Assessment of Level of Patient Satisfaction with Day-Care Surgery: An Observational Study

To assess the level of patient satisfaction with day-care surgery at a tertiary care centre and to find out the different determinants that influence the patient satisfaction. Observational study; Tertiary care hospital in Western India; Patients undergoing Day-care surgery at Dept of ENT from Feb 2018 to Aug 2018; All patients who underwent day-care surgery were given a questionnaire to determine level of satisfaction. On analysis of data according to questions the average score was in the range of 3.5 to 4.22 out of a maximum score of 5. On analysis of data according to domains of patient care the scores ranged from 3.61 to 4.19. Although patients were generally satisfied with the level of care being provided to them there is still scope of improvement.

Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Literature

Parapharyngeal space and infratemporal fossa are 2 overlapping spaces in head and neck which have complex anatomy with vital neurovascular structures passing through them. Tumors of this region are extremely rare but majority of them (80%) are benign. Benign tumors of this region can lead to swellings in facial region, neck and oropharynx. Dysphagia may be a complaint of the patient. Many of these tumors have malignant potential. Removal of these tumors requires a good understanding of the anatomy of this space so that correct surgical approach can be selected. The surgeon needs to be adept in using the most suitable surgical approach for excision of these tumors. There are various approaches which can be used to access these deeply seated tumors but the issue of prime importance is selecting the appropriate approach for the various tumors here based on their size and their exact location in this complex anatomical space. Inappropriate approach can lead to inadequate tumor excision and can lead to injuries to the neurovascular structures in this region which can cause significant disability. The case series reported here describes the various approaches to this region and highlights the importance of correct selection of the surgical approach.

Dermoid Cyst Floor of Mouth: A Diagnostic Conundrum

Dermoid cysts are benign tumours of ectodermal origin, commonly seen in young. The clinico-radiological presentation of dermoids can be equivocal, like in our case of a teenager who had painless swelling of floor of mouth. Radiological findings were consistent with cystic lesion but histopathological examination proved it as dermoid cyst.

Laryngeal Trauma Managed with Titanium Mesh Fixation: A Rare Case Report

Laryngeal fractures are though uncommon they can be potentially life threatening. Comminuted laryngeal cartilage fractures are difficult to manage and various fixation techniques have been described in literature. Outcome results of fixation with different materials can be varied. We report a case of 27 years old male who sustained laryngeal cartilage fracture following accidental fall. Patient underwent emergency tracheostomy and early surgical repair of fractured laryngeal thyroid cartilage with one of the newest techniques "titanium mesh fixation". After a month of surgery tracheostomy tube was removed and patient recovered with good laryngeal function. Titanium mesh fixation gave immediate effective fixation and stability to laryngeal fracture leading to good surgical outcome.

The Effect of Environmental Noise on Consonant Perception in Individual With Normal Hearing: A Prospective Observational Study

This study was done to identify the effect that environmental noises have on consonant perception of individuals with normal hearing sensitivity. The objectives were to find out the effect of white noise and environmental noises on consonant identification and to find the effect of noises on consonant features. Adult with normal hearing in both ears whose mother tongue was Odia were included. Initially the participants underwent pure tone audiometry, speech audiometry, immittance audiometry to confirm their normal hearing, good speech identification scores and normal middle ear function. For consonant identification test, the presentation level was 40 dB sensation level with reference to speech recognition threshold for all subjects. Consonant identification test was carried out in white noise and real environmental noises (traffic noise, classroom noise, park noise, restaurant noise) at 0 dB signal to noise ratio (SNR) and at + 5 dB (SNR). The results showed that at + 5 dB SNR condition all subjects were able to get 80% and above consonant identification (CI) scores irrespective of type of noise used for stimulus while at 0 dB SNR, the mean scores ranged from 75.5% (restaurant noise) to 84% (traffic noise). At + 5 dB SNR only in restaurant noise the CI scores were low as compared to those in white noise. At 0 dB SNR, the scores were low for both the test conditions of park noise and that of restaurant noise. Different types of noisy environments can affect consonant perception which can affect speech intelligibility.

The impact of Stress Management and Resilience Training (SMART) on academic physicians during the implementation of a new Health Information System: An exploratory randomized controlled trial

OBJECTIVE

The Stress Management and Resilience Training (SMART) program is an evidence-based intervention designed to build resilience in physicians in clinical practice. The objective of the current study was to assess the impact of the SMART program on academic physicians' levels of resilience, subjective happiness, stress, and anxiety, and specifically during the implementation of a new hospital-wide Health Information System (HIS).

METHODS

A total of 40 physicians in a tertiary care academic hospital were randomized (allocation ratio 1:1) to either the SMART intervention or the control condition. The SMART intervention consisted of one mandatory two-hour in-person workshop and an optional 24-week online program, designed to support the materials delivered in the workshop. Outcome measures were assessed using validated scales administered online at baseline and at 3-months and 6-months follow-up.

