Skin pH changes associated with iontophoresis

STUDY DESIGN

Randomized controlled trial. The researcher measuring skin pH was blinded to group assignment.

OBJECTIVES

To compare the skin surface pH changes associated with iontophoresis. The investigation was designed to address the question of whether significant skin pH changes occur under the cathode on the skin surface when performing iontophoresis and assessed the influence of different electrode-buffering systems intended to stabilize skin pH (surface).

BACKGROUND

Whether buffers are needed to stabilize skin pH during iontophoresis has not been thoroughly addressed in the literature. The effectiveness of immobile resins versus simple phosphate buffers is also unclear.

METHODS AND MEASURES

Sixty volunteer subjects were administered iontophoresis of normal saline using buffered or nonbuffered electrode systems. Each subject participated in 1 of the 12 doses by electrode conditions (i.e., 5 subjects per group). Surface skin pH was measured before and after iontophoresis with a flat-surface pH electrode in concert with an analog pH meter. The independent variables were electrode type (4 levels) and dosage (3 levels). The dependent variable was the change in skin surface pH.

RESULTS

A significant change in skin pH was found only when the treatment dose was 80 mA/minute with a nonbuffered electrode (x = 3.14 +/- 1.09).

CONCLUSIONS

The skin pH changes that occur during a properly delivered iontophoresis treatment at dosages of 20 and 40 mA/min were small and not significantly different with or without the addition of buffers. Those pH changes associated with 80 mA/min doses were significantly greater when no buffer was employed but were stabilized by each of the buffers used in the study (preloaded immobile resins or simple phosphates added at point of treatment).

Patients' perception of recovery after third molar surgery

PURPOSE

This study evaluated patients' perceptions of recovery after third molar surgery.

METHODS

Two hundred forty-nine patients (age 13 to 37 years) at 2 clinical centers were enrolled in a prospective study before the surgical removal of third molars. Each patient was given a 21-item Health-Related Quality of Life instrument (HRQOL) to be completed each postoperative day (POD) for 14 days. The instrument was designed to assess patients' perception of recovery: pain, oral function, general activity measures, and other symptoms. Pain dimensions were recorded with a 7-point Likert-type scale; all other conditions were measured on 5-point Likert-type scales. The impact of each predictor variable such as age, gender, and length of surgery on recovery was assessed with Cochran-Mantel-Haenszel statistics, controlling for clinical center.

RESULTS

After the 14-day postoperative period, 201 of the original 249 patients returned the completed HRQOL instrument; the 48 patients who did not return their diary had third molar conditions and surgery similar to the 201 patients who responded. On POD 1, 63.5% of patients reported their worst pain as severe (score, 5 to 7/7) at some time during the day. By POD 7, only 15% of patients reported their worst pain as severe. Average pain levels were much less; 29% reported their average pain as severe (score, 5 to 7/7) on POD 1, decreasing to 5.5% by POD 7. Patients experienced substantial interference in oral function; chewing, 85%; mouth opening 78.5%, and speaking 37.5% on POD 1. By POD 6, oral function had improved; chewing, 19%, mouth opening, 15%; and speaking, 1.5%. General measures also were affected on POD 1; social activity, 61.5%; recreation, 70.5%; and daily routine, 60%. Patients assumed a more normal lifestyle by POD 5. Swelling seemed to be at its maximum on PODs 1 and 2 (day 1, 53%; day 2, 61%) and decreased markedly by POD 5 (10%). Food collection in the surgical sites posed the biggest problem for patients on POD 9 (20%). Age was not a predictor of prolonged recovery. However, surgery time 30 minutes or longer, or having all third molars below the occlusal plane, did prolong recovery. Females also reported a longer recovery period.

CONCLUSIONS

This information is valuable to patients deciding on third molar surgery and to clinicians providing informed consent.

Evaluation of the carbon dioxide laser on vital human primary pulp tissue

PURPOSE

The purpose of this study was to evaluate the response of the human primary pulp to the carbon dioxide laser and formocresol for vital pulp therapy.

METHODS

Fifteen healthy children with intact, caries-and-restoration-free, contralateral primary cuspids with at least two-thirds of the roots remaining who were scheduled for orthodontic extraction were randomly assigned to pulpotomy treatment with a carbon dioxide laser or formocresol. The treated teeth were clinically and radiographically evaluated at 28 and 90 days post-treatment prior to extraction. The extracted teeth were evaluated histologically for pulpal response.

RESULTS

All teeth were asymptomatic and clinically normal at both observation periods. Internal root resorption was observed in one formocresol and two laser treated teeth. There was a significant inverse correlation between the laser energy applied to the pulp and the degree of inflammation at 28 days (P = .01) but not at 90 days (P = .27).

