The repeatability of periodontal imaging with intraoral ultrasound scanning.

OBJECTIVE: Ultrasound is a non-invasive and low-cost diagnostic tool widely used in medicine. Recent studies have demonstrated that ultrasound imaging might have the potential to be used intraorally to assess the periodontium by comparing it to current imaging methods. This study aims to characterize the repeatability of intraoral periodontal ultrasound imaging. MATERIALS AND METHODS: Two hundred and twenty-three teeth were scanned from fourteen volunteers participating in this study. One operator conducted all the scans in each tooth thrice with a 20 MHz intraoral ultrasound. The repeatability of three measurements, alveolar bone crest to the cementoenamel junction (ABC-CEJ), gingival thickness (GT), and alveolar bone thickness (ABT), was calculated with intercorrelation coefficient (ICC). Measurements were also compared with mean absolute deviation (MAD), repeatability coefficient (RC), and descriptive statistics. RESULTS: ICC scores for intra-rater repeatability were 0.917(0.897,0.933), 0.849(0.816,0.878), and 0.790(0.746,0.898), MAD results were 0.610 mm (± 0.508), 0.224 (± 0.200), and 0.067 (± 0.060), and RC results were 0.648, 0.327, and 0.121 for ABC-CEJ, GT, and ABT measurements, respectively. CONCLUSION: Results of the present study pointed towards good or excellent repeatability of ultrasound as a measurement tool for periodontal structures. CLINICAL RELEVANCE: Clinicians could benefit from the introduction of a novel chairside diagnostic tool. Ultrasound is a non-invasive imaging assessment tool for the periodontium with promising results in the literature. Further validation, establishment of scanning protocols, and commercialization are still needed before ultrasound imaging is available for clinicians.

Why Do We Feel Like Intellectual Frauds? A Self-Determination Theory Perspective on the Impostor Phenomenon in Medical Students.

Theory: Impostor phenomenon (IP) refers to people's feelings of intellectual fraudulence and fear of being "discovered," despite contradicting evidence of success. Due to its association with burnout and distress, it is progressively being studied in medicine. While various explanations for IP have been discussed in the literature, the role of motivation has largely been neglected. Hypotheses: Using self-determination theory (SDT) as a lens, it was hypothesized that different general causality orientations (impersonal, control, autonomy), domain-specific types of motivation (autonomous vs. controlled) toward going to medical school, and levels of satisfaction of basic psychological needs (autonomy, competence, relatedness) in the medical program, would each predict severity of IP symptoms. Method: A total of 1,450 medical students from three Canadian institutions were invited to complete a survey containing the Clance Impostor Phenomenon Scale and scales derived from SDT's mini theories: basic psychological needs theory, causality orientations theory, and organismic integration theory. We explored the prevalence of IP among the students and used regression to capture variable relationships, accounting for gender effects. Results: Data from 277 (19.1%) students were assessed, 73% of whom reported moderate or worse IP symptoms. Having an impersonal general causality orientation, more controlled motivation toward going to medical school, and lower need satisfaction in the medical program, each related to increased IP severity. Together, these motivational factors accounted for 30.3%, 13.6%, and 21.8% of the variance in students' IP severity, respectively. Conclusions: Findings from this study suggest that students who are more self-determined (both in general and in medical school), and whose basic psychological needs are more supported in their medical program, will experience less frequent and severe IP symptoms. Preliminary explanations and implications of these findings are discussed within the medical education context.

Measuring the alveolar bone level in adolescents: A comparison between ultrasound and cone beam computed tomography.

