From admissions to licensure: education data associations from a multi-centre undergraduate medical education collaboration.

This paper reports the findings of a Canada based multi-institutional study designed to investigate the relationships between admissions criteria, in-program assessments, and performance on licensing exams. The study's objective is to provide valuable insights for improving educational practices across different institutions. Data were gathered from six medical schools: McMaster University, the Northern Ontario School of Medicine University, Queen's University, University of Ottawa, University of Toronto, and Western University. The dataset includes graduates who undertook the Medical Council of Canada Qualifying Examination Part 1 (MCCQE1) between 2015 and 2017. The data were categorized into five distinct sections: demographic information as well as four matrices: admissions, course performance, objective structured clinical examination (OSCE), and clerkship performance. Common and unique variables were identified through an extensive consensus-building process. Hierarchical linear regression and a manual stepwise variable selection approach were used for analysis. Analyses were performed on data set encompassing graduates of all six medical schools as well as on individual data sets from each school. For the combined data set the final model estimated 32% of the variance in performance on licensing exams, highlighting variables such as Age at Admission, Sex, Biomedical Knowledge, the first post-clerkship OSCE, and a clerkship theta score. Individual school analysis explained 41-60% of the variance in MCCQE1 outcomes, with comparable variables to the analysis from of the combined data set identified as significant independent variables. Therefore, strongly emphasising the need for variety of high-quality assessment on the educational continuum. This study underscores the importance of sharing data to enable educational insights. This study also had its challenges when it came to the access and aggregation of data. As such we advocate for the establishment of a common framework for multi-institutional educational research, facilitating studies and evaluations across diverse institutions. This study demonstrates the scientific potential of collaborative data analysis in enhancing educational outcomes. It offers a deeper understanding of the factors influencing performance on licensure exams and emphasizes the need for addressing data gaps to advance multi-institutional research for educational improvements.

Insights into a collective impact partnership to promote consumption of healthy drinks in North East Melbourne: A qualitative case study.

ISSUE ADDRESSED: To explore insights and perspectives of a collective impact (CI) partnership taking on a new project that aimed to reduce sugary drink consumption and promote water as the drink of choice across North East Melbourne. METHODS: A qualitative case study was undertaken. Semi-structured interviews were conducted with key stakeholders in the partnership. Data were analysed using thematic analysis. RESULTS: Fourteen organisations participated in the North East Healthy Drinks Alliance. The data demonstrated that investing in developing a common agenda supported the establishment of a CI approach. The backbone organisation was found to have played a crucial role in coordinating the activities of the Alliance. This coordination was found to be particularly important in terms of ensuring that organisations were able to work on mutually reinforcing activities at their own pace. Program planning and reporting was managed through open continuous communication by the backbone organisation. The data collected pertains to the activities of the Alliance in its first 2 years, prior to the development of a shared measurement strategy, thus no data was collected on this aspect of the collective impact framework. Although some participants were found to have limited knowledge of CI, this did not seem to hinder their participation in the Alliance. CONCLUSION: Selecting a relevant and accessible focus area and investing in developing a common agenda supported the establishment of a CI approach. SO WHAT?: The CI framework offers a valuable tool for undertaking cross-sectoral, local partnerships for health.

The relationships between golf and health: a scoping review.

OBJECTIVE: To assess the relationships between golf and health. DESIGN: Scoping review. DATA SOURCES: Published and unpublished reports of any age or language, identified by searching electronic databases, platforms, reference lists, websites and from consulting experts. REVIEW METHODS: A 3-step search strategy identified relevant published primary and secondary studies as well as grey literature. Identified studies were screened for final inclusion. Data were extracted using a standardised tool, to form (1) a descriptive analysis and (2) a thematic summary. RESULTS AND DISCUSSION: 4944 records were identified with an initial search. 301 studies met criteria for the scoping review. Golf can provide moderate intensity physical activity and is associated with physical health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence related to golf and mental health. The incidence of golfing injury is moderate, with back injuries the most frequent. Accidental head injuries are rare, but can have serious consequences. CONCLUSIONS: Practitioners and policymakers can be encouraged to support more people to play golf, due to associated improved physical health and mental well-being, and a potential contribution to increased life expectancy. Injuries and illnesses associated with golf have been identified, and risk reduction strategies are warranted. Further research priorities include systematic reviews to further explore the cause and effect nature of the relationships described. Research characterising golf's contribution to muscular strengthening, balance and falls prevention as well as further assessing the associations and effects between golf and mental health are also indicated.

