Multiple cases in case-based learning: A qualitative description study.

INTRODUCTION: Case-based learning is widely used in health professions education to improve clinical learning, but little is known about how best to approach multiple cases in this active learning strategy. Our study explored dental student views of multiple case-based learning in oral pathology. MATERIALS AND METHODS: Qualitative description informed the study design. Data were collected through semi-structured, individual interviews with twenty-one third- and fourth-year dental students who participated in multiple case-based learning seminars. Data were analysed using inductive, manifest thematic analysis. RESULTS: Themes were identified at approach and case levels. Approach-level themes included preparing students for clinical practice and board exams and maximising exposure (e.g., to lesions/conditions), knowledge application, and engagement within the time allotted for the learning session. Case-level themes included using challenging but manageable cases, linking cases to lecture content, providing the necessary clinical information to solve the cases, and ensuring that cases were authentic and common with non-typical presentations. Aspects of themes encompassed definitions of case characteristics, benefits, conditions of implementation, and recommendations for improvement. CONCLUSION: Cases should be considered individually, collectively, purposefully, and contextually in multiple case-based learning. Evaluations of learning and behavioural outcome are needed to further establish the effectiveness of approaches and case characteristics in multiple case-based learning.

Impact of the COVID-19 pandemic on gender disparities in acute coronary syndrome patterns.

Background: Global evidence has emerged showing fewer Acute Coronary Syndrome (ACS) cases than expected during the COVID-19 pandemic. Our study aims to evaluate the incidence of ACS before and after the onset of the COVID-19 pandemic and analyze differences in gender distribution, and type of presentation. Methods: This is a retrospective study of 997 patients who presented to Huntsville Hospital's catheterization lab for elective and emergency catheterization for ACS and non-ACS during a four-week period from February 26, 2020, to March 10, 2020, and from March 25, 2020, to April 8, 2020, and compared with the equivalent weeks in 2019. Results: We report a 45.5% decrease in ACS cases presenting during the COVID-19 pandemic between March 25, 2020, to April 8, 2020 compared to equivalent weeks in 2019, with a significant drop in percentage of female patients presenting by 30.6%. Upsurge in STEMI cases and a drop in NSTEMI cases was observed during the COVID pandemic compared to 2019. Conclusions: Patients presenting after the onset of the pandemic had elevated cardiac markers, representing higher severity and potentially presenting later in the disease course. The number of total ACS cases and percentage of females presenting to the catheterization lab before the COVID surge (February/March 2019 and 2020) almost remained stable. This comparison data provides validity that the drop in ACS case volume and females in March/April 2020 is more likely due to the pandemic and not due to improvements in overall cardiovascular health metrics. Reasons for this disparity are likely multifaceted and deserve further investigation.

Behavioural change as a theme that integrates behavioural sciences in dental education.

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

Effects of cardiac toxicity of combination therapy with hydroxychloroquine and azithromycin in COVID-19 patients.

Coronavirus disease 2019 (COVID-19), which began in China, caused a global pandemic. Few studies have shown the benefit of hydroxychloroquine (HY) ± azithromycin (AZ) for treating COVID-19. Concerns of QT prolongation and increased risks of torsade's de pointes (TdP) with this combination have been raised since each agent can individually prolong the QT interval. This retrospective, observational study included hospitalized patients treated with HY and AZ from March 2020 to May 2020 at a large community hospital. Serial assessments of the QT interval were performed. Our aim is to evaluate the safety and characterize the change in QTc interval and arrhythmic events in COVID-19 patients treated with HY/AZ. A total of 21 COVID patients who received at least four days of HY and AZ were included in this study. Mean baseline was QTc 403 ms, mean maximum QTc was 440 ms, mean change in QTc was 36 ms. Only one patient (4.8%) developed prolonged QTc > 500 ms. No patient had a change in QTc of 60 ms or more. No patient developed TdP. Fifteen patients (71.4%) had hypoxia on admission, with only two patients (9.5%) required oxygen of 1-2 L at discharge. 80.9% of patients have been discharged home or inpatient rehabilitation.

Recommendations for approaching the introduction section of manuscripts and grant applications.