BACKGROUND: Cone beam computed tomography (CBCT) is an imaging modality, which is used routinely in orthodontic diagnosis and treatment planning but delivers much higher radiation than conventional dental radiographs. Ultrasound is a noninvasive imaging method that creates an image without ionizing radiation. AIM: To investigate the reliability of ultrasound and the agreement between ultrasound and CBCT in measuring the alveolar bone level (ABL) on the buccal/labial side of the incisors in adolescent orthodontic patients. DESIGN: One hundred and eighteen incisors from 30 orthodontic adolescent patients were scanned by CBCT with 0.3-mm voxel size and ultrasound at 20 MHz frequency. The ABL, distance from the cementoenamel junction (CEJ) to the alveolar bone crest (ABC), was measured twice to evaluate the agreement between ultrasound and CBCT. In addition, the intra- and inter-rater reliabilities in measuring the ABL by four raters were compared. RESULTS: The mean difference (MD) in the ABL between ultrasound and CBCT was -0.07 mm with 95% limit of agreement (LoA) from -0.47 to 0.32 mm for all teeth. For each jaw, the MDs between the ultrasound and CBCT were -0.18 mm (for mandible with 95% LoA from -0.53 to 0.18 mm) and 0.03 mm (for maxilla with 95% LoA from -0.28 to 0.35 mm). In comparison, ultrasound had higher intra-rater (ICC = 0.83-0.90) and inter-rater reliabilities (ICC = 0.97) in ABL measurement than CBCT (ICC = 0.56-0.78 for intra-rater and ICC = 0.69 for inter-rater reliabilities). CONCLUSION: CBCT parameters used in orthodontic diagnosis and treatment planning in adolescents may not be a reliable tool to assess the ABL for the mandibular incisors. On the contrary, ultrasound imaging, an ionizing radiation-free, inexpensive, and portable diagnostic tool, has potential to be a reliable diagnostic tool in assessing the ABL in adolescent patients.

Three Sources of Validation Evidence Needed to Evaluate the Quality of Generated Test Items for Medical Licensure.

Issue: Automatic item generation is a method for creating medical items using an automated, technological solution. Automatic item generation is a contemporary method that can scale the item development process for production of large numbers of new items, support building of multiple forms, and allow rapid responses to changing medical content guidelines and threats to test security. The purpose of this analysis is to describe three sources of validation evidence that are required when producing high-quality medical licensure test items to ensure evidence for valid test score inferences, using the automatic item generation methodology for test development. Evidence: Generated items are used to make inferences about examinees' medical knowledge, skills, and competencies. We present three sources of evidence required to evaluate the quality of the generated items that is necessary to ensure the generated items measure the intended knowledge, skills, and competencies. The sources of evidence we present here relate to the item definition, the item development process, and the item quality review. An item is defined as an explicit set of properties that include the parameters, constraints, and instructions used to elicit a response from the examinee. This definition allows for a critique of the input used for automatic item generation. The item development process is evaluated using a validation table, whose purpose is to support verification of the assumptions related to model specification made by the subject-matter expert. This table provides a succinct summary of the content and constraints that were used to create new items. The item quality review is used to evaluate the statistical quality of the generated items, which often focuses on the difficulty and the discrimination of the correct and incorrect options. Implications: Automatic item generation is an increasingly popular item development method. The generated items from this process must be bolstered by evidence to ensure the items measure the intended knowledge, skills, and competencies. The purpose of this analysis is to describe these sources of evidence that can be used to evaluate the quality of the generated items. The important role of medical expertise in the development and evaluation of the generated items is highlighted as a crucial requirement for producing validation evidence.

Social Media and the Transformation of the Physician-Patient Relationship: Viewpoint.

As many as 80% of internet users seek health information online. The social determinants of health (SDoH) are intimately related to who has access to the internet and health care as a whole. Those who face more barriers to care are more likely to benefit from accessing health information online, assuming the information they are retrieving is accurate. Virtual communities on social media platforms are beginning to serve as venues for seeking health information online because peers have been shown to influence health behavior more than almost anything else. As a positive mediator of health, social media can be used as a direct or indirect mode of communication between physicians and patients, a venue for health promotion and health information, and a community support network. However, false or misleading content, social contagion, confirmation bias, and security and privacy concerns must be mitigated to realize the full potential of social media as a positive mediator of health. This paper presents the shifting dynamics of how such communities are affecting physician-patient relationships. With the intersections between the SDoH, social media, and health evolving, physicians must take into consideration these factors when establishing their relationships with patients. We argue a paradigm shift in the physician-patient relationship is warranted, one where physicians acknowledge the impacts of the SDoH on information-seeking behavior, recognize the positive and negative roles of social media as a mediator of health through the lens of the SDoH, and use social media to catalyze positive changes in the physician-patient relationship. We discuss how the physician-patient relationship must evolve to accommodate for the ever-increasing role of social media in health and to best use social media as a tool to improve health outcomes. Finally, we present a fluid and multicomponent diagram that we believe will assist in framing future research in this area. We conclude that it is ineffective and even counterproductive for physicians to ignore the relationship between social media, the SDoH and health, their impact on one another, and the effect it has on designing the medical encounter and the delivery of care under the definition of precision medicine.

