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World\u27s greatest celebration of orthodontics: The American Association of Orthodontists 2024 Annual Session in New Orleans
No full textLong-term skeletodental changes with early and late treatment using modified C-palatal plates in hyperdivergent Class II adolescents
No full textObjectives: To compare skeletodental changes between early and late treatment groups using modified C-palatal plates (MCPP) and long-term retention outcomes in hyperdivergent Class II adolescents. Materials and Methods: Seventy-one hyperdivergent Class II patients were divided into four groups according to treatment modality and treatment timing: group 1, early treatment with MCPP (n ¼ 16; 9.9 6 0.9 years); group 2, late treatment with MCPP (n ¼ 19; 12.3 6 0.8 years); group 3, early treatment with headgear (HG; n ¼ 18; 9.6 6 0.8 years); and group 4, late treatment with HG (n ¼ 18; 12.1 6 1.2 years). Lateral cephalograms were taken and skeletal and dental variables were measured. For statistical analysis, paired t-tests, independent t-tests, and multiple regression were performed. Results: The early MCPP group showed a more significant decrease in mandibular plane angle than the late MCPP group did, and vertical control was more efficient in the early group than in the late group. In the MCPP groups, both FMA and SN-GoGn were increased with late treatment but decreased with early treatment, and the difference was statistically significant (P, .01). The early-treatment MCPP group had a significant decrease in SN-GoGn of 0.6° compared with an increase of 1.7° in the early treatment HG group (P, .01). Posttreatment stability of both the early and late MCPP groups was maintained in long-term retention. Conclusions: Early MCPP showed more significant vertical control than late MCPP. However, there was no difference in long-term stability between early and late groups
Exploring Advanced Technology in the Outpatient Adult Neurorehabilitation Clinical Setting
Get PDFBackground: Occupational therapists have access to many advanced technological devices that can aid in enhancing patients’ functional occupations. Such devices can be very costly and beneficial to the profession at large however they are not being used to their fullest potential. Barriers surrounding the usage of advanced technology can include a lack of therapist training, a lack of confidence in skills required to operate the devices and being uninformed on the benefit that technology can have on the client’s functionality. Purpose: The purpose of this study is to identify and reduce the barriers surrounding the usage of the neurosensorimotor integrator amongst the neurorehabilitation team (occupational therapy, speech therapy, physical therapy, and rehabilitation specialists) at Rehab Without Walls (RWW). Method: A non-probability convenience sample was recruited of the neurorehabilitation team at RWW. A pre-survey consisting of a needs assessment and the Systems Usability Scale (SUS) to gain understanding of the therapists perceived usability of the NSI was given. From the results of the pre-survey various deliverables were created including a device set-up guide, a program decision tree and a simplified user’s manual. Each of the therapy disciplines received a one-hour training outlining the NSI programs pertinent to the skills they target in therapy interventions. A post-survey was given to determine the therapist’s perceived usability of the NSI following the discipline specific training. Results: The average perceived usability of therapists increased by 8.75 points following the discipline-specific training on the NSI programs. However, a Wilcoxon signed-rank test indicated that the change in therapist-perceived usability was not statistically significant (Table 5; Z = −1.826, p = 0.068). Conclusion: Positive trends show an increase in therapists perceived usability of the NSI however, due to a small sample size further research is necessary to increase reliability and validity of the study to deem it generalizable
Examining the pedagogical practices that support cultural proficiency development in graduate health science students
No full textBackground: Health disparities are often a function of systemic discrimination and healthcare providers’ biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP. Methods: Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students’ implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions. Results: The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students’ perception of the training varied substantially (e.g., training range = 1–100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes. Conclusions: These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges
The Fragility of Statistical Findings in Cervical Disc Arthroplasty: a Systematic Review of Randomized Controlled Trials
No full textPurpose: This study employs both the fragility index (FI) and fragility quotient (FQ) to assess the level of robustness in the cervical disc arthroplasty (CDA) literature. We hypothesize that dichotomous outcomes involving CDA would exhibit statistical vulnerability. Methods: A PubMed search was conducted to evaluate dichotomous data for randomized controlled trials (RCTs) in CDA literature from 2000 to 2023. The FI of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. Results: Of the 1561 articles screened, 111 met the search criteria, with 35 RCTs evaluating CDA included for analysis. Six hundred and ninety-three outcome events with 130 significant (P \u3c 0.05) outcomes and 563 nonsignificant (P ≥ 0.05) outcomes were identified. The overall FI and FQ for all 693 outcomes were 5 (IQR 3–7) and 0.019 (IQR 0.011–0.043). Fragility analysis of statistically significant outcomes and nonsignificant outcomes both revealed an FI of 5. All of the studies reported loss to follow-up (LTF) data where 65.7% (23) did not report or reported an LTF greater or equal to 5. Conclusions: The literature regarding CDA RCTs lacks statistical robustness and may misrepresent the conclusions with the sole use of the P value. By implementing the FI and FQ along with the P value, we believe the interpretation and contextualization of the clinical data surrounding CDA will be better understood
Prophylactic Tranexamic Acid Prevents Postpartum Hemorrhage and Transfusions in Cesarean Deliveries: A Systematic Review and Meta-analysis
No full textAbstract
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and PPH resulting in transfusion is the most common maternal morbidity in the United States. Literature demonstrates that tranexamic acid (TXA) can reduce blood loss in cesarean deliveries; however, there is little consensus on the impact on major morbidities like PPH and transfusions. We conducted a systematic review/meta-analysis of randomized controlled trials (RCTs) to evaluate if administration of prophylactic intravenous (IV) TXA prevents PPH and/or transfusions following low-risk cesarean delivery. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. Five databases were searched: Cochrane, EBSCO, Ovid, PubMed, and ClinicalKey. RCTs published in English between January 2000 and December 2021 were included. Studies compared PPH and transfusions in cesarean deliveries between prophylactic IV TXA and control (placebo or no placebo). The primary outcome was PPH, and the secondary outcome was transfusions. Random effects models were used to calculate effect size (ES) of exposure in Mantel–Haenszel risk ratios (RR). All analysis was done at a confidence level (CI) of α = 0.5. Modeling showed that TXA led to significantly less risk of PPH than control (RR: 0.43; 95% CI: 0.28–0.67). The effect on transfusion was comparable (RR: 0.39; 95% CI: 0.21–0.73). Heterogeneity was minimal (I 2 = 0%). Due to the large sample sizes needed, many RCTs are not powered to interpret TXA\u27s effect on PPH and transfusions. Pooling these studies in a meta-analysis allows for more power and analysis but is limited by the heterogeneity of studies. Our results minimize heterogeneity while demonstrating that prophylactic TXA can lower PPH occurrence and reduce the need for blood transfusion. We suggest considering prophylactic IV TXA as the standard of care in low-risk cesarean deliveries.
