Developing a national undergraduate medical education pain management and substance use disorder curriculum to address the opioid crisis: a program evaluation pilot study.

BACKGROUND: Pain and addiction are one of the most common reasons for adults to seek health care, yet educational programs focused on pain are often underrepresented in medical school curricula. In January 2021, the Association of Faculties of Medicine of Canada (AFMC) launched an online national, bilingual, competency-based curriculum for undergraduate medical (UGME) students in pain management and substance use in response to the opioid crisis and to bridge the content gaps in programs across Canada. The purpose of this study is to evaluate the pilot of this national curriculum. METHODS: UGME students, from across Canada, participated in the program evaluation by completing online pre- and post-program surveys that assessed the influence of the curriculum on participants' knowledge as well as the value, usability, and feasibility of this curriculum. RESULTS: Participants' perceived confidence in their new knowledge and in utilizing resources required to maintain their knowledge significantly increased (75% and 51% respectively). Their perceived knowledge that addressed the 72 learning objectives within the curriculum significantly increased from pre- to post-program. Over 90% of participants reported that the curriculum was valuable, feasible, and usable. The most frequently discussed program strengths were the clear and comprehensive content, interactive and well-organized design, and relevance of curriculum content for future clinical practice. The overall weakness of the curriculum included the length, repetition of content, the lack of clarity and relevance of the assessment questions, end-user technology issues, and French translation discrepancies. Participant's recommendations for improving the curriculum included streamlining content, addressing technology issues, and enhancing the clarity and relevance of assessment questions embedded within each of the modules. CONCLUSION: Participants agreed that an online pain management and substance use curriculum is a valuable, usable, and feasible learning opportunity. Given the severity of the opioid crisis in Canada, these online modules provide a curriculum that can be integrated into existing UGME programs or can provide self-directed learning.

The feasibility and effectiveness of a novel online mental health literacy course in supporting university student mental health: a pilot study.

BACKGROUND: There is a need for effective universal approaches to promote and support university student mental health that are scalable and sustainable. In this pilot study we assess the feasibility and acceptability of a fully-digitalized, comprehensive mental health literacy course co-created with and tailored to the needs of undergraduate students. We also explore preliminary associations with mental health and positive behaviour change. METHODS: An accredited online mental health literacy course was developed using state-of-the-art pedagogical principles and a reverse mentorship approach. The course was offered as an interdisciplinary undergraduate elective. Students completed an online survey before and after the 12-week course that collected demographic information and assessed mental health knowledge, emotional self-awareness, mental health, stigma, and health-related behaviors using validated measures. Dependent group t-tests were used to compare pre- and post-course levels of knowledge, mental health, sleep quality and substance use. Mental health outcomes of students who completed the course were compared to an age and sex-matched sample of students not enrolled in the course and who completed the same survey measures over the same academic year. Multivariable linear regression was used to examine the effect of course participation on outcomes at follow-up. RESULTS: The course had good uptake and was positively reviewed by participants. Specifically, students found the course engaging, relevant, and applicable, and agreed they would recommend it to their peers. Among course participants there was improvement in mental health knowledge (p < 0.001) and emotional self-awareness (p = 0.02) at course completion. Compared to the matched comparison group, taking the course was associated with reduced alcohol (ß = - 0.41, p = 0.01) and cannabis use (ß = - 0.35, p = 0.03), and improved sleep quality (ß = 1.56, p = 0.09) at the end of the term. CONCLUSIONS: Findings suggest that delivering mental health literacy as an online accredited course may be an acceptable and effective way of promoting university student mental health through improved knowledge, emotional self-awareness, and healthy lifestyle choices. As the course is expanded to larger and more diverse student cohorts we will be able to further examine the short and long-term effectiveness of the course in supporting student mental health and the underlying mechanisms.

BIC extensions for order-constrained model selection.