RESULTS

After adjusting for baseline levels of each outcome, no statistically significant intervention effect was observed for resilience, subjective happiness, stress or anxiety at 3-months or 6-months follow-up. However, physicians in the intervention group demonstrated improvements in resilience, stress and anxiety at follow-up that were within the range of clinically relevant differences.

CONCLUSIONS

The findings of this exploratory study provide modest support that the SMART intervention may be beneficial for proactively addressing physician wellness during the implementation of a new HIS and that larger randomized trials are warranted.

TRIAL REGISTRATION

NCT04384861.

Fracture resistance of lab composite versus all-ceramic restorations in class II inlay cavity preparations: An in vitro study

Aim

The aim of this study was to evaluate and compare the fracture resistance of inlay preparations restored with indirect lab composite, conventional and translucent monolithic zirconia-based ceramics.

Materials and Methods

Fifty freshly extracted human maxillary premolars were selected for the study. Standardized inlay cavities were prepared and restored with indirect lab composite, conventional monolithic zirconia-based ceramic and translucent monolithic zirconia-based ceramic. After restoration each sample was subjected to axial compressive load with Universal testing machine. The force required to induce fracture was recorded in Newton (N).

Statistical Analysis Used

The data were analyzed using the one-way ANOVA test and Post hoc Bonferroni multiple comparison test.

Results

Results revealed that fracture resistance of prepared inlay cavities restored with conventional monolithic zirconia-based ceramics was found to be best followed by other groups. Group I > Group IV > Group V > Group III > Group II.

Conclusion

The fracture resistance of conventional monolithic zirconia-based ceramic inlays and translucent monolithic zirconia-based ceramic inlays were comparable with intact teeth but, indirect lab composite inlays showed lower fracture resistance than all.

Artificial intelligence research in agriculture: a review

Purpose

The purpose of this paper is to provide a comprehensive review on the academic journey of artificial intelligence (AI) in agriculture and to highlight the challenges and opportunities in adopting AI-based advancement in agricultural systems and processes.

Design/methodology/approach

The authors conducted a bibliometric analysis of the extant literature on AI in agriculture to understand the status of development in this domain. Further, the authors proposed a framework based on two popular theories, namely, diffusion of innovation (DOI) and the unified theory of acceptance and use of technology (UTAUT), to identify the factors influencing the adoption of AI in agriculture.

Findings

Four factors were identified, i.e. institutional factors, market factors, technology factors and stakeholder perception, which influence adopting AI in agriculture. Further, the authors indicated challenges under environmental, operational, technological, economical and social categories with opportunities in this area of research and business.

Research limitations/implications

The proposed conceptual model needs empirical validation across countries or states to understand the effectiveness and relevance.

Practical implications

Practitioners and researchers can use these inputs to develop technology and business solutions with specific design elements to gain benefit of this technology at larger scale for increasing agriculture production.

Social implications

This paper brings new developed methods and practices in agriculture for betterment of society.

Originality/value

This paper provides a comprehensive review of extant literature and presents a theoretical framework for researchers to further examine the interaction of independent variables responsible for adoption of AI in agriculture.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-10-2020-0448

Developmental Networks Among Mentors and Mentees Involved in a Mentoring Intervention

The growing application of social network-based theories and methods (Burt et al., 2013) in scholarship on mentoring illustrates that mentoring goes beyond dyadic relationships comprising a senior mentor and a junior protégé (Higgins & Kram, 2001). However, limited data exist on the state of developmental networks of university faculty. This study examines developmental network characteristics among mentors and mentees participating in an ongoing intervention that aims to enhance career success through improved mentoring. Cross-sectional data come from 81 faculty mentors and mentees at three universities in the Southwestern United States. Using the online Modified Mentoring Network Questionnaire (MNQ), participants provided information on relationships with developers, who are people that have taken concerted action, and provided professional and/or personal guidance to help participants advance in their careers. An individual's developmental network comprises relationships with developers. We conducted exploratory analyses examining key characteristics of mentors' and mentees' developmental networks. Participants received psychosocial and career support from an average of 4.9 developers (4.8 and 5.1 for mentors and mentees respectively) from 2.3 arenas (2.2 and 2.4 arenas for mentors and mentees, respectively). While the most common arena was the respondents' current job/position (62%, 64% and 59% for all participants, mentors, and mentees respectively), developers were from graduate school (11%, 6% and 17%); prior jobs/positions (13%, 16% and 9%) and family (8%, 5% and 11%). Our preliminary findings suggest that developers are important for university faculty and that methods and insights from social network analysis can be applied to examine their support networks. As our study is part of an ongoing longitudinal intervention, these findings will inform future analyses that will examine changes in developmental network characteristics and its impact on participants' careers.