Oral Cavity and Oropharyngeal Cancer Surveillance and Control in Alberta: A Scoping Review.

OBJECTIVES: This scoping review provides a comprehensive overview of oral cavity cancer (OCC) and oropharyngeal cancer (OPC) in Alberta. METHODS: A database search was conducted up to 2018 using Web of Science, Scopus, Medline, PubMed and Embase, along with a manual search of gray literature. Data from the Alberta Cancer Foundation's dedicated fund for research, Cancer Surveillance and Reporting and Alberta Cancer Registry were also collected. RESULTS: Our review included 8 published papers and 14 other sources, including data on 3448 OCC and OPC patients from Surveillance and Reporting and Alberta Cancer Registry. Cancer registry data (2005-2017) showed that most OCC and OPC lesions were diagnosed at an advanced clinical stage, with a significantly large number of advanced OPC lesions in stage IV (OCC 45.2%, OPC 82.4%); 47.9% of these patients died. Survival rates were lowest in rural and First Nations areas. In Alberta, 35% of HPV-associated cancers were linked to OPCs, which were more prevalent in men and younger age groups. No routine public oral cancer screening program currently exists in Alberta. General practitioners and dentists refer patients to specialists, often with long waiting times. CONCLUSION: OCC and OPC patients in Alberta continue to be diagnosed in stage IV and experience high mortality rates.

The DISCuSS model: Creating connections between community and curriculum - A new lens for curricular development in support of social accountability.

Medicine's social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students 'preparedness to provide care to diverse populations.' The DISCuSS model, which continues to evolve, can be adapted and used in other settings.

Patterns of performance in students with frequent low stakes team based learning assessments: Do students change behavior?

Team-based learning offers an active learning strategy that provides a structure for measurement of learning and feedback to the students. Aggregating these results provides a longitudinal pattern of student performance. In this study, we analyzed results from a sequence of assessments related to TBL IRAT and GRAT assessments and traditional quizzes in a second-year musculoskeletal course in an undergraduate medical education program to determine if there are any measurable patterns, or performance trends, that students demonstrate in the course. Analyzing results from four academic years, we found evidence supporting there is predictability in student's future week's performance based on past performances across teaching modalities. We hypothesize that students are moderating their own effort regarding weekly low-stake assessments in prioritizing their academic efforts. The results from this study highlight the role of self-efficacy in medical education and suggest a new area of research for assessment of student performance patterns. Future studies could investigate whether these performance patterns are replicated in other assessment modalities and whether the same pattern holds for high-stakes assessments.

Dental faculty and student views of didactic and clinical assessment: A qualitative description study.

OBJECTIVE: Although assessment is essential to accurately represent student learning, little is currently known about student and faculty perceptions of assessment in dental schools. Our study aimed to explore faculty and student views of didactic and clinical assessments in the School of Dentistry at the University of Alberta. METHOD: Qualitative description informed the study design. Data were collected through focus groups and analysed inductively using manifest content analysis. RESULTS: Five focus groups were conducted with faculty (n = 34) and three with students (n = 19). Faculty and student views of assessment were related to improvements made (perceived positive changes), improvements needed (perceived limitations) and improvements recommended (recommendations to improve perceived limitations). Faculty and students reported that improvements made (eg adequacy of assessment to students' levels of training) varied across instructors, courses and learning environments. Both faculty and students perceived clinical assessments as less appropriate than didactic assessments. Faculty perceived limitations were mostly related to assessment appropriateness, especially assessment accuracy and comprehensiveness, whilst student perceived limitations included other issues related to appropriateness (eg misalignment with course objectives) as well as issues related to assessment volume, pace and scheduling. Similarly, faculty recommendations focused on enhancing the assessment of clinical competencies, whilst students' recommendations aimed to also improve assessment scheduling, volume and usage (eg for learning purposes). CONCLUSIONS: Faculty and student views of assessment complemented one another. Our data show that assessment in dental education is multidimensional, so that multilevel strategies may be needed to improve this component of dental curricula.

Impact of tablet-scoring and immediate score sheet review on validity and educational impact in an internal medicine residency Objective Structured Clinical Exam (OSCE).