The Schwarz or Bayesian information criterion (BIC) is one of the most widely used tools for model comparison in social science research. The BIC however is not suitable for evaluating models with order constraints on the parameters of interest. This paper explores two extensions of the BIC for evaluating order constrained models, one where a truncated unit information prior is used under the order-constrained model, and the other where a truncated local unit information prior is used. The first prior is centered around the maximum likelihood estimate and the latter prior is centered around a null value. Several analyses show that the order-constrained BIC based on the local unit information prior works better as an Occam's razor for evaluating order-constrained models and results in lower error probabilities. The methodology based on the local unit information prior is implemented in the R package 'BFpack' which allows researchers to easily apply the method for order-constrained model selection. The usefulness of the methodology is illustrated using data from the European Values Study.

Simple Bayesian testing of scientific expectations in linear regression models.

Scientific theories can often be formulated using equality and order constraints on the relative effects in a linear regression model. For example, it may be expected that the effect of the first predictor is larger than the effect of the second predictor, and the second predictor is expected to be larger than the third predictor. The goal is then to test such expectations against competing scientific expectations or theories. In this paper, a simple default Bayes factor test is proposed for testing multiple hypotheses with equality and order constraints on the effects of interest. The proposed testing criterion can be computed without requiring external prior information about the expected effects before observing the data. The method is implemented in R-package called 'lmhyp' which is freely downloadable and ready to use. The usability of the method and software is illustrated using empirical applications from the social and behavioral sciences.

Impact of a multifaceted strategy to improve perioperative diabetes care.

AIMS: To assess the impact of a multifaceted strategy to improve perioperative diabetes care throughout the hospital care pathway. METHODS: We conducted a controlled before-and-after study in six hospitals. The purpose of the strategy was to target four predominant barriers that obstruct optimal care delivery. We provided feedback on baseline indicator performance, developed a multidisciplinary protocol and patient information, and provided professional education. After a 6-month intervention, we determined the performance changes against three outcome indicators and nine process indicators using data on 811 patients with diabetes who underwent major surgery. The progress of the interventions was monitored closely. RESULTS: Two process indicators improved significantly in the intervention hospitals: the proportion of patients for whom glycaemic control had been evaluated preoperatively increased by 9% (P < 0.002) and the proportion of patients with blood glucose measurements within 1 h after surgery increased by 29% (P < 0.0001). Four other process indicators and all three outcome indicators improved more in the intervention hospitals than in the control hospitals, but the differences were not statistically significant. These included the proportion of patients with all glucose values at 6-10 mmol/l (+3%) and the proportion of patients with hyperglycaemia (-8%). The implementation of the multidisciplinary protocol was still ongoing after the 6-month intervention period. CONCLUSIONS: The multifaceted improvement strategy had a limited impact on the quality of perioperative diabetes care. This study demonstrates the complexity of improving perioperative diabetes care throughout the multiprofessional hospital care pathway.

New insights into factors influencing adult height in short SGA children: Results of a large multicentre growth hormone trial.

BACKGROUND: Growth hormone (GH) treatment is effective in improving adult height (AH) in short children born SGA. However, there is a wide variation in height gain, even after adjustment for predictive variables. It is therefore important to investigate new factors which can influence the response to GH. OBJECTIVE: To investigate the efficacy of GH treatment (1 mg/m(2/) day) in short SGA children on AH. To assess the relation between spontaneous catch-up growth after birth and growth during puberty on the total height gain SDS to AH. PATIENTS: Longitudinal GH trial in 170 children. RESULTS: Median age at start of GH was 7·1 years and height -3·0 SDS. AH was -1·8 SDS (TH-corrected AH -1·1 SDS) in boys and -1·9 SDS (TH-corrected AH -1·3 SDS) in girls. Spontaneous catch-up growth after birth was ≥0·5 SDS in 42% of children. In contrast to expectation, spontaneous catch-up growth was negatively correlated with total height gain SDS during GH (P = 0·009). During puberty, height SDS declined (-0·4 SDS in boys and -0·5 SDS in girls) resulting in a lower total height gain SDS than expected. Pubertal height gain was 25·5 cm in boys and 15·3 cm in girls, significantly lower compared to AGA children (P < 0·001). At onset of puberty, BA for boys and girls was moderately advanced (P = 0·02 and P < 0·001, respectively). Growth velocity was comparable to AGA children during the first two years of puberty, but thereafter significantly lower until reaching AH (P < 0·001). CONCLUSION: In contrast to our hypothesis, children with greater spontaneous catch-up growth after birth show a lower total height gain SDS during GH. Height SDS declines from mid-puberty, due to a marked early deceleration of growth velocity.

