Decreasing the length of stay in phase I postanesthesia care unit: an evidence-based approach.

Patient length of stay (LOS) in the postanesthesia care unit (PACU) Phase I and Phase II influences patient throughput, staff nurse satisfaction, and financial expenditure. The purpose of this project was to determine if re-education of nursing staff would decrease the LOS in Phase I PACU. The goals of the leadership team were to implement a plan that would result in a decreased LOS, decreased financial expenditure, increased patient throughput, and a change in culture of the work environment. Methods included re-education of nursing staff on American Society of Perianesthesia Nursing (ASPAN) Standards for patient care in Phase I and Phase II PACU. In addition, a pre-survey of the nurses was completed to determine their knowledge of the ASPAN Standards and how they perceived their work environment. Data were collected on the LOS in Phase I for two groups of patients who underwent cystoscopy with stent implantation and hernia repair. The LOS data were collected before and after the staff education. Results of this re-education initiative revealed improved patient throughput, decreased operating room hold time, reduced perioperative expenditure, and an increase in staff nurse satisfaction. An unanticipated result was increased scores on patient satisfaction surveys after the educational initiative.

Learning Clinical Skills Using Haptic vs. Phantom Head Dental Chair Simulators in Removal of Artificial Caries: Cluster-Randomized Trials with Two Cohorts' Cavity Preparation.

Dental task trainer simulators using haptics (virtual touch) offers a cost-effective method of teaching certain clinical skills. The purpose of this study is to evaluate students' performance in removing artificial caries after training with either a haptic dental chair simulator with virtual reality or a traditional dental chair simulator with a mannequin head. Cluster Randomized Controlled Trials in two cohorts, both Year 1 dental students. Students taught using traditional dental chair simulators were compared with students taught using haptic-based simulators on their ability to cut a cavity in a plastic tooth following training. Across both cohorts, there was no difference in the quality of cavity cut, though students' technique differed across the two simulator groups in some respects. No difference was seen across both cohorts in the quality of cavity cut for a simple preparation, though students in the haptic condition performed less well in the more demanding task. Moreover, students in the haptic group were also less likely to be perceived to be 'holding the instrument appropriately'. These findings suggest further investigation is needed into the differences in handling of instruments and level of clinical task difficulty between the simulators.

Pig-mentation: postmortem iris color change in the eyes of Sus scrofa.

Experienced forensic pathologists and examiners may be familiar with the phenomenon of postmortem iris color change; however, only Knight, Simpson's forensic medicine, Arnold, London, 1997; Ref. 1 and Saukko and Knight, Knight's forensic pathology, 3rd ed., Arnold, London, 2004; Ref. 2 have referred to it in the literature, and to date, there have been no published scientific research studies on this taphonomic artifact. A controlled experiment was conducted of postmortem changes to isolated Sus scrofa eyes. The eyes (n = 137) were separated into three groups and each sample was observed for 3-day postmortem at a different temperature. In addition, a Sus scrofa head was obtained to observe postmortem changes of eyes in situ. All isolated blue eyes in the experiment, at room temperature and higher, changed to brown/black within 48 h. The in situ blue eye, at room temperature, turned brown/black within 72 h. If iris color consistently changes postmortem in humans, then this taphonomic artifact must be incorporated into victim identification protocol, including disaster victim identification software, and autopsy reports to prevent inaccurate victim identification and inappropriate exclusion from the identification process.

A Scoring System for Assessing Learning Progression of Dental Students' Clinical Skills Using Haptic Virtual Workstations.

The aim of this study was to develop and test a scoring system to assess the learning progression of novice dental students using haptic virtual workstations. For the study, 101 first-year dental students at a UK dental school conducted one practice task (task 1) and four simulated cavity removal tasks (tasks 2-5) of increasing difficulty over two laboratory sessions in 2015. Performance data on the students' attempts were recorded as haptic technology-enhanced learning (hapTEL) log-files showing the percentage of caries, healthy tissue, and pulp removed. On-screen results were photographed and submitted by the students to the tutors. A scoring system named the Accuracy of Caries Excavation (ACE) score was devised to score these results and achieve an even distribution of scores and a calculated combined score. A total of 127 individual logged attempts by 80% of the students over sessions 1 and 2 were recorded and submitted to the tutors. The mean ACE scores for both sessions for tasks 2 through 5 were 9.2, 11.6, 6.4, and 4.9, respectively; for Session 2 (tasks 3-5), scores were 12.4, 6.7, and 5.0, respectively (p<0.001). The average performance on task 3, which was attempted in similar numbers during both sessions, improved from the first to the second session (8.14 vs. 12.38; p=0.009). Using the HapTEL system in a first-year BDS curriculum improved the students' performance of simulated cavity preparation after practicing over two sessions. Use of the ACE scoring system enabled tutors to make consistent assessments across a large student cohort and provided an objective method of formative assessment.

