A feasibility and acceptability study of using an intra-oral camera and an asynchronous tele-mentoring protocol to detect and identify oral lesions.

Background: To examine the feasibility and acceptability of integrating a tele-mentoring component into the identification of oral lesions at the dental clinics of a Federally Qualified Health Center network. Design and Methods: General Practice Residency faculty and residents completed research ethics courses and trained dentists to use intra-oral cameras at chairside to photograph oral lesions of patients at routine dental visits. These images were then uploaded into the patient electronic health records (EHRs) with attendant descriptions and an oral surgeon was notified, who reviewed the charts, placed his observations in the EHR, and communicated his findings via secure e-mail to the involved residents, who in turn contacted their patients regarding follow-up actions. Feasibility was assessed via checklists completed by provider participants and semi-structured interviews. Acceptability was assessed via brief exit interviews completed by patient participants. Results: All 12 of the dentist participants reported that they had successfully provided the tele-mentoring intervention, and that the process (from EHR data entry to interaction with the oral surgeon over findings to patient referral) was clear and straightforward. Of 39 patient participants, most strongly agreed or agreed that the use of an intra-oral camera by their dentists helped them to better understand oral cancer screening (94.9%) and that dentists answered their questions about oral cancer and were able to provide them with resources (94.8%). Conclusions: Findings support further implementation research into adapting tele-mentoring using intra-oral cameras for training dental residents to detect and identify oral lesions and educating patients about oral cancer across settings.

Comparison of clinical competency self-assessments among Advanced Education in General Dentistry (AEGD) residents before and during COVID-19 pandemic.

PURPOSE/OBJECTIVES: Self-assessment of clinical competence is an important tool for effective learning and training for some educational programs. The New York University (NYU) Langone Hospital's Advanced Education in General Dentistry (AEGD) Program has had its residents complete self-assessment of clinical competency evaluations for many years. The evaluation is used to understand the residents' perception of their own clinical skill upon beginning the program and to determine the necessary resources to provide to the residents for them to meet program standards. The same evaluation is completed by the residents 6 months later to determine if they perceived advancement in their clinical performance while in the program. Dental education, along with other fields of education was disrupted by the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to examine the impact of COVID-19 on clinical competency self-assessments among the NYU Langone AEGD residents before and during the pandemic. METHODS: In this cross-sectional study, data was collected from two AEGD cohorts representing 2019-2020 and 2020-2021 academic years; from July 2019 (n = 196) to January 2020 (n = 189) and July 2020 (n = 202) to January 2021 (n = 184). The self-assessment evaluations were administered via an online residency management platform on the first days of July and January of the academic year. The survey consisted of 48 questions on "clinical skills and performance" as established by CODA standards for postdoctoral general dentistry programs. RESULTS: Survey response rate was 100% for both cohorts. When comparing results, the findings indicate the COVID-19 pandemic had interrupted clinical learning during dental school. However, training through the AEGD program led to improvements in perceived clinical competence by the residents in mid-program evaluation. CONCLUSION: The self-assessment evaluation can be used as a tool to enhance training as part of the AEGD program's performance improvement plan.

A system dynamics model of infection risk, expectations, and perceptions on antibiotic prescribing in the United States.

RATIONALE, AIMS, AND OBJECTIVES: Inappropriate antibiotic prescribing is still a major concern that can lead to devastating outcomes including antibiotic resistance. This study aimed to simulate the antibiotic prescribing behaviour by providers for acute respiratory tract infections (ARTIs) and to evaluate the impact of patient expectation, provider's perception of patient's expectation to receive a prescription, and patient's risk for bacterial infection, on the decision to prescribe. METHODS: We developed a unique system dynamics (SD) simulation model based on the significant factors that impact the interaction between provider and patient during visits for ARTIs and the decision to prescribe antibiotics. In order to validate the model for different age groups and regions in the United States, we used the sample of 53 000 ARTI patient visits made at outpatient settings between 1993 and 2015, based on the National Ambulatory Medical Care Survey (NAMCS). RESULTS: Simulation results reveal that physician diagnosis for prescribing antibiotics is based on physician's experience from their prior prescribing behaviour, their perception of patient's infection risk, and patient's expectation to receive antibiotics. Also, there are some variations depending on patient's age and residential region. The simulation analysis also depicts the decreasing trend in patient's expectation over the past two decades for most age groups and regions. CONCLUSIONS: Given the high number of unnecessary prescriptions for ARTI, we found that policies are needed to influence provider's prescribing behaviour through patient's expectation and provider's perception regarding those expectations. Our simulation framework can further be used by policymakers to design and evaluate interventions that may modify the interaction between health providers and patients to optimize antibiotic prescriptions among ARTI patients for different regions and age groups.

Knowledge and Attitude of Midwifery Students on Oral Health Care.

Midwifery students can have an important role in transferring oral health care information to expecting mothers. The aim of this study was to assess the effect of an educational intervention on knowledge and attitudes of midwifery students on oral health in pregnancy. Study population consisted of 60 midwifery students in a Midwifery School in Iran who were randomly allocated into case and control groups. Self-administered questionnaires were distributed before, immediately after the intervention and also three months later. The validity and reliability of the questionnaire was confirmed at the beginning. Mean total pre-test knowledge scores from total 10 in the interventional and control groups were 4.63 ± 0.25 (Standard Error, SE) and 4.79 ± 0.31 (SE) respectively. After three months scores reached to 8.87 ± 0.15 (SE) in the interventional and 5.57 ± 0.29 (SE) in the control groups. Mean attitude pre-test scores in the interventional group was 27.23 ± 0.75 (SE) and after the intervention reached to 31.13 ± 0.25 (SE). Lecture-based educational intervention improved the knowledge and attitudes of midwifery students on oral health care in pregnancy. Incorporating courses on oral health in pregnancy into the curricula of midwifery programs can be effective in promoting oral health care in pregnant women.

Comparative Sensitivity Assessment of Cone Beam Computed Tomography and Digital Radiography for detecting Foreign Bodies.

AIM: Foreign body detection and determining whether it is adjacent to critical organs has a significant role in its removal. Various imaging techniques have been used to locate foreign bodies. This study aimed to compare cone beam computed tomography (CBCT) and digital radiography for detecting foreign bodies in an in vitro model. MATERIALS AND METHODS: Foreign bodies composed of normal glass, barium glass, wood, and stone with two sizes were placed into three different locations of two sheep heads. Digital radiography [lateral cephalometric, submentovertex (SMV)] and CBCT were compared to investigate their sensitivity for detecting foreign bodies. RESULTS: Diagnostic sensitivity of digital radiography in lateral cephalometric view, SMV view, and CBCT for detecting all types of foreign bodies was 67.2, 32.3, and 76.6% respectively. None of these techniques were successful in detecting wood satisfactory. Stone was detected relatively higher than other foreign bodies (82.6%). Diagnostic sensitivity of CBCT in detecting foreign bodies was 100%, except for wood. Accuracy of imaging techniques in detecting foreign bodies according to locations in descending order was lip, mandibular angle, and maxillary sinus. CONCLUSION: It can be concluded that appropriate amount of radiopacity is enough for CBCT to exactly detect foreign body, regardless of its location or size. CLINICAL SIGNIFICANCE: In maxillofacial traumatic patients, CBCT seems to be a better and cost-effective technique for detecting hidden foreign bodies than other routine techniques.