Is There a Correlation Between Comprehensive Basic Science Examination and United States Medical Licensure Examination Step 1 Performance Among Oral and Maxillofacial Surgery Residents?

PURPOSE: Oral and maxillofacial surgery (OMS) applicant Comprehensive Basic Science Examination (CBSE) scores are scrutinized by residency programs and medical schools because of their perceived predictive value for United States Medical Licensure Examination (USMLE) Step 1 performance. The purpose of this study was to answer the following question: Is there a correlation between the OMS applicant's CBSE score and his or her later USMLE Step 1 score? MATERIALS AND METHODS: We e-mailed all current 45 dual-degree OMS residency programs to request participation in the study. Participating programs submitted residents' CBSE scores and USMLE Step 1 scores. RESULTS: Of 45 United States-based, dual-degree OMS residency programs, 23 (51%) enrolled in the study, including data for 152 residents from 2012 to 2018. The mean CBSE score was 71 (range, 47 to 99). The mean USMLE Step 1 score was 220 (range, 177 to 266). The Pearson correlation coefficient for the relationship between the CBSE and USMLE Step 1 scores was 0.36. The overall USMLE pass rate was 97%. On the USMLE Step 1, OMS residents outperformed their translated CBSE score by an average of 15 points. Of the 50 residents (33%) with a translated CBSE score below the passing level, 94% passed the USMLE Step 1. Residents who had a translated passing CBSE score outscored residents with a translated failing score by 14 points when taking the USMLE Step 1 (225 vs 211). CONCLUSIONS: Although no statistically significant difference in the USMLE Step 1 pass rates was found between OMS residents with a translated passing CBSE score and those with a translated failing CBSE score, a weak positive correlation was noted between CBSE and USMLE Step 1 scores. These data do not support the use of a certain cutoff CBSE score for OMS applications by OMS program directors, especially as it pertains to interview offers.

Infection prevalence and patterns in self-inflicted gunshot wounds to the face.

OBJECTIVE: Self-inflicted gunshot wounds (SIGSWs) to the craniomaxillofacial region are uncommon injuries but are associated with a high mortality rate. Therefore, treating these patients is a rare occurrence even in the largest trauma centers. As with many rare conditions, data specifically addressing this injury pattern are scarce. Because of the proximity of the blast, even low-velocity injuries can be associated with significant avulsion of tissue, comminution of structures, and tissue die back. Previous case reports have recommended the use of prophylactic antibiotics, but no study has specifically investigated the postinjury infection rate or microbial patterns in this patient population. The purpose of this study was to answer the following clinical question: "Among patients with SIGW to the maxillofacial region, what is the prevalence of postinjury infection, and are there any microbial patterns that can guide empiric antibiotic selection?" STUDY DESIGN: We designed retrospective cohort study at a level I trauma center in Portland, Oregon. Data on 17 patients who had sustained a SIGSW involving the maxilla or the mandible and survived their initial injury were collected from 2010 to 2017. RESULTS: Patients who had a culture-positive infection within 30 days of their injury were defined to have a postinjury infection. Six of the 17 patients (35%) developed a postinjury infection, with an average time to infection of 11 days from initial injury (range 3-19 days). Of the 17 subjects, 15 (88%) received a course of prophylactic antibiotics, on average, for 14 days (range 3-24 days). Of the 6 cases of postinjury infection, culture grew gram-negative bacteria in 4 cases-anaerobic bacteria in 2 and polymicrobial organisms in 2. There was no clear pattern or prevalence of any specific bacterium, but cultures notably included Staphylococcus aureus, Enterobacter species, Bacteroides species, and Escherichia coli. CONCLUSIONS: SIGSWs are associated with a high rate of postinjury infection (35%) despite prophylactic antibiotic usage in 88% of these cases. Given the antimicrobial patterns observed in this study, prophylactic antibiotics in this patient population should include empiric coverage for gram-negative and anaerobic bacteria.

The Effect of Oral and Maxillofacial Surgery Curriculum on United States Medical Licensing Examination Step 1 Performance.

PURPOSE: Over the years, a few types of combined oral and maxillofacial surgery (OMS)-MD residency curricula have evolved that differ in how the MD is integrated. The purpose of this study was to look for a difference in United States Medical Licensure Examination (USMLE) Step 1 pass rates among these different curricula. MATERIALS AND METHODS: An anonymous electronic survey was e-mailed to the directors of all 46 United States-based OMS-MD-integrated programs, querying OMS curriculum type and USMLE Step 1 results over the years 2007-2017. Programs were then characterized by the curriculum sequence, whether USMLE Step 1 was taken before or after starting medical school, and the amount of dedicated test preparation time. RESULTS: Of 46 OMS-MD program directors, 32 (70%) responded. No statistically significant difference in the USMLE Step 1 pass rate was found among the 4 main types of OMS-MD curricula (range, 89 to 95%; P = .06). Completing some part of medical school before taking USMLE Step 1 also had no effect on OMS residents' pass rates (94% vs 92%, P = .23). However, an increasing number of weeks of dedicated test preparation time was significantly correlated with increasing USMLE Step 1 pass rates (87% with no dedicated test preparation time, increasing to 96% with ≥6 weeks of dedicated test preparation time; P = .05). Finally, only 7 of 806 total residents (0.9%) dropped out of a program because of the inability to pass USMLE Step 1. CONCLUSIONS: The data show a high overall USMLE Step 1 pass rate with a direct correlation between the duration of dedicated test preparation time and pass rate. No difference in USMLE Step 1 pass rates was observed based on the sequence of OMS-MD-integrated curricula or the completion of some pre-USMLE medical school before USMLE Step 1 among OMS residents.

