Clinical teaching in restorative dentistry and the variation between students' and supervisors' perceptions of its effectiveness

OBJECTIVES

To investigate if there was an agreement between the students and supervisors on the quality of clinical teaching in Restorative Dentistry in the Dublin Dental School and Hospital and to identify differences on how effective clinical teaching is perceived between three academic years. In addition it aimed to identify the existence of any similarities between students' and supervisors' perceptions of specific teaching behaviours that are most and least helpful in learning.

MATERIALS AND METHODS

An anonymous questionnaire based on the above objectives was distributed to three cohorts of undergraduate students and three cohorts of clinical supervisors. The response rate was 94% for the first, 94% for the second and 63% for the third student cohort. Twenty-one (21) out of the 36 supervisors returned the questionnaire. Basic analysis of the clinical questionnaire was carried out in order to find the distributions of the variables between the groups. These distributions were compared using a non-parametric analysis (Kruskal-Wallis). The degree of association was measured by the Pearson's chi-square values.

RESULTS

Students from all 3 years reported to be neither very satisfied nor very dissatisfied with their clinical teaching with a few statistically significant differences across the 3 years. The supervisors on the other hand, replied with a great deal of similarity across the 3 years. Furthermore, supervisors gave a high degree of straight line responses and generally felt very good about the level of clinical teaching. There was a high degree of variability in what the supervisors thought was important but also a high degree of similarity in what they thought was not helpful. It was exactly the opposite for the students.

CONCLUSIONS

There is a limited agreement between students and staff on the effectiveness of clinical teaching and the way effectiveness is perceived between students and clinical supervisors as well as between senior and more junior students. Overall though students and supervisors rated the clinical teaching favourably but indicated several areas of concern.

The role of the curriculum and other factors in determining the medium- to long-term attitude of the practicing dentist towards life-long learning

OBJECTIVES

To investigate the significance of the undergraduate dental curriculum on the medium- to long-term attitudes of the clinician to life-long learning, and to identify demographical and professional characteristics which may influence this attitude.

METHODS

A specially designed questionnaire targeted 12 cohorts of dentists who qualified from Dublin Dental School and Hospital between 1994 and 2005. The curricula of the cohorts varied from fully didactic, exclusively Problem Based Learning or a hybrid for the oldest, youngest and middle graduates, respectively. Participants were questioned about current professional activities, postgraduate training, practice type, hospital affiliation, use of information services and time dedicated to continuing dental education (CDE), etc. A number of dental scenarios were proposed to determine if participants were adherent to current clinical guidelines. Additionally, a visual analogue scale assessed the overall satisfaction of dentists with their undergraduate programme and determined their opinion regarding its influence on subsequent ability to practice dentistry and keep up-to-date with scientific developments.

RESULTS

Contingency analysis of the association between curriculum and continuous educational data did not produce statistical significance. Dentists who work in a hospital environment spend more time on CDE (chi(2), Pearson's, P = 0.001), are more adherent to current guidelines (chi(2), Pearson's, P = 0.005) and found their undergraduate studies more enjoyable (Wilkoxon/Kruskal-Wallis, P = 0.01).

CONCLUSIONS

Undergraduate curriculum type was found to have very little or no effect on the graduate's attitude towards life-long learning or confidence in their ability to practice dentistry. However, these attitudes did appear to be influenced by certain family, demographical and professional characteristics.

A screening procedure for primary aldosteronism based on the Diasorin Liaison® automated chemiluminescent immunoassay for direct renin

Background

Primary aldosteronism (PA), the most common secondary cause of hypertension, can be screened for using the aldosterone/renin ratio. This ratio is raised in PA and its accuracy depends on the ability to measure plasma renin at extremely low concentrations.

Methods

We compared two different procedures for assessing plasma renin. The conventional method, which measures plasma renin activity (PRA), is technically demanding and laborious, and the Diasorin Liaison® method, which measures plasma renin concentration (PRC), is an automated immunoassay. Results from each method were used to calculate the aldosterone/renin ratio (ARR) and the performance of the Diasorin Liaison® method compared with that of the conventional assay using receiver operator characteristic curves.

Results

The analytical and functional sensitivity of the PRC method were 2.1 and 5 μIU/mL, respectively. Intra- and inter-assay precision were <7.2% and 10.4%, respectively. There was significant (9%) prorenin interference. Samples with PRA > 1.0 ng/mL/h showed significant correlation with PRC ( r = 0.93; P < 0.05; n = 146); however, with PRA < 1.0 ng/mL/h, no significant correlation occurred ( r = 0.14; P < 0.05; n = 79). An aldosterone (pmol/L)/PRC(μIU/mL) ratio of >35, in patients with aldosterone >300 pmol/L, resulted in 100% sensitivity and 93% specificity, when compared with the commonly accepted aldosterone (pmol/L)/PRA (ng/mL/h) ratio of >750, in identifying patients who may suffer from PA.