The relationship and effects of golf on physical and mental health: a scoping review protocol.

INTRODUCTION: Golf is a sport played in 206 countries worldwide by over 50 million people. It is possible that participation in golf, which is a form of physical activity, may be associated with effects on longevity, the cardiovascular, metabolic and musculoskeletal systems, as well as on mental health and well-being. We outline our scoping review protocol to examine the relationships and effects of golf on physical and mental health. METHODS AND ANALYSIS: Best practice methodological frameworks suggested by Arksey and O'Malley, Levac et al and the Joanna Briggs Institute will serve as our guide, providing clarity and rigour. A scoping review provides a framework to (1) map the key concepts and evidence, (2) summarise and disseminate existing research findings to practitioners and policymakers and (3) identify gaps in the existing research. A three-step search strategy will identify reviews as well as original research, published and grey literature. An initial search will identify suitable search terms, followed by a search using keyword and index terms. Two reviewers will independently screen identified studies for final inclusion. DISSEMINATION: We will map key concepts and evidence, and disseminate existing research findings to practitioners and policymakers through peer-reviewed and non-peer reviewed publications, conferences and in-person communications. We will identify priorities for further study. This method may prove useful to examine the relationships and effects of other sports on health.

Management of fractures of the nasofrontal complex.

Repair of fractures involving the nasofrontal region remains a mainstay of contemporary oral and maxillofacial surgery. This article discusses the epidemiology of these injuries, anatomy of the area, and management of these fractures with insight into potential complications. These include fractures of the frontal sinus, naso-orbital-ethmoidal region, root of the nose, and associated adjacent structures.

Concomitant removal of mandibular third molars during sagittal split osteotomy minimizes neurosensory dysfunction.

PURPOSE: Inferior alveolar nerve (IAN) injury is 1 of the most important postoperative complications after sagittal split osteotomy (SSO). The purpose of our study was to investigate the effects of the presence or absence of a mandibular third molar on the neurosensory recovery of the IAN after SSO. MATERIALS AND METHODS: A prospective cohort study enrolled a sample composed of patients who underwent SSO to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO and it was divided into two levels, present at the time of SSO (Group I) or absent at the time of SSO (Group II). The primary outcome variable was neurosensory recovery of the IAN, assessed using the Medical Research Council scale, functional sensory recovery, and subjective evaluation. Neurosensory status was measured 3 times (preoperatively and 3 and 6 months postoperatively). Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P < .05. RESULTS: A total of 120 SSOs were performed in 60 patients. Group I included 64 SSOs (mean patient age ± SD 19.3 ± 8.0 years) and group II, 56 SSOs (mean patient age 24.9 ± 10.0 years). The Medical Research Council scale scores showed that the presence of third molars during SSO was associated with a statistically significant decreased incidence of neurosensory disturbance of the IAN at 3 and 6 months postoperatively (all P < .01). Functional sensory recovery was achieved more frequently in group I, but this difference remained significant only at 3 months after adjusting (P = .01). A "normal sensation" was subjectively reported more frequently in group I at 3 and 6 months postoperatively (P ≤ .05). CONCLUSIONS: The presence of third molars during SSO minimizes postoperative neurosensory disturbance of the IAN.

The presence of mandibular third molars during sagittal split osteotomies does not increase the risk of complications.