Research on dental and dental hygiene education is key to improving learning, teaching, and oral health care in academic dental institutions. Faculty should be able to write research proposals and reports properly to secure funding for research and share the findings of studies with stakeholders. Specifically, they should demonstrate why the study matters in the introduction section of their text. Our experience in mentoring dental and dental hygiene faculty shows that some have difficulty justifying the importance of their studies due to the way they approach the introduction section. This short communication provides 3 recommendations to help faculty approach and write this section adequately, which can be useful for writing other sections of manuscripts and grant applications.

La recherche sur l'éducation en matière d'art dentaire et d'hygiène dentaire joue un rôle clé dans l'amélioration de l'apprentissage, de l'enseignement et des soins de santé buccodentaire dans les établissements universitaires dentaires. Le corps professoral devrait pouvoir rédiger des offres de service et des rapports de recherche de façon adéquate en vue d'obtenir du financement pour la recherche et de partager les résultats des études avec les parties intéressées. Plus précisément, il devrait démontrer l'importance de l'étude dans l'introduction de ses textes. Notre expérience en matière de mentorat du corps professoral de l'art dentaire et de l'hygiène dentaire montre que beaucoup de personnes ont de la difficulté à justifier l'importance de leurs études en raison de la façon dont ils abordent la section d'introduction. Ce bref article fournit 3 recommandations qui aideront au corps professoral à aborder cette section et à la rédiger de manière adéquate, ce qui peut être utile lors de la rédaction d'autres sections de manuscrits et de demandes de subventions.

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.

Thinking ecologically about clinical education in dentistry.

Traditional approaches to clinical education (CE) in dentistry have primarily focused on the needs and interests of students (student-centred), patients (patient-centred) or individuals receiving care (person-centred). Research has shown that giving priority to the interests of one stakeholder (eg students) may negatively affect the interests of others (eg patients, instructors and administrators). In this commentary, we discuss some limitations of traditional approaches to CE and suggest an eco-centred approach that assumes that the interests of all stakeholders must be considered when planning CE due to the interdependent relationships between stakeholders. A description of this new approach is provided, whilst research and innovation are encouraged to develop an ecologically informed system of CE.

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.

Taking the Reins on Systems of Care for ST-Segment-Elevation Myocardial Infarction Patients: A Report From the American Heart Association Mission: Lifeline Program.

BACKGROUND: Early success with regionalization of ST-segment-elevation myocardial infarction (STEMI) care has led many states to adopt statewide prehospital STEMI hospital destination policies, allowing emergency medical services to bypass non-percutaneous coronary intervention-capable hospitals. The association between adoption of these policies and patterns of care among STEMI patients is unknown. METHODS AND RESULTS: Using data from January 1, 2013, to December 31, 2014, from the National Cardiovascular Data Registry and Acute Coronary Treatment and Intervention Outcomes Network Registry, 6 states with bypass policies (cases included Delaware, Iowa, Maryland, North Carolina, Pennsylvania, and Massachusetts) were matched to 6 states without bypass policies (controls included South Carolina, Minnesota, Virginia, Texas, New York, and Connecticut) a priori on region, hospital density, and percent state participation in the registry. Using the matched sample, logistic regression models were adjusted for patient- and state-level characteristics. Outcomes were receipt of reperfusion and receipt of timely percutaneous coronary intervention. Our study cohort included 19 287 patients at 379 sites across 12 states. Patients from states with hospital destination policies were similar in age, sex, and comorbidities to patients from states without such policies. After adjustment for patient- and state-level characteristics, 57.9% (95% confidence intervals, 53.2%-62.5%) of patients living in states with hospital destination policies when compared with 47.5% (95% confidence intervals, 43.4%-51.7%) living in states without hospital destination policies received primary percutaneous coronary intervention within their relevant guideline-recommended time from first medical contact. CONCLUSIONS: Statewide adoption of STEMI hospital destination policies allowing emergency medical services to bypass non-percutaneous coronary intervention-capable facilities is associated with significantly faster treatment times for patients with STEMI.

Dental Hygiene Students' Clinical Skill Acquisition: Activity theory and the use of videos.