CONCLUSION

Carbon dioxide laser treatment compared favorably to formocresol for pulpotomy in primary teeth.

Down syndrome and the phonological loop: the evidence for, and importance of, a specific verbal short-term memory deficit

Individuals with Down syndrome are thought to perform poorly on tests of verbal short-term memory, such as measures of word span or digit span. This review critically examines the evidence for a specific deficit in verbal short-term memory in Down syndrome, and outlines a range of possible explanations for such a deficit. The potential implications of a verbal short-term memory impairment for broader aspects of development are outlined, in particular with respect to vocabulary development. Possible intervention strategies, which might improve verbal short-term memory performance in Down syndrome are also considered. However, we argue that further research is needed to fully clarify the nature of a verbal short-term memory deficit in Down syndrome, before the merits of these various intervention approaches can be properly evaluated.

Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery

OBJECTIVE

To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function.

METHODS

This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study.

RESULTS

Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement.

CONCLUSION

Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.

Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery

OBJECTIVE

To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function.

METHODS

This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study.

RESULTS

Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement.

CONCLUSION

Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.

Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery

OBJECTIVE

To determine whether patients with knee or hip osteoarthritis (OA) who have worse physical function preoperatively achieve a postoperative status that is similar to that of patients with better preoperative function.

METHODS

This study surveyed an observational cohort of 379 consecutive patients with definite OA who were without other inflammatory joint diseases and were undergoing either total hip or knee replacement in a US (Boston) and a Canadian (Montreal) referral center. Questionnaires on health status (the Short Form 36 and Western Ontario and McMaster Universities Osteoarthritis Index) were administered preoperatively and at 3 and 6 months postoperatively. Physical function and pain due to OA were deemed the most significant outcomes to study.

RESULTS

Two hundred twenty-two patients returned their questionnaires. Patients in the 2 centers were comparable in age, sex, time to surgery, and proportion of hip/knee surgery. The Boston group had more education, lower comorbidity, and more cemented knee prostheses. Patients undergoing hip or knee replacement in Montreal had lower preoperative physical function and more pain than their Boston counterparts. In patients with lower preoperative physical function, function and pain were not improved postoperatively to the level achieved by those with higher preoperative function. This was most striking in patients undergoing total knee replacement.

CONCLUSION

Surgery performed later in the natural history of functional decline due to OA of the knee, and possibly of the hip, results in worse postoperative functional status.

A two-year study of microscopic urinalysis competency using the urinalysis-review computer program

BACKGROUND

The microscopic examination of urine sediment is one of the most commonly performed microscope-based laboratory tests, but despite its widespread use, there has been no detailed study of the competency of medical technologists in performing this test. One reason for this is the lack of an effective competency assessment tool that can be applied uniformly across an institution.

METHODS

This study describes the development and implementation of a computer program, Urinalysis-ReviewTM, which periodically tests competency in microscopic urinalysis and then summarizes individual and group test results. In this study, eight Urinalysis-Review exams were administered over 2 years to medical technologists (mean, 58 technologists per exam; range, 44-77) at our academic medical center. The eight exams contained 80 test questions, consisting of 72 structure identification questions and 8 quantification questions. The 72 structure questions required the identification of 134 urine sediment structures consisting of 63 examples of cells, 25 of casts, 18 of normal crystals, 8 of abnormal crystals, and 20 of organisms or artifacts.

RESULTS

Overall, the medical technologists correctly identified 84% of cells, 72% of casts, 79% of normal crystals, 65% of abnormal crystals, and 81% of organisms and artifacts, and correctly answered 89% of the quantification questions. The results are probably a slight underestimate of competency because the images were analyzed without the knowledge of urine chemistry results.

CONCLUSIONS

The study shows the feasibility of using a computer program for competency assessment in the clinical laboratory. In addition, the study establishes baseline measurements of competency that other laboratories can use for comparison, and which we will use in future studies that measure the effect of continuing education efforts in microscopic urinalysis.

Two- and three-dimensional imaging modalities for the detection of caries. A comparison between film, digital radiography and tuned aperture computed tomography (TACT)

OBJECTIVES

To compare the diagnostic performance provided by two- (film and digital radiography) and three-dimensional imaging modalities (TACT slices and TACT pseudoholograms) in the detection of primary caries.