Introduction: The Objective Structured Clinical Examination (OSCE) is used globally for formative and summative purposes. The objective of this study was to examine the impact of tablet-scoring on sources of validity evidence for an Internal Medicine residency OSCE. Methods: We compared paper-scored OSCEs from 2014 to tablet-scored OSCEs in 2015 for missing data, amount of comments, and time to pass/fail decision. We then examined in 2016 the impact on learning of showing residents their score sheets and asking them to write an action plan immediately after an OSCE. Results: Tablet-scoring significantly reduced stations with missing data from 1.8 to 0.2%, and stations without comments from 42 to 28% with an increase in word count per comment. Time to official results reduced from 3 weeks to 12 h with tablet-scoring. Residents who wrote a learning plan after reviewing their OSCE score sheets were more likely (with medium to large effect sizes) to pursue further studying and/or change their behavior (e.g. history taking or physical examination) in the clinical environment. Conclusions: OSCE tablet-scoring improved many sources of validity evidence, especially educational impact with timeliness of feedback supporting a change in behavior, a hard to achieve goal of educational interventions.

Dental hygiene students and faculty attitudes and utilization of a single source electronic textbook platform.

OBJECTIVE: Transitioning to interactive e-textbooks has been considered revolutionary for enhancing student learning. However, adopting this technology has been met with hesitation. This study investigates student and faculty attitudes and utilization of mandatory e-textbooks in a dental hygiene program. METHODS: In 2017, an online questionnaire was distributed to students and a focus group was conducted with faculty to examine their perspectives about using VitalSource™. Using a 5-point Likert scale with five indicating strongly agree, the questionnaire examined convenience; compatibility with learning style; perceived enjoyment; and usefulness. Open-ended questions captured benefits and challenges. The focus group gathered faculty perspectives. Questionnaire data were analysed using descriptive statistics. Data from the open-ended questionnaire questions and focus group transcript followed a narrative analysis process. RESULTS: Survey response was 48% (n = 105). Students scored all factors below neutral. Results from four categories showed convenience (M = 2.75, SD = 0.92); compatibility (M = 1.93, SD = 0.83); perceived effectiveness (M = 2.15, SD = 0.90); and perceived usefulness (M = 2.36, SD = 1.04). A high correlation between all factors suggests they were uniformly rated by students. Majority of students (71%) did not use a textbook greater than once a month. Narrative analysis revealed few benefits; challenges included technical glitches, eyestrain, cost and inability to choose books as desired. Faculty's perspectives aligned with the students, but they appreciated portability of texts and quality of clinical images. CONCLUSIONS: Students strongly disliked the platform and the online medium and do not frequently access e-textbooks but rely on PowerPoint handouts for studying. Faculty felt e-textbooks do not align with positive learning experiences.

Identifying a Potential Summary Measure for Overall Caries Level in Children Examined with the International Caries Detection and Assessment System.

OBJECTIVE: To identify a potential summative summary measure that reflects a patient's overall caries level in children examined with the International Caries Detection and Assessment System (ICDAS). SUBJECTS AND METHODS: Participants were 1- to 15-year-old children from Kuwait, Brazil, and Spain. Children's teeth were examined using the ICDAS. Multiple measures of central tendency and dentition-specific indices were considered as potential summative measures. The relationship between the summative measures and number of caries lesions was evaluated considering degrees of caries severity using Spearman's correlation analysis. The results were generated using the Kuwaiti sample and were cross-validated using the Brazilian and Spanish samples. RESULTS: A total of 2,808 children participated in the present study. Total ICDAS score and mean ICDAS score showed a strong correlation with the number of caries lesions at different caries severity levels in primary, mixed, and permanent dentitions. The total ICDAS score of 51 buccal (B), 61B, 54 occlusal (O), 55O, 64O, 65O, 74O, 75O, 84O, and 85O surfaces in primary dentition and the total ICDAS score of 14O, 16 lingual (L), 16O, 24O, 26L, 26O, 36B, 36O, 37O, 46O, 46B, and 47O surfaces in permanent dentition or mixed dentition (if present) showed strong correlations with the number of caries lesions at different caries severity levels. CONCLUSIONS: Total ICDAS and mean ICDAS scores were the best summary measures of overall caries level at different dental stages. Total ICDAS scores of selectively examined 10 surfaces in primary dentition and 12 surfaces in permanent dentition can give an excellent summary measure for a patient's overall caries level with high diagnostic accuracy.

