Using Standardized Patients to Teach Complete Denture Procedures in Second Year of Dental School.

Second-year dental students are commonly instructed on the process of complete denture fabrication with a traditional didactic lecture and preclinical dental laboratory education model. The problem with this limited mode of instruction is that dental students often fail to understand the various chairside procedures required to fabricate a complete denture. The aim of this study was to investigate the use of standardized dental patients to enhance students' understanding of the procedures involved with each appointment in the complete denture process. The Midwestern University College of Dental Medicine-Arizona created an event using standardized patients in four simulated chairside dental appointments for complete denture instruction of second-year dental students. Each appointment simulated the various sequential chairside procedures required to fabricate complete dentures. Following the didactic and dental laboratory instruction and the standardized patient event, a survey was conducted requesting the students' response to six statements regarding their understanding of the denture fabrication process. Of the 110 students who participated in the instructional events, 107 responded to the survey (97% response rate). These students responded very favorably to the simulated appointments, with the majority agreeing or strongly agreeing that their best understanding of the complete denture process was obtained through the standardized patient experiences. The use of standardized patients in simulated denture fabrication appointments enhanced the educational experience of these students when added to the traditional didactic lecture and preclinical laboratory education format. The experience has since been incorporated into the school's second-year oral health science laboratory curriculum.

Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery.

BACKGROUND: Shoulder-tip pain is commonly reported following laparoscopic adjustable gastric band (LAGB) placement. The incidence, nature and factors that may increase the risk of pain have not been explored. METHODS: A prospective extensive collection of patient characteristics and operative details was obtained from consecutive patients having band placement for severe obesity. Postoperatively, the presence and characteristics of shoulder pain were obtained using a structured interview at discharge from hospital, and at 1 and 5 weeks after placement. RESULTS: 66% and 21% of patients at 1 and 5 weeks respectively following surgery reported pain predominantly in the left shoulder. At 5 weeks, only 7% found the pain of concern and 5% required analgesics. There were no factors found that predicted the presence and severity of pain at 1 week. Injury to the crus of the diaphragm (OR 4.2, 1.4-12.6, P=0.01) and a past history of any upper abdominal surgery (OR 4.2, 1.5-11.7, P=0.007) independently predicted an increased risk of pain at 5 weeks. CONCLUSION: Shoulder pain following LAGB surgery is common, usually affects the left shoulder, and can in some cases last 5 weeks or more. Avoiding injury to the crura during the procedure may prevent more prolonged pain.

The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life.

BACKGROUND: Obesity is now one of our major public health problems. Effective and acceptable treatment options are needed. The Lap-Band system is placed laparoscopically and allows adjustment of the level of gastric restriction. METHODS: A prospective study of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center. After extensive preoperative evaluation, patients with a body mass index > 35 were treated by Lap-Band placement. Close follow-up with progressive adjustment of gastric restriction continued permanently. Medical co-morbidities were monitored as part of comprehensive prospective data collection. RESULTS: There have been no deaths perioperatively or during follow-up. Significant perioperative adverse events occurred in 1.2% only. Reoperation has been needed for prolapse (slippage) in 12.5%, erosion of the band into the stomach in 2.8% and for tubing breaks in 3.6%. A steady progression of weight loss has occurred through the duration of the study with 52 +/- 19% EWL at 24 months (n = 333), 53 +/- 22% EWL at 36 months (n = 264), 52 +/- 24% EWL at 48 months (n = 108), 54 +/- 24% EWL at 60 months (n = 30), and 57 +/- 15% EWL at 72 months (n = 10). Major improvements have occurred in diabetes, asthma, gastroesophageal reflux, dyslipidemia, sleep apnea and depression. Quality of life as measured by Rand SF-36 shows highly significant improvement. CONCLUSIONS: Placement of the Lap-Band system provides safe and effective control of severe obesity. The effect on weight loss is durable and is associated with major improvement in health and quality of life. It has the potential to provide a broadly acceptable option for this common and serious disease.