Managing Placenta Accreta Spectrum: A case report on combining conservative care with uterine angioembolization.

INTRODUCTION: Placenta Accreta Spectrum (PAS) stands out as one of the most significant complications in pregnancy, capable of causing maternal morbidity and mortality. PRESENTATION OF CASE: In this report, we aim to discuss a case involving unsatisfactory conservative care coupled with uterine angioembolization, resulting in multiple hospitalizations due to placental infection and eventual hysterectomy. DISCUSSION: Both conservative and non-conservative approaches have been utilized to mitigate maternal complications and mortality associated with Placenta Accreta Syndrome. While uterus-preserving methods play a crucial role, leaving the placenta in situ can lead to numerous severe long-term complications. Previous Research highlights the limitations of conservative management in the case of placenta accreta, necessitating careful patient selection due to potential morbidity and the risk of secondary hysterectomy. CONCLUSION: invasive placentation poses challenges in obstetrics, presenting a risk of severe maternal morbidity and mortality. Conservative management poses limitations and risks, emphasizing the need for further research and evidence-based guidelines to enhance the management of PAS.

Attitude of Iranian medical specialty trainees toward providing health care services to patients with mental disorders.

Introduction: The stigma of mental illness has a negative impact on the diagnosis and treatment of these disorders. Considering the high prevalence of mental illness, the attitude of medical specialists toward mental disorders, who are front liners in diagnosing and treating these patients, is critical. Therefore, we examined the attitude of Iranian medical specialty trainees toward providing health care services for patients with mental illness. Methods: We included 143 residents in the fields that have the most interactions with patients with mental disorders, including internal medicine, surgery, neurology, cardiovascular diseases, and psychiatry. A demographic checklist, as well as the opening minds scale for health care providers stigma assessment questionnaire, was provided, which measures five dimensions of improvement, social responsibility, social distance, exposure, and other (such as risk) in health care providers toward delivering the healthcare services to patients with mental disorders. Results: The mean score of stigma for mental illness in medical specialty trainees was 61.36 ± 4.83 out of 100. Psychiatric residents have the least stigmatizing attitude (58.38 ± 3.54), and internal medicine and cardiology residents have the highest score, respectively, (62.96 ± 6.05, 62.45 ± 3.80). As for comparing subscales between specialties, only the social responsibility subscale showed a significant difference, with psychiatry having less stigma toward social responsibility (12.93 ± 2.01) than cardiology (15.09 ± 1.50) trainees. Conclusion: The attitude of medical specialty trainees toward providing health care services for patients with mental illness is not uniform; internal medicine and cardiology residents have more stigmatizing attitude, while psychiatric residents have less stigmatizing attitude. It seems that not every contact could be useful in making a better attitude toward mental illness, but it needs preconditions, like a structured contact that leads to positive outcomes. Anti-stigma interventions are needed to improve the attitude of medical specialty trainees toward providing health care services to patients with mental illness.

Service Evaluation of Recording Jaw Registrations for Removable Partial Dentures in NHS General Dental Practices.

AIMS: To establish the prevalence of jaw registrations being taken for removable partial dentures (RPDs) in primary dental NHS practices. METHOD: 271 RPDs made by 16 general dental practitioners across four NHS dental practices were evaluated prospectively. The number of teeth replaced, whether jaw registration was undertaken, and the number of denture adjustment appointments were recorded. Telephone interviews with dental technicians were held to establish their preferred jaw registrations material. MAIN FINDINGS: Jaw registrations were not carried out in 27% (n=72) of RPD. When jaw registration was recorded, 14% (n=28) required a further denture adjustment appointment. 64% (n=46) of dentures where jaw registration was not recorded required at least one further denture adjustment appointment. Dental technicians unanimously preferred a squash-bite wax block, with centre and canine positions marked and cast models secured with elastic bands. CONCLUSION: Overall, recording a jaw registration reduced the number of denture adjustment appointments required.

Restorative intervention thresholds and treatment decisions of general dental practitioners in London.

Introduction Minimally invasive dentistry has been promoted as the contemporary approach to the operative management of dental caries. Operative intervention should be undertaken on cavitated lesions which are actively progressing. However, there may be large variability in the restorative intervention thresholds and care plans of general dental practitioners (GDPs).Aims To investigate restorative threshold and treatment decisions for occlusal and proximal carious lesions in a cohort of GDPs in London. To investigate potential differences based on number of years since graduation and attendance on a caries management course.Materials and methods A previously used, validated caries questionnaire was distributed to foundation dentists, general practice dentists and practising educational supervisors in NHS London dental practices. Results Two hundred and seventeen GDPs participated in the study. For occlusal lesions, nine (9.1%) newly-qualified dentists selected to intervene surgically on lesions confined to enamel, compared to 24 (29.8%) dentists who have been qualified for more than five years (p <0.05). In addition, a greater number of dentists who had attended a training course were more likely to do a minimally invasive preparation for a proximal lesion (38.2%), compared to 19.8% of those who had not (p <0.05). The majority of all participants (74.2%) chose to restore a proximal lesion using resin composite. Despite this material choice, 58.5% of those graduating within five years opted to prepare a traditional Black's class II cavity. Conclusion A practitioner's restorative intervention threshold and their choice of treatment appears to be negatively affected by the number of years post-qualification, and positively influenced by attending a caries management course.

Early years postgraduate learning and training in prosthodontic dentistry: 2019 and beyond.

The intended outcome of dental education is to produce dental clinicians who have the knowledge, technical skills, personal attributes, values and professional outlook to deliver the highest level of patient care. Due to the development and improvement of dental materials and clinical techniques, combined with a steady rise in patient expectations and complaints, prosthodontics has developed into a dental speciality recognised by the General Dental Council. Going forward, there will be a requirement to provide complex and difficult operative and prosthodontic dentistry. Much will be replacement and repair of existing failing work, with the application and choice of newer materials and clinical approaches. How does the dental education sector respond to this challenge? This article attempts to discuss potential solutions for training and education, for all levels of prosthodontics in the UK.