Perioperative diabetes care: room for improving the person centredness.

AIMS: Person centredness is an important principle for delivering high-quality diabetes care. In this study, we assess the level of person centredness of current perioperative diabetes care. METHODS: We conducted a survey in six Dutch hospitals, among 690 participants with diabetes who underwent major abdominal, cardiac or large-joint orthopaedic surgery. The survey included questions regarding seven dimensions of person-centred perioperative diabetes care. RESULTS: Complete data were obtained from 298 participants. The survey scores were low for many of the dimensions of person centredness. The dimensions 'information', 'patient involvement' and 'coordination and integration of care' had the lowest scores. Only half the participants had received information about perioperative diabetes treatment, and approximately one-third had received information about the effect of surgery on blood glucose values, target glucose values and glucose measurement times. Similarly, half the participants had an opportunity to ask questions preoperatively, and only one-third of the participants felt involved in the decision-making regarding diabetes treatment. Most participants knew neither the caregiver in charge of perioperative diabetes treatment nor whom to contact in case of diabetes-related problems during their hospital stay. CONCLUSIONS: Current perioperative diabetes care is characterized by a lack of patient information and limited patient involvement. These results indicate that there is ample room for improving the person centredness of perioperative diabetes care.

The efficacy of a specific stabilization splint.

BACKGROUND: The use of a Tanner type stabilization splint, fabricated on a leaf gauge articulation for the treatment of patients with disc displacement without reduction, is lacking in the literature. OBJECTIVES: The purpose of the study is to collect non-controlled, therapy-related observations; in other words, to demonstrate the efficacy of this appliance for the treatment of patients with disc displacement without reduction. METHODS: The study enrolled 55 patients, 5 men, and 50 women, with the clinical diagnosis disc displacement without reduction, 42 with and 13 without limited mouth opening. All patients received a splint in the musculoskeletally stable centric relation (CR) position. Mouth opening, clinical performance, and the timeframe of splint treatment were assessed. RESULTS: For 37 patients with a disc displacement without reduction with limited opening, the largest increase in mouth opening (9.5 +/- 5.6 mm) occurred in the first week (7.9 +/- 2.5 days). No occlusal adjustment of the splint was needed during the treatment sequence. For three patients, treatment took up to 3 months (8.1%), for 13 patients, between 3 and 6 months (35.1%), and for 17 patients, within a year (45.9%), making a total of 89.1% successfully treated patients. Out of 50 patients, 29 had a total resolution of signs and symptoms, whereas 21 patients still suffered from solitary temporomandibular disorder (TMD) signs. CONCLUSION: A Tanner type stabilization splint, fabricated in the musculoskeletally stable CR position, appears to be an effective and efficient means for the treatment of patients with disc displacement without reduction. Its efficacy makes it eligible to be tested in a randomized controlled trial. CLINICAL IMPLICATIONS: The efficacy of this specific splint, fabricated in the musculoskeletally stable CR position, makes it a promising tool to treat TMD patients with disc displacement without reduction.

Gut microbiome composition and functionality impact the responsiveness to a dairy-based product containing galacto-oligosaccharides for improving sleep quality in adults.