Using cognitive models to develop quality multiple-choice questions.

With the recent interest in competency-based education, educators are being challenged to develop more assessment opportunities. As such, there is increased demand for exam content development, which can be a very labor-intense process. An innovative solution to this challenge has been the use of automatic item generation (AIG) to develop multiple-choice questions (MCQs). In AIG, computer technology is used to generate test items from cognitive models (i.e. representations of the knowledge and skills that are required to solve a problem). The main advantage yielded by AIG is the efficiency in generating items. Although technology for AIG relies on a linear programming approach, the same principles can also be used to improve traditional committee-based processes used in the development of MCQs. Using this approach, content experts deconstruct their clinical reasoning process to develop a cognitive model which, in turn, is used to create MCQs. This approach is appealing because it: (1) is efficient; (2) has been shown to produce items with psychometric properties comparable to those generated using a traditional approach; and (3) can be used to assess higher order skills (i.e. application of knowledge). The purpose of this article is to provide a novel framework for the development of high-quality MCQs using cognitive models.

Using Automatic Item Generation to Improve the Quality of MCQ Distractors.

UNLABELLED: CONSTRUCT: Automatic item generation (AIG) is an alternative method for producing large numbers of test items that integrate cognitive modeling with computer technology to systematically generate multiple-choice questions (MCQs). The purpose of our study is to describe and validate a method of generating plausible but incorrect distractors. Initial applications of AIG demonstrated its effectiveness in producing test items. However, expert review of the initial items identified a key limitation where the generation of implausible incorrect options, or distractors, might limit the applicability of items in real testing situations. BACKGROUND: Medical educators require development of test items in large quantities to facilitate the continual assessment of student knowledge. Traditional item development processes are time-consuming and resource intensive. Studies have validated the quality of generated items through content expert review. However, no study has yet documented how generated items perform in a test administration. Moreover, no study has yet to validate AIG through student responses to generated test items. APPROACH: To validate our refined AIG method in generating plausible distractors, we collected psychometric evidence from a field test of the generated test items. A three-step process was used to generate test items in the area of jaundice. At least 455 Canadian and international medical graduates responded to each of the 13 generated items embedded in a high-stake exam administration. Item difficulty, discrimination, and index of discrimination estimates were calculated for the correct option as well as each distractor. RESULTS: Item analysis results for the correct options suggest that the generated items measured candidate performances across a range of ability levels while providing a consistent level of discrimination for each item. Results for the distractors reveal that the generated items differentiated the low- from the high-performing candidates. CONCLUSIONS: Previous research on AIG highlighted how this item development method can be used to produce high-quality stems and correct options for MCQ exams. The purpose of the current study was to describe, illustrate, and evaluate a method for modeling plausible but incorrect options. Evidence provided in this study demonstrates that AIG can produce psychometrically sound test items. More important, by adapting the distractors to match the unique features presented in the stem and correct option, the generation of MCQs using automated procedure has the potential to produce plausible distractors and yield large numbers of high-quality items for medical education.

Automated essay scoring and the future of educational assessment in medical education.

CONTEXT: Constructed-response tasks, which range from short-answer tests to essay questions, are included in assessments of medical knowledge because they allow educators to measure students' ability to think, reason, solve complex problems, communicate and collaborate through their use of writing. However, constructed-response tasks are also costly to administer and challenging to score because they rely on human raters. One alternative to the manual scoring process is to integrate computer technology with writing assessment. The process of scoring written responses using computer programs is known as 'automated essay scoring' (AES). METHODS: An AES system uses a computer program that builds a scoring model by extracting linguistic features from a constructed-response prompt that has been pre-scored by human raters and then, using machine learning algorithms, maps the linguistic features to the human scores so that the computer can be used to classify (i.e. score or grade) the responses of a new group of students. The accuracy of the score classification can be evaluated using different measures of agreement. RESULTS: Automated essay scoring provides a method for scoring constructed-response tests that complements the current use of selected-response testing in medical education. The method can serve medical educators by providing the summative scores required for high-stakes testing. It can also serve medical students by providing them with detailed feedback as part of a formative assessment process. CONCLUSIONS: Automated essay scoring systems yield scores that consistently agree with those of human raters at a level as high, if not higher, as the level of agreement among human raters themselves. The system offers medical educators many benefits for scoring constructed-response tasks, such as improving the consistency of scoring, reducing the time required for scoring and reporting, minimising the costs of scoring, and providing students with immediate feedback on constructed-response tasks.