PURPOSE: The purpose of this study was to investigate prospectively the effects of the presence or absence of third molars during sagittal split osteotomies (SSOs) on the frequency of unfavorable fractures, degree of entrapment and manipulation of the inferior alveolar nerve (IAN), and procedural time. MATERIALS AND METHODS: The investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who underwent SSOs to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO, and it was divided into 2 levels, present at the time of SSO (group I) or absent at the time of SSO (group II). The primary outcome variable was unfavorable splits. The secondary outcome variables were the degree of entrapment/manipulation of the IAN and the procedural time. Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P < .05. RESULTS: Six hundred seventy-seven SSOs were performed in 339 patients: group I consisted of 331 SSOs (mean age ± SD: 19.6 ± 7.4 yrs), and group II consisted of 346 SSOs (30.4 ± 12.1 yrs). The overall rate of unfavorable fractures was 3.1% (21 of 677), with frequencies of 2.4% (8 of 331) in group I, compared with 3.8% (13 of 346) in group II (P = .3). The rate of IAN entrapment in the proximal segment was significantly lower in group I (37.2%) than in group II (46.5%; P = .01). The degree of entrapment was also significantly more severe for group II (P < .001). Third molars increased procedural time by 1.7 minutes (P < .001). CONCLUSIONS: The presence of third molars during SSOs is not associated with an increased frequency of unfavorable fractures. Concomitant third molar removal in SSOs also decreases proximal segment IAN entrapment but only slightly increases operating time.

Bisphosphonate associated osteonecrosis of the jaw.

In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.

Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw.

OBJECTIVE: Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. The purpose of the guidelines is to provide recommendations regarding diagnosis, identification of at-risk patients, and prevention and management strategies, based on current evidence and consensus. These guidelines were developed for medical and dental practitioners as well as for oral pathologists and related specialists. METHODS: The multidisciplinary task force established by the CAOMS reviewed all relevant areas of research relating to ONJ associated with bisphosphonate use and completed a systematic review of current literature. These evidence-based guidelines were developed utilizing a structured development methodology. A modified Delphi consensus process enabled consensus among the multidisciplinary task force members. These guidelines have since been reviewed by external experts and endorsed by national and international medical, dental, oral surgery, and oral pathology societies. RESULTS: RECOMMENDATIONS regarding diagnosis, prevention, and management of ONJ were made following analysis of all current data pertaining to this condition. ONJ has many etiologic factors including head and neck irradiation, trauma, periodontal disease, local malignancy, chemotherapy, and glucocorticoid therapy. High-dose intravenous bisphosphonates have been identified as a risk factor for ONJ in the oncology patient population. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ. Prevention, staging, and treatment recommendations are based upon collective expert opinion and current data, which has been limited to case reports, case series, surveys, retrospective studies, and 2 prospective observational studies. RECOMMENDATIONS: In all oncology patients, a thorough dental examination including radiographs should be completed prior to the initiation of intravenous bisphosphonate therapy. In this population, any invasive dental procedure is ideally completed prior to the initiation of high-dose bisphosphonate therapy. Non-urgent procedures are preferably delayed for 3 to 6 months following interruption of bisphosphonate therapy. Osteoporosis patients receiving oral or intravenous bisphosphonates do not require a dental examination prior to initiating therapy in the presence of appropriate dental care and good oral hygiene. Stopping smoking, limiting alcohol intake, and maintaining good oral hygiene should be emphasized for all patients receiving bisphosphonate therapy. Individuals with established ONJ are most appropriately managed with supportive care including pain control, treatment of secondary infection, removal of necrotic debris, and mobile sequestrate. Aggressive debridement is contraindicated. CONCLUSION: Our multidisciplinary guidelines, which provide a rational evidence-based approach to the diagnosis, prevention, and management of bisphosphonate-associated ONJ in Canada, are based on the best available published data and the opinion of national and international experts involved in the prevention and management of ONJ.

Resterilization of instruments used in a hospital-based oral and maxillofacial surgery clinic.

OBJECTIVE: The transmission of pathogens from one patient to another via contaminated devices has been a high profile issue in infection control. Although single-use devices have been promoted as a preventative strategy, resterilization of instruments has been a common practice in dentistry. The purpose of this study was to investigate the rate of bacterial contamination of instruments resterilized for use in oral and maxillofacial procedures in a hospital-based clinic. METHODS: The experiment was a prospective randomized controlled study. The test group consisted of burs that had been used in surgical procedures. These burs were grossly debrided before being cleaned and gas sterilized in the central sterilizing department of the hospital. The burs were transferred in a sterile fashion into a culture medium selected to grow oral bacteria. The control group comprised new unused instruments treated in an identical fashion before culturing. All burs were incubated and monitored daily for 72 h. RESULTS: The rate of bacterial contamination in the test groups was significantly higher than in the control group (p < 0.05). CONCLUSIONS: Reuse of instruments can be cost-effective if the safety of patients can be assured; however, there is increasing evidence that the sterilization process may not be completely effective. Consideration should be given to the classification of certain types of dental burs as single-use devices if sterilization cannot be guaranteed.