Conclusion

This study indicates the feasibility of using the automated PRC assay as a replacement for the conventional manual PRA assay in calculating the ARR as a first-line screen for PA.

Ruptured aneurysm of the common iliac artery as a cause of unilateral hip pain

Rupture of an aneurysm of the common iliac artery is a rare cause of pain in the hip. We describe an elderly hypertensive patient with an aneurysmal rupture of the left common iliac artery who presented with unilateral hip pain masquerading as septic arthritis.

A homologue of the Drosophila female sterile homeotic (fsh) gene in the class II region of the human MHC

The RING3 gene maps in the class II region of the human major histocompatibility complex, at a CpG island distal of the HLA-DNA gene. RING3 cDNAs were obtained from a T cell cDNA library and the longest (4 kb) was sequenced. The sequence contained an open reading frame encoding a protein of 754 amino acids. A screen of protein databases revealed striking homology between the RING3 protein and the Drosophila female sterile homeotic gene (fsh) which is implicated in the establishment of segments in the early embryo. Partial sequence homology was also observed with some other proteins involved in cell cycle control (CCG1), cell division (ftsA) and regulation of cell growth (gamma interferons). This highly conserved gene may play an important role in human development. In addition, its location in the MHC class II region may be related to some HLA-associated diseases.

Control of cytokine gene transcription in Th1 and Th2 cells

Summary Analysis of T-helper cell differentiation to T-helper type 1 (Th1) and Th2 lineages has begun to reveal a complex mechanism whereby transcription factors, enzymes that either deposit or remove covalent modifications from histone tails and DNA methylating enzymes are recruited to cytokine genes. Each resultant cell lineage subsequently displays a programme of transcriptional restrictions that firstly, facilitates expression of a particular subset of signature cytokines and secondly, silences expression of the cytokines normally recognized as being markers of the opposite differentiation limb. Some essential proteins in this differentiative paradigm, such as the transcription factors GATA3 and T-bet, are well studied; however, the types of enzymatic activities that these proteins recruit in order to implement differentiation are more obscure. Recent genome-wide studies of histone modifications have begun to clarify how specific modifications of histones impact upon both transcriptional regulation and chromatin organization. Here we review how this information has enlightened our knowledge of how Th1/Th2 differentiation is orchestrated.

Self-Stimulatory Behavior Detection Using Wearable Sensors for Children With Autistic Spectrum Disorder

An affordable, user-friendly and reliable infrastructure that supportsevidence based tools for health assessment of children withAutistic Spectrum Disorder (ASD) has been developed. This systemcan detect the behaviors of children at various stages of autismand enables the therapist and parents to monitor, assist diagnosisand therapies of autistic children. The system incorporates 2different sensor platforms which are wearable and static. Thewearable system consists of a 3-axis accelerometer, small microprocessor and a Bluetooth module to transmit data to the basestation. This wearable device integrates these 3 modules to a customizedPrinted Circuit Board (PCB) which can be worn as a cuff or could be sewed intothe sleeves of a child's shirt. The static sensor is composed of an audio sensorand a webcam which detects the sound/speech and captures video data of thesubject within the room. Using this sensor system, we are able to achieve thenecessary information for assessment and therapy in autism research.Based on the data collected and our preliminary analysis, we wereable to detect and recognize several self-stimulatory behaviors of achild with autism. The device allows for a continuous monitoringof the activities and self-stimulatory behaviors. It benefits both therapistsand parents by helping them to better understand the behaviors of an autisticchild and it will also enable early diagnosis of ASD.

Intracervical prostaglandins for induction of labour

BACKGROUND

Prostaglandins have been used for cervical ripening and induction of labour since the 1970s. The goal of the administration of prostaglandins in the process of induction of labour is to achieve cervical ripening before the onset of contractions. One of the routes of administration that was proposed is intracervical. Using this route, prostaglandins are less easy to administer and the need for exposing the cervix may cause discomfort to the woman.

OBJECTIVES

To determine the effects of intracervical prostaglandins for third trimester cervical ripening or induction of labour compared with placebo/no treatment and with vaginal prostaglandins (except misoprostol).

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007) and bibliographies of relevant papers.

SELECTION CRITERIA

Clinical trials comparing intracervical prostaglandins used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods (vaginal prostaglandins, except misoprostol).

DATA COLLECTION AND ANALYSIS

A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.