Reproducibility of Retinal Nerve Fiber Layer and Macular Thickness Measurements Using Spectral Domain Optical Coherence Tomography

The objective of the research was to assess the reproducibility of retinal nerve fiber layer (RNFL) and macular thickness using spectral domain optical coherence tomography and to establish whether the same investigator can get the same or similar results when performing the scan thrice in an hour, without reference to the previous scan and the repeat function. Materials and Methods. In this prospective observational study, 200 subjects who fulfilled the inclusion and exclusion criteria were scanned 3 times according to predefined guidelines at 0, 30 and 60 minutes on the same day, by the same investigator, using spectral domain optical coherence tomography for measurements of RNFL and macular thickness; observations were statistically analyzed and correlated. Results. In RNFL thickness, the temporal sector showed the worst reproducibility as compared to other sectors. RNFL was the greatest in the superior quadrant and the thinnest in the temporal quadrant. For macular thickness, the temporal sector (mid zone) showed the worst reproducibility, while in the outer zone, the inferior sector showed the worst reproducibility; macular thickness was the thinnest at the central zone (innermost 1-mm ring), the thickest within the inner 3-mm ring and diminished peripherally. Conclusions. RNFL and macular thickness measurements using spectral domain optical coherence tomography by the same observer at 0, 30 and 60 minutes were very reproducible, except for the sectors specifically mentioned. The greater the thickness of the RNFL in any sector the better was the reproducibility in that sector. For macular thickness, the temporal sector (mid zone) showed the worst reproducibility.

Faculty Rating of the Importance and Availability of Organizational Mentoring Climate

Organizational climate is the shared perception of and the meaning attached to the policies, practices, and procedures employees experience. University faculty can assess their organizational mentoring climate (OMC) using recently published, reliable, and valid OMC importance (OMCI) and availability (OMCA) scales. Factors affecting the OMC's importance and availability are, however, not known. By studying these factors, organizational leaders can determine whether and how to change the OMC to improve faculty mentoring outcomes. In this cross-sectional study, 300 faculty from the University of New Mexico (Main, Health Sciences Center [HSC] and branch campuses) and Arizona State University (a non-HSC campus) completed the online OMCI and OMCA scales, each with three subscales: Organizational Expectations, Mentor-Mentee Relationships, and Resources. OMCI scale items were rated from very unimportant (1) to very important (5); and, for OMCA, -1 (no), 0 (don't know), 1 (yes). The study used linear regression analysis after normalizing the scales to M=0 and SD=1. Although not explicitly targeted for recruitment, the respondents were predominantly women, non-Hispanic White, senior, tenure-track faculty members who were neither providing mentoring nor receiving mentoring. In the multivariable models, women faculty attached greater importance to mentoring climate components than men. HSC faculty and those receiving mentoring reported greater availability of mentoring climate components than their respective counterparts. Underrepresented minority (URM) faculty did not rate OMCI or OMCA differently than non-URM faculty. Faculty subgroups in this study attached varying levels of importance to the OMC and rated the availability of climate components differently. Factors impacting the importance of the OMC differed from those affecting the perceived availability of the climate components. Based on their relative importance and lack of availability, organizational leaders should create, modify and implement structures, programs, and policies to improve organizational mentoring expectations, mentor-mentee relationships, and mentoring resources, thereby strengthening their OMC.

Factors Related to Faculty Work Life Balance as a Reason to Leave a School of Medicine

Mentoring can help promote faculty retention at academic health centers (AHCs). Faculty retention is important to optimize patient care and reduce replacement costs. Nationally "work life balance" (WLB) is identified by faculty as a reason to leave (ARTL) AHCs (Alexander & Lang, 2008). To help mitigate faculty attrition at AHCs, we examined work life balance as a reason to leave (WLB-ARTL) and other associated factors at the University of New Mexico School of Medicine (UNM SOM). Faculty responses from 255 faculty that left UNM SOM between July 2017 and December 2020 were analyzed using logistic regression with the outcome WLB-ARTL. Distributions of each variable were tabulated. Odds ratio associations from logistic regression between WLB-ARTL and each variable were obtained. Multivariate logistic regression modeling was performed with backward selection at p<0.05. Of the 255 faculty who exited the University of New Mexico School of Medicine (UNM SOM), 25% had WLB-ARTL, 48% were women, 72% were physicians, 58% were clinician-educators, and 13% were from racial/ethnic underrepresented minorities (URMs). Multivariate modeling found four factors associated with increased WLB-ARTL: compensation, time for academic pursuits, spousal and family support, and dislike of patient care conditions and environment. Two factors associated with lower WLB-ARTL were better leadership and periodic reviews addressing job satisfaction. Gender, URM, and physician status were not found to be significant. Similar to previous studies (Whittaker et al., n.d.), we found that WLB-ARTL at UNM SOM was associated with specific "work" and "life" factors. Faculty retention efforts should focus on "work" factors such as providing protected time for academic pursuits and improving patient care conditions, and "life" factors such as addressing compensation and supporting families.