The use of thermal biofeedback in the treatment of pain associated with endometriosis: preliminary findings.

Endometriosis is a common gynecological disease that causes marked physical and emotional distress in lives of women, resulting in dysmenorrhea, pain, or both throughout the menstrual cycle in over 96% of cases. A multiple case study design (N = 5) was employed to investigate the use of thermal biofeedback in the treatment of pain associated with endometriosis. The majority of participants (4 out of 5) were able to demonstrate mastery over hand temperature through thermal biofeedback. Of those participants, significant reductions in various aspects of pain were observed by the end of the study; one had a significant increase in Life Control; two had reductions in Pain Severity; three had a decrease in Affective Distress; and all 4 demonstrated reduction in Life Interference, as measured by the West Haven-Yale Multidimensional Pain Inventory. This is a preliminary study with a small sample size and without a control sample; hence, the results are considered only as suggestive of the potential use of biofeedback therapy in alleviating pain and associated symptomatology related to endometriosis. Further research is warranted.

Utilization of phosphorus in lactating cows fed varying amounts of phosphorus and forage.

The objective of this study was to determine the effect of dietary forage proportion and P content on fecal P excretion. Four dietary treatments were formed in a 2 x 2 factorial arrangement. The P content was 0.33 or 0.42%, and the forage proportion was 48 or 58% on a dry matter (DM) basis. The neutral detergent fiber content was 27 and 30% for the low and high forage diets, respectively. The P amount was varied by using monosodium phosphate, and the forage amount by changing the proportions of alfalfa silage and corn. The diets were fed to 44 midlactation Holsteins for 14 wk. Fecal P excretion was estimated using Cr marker and grab sampling. Dietary P content did not affect DM intake, milk yield, or milk composition. The P intake averaged 74 and 96 g/d and fecal P averaged 0.69 and 0.92% (DM basis) or 49 and 65 g/d for the low and high P diets, respectively. Thus, reducing dietary P from 0.42 to 0.33% resulted in approximately 25% less estimated fecal P excretion. Increasing dietary forage reduced milk yield (34.0 vs. 36.5 kg/d), but increased milk fat content (3.66 vs. 3.25%). Estimated apparent digestibility of P tended to decrease (31.1 vs. 36.6%) when the forage proportion increased, but most of the change occurred when the diets contained the low amount of P. Overall, the effect of forage proportion on estimated fecal P excretion was small when diets contained 48 or 58% forage, varied by alfalfa silage. Phosphorus intake has a much larger impact on fecal P excretion than forage proportion, and it does not seem necessary to adjust the dietary P content according to the forage proportion to provide the same amount of absorbed P.

Analysis of fiber content in flax stems by near-infrared spectroscopy.

The conventional means of measuring the fiber content of flax is time-consuming and laborious, and the results obtained vary with the analysis technique used. The plant tissues must first be "retted", a process by which the fibers are separated from the rest of the stem, either by indigenous organisms in the soil when the stems are left in the field or by water (anerobic bacteria) or enzymatic retting. The fiber content is then determined by mechanical or manual separation. In this study, fiber content of flax stems was measured rapidly and objectively by near-infrared spectroscopy (NIRS) using whole pieces of stem in a large cell, in reflectance mode. Compared to the conventional method, the standard error of performance of the NIRS method was between 0.96 and 1.45% (dry matter basis), depending on the model and data processing used. NIRS calibrations were generated by hand separation of fiber from water-retted specimens. The water retting procedure takes several days to complete and requires considerable trained labor to complete the hand separation step. The NIRS procedure was conducted on pieces of stem to simulate measurement in the field.

Determination of total dietary fiber of intact cereal food products by near-infrared reflectance.

Near-infrared reflectance spectra of cereal food products were acquired with a commercial dual-diode-array (Si, InGaAs) spectrometer customized to allow rapid acquisition of scans of intact breakfast cereals, snack foods, whole grains, and milled products. Substantial gains in the performance of multivariate calibration models generated from these data were obtained by a computational strategy that systematically analyzed the performance of various spectral windows. The calibration model based on 137 cereal food products determined the total dietary fiber (TDF) content of a test set of 45 intact diverse cereal food products with root-mean-squared error of cross-validation of between 1.8 and 2.0% TDF, relative to the laborious enzymatic-gravimetric reference method. The calibration performance is adequate to estimate TDF over the range of values found in diverse types of cereal food products (0.7-50.1%). The method requires no sample preparation and is relatively unaffected by specimen moisture content.