Sleep quality and duration can be impacted by diet, and has been linked to gut microbiota composition and function as the result of communication via the microbiota-gut-brain axis. As one strategy to improve sleep quality could be through the modulation of the gut microbiome, we assessed the effects of a dairy-based product containing whey protein, galacto-oligosaccharides, tryptophan, vitamins and minerals after a 3 weeks intervention on gut microbiota composition and (gut-brain related) functions on basis of 67 healthy subjects with moderate sleep disturbances. Associations of the gut microbiota with sleep quality and with response/non-response to the treatment were revealed by shotgun metagenomics sequencing of faecal DNA samples, and subsequent analyses of microbiota taxonomy and generic functionality. A database of manually curated Gut-Brain Modules (GBMs) was applied to analyse specific microbial functions/pathways that have the potential to interact with the brain. A moderate discriminating effect of the DP treatment on gut microbiota composition was revealed which could be mainly attributed to a decrease in Pseudomonas resinovorans, Flintibacter sp. KGM00164, Intestinimonas butyriciproducens, and Flavonifractor plautii. As interindividual variance in microbiota composition could have given rise to a heterogenous responsiveness of the subjects in the intervention group, we zoomed in on the differences between responders and non-responders. A significant difference in baseline microbiota composition between responders and non-responders was apparent, showing lower Bifidobacterium longum and Bifidobacterium adolescentis, and higher Faecalibacterium prausnitzii relative abundances in responders. The findings provide leads with respect to the effectiveness and potential underlying mechanisms of mode of action in sleep improvement that could support future nutritional interventions to aid sleep improvement.

The incidence of centric slides in healthy individuals and TMD patients.

Controversy exists as to whether centric slide is an etiological factor for temporomandibular disorders. In this cross-sectional study the magnitude of centric slides, obtained with 2 different articulations and one with a millimetre ruler was compared. The study enrolled a group of 27 healthy individuals and 83 TMD patients, the latter divided in 3 groups of 26, 28 and 29 subjects with the RDC/TMD diagnoses of myofascial pain, osteoarthritis and disc displacement without reduction, respectively. Measurement reliability of a chinpoint guided articulation was compared with a musculoskeletally stable articulation, obtained using a leaf gauge. Next, centric slide was measured, if any, intraorally with a millimetre ruler and in both articulations measuring the difference between centric relation and the maximal intercuspal position. A mandibular full-arch Tanner type stabilisation splint was fabricated for each of the TMD patients. After splint treatment, new casts were obtained and mounted using both methods to locate centric relation. The magnitude of centric slide intraorally and in both articulations was reassessed. For the analysis of the variables a mixed-model procedure was applied (alpha = 0.05). At baseline and upon conclusion of splint treatment all groups exhibited centric slides with large standard deviations (ranging from 1.03 +/- 0.83 to 1.97 +/- 1.3 millimetre). In the mixed-model procedure a significant difference in magnitude existed between the millimetre ruler and both the chinpoint guidance as well as the leaf gauge articulation (P < 0.001). No correlation between centric slide and TMD could be demonstrated.

Single-arm trials supporting the approval of anticancer medicinal products in the European Union: contextualization of trial results and observed clinical benefit.

BACKGROUND: Single-arm trials (SATs) can sometimes be used to support marketing authorization of anticancer medicinal products in the European Union. The level and durability of antitumor activity of the product as well as context are important aspects to determine the relevance of trial results. The aim of this study is to provide details on the contextualization of trial results and to evaluate the magnitude of benefit of medicinal products approved based on SATs. MATERIALS AND METHODS: We focused on anticancer medicinal products for solid tumors approved on the basis of SAT results (2012-2021). Data were retrieved from European public assessment reports and/or published literature. The benefit of these medicinal products was evaluated via the European Society for Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS). RESULTS: Eighteen medicinal products were approved based on 21 SATs-few medicinal products were supported by >1 SAT. For the majority of clinical trials, a clinically relevant treatment effect was (pre)specified (71.4%) and most often an accompanying sample size calculation was provided. For 10 studies, each testing a different medicinal product, a justification for the threshold for a clinically relevant treatment effect could be identified. At least 12 out of 18 applications included information to facilitate the contextualization of trial results, including six supportive studies. Of the pivotal SATs analyzed (n = 21), three were assigned an ESMO-MCBS score of 4, which corresponds to 'substantial' benefit. CONCLUSIONS: The clinical relevance of the treatment effects shown by medicinal products for solid tumors tested in SATs is dependent on the effect size and context. To better facilitate regulatory decision making, prespecifying and motivating a clinically relevant effect and aligning the sample size to that effect is important. External controls may facilitate in the contextualization process, but the associated limitations must be addressed.