Trends and predictors of unplanned hospitalization among oral and oropharyngeal cancer patients; an 8-year population-based study.

PURPOSE: The incidence of oral cancers, particularly HPV-related oropharyngeal cancer, is steadily increasing worldwide, presenting a significant healthcare challenge. This study investigates trends and predictors of unplanned hospitalizations for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) patients in the province of Alberta, Canada. METHODS: This retrospective, population-based, cohort study used administrative data collected from all hospitals in the province. Using the Alberta Cancer Registry (ACR), a cohort of adult patients diagnosed with a single primary OCC or OPC between January 2010 and December 2017 was identified. Linking this cohort with the Discharge Abstract Database (DAD), trends in hospitalizations, primary diagnoses, and predictors of unplanned hospitalization (UH) and 30-day unplanned readmission were analyzed. RESULTS: Of 1,721 patients included, 1,244 experienced 2,228 hospitalizations, with 48 % being categorized as UH. The UHs were significantly associated with a higher mortality rate, 18.5 % as compared to 4.6 % for planned, and influenced by sex, age groups, comorbidities, cancer types, stages, and treatment modalities. The rate of UH per patient decreased from 0.69 to 0.54 visits during the study period (P = 0.02). Common diagnoses for UH were palliative care and post-surgical convalescence, while surgery-related complications such as infection and hemorrhage were frequent in 30-day unplanned readmissions. Predictors of UH included cancer stage, material deprivation, and treatment, while cancer type and comorbidity predicted readmissions. CONCLUSION: The rate of UHs showed a noteworthy decline in this study, which could be a result of enhanced care coordination. Furthermore, identified primary diagnosis and predictors associated with UHs and readmissions, provide valuable insights for enhancing the quality of care for cancer patients.

Uncovering the Hidden: A Study on Incidental Findings on CBCT Scans Leading to External Referrals.

OBJECTIVES: This project aims to determine the prevalence of cone-beam computed tomography (CBCT) findings requiring referral. Additionally, the goal is to establish a reference standard protocol for incidental findings, outlining indications for further investigation and management protocol. METHODS: Patients records from the Advanced Imaging Centre at the School of Dentistry, University of Alberta, underwent systematic examination to identify CBCT incidental findings. Radiographic findings requiring referral were categorised into 8 anatomic zones. Analysis assessed prevalence and a management protocol was developed for significant findings. Inferential analyses were conducted to determine the frequency and prevalence of specific findings requiring further investigation. RESULTS: A total of 1260 CBCT interpretive reports were analysed. The most prevalent radiographic findings outside the areas of interest were found in the cervical vertebrae (18%), followed by the sinuses (15%), temporomandibular joints (8%), jaw lesions (7%), airway (5%), teeth (5%), soft tissue calcifications (5%), and other (1%). CONCLUSIONS: Findings most commonly requiring external referral included carotid atheroma (2.7%), cervical vertebrae osteoarthritis (0.97%), jaw lesions (0.86%), adenoid and/or tonsillar hypertrophy (0.86%), and paranasal sinus pathology (0.73%). Increased medicolegal awareness and practitioner knowledge contribute to the rising number of CBCT-identified radiographic findings outside the area of concern. The study addresses the debate on reporting all CBCT/radiographic findings by exploring their prevalence and providing protocols. These guidelines assist dentists in identification, decision-making, and referral processes.

Healthcare Utilization of Oral and Oropharyngeal Cancer Patients in Emergency Department and Outpatient Settings: An 8-year Population-Based Study.

INTRODUCTION: This study aimed to determine trends in the healthcare utilization by Oral Cavity and Oropharyngeal cancer patients across emergency department (ED) and outpatient settings in Alberta and examine the predictors of ED visits. METHODS: This is a retrospective, population-based, cohort study using administrative data collected by all healthcare facilities between 2010 and 2019 in Alberta, Canada. Trend of visits to different facilities, patients' primary diagnosis, and predictors of ED visits were analyzed. RESULTS: In total, 34% of patients had at least one cancer-related ED visit. With a rise of 31% in cancer incidence, there was a notable upswing in visits to outpatient clinics and community offices, while ED visits decreased. Cancer stage, rural residence, high material deprivation score, and treatments were found as predictors of ED visits. CONCLUSION: Improved symptom management and better care access for disadvantaged and rural oral cancer patients may decrease avoidable ED visits.