Key Points
Consider TXA prior to incision for singleton, term pregnancies undergoing elective cesarean.
Prophylactic TXA is effective in preventing PPH and blood transfusions.
Routine use of TXA has the potential to decrease transfusion-related complications and costs
Full-ceramic resin-bonded fixed dental prostheses: A systematic review
No full textAbstract
Despite the development of implant-supported prostheses, there are still patients for whom conservative treatments such as resin-bonded fixed dental prostheses (RBFDPs) are more appropriate. This study\u27s objective was to analyze the available research on full-ceramic RBFDPs. In this study, Web of Science, MEDLINE/PubMed, Scopus, Embase, Cochrane Library, and Google Scholar databases were searched for articles published in English between 2010 and 2020. A total of 14 studies were reviewed based on the eligibility criteria. The results showed that using a cantilever design with one abutment had an advantage over two abutments. Additionally, it was proposed that preparations designed with retentive aids, such as a proximal box, groove, and pinhole, could improve RBFDP survival rates. IPS e.max ZirCAD, In-Ceram alumina, and zirconia CAD/CAM were the most commonly used framework materials. Most studies used air abrasion, salinization, or hydrofluoric acid for surface treatment. Adhesive resin cements were the most frequently used type of cement. The survival rate of In-Ceram ceramics (85.3%-94.8%) was lower than that of In-Ceram zirconia and IPS e.max ZirCAD. Debonding, followed by framework fracture, was the leading cause of failure. Following 3-10 years follow-up, the survival percentage of all-ceramic RBFDPs ranged from 76% to 100%. Although RBFDPs have demonstrated satisfactory success as a conservative treatment, long-term follow-ups and higher sample sizes in clinical research are required to gain more reliable outcomes on the clinical success rate of various RBFDP designs
Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies
No full textAbstract Objective
The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). Methods
The focus question was “For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques’ outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?” An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. Results
After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). Conclusion
MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity
The anatomical basis of amphibious hearing in the American alligator (Alligator mississippiensis)
No full textAbstract
The different velocities of sound (pressure waves) in air and water make auditory source localization a challenge for amphibious animals. The American alligator (Alligator mississippiensis) has an extracolumellar cartilage that abuts the deep surface of the tympanic membrane, and then expands in size beyond the caudal margin of the tympanum. This extracolumellar expansion is the insertion site for two antagonistic skeletal muscles, the tensor tympani, and the depressor tympani. These muscles function to modulate the tension in the tympanic membrane, presumably as part of the well-developed submergence reflex of Alligator. All crocodilians, including Alligator, have internally coupled ears in which paratympanic sinuses connect the contralateral middle ear cavities. The temporal performance of internally coupled ears is determined, in part, by the tension of the tympanic membrane. Switching between a tensed and relaxed tympanic membrane may allow Alligator to compensate for the increased velocity of sound underwater and, in this way, use a single auditory map for sound localization in two very different physical environments
Instructional strategies and challenges for implementing teledentistry in dental hygiene curricula: A qualitative study
No full textAbstract Purpose/Objectives
Research has documented the implementation of telecommunications and virtual technology use in health care disciplines to expand accessibility. Despite the current trend of digital innovations in healthcare systems, telehealth technology is not readily adopted in the dental hygiene profession yet. Currently, no standardized educational framework exists in dental hygiene curricula to prepare professionals with the technical skill set and professional knowledge necessary for telehealth applications. The aims and objectives of this research were (1) to investigate existing dental hygiene educators’ pedagogical frameworks for incorporating telehealth technology into dental hygiene curricula, (2) explore these educators’ instructional strategies for teaching telehealth technology, and (3) examine the theoretical implications and practical outcomes of teaching telehealth technology for professional development and transferrable work-force ready skills. Methods
A nine-item, open-ended, semi-structured interview guide was prepared and approved by the Institutional Review Board (IRB) in January 2023 to qualitatively investigate accredited entry-level dental hygiene programs in the United States. Thematic interpretational analysis was conducted using NVivo software. Results
A total of 54 of the 328 dental hygiene programs volunteered for participation. Thirteen full-time and part-time dental hygiene educators met inclusion criteria. The core salient themes identified included (a) curriculum mapping, (b) technology integration, (c) professional collaboration, and (d) supplemental skill set. Conclusions
These findings provide guidance to dental hygiene programs for bridging the teledentistry knowledge gap in curriculum development. Incorporating telehealth applications into dental hygiene curricula prepares future dental hygienists with the specialized training needed to function as a member of contemporary health care teams addressing access to care