Purpose: Entry-level students in dental hygiene programs have already demonstrated a level of academic success; however they often struggle with the acquisition of psychomotor skills. Recognizing that traditional course materials were not addressing the needs of entry level dental hygiene students, instructional videos were produced to demonstrate clinical skills. The purpose of this study was to investigate students' perception of instructional videos and their impact on the learning environment in regards to students' experiences of skills acquisition.Methods: Online surveys were distributed to all students (n=84) in the fall semesters of 2015 (n=42) and 2016 (n=42). Responses from the surveys were analyzed qualitatively, utilizing an activity theory framework, to identify the impact of instructional videos on the learning environment. The activity theory framework involves the encapsulation of the learning environment that is mediated by tools and situated in a community where a learning activity is carried out to achieve an outcome.Results: Response rates were 76% (n=32) and 69% (n=29), respectively. Student responses concluded that the videos were very or extremely helpful, with 84% (n=27) in 2015 and 79% (n=23) in 2016. Students made comments on the usefulness of the videos and gave suggestions for future improvements. In addition, the comments demonstrated that students found the videos helpful for review purposes and for overall stress reduction associated with the process of psychomotor skill acquisition.Conclusion: Results from this study demonstrate the positive impact instructional videos have on the acquisition of psychomotor skills even within the dynamics of a small class size. Videos can also be utilized as an on-demand review tool that can be accessed before clinical evaluation processes, reducing student stress and providing a level of clarification to support student success.

The effects of caloric restriction on health and longevity.

OPINION STATEMENT: There is increasing evidence that restricting caloric intake may have considerable health benefits in humans. Significant evidence in non-primate animals demonstrates that caloric restriction increases average and maximal life span. However, historically, caloric intake reduction in humans has been involuntary and accompanied by poverty, malnutrition, poor sanitation, and a lack of modern health care. As a result, caloric restriction in people typically has been accompanied by a reduction of both average and maximal life span. Conversely, improvements in standards of living usually are accompanied by an increased food supply and resultant improved health and longevity. The majority of the world is now in a new era where an abundance of caloric intake and its associated obesity are causing widespread chronic illness and premature death. What would happen if one were to institute caloric restriction with high-quality nutrition within an environment of modern sanitation and health care? This review argues that improved health and improved average life span would quite likely result. A lengthening of maximal human life span with this combination is perhaps possible but by no means certain.

Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population?

BACKGROUND: Studies indicate that adverse drug events (ADEs) are common and costly. It appears that the elderly are at greater risk of ADEs because they use more medications, have less specific presentations, and have more chronic conditions than younger populations. OBJECTIVE: The goal of this study was to determine if the number of physicians prescribing medications to an elderly patient was associated with that patient's likelihood of reporting an ADE. METHODS: This cohort study was a secondary analysis of data collected from a previous survey of Medicare managed care enrollees aged > or =65 years at the time of enrollment. A telephone survey of residents in the Philadelphia, Pennsylvania, area was conducted. Data included self-reported information on the number of prescribing physicians, chronic conditions, medications, ADEs, and general health status. RESULTS: A total of 405 patients (mean [SD] age, 74 [5.1] years) were included in the study. Enrollees had a mean (SD) of 2.9 (1.3) prescribing physicians, and 98 (24%) patients reported having experienced an ADE in the previous 6 months. The mean (SD) number of self-reported chronic medical conditions and number of prescription medications was 4.7 (2.4) and 4.0 (2.8), respectively. In a multivariable logistic regression model, each additional provider prescribing medications increased the odds of reporting an ADE by 29% (odds ratio [OR], 1.3; 95% CI, 1.0-1.6). The number of chronic health conditions was also associated with ADEs. Having 4 or 5 self-reported chronic conditions doubled a person's odds of experiencing an ADE (OR, 2.1; 95% CI, 1.0-4.1) and having > or =6 conditions tripled the likelihood of experiencing an ADE (OR, 3.4; 95% CI, 1.6-6.9). The number of prescription medications or taking a potentially contraindicated medication was not significantly associated with self-reported ADEs. CONCLUSIONS: In this study population, the number of prescribing physicians was an independent risk factor for patients self-reporting an ADE. More research is needed to confirm and explain this finding. One possibility is poor communication between multiple providers. Physicians should work to ensure more effective coordination of care between providers and communicate information about all medications prescribed to their patients with their colleagues.