Double-blind, placebo-substitution study of nefazodone in the prevention of relapse during continuation treatment of outpatients with major depression.

The efficacy of nefazodone in prevention of relapse of depression was evaluated in a 36-week double-blind, placebo-substitution, continuation treatment trial. After 16 weeks of acute, single-blind treatment with nefazodone, 131 patients responding to treatment and in stable remission were randomized in a 36-week double-blind trial to either nefazodone (n = 65) or placebo (n = 66). Patients were defined as having relapsed if they had a total score > or = 18 on the 17-item Hamilton Depression Scale on two consecutive visits or if they discontinued treatment for lack of efficacy. Relapse rates were significantly lower for patients randomized to continued nefazodone treatment than for patients switched to placebo. Kaplan-Meier estimates of relapse rates 9 months (36 weeks) after the end of acute treatment were 1.8% for nefazodone versus 18.3% for placebo (P = 0.009) by the Hamilton Depression Scale and 17.3% versus 32.8% (P = 0.028) by discontinuation for lack of efficacy. The mean modal dose of nefazodone was 412 mg/day at study endpoint. These results demonstrate the clinical effectiveness of up to 1 year's treatment (16 weeks acute and 36 weeks continuation) with nefazodone in depressed patients. Long-term efficacy of nefazodone was accompanied by a good safety profile without any weight gain and with minimal symptoms of withdrawal upon abrupt discontinuation of treatment.

JTc prolongation with d,l-sotalol in women versus men.

Women are at increased risk for torsades de pointes associated with a variety of drugs that prolong ventricular repolarization, but few data exist regarding possible sex differences in extent of repolarization changes with these medications. We sought to compare JTc interval responses in women and men during treatment with d,l-sotalol. The study cohort consisted of 1,897 patients (26% women) with available baseline and > or =1 on-drug electrocardiogram from a database involving patients exposed to oral d,l-sotalol without developing torsades de pointes. The mean lowest and highest daily d,l-sotalol dose, normalized for weight, was not significantly different between sexes. At each dosing extreme, on-drug JTc was significantly longer in women (p < or =0.0002). Statistically independent predictors of on-drug JTc included gender (p = 0.003), baseline JTc (p = 0.0001), dose (p = 0.0001), serum creatinine (p < or =0.03), and history of sustained ventricular tachyarrhythmias (p = 0.01). In both men and women, as baseline JTc increased, the drug-induced increment in JTc became progressively smaller. Thus, in response to d,l-sotalol, JTc intervals become longer in women than in men. This sex difference is independent of dose and not solely attributable to the known gender disparity in baseline JTc. The greater propensity of women to drug-induced torsades de pointes may represent the most extreme expression of a basic sex difference in the response to medications that prolong ventricular repolarization.

1997 Judson C. Hickey Scientific Writing Awards. Lip prosthesis retained with resin-bonded retentive elements as an option for the restoration of labial defects: a clinical report.

Surgical resection of the lips is a relatively uncommon procedure, and it usually presents surgical and prosthodontic rehabilitation challenges. The goals of prosthetic treatment include regaining favorable speech and restoration of esthetics. This clinical report described a method for fabricating a lip prosthesis that uses resin-bonded retentive elements bonded to the patient's teeth for retention. Clinical and laboratory procedures of the prosthetic treatment were described, and the advantages and disadvantages were reviewed.

Vacuum-formed matrix as a guide for the fabrication of craniofacial implant tissue bar-retained auricular prostheses.

Craniofacial implant-retained auricular prostheses usually require a tissue bar and/or retentive elements in addition to the prosthetic ear. Complete coverage of the tissue bar and retentive elements in a given bulk of prosthetic material is sometimes difficult to achieve, but it is crucial to ensure that all the prosthetic components are kept within the contour of the auricular prosthesis to maintain esthetics and form. This article describes a method for fabrication of auricular prostheses with all the elements predictably confined within the anatomic contour of the prostheses.