Salivary gland dysfunction and nasolacrimal duct obstruction: stenotic changes following I-131 therapy.

Radioactive iodine has long been used in the treatment of cancers of the thyroid. While salivary complications secondary to I-131 therapy in association with xerophthalmia are well documented, there is little in the literature addressing simultaneous nasolacrimal duct obstruction with salivary gland dysfunction. The authors present 2 patients with epiphora from bilateral nasolacrimal duct obstruction and concurrent sialadenitis following I-131 ablation therapy for papillary thyroid carcinoma. These cases highlight the lacrimal and salivary duct complications resulting from I-131 therapy, introduce the possibility of a shared mechanism of damage, and demonstrate the availability of effective treatments for both conditions. Ophthalmologists see patients with epiphora from I-131 therapy and should be aware of the possible concurrent symptoms caused by salivary duct stenosis to make timely and appropriate referrals.

A model for critical thinking measurement of dental student performance.

The educational application of critical thinking has increased in the last twenty years with programs like problem-based learning. Performance measurement related to the dental student's capacity for critical thinking remains elusive, however. This article offers a model now in use to measure critical thinking applied to patient assessment and treatment planning across the four years of the dental school curriculum and across clinical disciplines. Two elements of the model are described: 1) a critical thinking measurement "cell," and 2) a list of minimally essential steps in critical thinking for patient assessment and treatment planning. Issues pertaining to this model are discussed: adaptations on the path from novice to expert, the role of subjective measurement, variations supportive of the model, and the correlation of individual and institutional assessment. The critical thinking measurement cell consists of interacting performance tasks and measures. The student identifies the step in the process (for example, chief complaint) with objective measurement; the student then applies the step to a patient or case with subjective measurement; the faculty member then combines the objective and subjective measurements into an evaluation on progress toward competence. The activities in the cell are then repeated until all the steps in the process have been addressed. A next task is to determine consistency across the four years and across clinical disciplines.

Integrating critical thinking and evidence-based dentistry across a four-year dental curriculum: a model for independent learning.

Introducing critical thinking and evidence-based dentistry (EBD) content into an established dental curriculum can be a difficult and challenging process. Over the past three years, the University of Iowa College of Dentistry has developed and implemented a progressive four-year integrated critical thinking and EBD curriculum. The objective of this article is to describe the development and implementation process to make it available as a model for other dental schools contemplating introduction of critical thinking and EBD into their curricula. The newly designed curriculum built upon an existing problem-based learning foundation, which introduces critical thinking and the scientific literature in the D1 year, in order to expose students to the rationale and resources for practicing EBD in the D2 and D3 years and provide opportunities to practice critical thinking and apply the EBD five-step process in the D2, D3, and D4 years. All curricular content is online, and D3 and D4 EBD activities are integrated within existing clinical responsibilities. The curricular content, student resources, and student activities are described.

Toward defining dentists' evidence-based practice: influence of decade of dental school graduation and scope of practice on implementation and perceived obstacles.

Academic dental institutions today seek to provide curricular content and learning opportunities for students to develop an essential skill set for evidence-based practice. To support that effort, studies that explore current practice patterns are valuable in identifying factors that influence the evidence-based habits and behaviors of dental school graduates. The purpose of this study was to explore the knowledge, perceptions, and behavior of private practice dentists in the state of Iowa with respect to evidence-based dentistry and to determine the influence of the dentist's education and the scope of his or her practice on those opinions and habits. A questionnaire addressing practitioners' familiarity with, understanding of, and adoption of an evidence-based philosophy of practice was mailed in September 2009 to all dentists licensed and practicing in Iowa. Questionnaires were returned by 518 practitioners, for an overall response rate of 38.4 percent. The majority of respondents reported awareness, understanding, and adoption of an evidence-based approach to their practice of dentistry. Recent graduates were more likely to report insufficient time as the primary obstacle to practicing evidence-based dentistry. Dental specialists indicated a higher level of comfort in assessing scientific information, as well as implementing current reliable, valid published research in practice, than did general practitioners.

Perceptions and practices of dental school faculty regarding evidence-based dentistry.

Successful integration of critical thinking and evidence-based dentistry (EBD) concepts throughout didactic and clinical dental curricula require faculty support. Critical thinking and EBD definitions and practice continue to evolve, and not all dental faculty members were exposed to such concepts during their education. The objective of this study was to understand faculty members' perspectives on both critical thinking and EBD. An online survey was designed to assess full- and part-time faculty members' understanding, practice and teaching of critical thinking and EBD, interest in and perceived significance of EBD, and perceived barriers to teaching critical thinking and EBD at one U.S. dental school. Forty-three faculty members completed the survey for a 41 percent response rate. Most respondents (46 percent) defined critical thinking as the use of evidence or the scientific method in decision making and EBD as clinical practice based on "science only" (39 percent) or "quality science only" (34 percent). Based on their individual definitions, over 75 percent of the respondents reported incorporating critical thinking into didactic and clinical teaching; 79 percent and 47 percent, respectively, reported incorporating EBD into their didactic and clinical teaching. While these faculty members confirmed the importance of teaching students EBD, they identified barriers to teaching as time, knowledge, and resources. These results, which reflect one school's efforts to understand faculty perceptions and practices of EBD, suggest that faculty training and resource support are necessary for successful curricular integration of critical thinking and EBD.