METHODS

Forty-two extracted human posterior teeth were mounted and imaged with conventional film and direct digital radiography. Free-hand positioning of a dental X-ray source was used for all exposures. From the digital images, iteratively restored TACT slices and TACT pseudoholograms were generated. Film images were viewed on a viewbox. Digital format images were viewed on a high-resolution monitor. Eight observers used a five-point scale to score the presence or absence of occlusal and proximal caries using the four image modalities. Observers' assessments were compared with the histological examination of tooth sections. Possible differences in ROC curve areas among image modalities, observers, and surfaces were assessed by ANOVA. Intra- and interobserver reliability as indicated by intraclass correlation was also calculated.

RESULTS

There were no statistically significant differences between the diagnostic performances of film, digital radiography, TACT slices and TACT pseudoholograms in the detection of caries (P = 0.310). Intraclass correlation indicated the highest concordance both within and between observers when film was used for the evaluation.

CONCLUSIONS

Under the experimental conditions of this study, three-dimensional TACT images did not improve caries detection over film or digital radiography. Further research should investigate the effects of imaging variables on TACT's diagnostic efficacy.

Presurgery experiences of prostate cancer patients and their spouses

PURPOSE

In this article, the authors describe the experiences of men with prostate cancer and their spouses between diagnosis and surgery.

DESCRIPTION

As part of a longitudinal qualitative study, semistructured interviews were held with 34 prostate cancer patients who were waiting for surgery. Separate interviews were held with their spouses.

RESULTS

Six main components of experience were evident from the analysis of transcripts related to the presurgery period: 1) the news of a diagnosis of prostate cancer came initially as a shock for both partners, the impact of which lessened over time; 2) the new reality of illness necessitated readdressing the marital relationship, most often resulting in a sense of renewed connection and commitment; 3) the illness crisis precipitated a search for information to guide decisions about treatment; 4) there was a need for couples to decide who to inform about the cancer diagnosis and how much to say about it; 5) couples attempted to seek a semblance of normality in their lives, especially after treatment decisions had been made; and 6) despite attempts to minimize the potential impact of upcoming surgery, anxiety was typically experienced at least intermittently by one or both partners.

CLINICAL IMPLICATIONS

Physicians, nurses, social workers, and other health professionals need to facilitate attempts by the patient to gather and synthesize information. Cancer specialists can play a positive role in reducing distress in couples, and, thus, the attention of the specialists to communication issues is critical. The strain of waiting for surgery must be considered when treatment recommendations are made; watchful waiting protocols require further study from a psychological perspective. Clinicians need to be alert to the balance between being positive and carrying on as normal, and acknowledging and dealing with the distress that arises.

Endodontic complications of root canal therapy performed by dental students with stainless-steel K-files and nickel-titanium hand files

Straightening of curved canals is one of the most common procedural errors in endodontic instrumentation. This problem is commonly encountered when dental students perform molar endodontics. The purpose of this study was to compare the effect of the type of instrument used by these students on the extent of straightening and on the incidence of other endodontic procedural errors. Nickel-titanium 0.02 taper hand files were compared with traditional stainless-steel 0.02 taper K-files. Sixty molar teeth comprised of maxillary and mandibular first and second molars were treated by senior dental students. Instrumentation was with either nickel-titanium hand files or stainless-steel K-files. Preoperative and postoperative radiographs of each tooth were taken using an XCP precision instrument with a customized bite block to ensure accurate reproduction of radiographic angulation. The radiographs were scanned and the images stored as TIFF files. By superimposing tracings from the preoperative over the postoperative radiographs, the degree of deviation of the apical third of the root canal filling from the original canal was measured. The presence of other errors, such as strip perforation and instrument breakage, was established by examining the radiographs. In curved canals instrumented by stainless-steel K-files, the average deviation of the apical third of the canals was 14.44 degrees (+/- 10.33 degrees). The deviation was significantly reduced when nickel-titanium hand files were used to an average of 4.39 degrees (+/- 4.53 degrees). The incidence of other procedural errors was also significantly reduced by the use of nickel-titanium hand files.

Impaired effective cortical connectivity in vegetative state: preliminary investigation using PET

Vegetative state (VS) is a condition of abolished awareness with persistence of arousal. Awareness is part of consciousness, which itself is thought to represent an emergent property of cerebral neural networks. Our hypothesis was that part of the neural correlate underlying VS is an altered connectivity, especially between the associative cortices. We assessed regional cerebral glucose metabolism (rCMRGlu) and effective cortical connectivity in four patients in VS by means of statistical parametric mapping and [18F]fluorodeoxyglucose-positron emission tomography. Our data showed a common pattern of impaired rCMRGlu in the prefrontal, premotor, and parietotemporal association areas and posterior cingulate cortex/precuneus in VS. In a next step, we demonstrated that in VS patients various prefrontal and premotor areas have in common that they are less tightly connected with the posterior cingulate cortex than in normal controls. These results provide a strong argument for an alteration of cortical connectivity in VS patients.