Reproducibility of 2 methods to locate centric relation in healthy individuals and TMD patients.

No conclusive evidence exists for any maxillomandibular relationship as the preferable treatment position. Measurement reliability of 2 different methods to attempt to locate centric relation in control and TMD patients was assessed to determine if both methods lead to the same position. A group of 27 controls and 91 TMD patients were examined using the Research Diagnostic Criteria for TMD (RDC/TMD). Three patient groups were recruited: 27 patients with myofascial pain (MYO), 34 patients with disc displacement without reduction (ID), and 30 patients with osteoarthritis (OA). For each study participant centric relation was located with chinpoint guidance and a technique with a leaf gauge, for the controls once, for all TMD patients before and after stabilization splint treatment. The mixed model procedure revealed no significant differences between the methods, the patient groups and the time interval. However the patient groups at baseline and conclusion of treatment differed significantly from the controls. The percentage of patients (15.9%) having a coincident split-cast result for both methods was significantly smaller (P < 0.001) than the corresponding percentage (85.2%) of controls. After splint treatment, the percentage of coincident split-casts increased from 15.9% to 76.8%. Both methods are reproducible techniques to locate centric relation for control and TMD patients. However, the leaf gauge provides the clinician a different centric relation position in TMD patients than chinpoint guidance does.

Reasons for contacting the consultation service of a Dutch assault centre.

A telephone and e-mail helpline known as the Consultation Service, open to all the public, was launched at a Dutch Centre for Sexual Violence to deal with non-acute sexual violence. The aim of this study was to gain insight into case characteristics, reasons for contacting the Consultation Service and whether these reasons differed for victims, their relatives and professionals. Using a mixed methods design, the study included all consultations handled at the Consultation Service in 2018 and 2019. Descriptive statistics described quantitatively the case characteristics, the themes and differences between victims, relatives and professionals. The themes of the reasons for contact were established from the qualitative analysis, using the method of content analysis. Cases were characterised by complexity. Three themes emerged: case complexity, decision-making on care options and reporting to the police, which differed for victims, relatives and professionals. The differences in reasons for contacting the helpline imply that approaches should be adapted and fitted to different clients. Specialised care is needed to guide clients through cases that are challenging and often complex. There is a widespread lack of knowledge of options in addition to the complex multifaceted aspects to decision making about actions post-assault. Assault centres should implement a Consultation Service in which integrated care is offered not only to the victims, but also to their relatives and professionals.

Creating a kidney organoid-vasculature interaction model using a novel organ-on-chip system.

Kidney organoids derived from human induced pluripotent stem cells (iPSCs) have proven to be a valuable tool to study kidney development and disease. However, the lack of vascularization of these organoids often leads to insufficient oxygen and nutrient supply. Vascularization has previously been achieved by implantation into animal models, however, the vasculature arises largely from animal host tissue. Our aim is to transition from an in vivo implantation model towards an in vitro model that fulfils the advantages of vascularization whilst being fully human-cell derived. Our chip system supported culturing of kidney organoids, which presented nephron structures. We also showed that organoids cultured on chip showed increased maturation of endothelial populations based on a colocalization analysis of endothelial markers. Moreover, we observed migration and proliferation of human umbilical vein endothelial cells (HUVECs) cultured in the channels of the chip inside the organoid tissue, where these HUVECs interconnected with endogenous endothelial cells and formed structures presenting an open lumen resembling vessels. Our results establish for the first-time vascularization of kidney organoids in HUVEC co-culture conditions using a microfluidic organ-on-chip. Our model therefore provides a useful insight into kidney organoid vascularization in vitro and presents a tool for further studies of kidney development and drug testing, both for research purposes and pre-clinical applications.

Discontinuation of long-term benzodiazepine use: 10-year follow-up.