Framework for e-learning assessment in dental education: a global model for the future.

The framework presented in this article demonstrates strategies for a global approach to e-curricula in dental education by considering a collection of outcome assessment tools. By combining the outcomes for overall assessment, a global model for a pilot project that applies e-assessment tools to virtual learning environments (VLE), including haptics, is presented. Assessment strategies from two projects, HapTEL (Haptics in Technology Enhanced Learning) and UDENTE (Universal Dental E-learning), act as case-user studies that have helped develop the proposed global framework. They incorporate additional assessment tools and include evaluations from questionnaires and stakeholders' focus groups. These measure each of the factors affecting the classical teaching/learning theory framework as defined by Entwistle in a standardized manner. A mathematical combinatorial approach is proposed to join these results together as a global assessment. With the use of haptic-based simulation learning, exercises for tooth preparation assessing enamel and dentine were compared to plastic teeth in manikins. Equivalence for student performance for haptic versus traditional preparation methods was established, thus establishing the validity of the haptic solution for performing these exercises. Further data collected from HapTEL are still being analyzed, and pilots are being conducted to validate the proposed test measures. Initial results have been encouraging, but clearly the need persists to develop additional e-assessment methods for new learning domains.

Comparative analysis of the effects of heat on the PCR-amplification of various sized DNA fragments extracted from Sus Scrofa molars.

This study examined the effects of heat on the amplification of DNA from the dental pulp of Sus scrofa molars and investigated the protection afforded to the pulp tissue by the dental enamel, alveolar process, and soft tissue of the head. Segments of defleshed maxilla and mandible encasing the first molar (n = 60) were subject to a range of temperatures for 15 min. Dental pulps were retrieved. Amplifications using three-primer and four-primer multiplexes showed no degradation of the largest fragment following exposure to 450 degrees C. Amplifications in the three-primer multiplex (283 bp) were successful following exposure to 525 degrees C in maxillary samples only. This study revealed the enamel density of maxillary molars to be greater than mandibular molars in Sus scrofa. Following incineration of intact heads for 15 min (n = 10) and 1 h (n = 4) at an average temperature of 625 degrees C, amplifications of the largest fragment (450 bp) were successful from both maxillary and mandibular teeth.

Patient perspectives on the management of atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is increasingly common, with a point prevalence of more than 30% in some countries, and is characterized by visible skin lesions and intense itching. OBJECTIVE: The International Study of Life with Atopic Eczema (ISOLATE) is the first large-scale study to assess the effect of AD on the lives of patients and society, how patients and caregivers manage the condition, and how well patients and caregivers currently believe that AD is controlled. METHODS: Two thousand two patients (>13 years) and caregivers of children (2-13 years) with moderate-to-severe AD randomly selected from 8 countries underwent standardized telephone interviews using questions developed in collaboration with national eczema patient groups and physicians. RESULTS: During each year, patients spend, on average, 1 of 3 days in flare. The majority of patients receive prescription topical corticosteroids to treat flares; however, 49% of respondents are concerned about using these agents. On average, patients and caregivers delay initiating treatment for 7 days after onset of a flare. Only 24% of patients and caregivers feel confident they can manage AD flares adequately. Seventy-five percent of caregivers and patients feel that being able to effectively control AD would be the single most important improvement to their or their child's quality of life. The avoidable secondary economic cost of AD is estimated at 2 billion Euro per year across the European Union. CONCLUSION: ISOLATE highlights the need to improve patients' control of AD to reduce the significant effect this condition has on the patient and society. CLINICAL IMPLICATIONS: ISOLATE shows that patients with AD are untreated for half the time they are in flare, and thus there is an urgent need for physicians to ensure that the patients are educated and confident in using medication as prescribed to gain disease control.

Nuclear ribosomal DNA internal transcribed spacer 1 (ITS1) in Picea (Pinaceae): sequence divergence and structure.

The nrDNA ITS1 of Picea is 2747-3271 bp, the longest known of all plants. We obtained 24 cloned ITS1 sequences from six individuals of Picea glehnii, Picea mariana, Picea orientalis, and Picea rubens. Mean sequence divergence within these individuals (0.018+/-0.009) is more than half that between the species (0.031+/-0.011) and may be maintained against concerted evolution by separation of Picea 18S-26S rDNA repeats on multiple chromosomes. Picea ITS1 contains three subrepeats with a motif (5'-GGCCACCCTAGTC) that is conserved across Pinaceae. Two subrepeats are tandem, remote from the third, and more closely related and significantly more similar to one another than either is to the third subrepeat. This correlation between similarity and proximity may be the result of subrepeat duplication or concerted evolution within rDNA repeats. In inferred secondary structures, subrepeats generally form long hairpins, with a portion of the Pinaceae conserved motif in the terminal loop, and tandem subrepeats pair with one another over most of their length. Coalescence of ITS1 sequences occurs in P. orientalis but not in the other species.