The Effect of Low-Intensity Pulsed Ultrasound on Temporomandibular Joint Arthritis in Juvenile Rats.

Juvenile idiopathic arthritis is an inflammatory disease that can affect the temporomandibular joint (TMJ) and lower jaw growth. Better treatment options are needed, so this study investigated the effect of low-intensity pulsed ultrasound (LIPUS) on TMJ arthritis. Seventy-two 3-week-old male Wistar rats were in vivo microcomputed tomography (micro-CT) scanned and divided into eight groups (n = 9). These groups were Group 1-TMJ arthritis and immediate LIPUS treatment (20 min/day, 4 weeks); Group 2-immediate LIPUS treatment and no TMJ arthritis; Group 3-TMJ arthritis and no LIPUS; Group 4-no TMJ arthritis and no LIPUS; Group 5-TMJ arthritis and LIPUS treatment with a delayed start by 4 weeks; Group 6-Delayed LIPUS and no TMJ arthritis; Group 7-TMJ arthritis and no (delayed) LIPUS; and Group 8-no TMJ arthritis and no (delayed) LIPUS. Ex vivo micro-CT scanning was completed, and samples were prepared for tissue analysis. Synovitis was observed in the TMJ arthritis (collagen-induced arthritis [CIA]) groups, but the severity appeared greater in the groups without LIPUS treatment. Fibrocartilage and hypertrophic cell layer thicknesses in the CIA group without LIPUS treatment were significantly greater (p < 0.05). Proteoglycan staining appeared greater in the LIPUS groups. Immediate LIPUS treatment increased the expression of type II collagen, type X collagen, and transforming growth factor-beta 1 (TGF-ß1) immunostaining, and CIA (no LIPUS) increased MMP-13, vascular endothelial growth factor, and interleukin-1 beta (IL-1ß) immunostaining. LIPUS treatment prevented growth disturbances observed in the CIA groups (no LIPUS) (p < 0.005). Our results have contributed to the understanding of the uses and limitations of the CIA juvenile rat model and have demonstrated the effects of LIPUS on the TMJ and mandibular growth. This information will help in designing future studies for investigating LIPUS and TMJ arthritis, leading to the development of new treatment options for children with juvenile arthritis in their TMJs.

Evaluating the quality of medical multiple-choice items created with automated processes.

OBJECTIVES: Computerised assessment raises formidable challenges because it requires large numbers of test items. Automatic item generation (AIG) can help address this test development problem because it yields large numbers of new items both quickly and efficiently. To date, however, the quality of the items produced using a generative approach has not been evaluated. The purpose of this study was to determine whether automatic processes yield items that meet standards of quality that are appropriate for medical testing. Quality was evaluated firstly by subjecting items created using both AIG and traditional processes to rating by a four-member expert medical panel using indicators of multiple-choice item quality, and secondly by asking the panellists to identify which items were developed using AIG in a blind review. METHODS: Fifteen items from the domain of therapeutics were created in three different experimental test development conditions. The first 15 items were created by content specialists using traditional test development methods (Group 1 Traditional). The second 15 items were created by the same content specialists using AIG methods (Group 1 AIG). The third 15 items were created by a new group of content specialists using traditional methods (Group 2 Traditional). These 45 items were then evaluated for quality by a four-member panel of medical experts and were subsequently categorised as either Traditional or AIG items. RESULTS: Three outcomes were reported: (i) the items produced using traditional and AIG processes were comparable on seven of eight indicators of multiple-choice item quality; (ii) AIG items can be differentiated from Traditional items by the quality of their distractors, and (iii) the overall predictive accuracy of the four expert medical panellists was 42%. CONCLUSIONS: Items generated by AIG methods are, for the most part, equivalent to traditionally developed items from the perspective of expert medical reviewers. While the AIG method produced comparatively fewer plausible distractors than the traditional method, medical experts cannot consistently distinguish AIG items from traditionally developed items in a blind review.