BACKGROUND: Several interventions aiming at discontinuation of long-term benzodiazepine use have been proven effective in the short term. However, data on the persistence of discontinuation are lacking. OBJECTIVES: To assess 10-year follow-up status in patients who succeeded in stopping benzodiazepine use after a discontinuation letter from the patient's own GP. To identify determinants of successful discontinuation on the long term. METHODS: Follow-up data of patients who participated in a large prospective, controlled stepped care intervention programme among long-term benzodiazepine users in primary care. RESULTS: At 10-year follow-up, the percentage of benzodiazepine abstinence was 58.8%. Non-abstinent patients used lower doses of benzodiazepine. Being abstinent at 21 months after the intervention predicted abstinence at 10-year follow-up. CONCLUSIONS: Ten years after a minimal intervention to decrease long-term benzodiazepine use, the majority of patients who were able to discontinue benzodiazepine use initially, does not use benzodiazepines at 10-year follow-up. Patients who did not succeed in maintaining abstinence from benzodiazepines appear to use lower or average dosages.

Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil.

Disadvantaged children suffer because tooth cavities are not being treated and their clinical consequences not being surveyed. The present study aimed to assess the prevalence and severity of clinical consequences of untreated dentine carious lesions in schoolchildren from a deprived area of Brazil and to investigate the determinants of the pufa index. A sample of 835 children aged 6-7 years, from six public schools, was examined by 3 calibrated examiners. Clinical consequences of untreated dentine carious lesions in primary teeth were diagnosed using the four codes of the pufa index: 'p' (pulpal involvement), 'u' (ulceration), 'f' (fistulae), 'a' (abscess). Effects of gender, age, school, history of extraction, and toothache on the prevalence of pufa codes were tested. The prevalence of pufa codes was 23.7%. The mean pufa score was 0.4 ± 0.9. Code 'p' was the most prevalent (19.5%), whereas code 'u' was least prevalent (0.1%). Children with a history of extracted primary teeth due to caries had a 2.7 times higher chance to have a pufa code than children with no previous extraction. Children with toothache had a 5.6 times higher chance to have a pufa code than children without toothache. The prevalence of clinical consequences of untreated dentine carious lesions was moderate and the severity was low. The pufa index is an epidemiological tool complementary to existing caries indices aimed to assess dental caries. However, there appears to be no need to include code 'u' nor to score codes 'f' and 'a' separately.

Caries experience of Egyptian adolescents: does the atraumatic restorative treatment approach offer a solution?

OBJECTIVES: To assess the prevalence and severity of dental caries amongst Egyptian adolescents and the prevalence of carious lesions treatable through the atraumatic restorative treatment (ART) approach. SUBJECTS AND METHODS: Using a convenient sample procedure, two secondary schools with a dental clinic were selected (967 students, average age: 13.7 ± 0.8 years, range: 12-15). Dental caries was diagnosed using the ART caries criteria, and plaque and calculus were assessed using the Green and Vermillion criteria amongst students grades 1-3 in the dental clinic by 3 calibrated examiners. The effect of the independent variables gender, age, tooth surface, jaw side (left or right) and type of jaw (mandible/maxilla) on dependent caries experience variables and D(2) and D(3) variables were tested using ANOVA. RESULTS: The prevalence of dental caries including enamel lesion (D(2)MFT) amongst the 967 students was 51.4% and that of dental caries excluding enamel lesions (D(3)MFT) was 38.1%. The mean D(2)MFT and D(3)MFT scores were 1.5 and 0.8, respectively. The percentage of teeth filled and extracted was low. Female students had statistically significantly higher mean D(3)MFT/S and D(2)MFT/S scores than males (p < 0.0001). The prevalence of cavitated carious lesions (D(3)) treatable through ART was 48% for score 2 and 28% for score 3. CONCLUSIONS: Most of the cavitated lesions were found untreated despite the presence of a dental clinic and a dentist on the school premises. The majority of cavitated lesions without pulp involvement could be treated using the preventive and restorative components of the ART approach.

Reporting after sexual violence: The influence of victim, assault and perpetrator characteristics.

