Peri-Implant Mucosal Fenestration and Histologic Observation of Bone Xenograft Material 7-Years After Implant Installation: A Case Report.

Bone augmentation is often required before the installation of dental implants. Here, we report a case for a patient who previously received bone augmentation at the upper right jaw using a xenogenic graft, followed by successful implant installation. Seven years later, the patient presented with mucosal fenestration with bone exposure at the area and gave a history of a recent diagnosis of cutaneous lichen planus. Several attempts were made to manage the situation, and finally, we resorted to connective tissue graft placement at the site. A piece of bone was sent for histologic evaluation, where the results indicated the presence of un-resorbed graft material surrounded by inflammatory cells, with no evidence of bone formation in the area. The case presents histologic evidence for the lack of new bone formation using xenograft over the evaluation period. The case also shows lichen planus, a possible cause for oral complication for patients undergoing augmentation and implant installation.

Factors underlying suboptimal diagnostic performance in physicians under time pressure.

CONTEXT: Time pressure has been implicated in the suboptimal diagnostic performance of doctors and in increases in diagnostic errors. However, the reasons underlying these effects are not clear. The aim of this study was to investigate the influence of time pressure on physicians' diagnostic accuracy and to explore the mediating effects of perceived stress (emotional pathway) and number of plausible diagnostic hypotheses (cognitive pathway) on the proposed relationship. METHODS: We conducted a randomised controlled experiment. A total of 75 senior internal medicine residents completed eight written clinical cases under conditions with (n = 40) or without (n = 35) time pressure. They were then asked to: (i) rate the overall stress experienced, and (ii) write down any alternative hypotheses they had thought of when diagnosing the cases. In a post hoc analysis, a mediation path analysis was performed to test the causal relationships between time pressure, perceived stress and number of alternative diagnoses. RESULTS: Participants who were under time pressure spent less time diagnosing the cases (85.54 seconds versus 181.81 seconds; p< 0.001) and had a lower mean diagnostic accuracy score (0.44 versus 0.53; p = 0.01). In addition, they reported more stress (5.80 versus 4.69; p = 0.01) and generated fewer plausible tentative hypotheses (0.37 versus 0.51; p = 0.01). Two path coefficients were found to be statistically significant; the first path coefficient referred to the relationship between time pressure and perceived stress (standardised ß = 0.25, p = 0.029), and the second negative path coefficient referred to the relationship between time pressure and number of plausible alternative hypotheses (standardised ß = -0.32, p< 0.01). CONCLUSIONS: Time pressure adversely influences physicians' diagnostic accuracy by increasing their stress response and reducing the number of plausible hypotheses as mediators.

Does Time Pressure Have a Negative Effect on Diagnostic Accuracy?

PURPOSE: Studies suggest time pressure has negative effects on physicians' working conditions and may lead to suboptimal patient care and medical errors. Experimental evidence supporting this is lacking, however. This study investigated the effect of time pressure on diagnostic accuracy. METHOD: In 2013, senior internal medicine residents at three hospitals in Saudi Arabia were divided randomly into two groups: a time-pressure condition and a control condition without time pressure. Both groups diagnosed eight written clinical cases presented on computers. In the time-pressure condition, after completing each case, participants received information that they were behind schedule. Response time was recorded, and diagnostic accuracy was scored. RESULTS: The 23 participants in the time-pressure condition spent significantly less time diagnosing the cases (mean = 96.00 seconds) than the 19 control participants (mean = 151.97 seconds) (P < .001). Participants under time pressure had a significantly lower diagnostic accuracy score (mean = 0.33; 95% CI, 0.23-0.43) than participants without time pressure (mean = 0.51; 95% CI, 0.42-0.60) (F[1, 41] = 6.90, P = .012, η = 0.15). This suggests participants in the time-pressure condition made on average 37% more errors than control participants. CONCLUSIONS: Time pressure has a negative impact on diagnostic performance. The authors propose that the effect of time pressure on diagnostic accuracy is moderated by both the case difficulty level and the physician's level of experience. Post hoc analyses demonstrated that time pressure affects diagnostic accuracy only if cases are not too difficult and physicians' expertise level is intermediate.

Assessing learning styles of Saudi dental students using Kolb's Learning Style Inventory.

Experiential learning theory (ELT), a theory developed by David Kolb that considers experience to be very important for learning, classifies learners into four categories: Divergers, Assimilators, Convergers, and Accommodators. Kolb used his Learning Style Inventory (LSI) to validate ELT. Knowing the learning styles of students facilitates their understanding of themselves and thereby increases teaching efficiency. Few studies have been conducted that investigate learning preferences of students in the field of dentistry. This study was designed to distinguish learning styles among Saudi dental students and interns utilizing Kolb's LSI. The survey had a response rate of 62 percent (424 of 685 dental students), but surveys with incomplete answers or errors were excluded, resulting in 291 usable surveys (42 percent of the student population). The independent variables of this study were gender, clinical experience level, academic achievement as measured by grade point average (GPA), and specialty interest. The Diverging learning style was the dominant style among those in the sample. While the students preferred the Assimilating style during their early preclinical years, they preferred the Diverging style during their later clinical years. No associations were found between students' learning style and their gender, GPA, or specialty interest. Further research is needed to support these findings and demonstrate the impact of learning styles on dental students' learning.