MAIN RESULTS

Fifty-six trials (7738 women) are included. INTRACERVICAL PGE2 WITH PLACEBO/NO TREATMENT: 28 TRIALS, 3764 WOMEN: Four studies reported the number of women who did not achieve vaginal delivery within 24 hours, showing a decreased risk with PGE2 (relative risk (RR) 0.61; 95% confidence interval (CI) 0.47 to 0.79). There was a small, and statistically non-significant, reduction of the risk of caesarean section when PGE2 was used (RR 0.88; 95% CI 0.77 to 1.00). The finding was statistically significant in a subgroup of women with intact membranes and unfavourable cervix only (RR 0.82; 95% CI 0.68 to 0.98). The risk of hyperstimulation with fetal heart rate (FHR) changes was not significantly increased (RR 1.21; 95% CI 0.72 to 2.05). However, the risk of hyperstimulation without FHR changes was significantly increased (RR 1.59; 95% CI 1.09 to 2.33. INTRACERVICAL PGE2 WITH INTRAVAGINAL PGE2: 29 TRIALS, 3881 WOMEN: The risk of not achieving vaginal delivery within 24 hours was increased with intracervical PGE2 (RR 1.26; 95% CI 1.12 to 1.41). There was no change in the risk of caesarean section (RR 1.07; 95% CI 0.93 to 1.22). The risks of hyperstimulation with FHR changes (RR 0.76; 95% CI 0.39 to 1.49) and without FHR changes (RR 0.80; 95% CI 0.56 to 1.15) were non-significantly different with the two methods of PGE2 administration. Only one trial with small sample size reported on women's views, with no difference between groups. INTRACERVICAL PGE2 LOW DOSE WITH INTRACERVICAL PGE2 HIGH DOSE: TWO TRIALS, 102 WOMEN: The trials are too small to provide any useful information.

AUTHORS' CONCLUSIONS

Intracervical prostaglandins are effective compared to placebo, but appear inferior when compared to intravaginal prostaglandins.

Reliability assessment of a plaque scoring index using photographs

OBJECTIVES

The need to evaluate the reliability of a clinical index before using it as a research tool is clearly recognized. Therefore the aim of this study was to evaluate whether a new calibration method by means of photographs would be useful for assessing the examiners' reliability in the interpretation of a plaque index.

METHODS

Nine children were randomly recruited from a public school in Rio de Janeiro, Brazil. Two trained examiners evaluated these children for dental plaque, in a classroom environment, in order to record plaque scores. The children's teeth were dyed and colored photographs were taken of all tooth surfaces using a camera, mouth mirrors and lip retractors. The photographs were evaluated to select and identify the best visible tooth surfaces, and the final sample consisted of 343 tooth surfaces. One week after the clinical examination, both examiners scored the tooth surfaces from the photographs according to the index used. The intra and inter-examiner agreements were measured by intra-class correlation coefficient (ICC) for individual mean scores and for tooth surfaces scores.

RESULTS

The data showed an excellent agreement (ICC >0.80) between clinical and photographic examinations, for both examiners, both for tooth surface and patient analysis. The statistics also demonstrated excellent (ICC >0.80) inter-examiner agreement on clinical and photographic examinations.

CONCLUSION

The method seems to be an effective technique to evaluate the reliability of the plaque index, improving the reproducibility of epidemiological studies.

Pre-admission escalation rate of daily opioid consumption (PERDOC), and total morphine equivalent daily dose on the first complete day of admission (D1-MEDD) to a tertiary-level palliative care unit (TPCU): Correlates and predictors in patients with advan

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Background: Although animal laboratory studies attest to opioid tolerance (OT), it can be difficult in clinical practice to determine whether substantive escalation in opioid dose (average of >5% per day between initial daily dose and maximum daily dose to date) is due to disease progression (DP) or decreased opioid responsiveness, which in turn may be due to OT or other factors. Our study aims were to determine (1) the frequency of PERDOC>5%, (2) the correlates and predictors of PERDOC>5% and D1-MEDD. Methods: We retrospectively examined TPCU patient database records for demographics, physician rating of PERDOC in the Edmonton Staging System (ESS) for cancer pain classification, Edmonton Symptom Assessment System (ESAS) scores, and D1-MEDD. Consecutive 1st admission data on patients surviving >3 days were included in the initial analysis. Using complete data, logistic regression and multiple regression models were created with PERDOC>5% and logn D1-MEDD, respectively, as dependent variables. Results: From 1,351 patients who met the initial descriptive analysis eligibility criteria, 1212 (90%) had an ESS rating for PERDOC. The prevalence of PERDOC>5% was 274/1212 (19.3%). Bivariate analysis (N=969, complete data) showed that PERDOC>5% was positively associated (p<0.05) with younger age, neuropathic pain component (NPC), a pathological level of psychological distress (PLPD), substance abuse, higher D1-MEDD, and higher ESAS pain score (ESAS-P). In the multivariate analysis, NPC (Odds ratio: 2.1, 95% confidence interval: 1.5–2.9), PLPD (1.7, 1.2–2.6), and higher D1-MEDD (2.2, 1.03–4.7) were the strongest independent positive predictors, and ESAS-P (1.01, 1.003–1.02) remained as a weaker predictor. In the D1-MEDD regression model, positive predictors (p<0.05) were younger age, NPC, incident pain, PERDOC>5%, PLPD, ESAS-P and ESAS anxiety scores. Conclusions: Aside from OT and DP, the multiple predictors identified for PERDOC>5% and D1-MEDD underscore the need for a systematic multidimensional assessment of cancer pain that incorporates psychological and physical characteristics.

No significant financial relationships to disclose.