A pilot study comparing hearing thresholds of soldiers at induction and after completion of one year in high altitude area

Background

Despite so much research in high altitude area, our existing knowledge is still lacking on otological effects of long-term stay in high altitude. This pilot study was conducted to compare the hearing thresholds of army soldiers at induction and after completion of one year in high altitude area (HAA).

Methods

Hearing thresholds of 433 soldiers posted in HAA were recorded using pure tone audiometry at the time of induction and second thresholds after one year of stay in high altitude for frequencies of 500Hz, 1KHzs, 2 KHzs and 4 KHzs. The two sets of hearing thresholds for air conduction were compared using paired "t" test for any statistical significance.

Results

The mean Pure Tone Audiometry (PTA) thresholds for 433 left ears worsened from 9.43dB to 9.65dB at 500 HZs ; 14.02dB to 14.32dB at 1 KHZs ; 15.04dB to 16.09dB at 2KHzs and 18.63dB to 22.59dB at 4 KHZs. Similarly for right ear, PTA thresholds worsened from 9.43dB to 9.69dB at 500HZs; 13.95dB to 14.34dB at 1 KHZs; 15.38dB to 17.26dB at 2 KHZs and from 18.59dB to 23.06dB at 4KHZs. These results are found to be statistically significant (p<0.05) for all frequencies.

Conclusion

This pilot study shows deterioration of hearing thresholds in tested frequencies in both ears after a long stay (one year) in high altitude area. We recommend further structured research on otologic effect of long term stay in high altitude.

Is "Transcolumnar" a better Terminology than "Transverse" in Judet-Letournel Classification of Acetabular Fractures?

Acetabular fractures are among the most complex and challenging injuries for orthopaedic surgeons. The choice of surgical treatment in acetabular fracture is important for optimal outcomes. It requires an understanding of the precise outline of the fracture by appropriate classification because it is important for decision making. For this purpose, the classification proposed by Judet and Letournel in 1963 remains the gold standard despite its shortcoming, which are attributed to the inclusion of multiple criteria including anatomical, directional and geometrical. This complex classification remains challenging especially to lesser experienced surgeons. In this article, a new method for classification of acetabulum fractures is proposed. It places posterior column with posterior wall fractures to simple fractures instead of complex fractures in Judet and Letournel classification. More importantly the proposed new classification renames “transverse fracture” as “transcolumnar fracture” to better represent anatomical structure rather than morphology. It is expected that by coining the new term “transcolumnar ”it will be easy to understand different types of acetabular fractures. Especially the confusion between “transverse” and “both column fractures” would not be a concern in future.

Couples' Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial

Introduction

Mindfulness is a promising intervention for female sexual dysfunction (FSD); however, of the mindfulness interventions studied, few treat the woman and her partner.

Aim

We developed a brief online mindfulness, resilience, and psychoeducation intervention, Stress Management and Resiliency Training for Sexuality (Sex SMART), for women with sexual health concerns and their partners.

Methods

Women with female sexual interest/arousal disorder and their partners were recruited between February 24, 2015, and October 6, 2016, and randomized to treatment or control groups (received educational pamphlets). The treatment intervention comprised of an online SMART and sexual health psychoeducation module.

Main Outcome Measures

The Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Sexual Desire Inventory-2 (SDI-2), Revised Dyadic Adjustment Scale (RDAS), International Index of Erectile Function (IIEF), and other subjective measures were used to assess sexual function and sexual distress at baseline and 12 weeks.

Results

The study included 60 women and their partners (30 couples in each group). In both groups, sexual function by total FSFI scores and sexual distress scores significantly improved at 12 weeks compared with baseline, with no significant between-group differences (FSFI effect estimate for Sex SMART vs control = +1.4 (90% CI [–0.6 to +3.4]; P=.13). Both participants and partners randomized to the intervention reported significantly improved attitude and feelings, comfort as a sexual person, and subjective sexual functioning at 12 weeks. The findings provide preliminary evidence for efficacy of an online intervention for couples with sexual health problems.

Conclusions

A brief online mindfulness, resilience, and psychoeducation–based intervention showed no significant improvement in many outcomes (FSFI, FSDS-R, SDI-2, RDAS) of sexual health versus controls. Although this is the first online randomized controlled trial to evaluate a mindfulness-based therapy intervention, it was limited by its lack of population diversity and high attrition rate. Significant improvements in subjective sexual health and partner sexual function by the International Index of Erectile Function were reported only in the intervention group.

Rullo JE, Sood R, Fokken SC, et al. Couples’ Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial. Sex Med 2021;9:100404.