Clinical and in vitro film quality comparison of manual and automatic exposure control in panoramic radiography

OBJECTIVE

Automatic exposure control has been used successfully in medicine to improve image quality and reduce the number of retakes necessitated by inadequate operator selection of exposure factors. The purpose of this study was to assess the influence of automatic exposure control on panoramic image quality.

STUDY DESIGN

A total of 352 patients were imaged with either the OP 100 or the Orthophos Plus panoramic machine. An expert consensus panel judged film quality using a 5-point scale. Differences in quality that would have resulted from the use of operator-determined exposures were calculated through use of an algorithm validated with test images of a human phantom.

RESULTS

McNemar's test demonstrated significant improvements in quality with automatic exposure control (P = .001) in comparison with manual exposure control. No quality difference was found between the 2 machines (P = .9661). Manual exposure selection by oral and maxillofacial radiology residents was better than selection by technologists and assistants (P = .006).

CONCLUSIONS

This study confirms the utility of automatic exposure control for panoramic radiography.

Boston University's biosciences education program for Boston-area students

The authors describe the CityLab program, which has the goal of providing equal educational opportunities in biotechnology and medical sciences for all students in the greater Boston area in grades seven through 12, particularly students from groups traditionally underrepresented in science. Since 1992, more than 16,000 students and 1,200 teachers have participated in the program's activities, which focus on giving students meaningful laboratory experiences in the biosciences (either at Boston University of by means of a traveling laboratory in a bus). Students develop confidence in their ability to apply molecular biology and biotechnology concepts and skills to scientific problems and learn that they can pursue careers in the biosciences. The authors describe the CityLab program, its inquiry-based teaching methods, its effects, and its potential to increase students' interest in biomedical studies and careers.

Mite allergens: significance of enzymatic activity

Ten years ago, the cloning and sequencing of a cDNA encoding the group I allergen of house-dust mites unequivocally determined that protein allergens may have biochemical functions in addition to their ability to bind IgE. Since this discovery, several groups have speculated that the biochemical activities of allergens, or substances associated with allergens, may be involved in their immunogenicity or allergenicity. This paper will focus on just one biochemical function, proteolytic activity, and will be illustrated by examples of our own work that we believe support the hypothesis that this category of molecules are endowed with the properties of proallergic adjuvants.

Cost-effectiveness of ondansetron for postoperative nausea and vomiting

The decision as to whether prophylaxis against postoperative nausea and vomiting is better than treatment of established postoperative nausea and vomiting could be made on the basis of cost-effectiveness. The cost-effectiveness of ondansetron was calculated using data from published quantitative systematic reviews of randomised trials. Milligrams of ondansetron required to achieve a desired endpoint were chosen as a cost unit. Modelling was based on a cohort of 1000 patients, and examined control event rates (i.e. incidence of postoperative nausea and vomiting without prophylaxis) of between 10 and 90%. In a sensitivity analysis, cost-effectiveness of recommended intravenous doses (4 mg for treatment and prophylaxis) was compared with minimal effective doses as shown by meta-analysis (1 mg for treatment, 8 mg for prophylaxis). Fewer patients experience any postoperative nausea and vomiting symptoms with prophylaxis compared with treatment. But prophylaxis is only marginally more effective than treatment, and treatment of established postoperative nausea and vomiting with effective doses (i.e. 1 or 4 mg) is more cost-effective and safer than prophylaxis with effective doses (i.e. 4 or 8 mg). Reasons for this are the selective treatment of patients who actually need treatment, the high success rate with a lowest dose tested (1 mg) in established postoperative nausea and vomiting, and the disappointing antinausea effect of prophylactic ondansetron even at an eight-fold higher dose.

Job satisfaction amongst nurses in an interim secure forensic unit in Wales

All grades of nursing staff in a recently established interim secure forensic unit completed the Index of Work Satisfaction (IWS; n = 40). High levels of job satisfaction were achieved on four of the IWS subscales: (i) professional status; (ii) interaction; (iii) doctor-nurse relationship; and (iv) autonomy. Moderate levels of satisfaction were found on two of the subscales, task requirements and administration, while the salary subscale was the major area of dissatisfaction across the group. The high level of overall satisfaction in this area of psychiatric nursing may be regarded as a significant achievement in the development of new clinical services in what is regarded as a stressful area of nursing. Measures of job satisfaction may be useful benchmarks for evaluating future changes and developments in the service and for monitoring and improving the clinical work environment.