Keratocystic odontogenic tumor: a retrospective analysis of genetic, immunohistochemical and therapeutic features. Proposal of a multicenter clinical survey tool.

OBJECTIVE: In 2005, the World Health Organization reclassified the parakeratinizing odontogenic keratocyst as a neoplasm. This article reviews the research leading to this reclassification, and validates a new survey tool that can be easily used to pool surgical and recurrence data from multiple offices. STUDY DESIGN: All odontogenic lesions accessioned in the Iowa Surgical Oral Pathology Laboratory between 1949 and 2010 were identified from the database. A survey tool to assess treatment and follow-up was created. A total of 46 surgeons agreed to participate. RESULTS: A total of 70 keratocystic odontogenic tumors (KOTs) had documented recurrences at follow-up intervals ranging from 6 months to 5 years. Primary tumors that recurred ranged in size as measured by greatest radiographic diameter from 0.7 to 6 cm. CONCLUSIONS: This survey tool is recommended as standard allowing treatment of cases by multiple practitioners to be compared retrospectively or prospectively.

Guiding dental student learning and assessing performance in critical thinking with analysis of emerging strategies.

Patient-centered care involves an inseparable set of knowledge, abilities, and professional traits on the part of the health care provider. For practical reasons, health professions education is segmented into disciplines or domains like knowledge, technical skills, and critical thinking, and the culture of dental education is weighted toward knowledge and technical skills. Critical thinking, however, has become a growing presence in dental curricula. To guide student learning and assess performance in critical thinking, guidelines have been developed over the past several decades in the educational literature. Prominent among these guidelines are the following: engage the student in multiple situations/exercises reflecting critical thinking; for each exercise, emulate the intended activity for validity; gain agreement of faculty members across disciplines and curriculum years on the learning construct, application, and performance assessment protocol for reliability; and use the same instrument to guide learning and assess performance. The purposes of this article are 1) to offer a set of concepts from the education literature potentially helpful to guide program design or corroborate existing programs in dental education; 2) to offer an implementation model consolidating these concepts as a guide for program design and execution; 3) to cite specific examples of exercises and programs in critical thinking in the dental education literature analyzed against these concepts; and 4) to discuss opportunities and challenges in guiding student learning and assessing performance in critical thinking for dentistry.

Improved student performance following instructional changes in a problem-based learning curriculum.

Problem-based learning (PBL) supplements the traditional curriculum at the University of Iowa College of Dentistry and is used to introduce basic critical thinking skills and evidence-based dentistry. The objective of this article is to describe instructional changes made in response to student and faculty concerns and to compare the quality of student performance before and after the instructional changes. Instructional changes introduced in fall 2008 included replacing one learning report with a structured peer-reviewed manuscript critique in each of four cases, having the same course director evaluate all written assignments rather than facilitating faculty members, and eliminating midterm and final assessment cases. The final learning reports from first-year dental students entering dental school in fall 2007 were compared to the final reports of students entering in fall 2008. Final learning reports were evaluated using course grading criteria. Scores for students from fall 2008 were higher than those from fall 2007 for overall performance (p<0.001), overall background quality (p<0.001), overall clinical significance (p<0.001), and overall reference quality (p<0.001) as well as for individual components within each category. These results suggest that the implemented instructional changes were effective in improving student performance and reinforce the need to evaluate and revise instructional strategies in response to student and faculty concerns.

Informational resources utilized in clinical decision making: common practices in dentistry.

This study investigated current trends of Iowa dental practitioners with regard to acquisition and utilization of scientific information resources to support decision making in the clinical practice of dentistry. A survey questionnaire regarding the utilization of various sources of information to support clinical decisions was mailed in September 2009 to all dentists licensed and practicing in the state of Iowa. Dentists appointed full-time within the University of Iowa College of Dentistry were excluded from this study. Continuing education courses were the most frequently utilized and preferred information source by respondents, followed by print journals and consultation with other health care professionals. Practice patterns according to decade of dental school graduation as well as scope of practice were noted. The results of this study demonstrate that dental practitioners utilize a variety of evidence-based and non-evidence-based information resources to support decisions in clinical practice. The habits of newer graduates vary somewhat from those of earlier graduates; the habits of specialists vary from those of general practitioners.

A model for overview of student learning: a matrix of educational outcomes versus methodologies.

A concise overview of an institution's aspirations for its students becomes increasingly elusive because dental education has evolving emphases on priorities like critical thinking and adapting to new technology. The purpose of this article is to offer a learner-oriented matrix that gives a focus for discussion and an overview of an institution's educational outcomes. On one axis of the matrix, common educational outcomes are listed: knowledge, technical skills, critical thinking, ethical and professional values, patient and practice management, and social responsibility awareness. On the other axis, methodologies are listed: definition, cultivation strategies, measures (summative/formative, objective/subjective), institutional coordination, and competency determination. By completing the matrix, an overview of the process by which students reach these outcomes emerges. Each institution would likely complete the matrix differently and, ideally, with active discussion. While the matrix can first be used to establish "Where are we now?" for an institution, it can also be a starting point for more extensive matrices and further discussion. Vertical and horizontal analyses of the matrix provide a unique lens for viewing the institution's learning environment.