Sexual violence is a worldwide public health concern. Care for victims has improved with the development of sexual assault centres, which have served to professionalise and tailor care and to get different services to improve collaboration. Nonetheless, reporting rates remain low, causing perpetrators to walk free without prosecution. We aimed to investigate, firstly, the influence of victim, perpetrator and assault characteristics on the reporting rate, and, secondly, the reasons why victims did not report to the police. Data of a Dutch sexual assault centre was used in this cross-sectional study. All victims who attended the centre between January 2016 and January 2019 were included. Logistic regression analysis was used to assess the relation of certain characteristics with reporting. Forty per cent of the victims reported to the police. Age and injuries were significantly related to reporting. Victims of 26 years or over were less likely to report than victims under 18 years old. Victims with objectified injuries reported to the police more often. Contrary to previous research, no relation between the perpetrator being well-known to the victim and a lower reporting rate was found. Victims mainly refrained from reporting as they experienced conflicting emotions, followed by their feeling discouraged by the police. Other reasons were fear of the perpetrator and defamation, wanting to move on with their life and wanting to spare the perpetrator. Our findings will serve to further optimise care for victims of sexual violence and increase reporting rates.

Treatment of age-related hearing loss in dogs with the vibrant soundbridge middle ear implant: short-term results in 3 dogs.

BACKGROUND: Age-related hearing loss (ARHL), or presbycusis, is the most common form of acquired hearing loss in dogs. Middle ear implants have been used successfully in people with ARHL who cannot benefit from conventional hearing aids. HYPOTHESIS: Audibility improves in dogs with ARHL after implantation of the Vibrant Soundbridge (VSB) middle ear implant. ANIMALS: Three Beagle dogs with ARHL, mean age 11.1 years. METHODS: The dogs were assessed pre- and postoperatively by brainstem-evoked response audiometry (BERA), otoscopy, and computed tomography scans of the ears. A VSB middle ear implant was implanted unilaterally. Three months later the functionality of the implants was assessed by auditory steady-state responses (ASSRs), after which the dogs were euthanized for histopathological examination. RESULTS: The VSB was implanted successfully in all dogs. Recovery from surgery was uneventful, except for transient facial nerve paralysis in 2 dogs. ASSRs showed that hearing improved after activation of the implants with a mean of 20.7, 13, and 16.3 dB at 1, 2, and 4 kHz, respectively. The implantation procedure did not affect residual hearing (with inactive implants) as measured by BERA. CONCLUSIONS AND CLINICAL IMPORTANCE: Implantation of the VSB resulted in lower ASSR thresholds, but only at the higher gain settings of the audioprocessor. As in humans, a more powerful audioprocessor is required to treat sensorineural hearing loss exceeding 20 dB in dogs. A substantial improvement in patient-owner communication will have to be demonstrated in future studies before the procedure can be recommended in clinical practice.

Barriers to restorative care as perceived by dental practitioners in Tanzania.

OBJECTIVE: To identify barriers to restorative care, as perceived by dental practitioners. METHODS: Of the total of 147 dental practitioners employed in regional and district government hospitals and municipal health centres, 138 completed a pre-tested questionnaire: a response rate of 94%. Factor analysis was performed to extract barrier factors. Chi-square test was used to test the influences of independent variables on discrete dependent variables, and ANOVA was used to test the influences of independent variables on continuous dependent variables. RESULTS: Knowledge of patients and beliefs of patients were perceived as the most important barriers. Others were financial, motivation of practitioners, dentistry looked down upon by administration and patients' fear of noise from drill. Practitioners who worked in high and medium economic zones perceived patients' fear of noise from drill as a barrier to restorative care more than their counterparts in low economic zones. Practitioners who worked in low economic zones perceived dentistry looked down upon by administration as a barrier to restorative care more than colleagues in high and medium economic zones. CONCLUSIONS: Knowledge and beliefs of patients about restorative care were the two main factors that hindered restorative care, as perceived by dental practitioners in Tanzania. Organized information provision to the population and regular continuing education meetings for practitioners on restorative and preventive care, plus adoption of Atraumatic Restorative Treatment in daily clinical work are considered appropriate in addressing these barriers.