Controversies in Microvascular Maxillofacial Reconstruction.

The effectiveness and reliability of microvascular reconstruction for large defects in the head and neck is no longer disputed. However, many controversies still persist in the ideal perioperative management of patients undergoing free tissue transfer. The optimal method of postoperative monitoring, the use of vasoconstrictors in the perioperative period, and the use of anticoagulants in the postoperative period remain topics of debate. This article offers recommendations on each of these controversies based on a review of the current literature.

Morbidity and Functional Outcomes With Head and Neck Free Flap Reconstruction in Patients Aged 90 Years or Older.

PURPOSE: Morbidity of free tissue transfer in the extremes of age is controversial and not well studied in patients aged 90 years or older because of the rarity of these patients and many clinicians' natural hesitancy to perform such a large operation in patients of this group. The purpose of this study was to answer the following clinical question: Do patients aged 90 years or older who undergo free flap reconstruction have worse functional outcomes than their younger counterparts? MATERIALS AND METHODS: We performed a retrospective chart review of patients aged 90 years or older who underwent free flap reconstruction at Oregon Health and Science University Hospital from 2000 to 2015. All patients aged 90 years or older undergoing free flap reconstruction were included. Patients younger than 90 years during the same period were randomly selected to serve as controls. RESULTS: Free flap reconstructions were performed in 14 patients aged 90 years or older, who were then compared with their randomly selected controls. The only statistically significant difference observed in the outcome variables analyzed was the location of discharge from the hospital, with the older patients more likely to be discharged to a skilled nursing facility (P = .002). However, there was no difference in return-to-baseline level of care at last follow-up between the 2 groups. There also was no statistically significant difference in major or minor medical or surgical complication rates, duration of hospitalization, duration of tracheostomy, return to baseline respiratory status, or return to baseline feeding status between the 2 groups. CONCLUSIONS: Patients aged 90 years or older are more likely to be discharged to a skilled nursing facility than their younger counterparts, but otherwise have similar outcomes in terms of complications and return to baseline function. The results of this study suggest that age 90 years or older should not be a direct contraindication for free flap reconstruction in the head and neck.

Impact of the NBDE grading change on postgraduate admissions processes.

The aim of this study was to assess the effect of discontinuing the reporting of National Board Dental Examination (NBDE) Part I numerical scores on postgraduate program directors' admissions selection processes. This cross-sectional survey-based study collected information about two admissions cycles (2012-13 and 2013-14) from directors of American Dental Education Association Postdoctoral Application Support Service (ADEA PASS(SM)) programs in all postdoctoral training disciplines; the response rate was 54.5%. According to the 2012-13 cycle results, these program directors rated an NBDE Part I score the third most important part of an application, behind grade point average (GPA) and class rank (ranked first and second, respectively). In the 2013-14 cycle, in the absence of an NBDE Part I score, almost all other parts of the application increased in importance for the responding directors, but the relative rank of factors remained almost unchanged. Significantly, 71% of the directors reported that it was now more difficult to select interview candidates, and 76% said they wanted some form of national, numerically scored exam. No significant change was noted between the two years in the number of applications or interviews offered per resident position, although the standard deviation of the number of interviews offered increased in both pediatric dentistry and postdoctoral general dentistry.

The impact on dental students of changes to the National Board Dental Examination grading system.

The purpose of this study was to assess how the change to pass/fail grading of the National Board Dental Examination (NBDE) Part I has impacted dental students' study habits and their perspectives on pursuit of postdoctoral specialty education. This cross-sectional survey-based study included over 75 percent of U.S. dental schools and a total of 1,843 responses. This sample was 18.5 percent of all potentially eligible U.S. dental students. Participating schools distributed the electronic survey to their last class to take the NBDE Part I for a numerical score and the first class to take the NBDE Part I pass/fail. Respondents who took the exam for a numerical score and were interested in a specialty reported studying the most (average 167 hours) compared to respondents who took the exam pass/fail (average 114 hours). Respondents who took the exam pass/fail and reported feeling that this change decreased their chances of getting into a specialty program outnumbered those who thought the change increased their chances (3:1). This study observed a correlation between the recent grading changes to the NBDE Part I and decreased reported study time. Eighty percent of the respondents preferred a standardized, objective measure to help differentiate them when applying to specialty programs, and the majority reported feeling that the change in grading practices negatively affected their chances of pursuing a specialty.

Novel PI3Kγ mutation in a 44-year-old man with chronic infections and chronic pelvic pain.

A 44-year-old man is presented here with 14 years of chronic purulent sinusitis, a chronic fungal rash of the scrotum, and chronic pelvic pain. Treatment with antifungal therapy resulted in symptom improvement, however he was unable to establish an effective long-term treatment regimen, resulting in debilitating symptoms. He had undergone extensive work-up without identifying a clear underlying etiology, although Candida species were cultured from the prostatic fluid. 100 genes involved in the cellular immune response were sequenced and a missense mutation was identified in the Ras-binding domain of PI3Kγ. PI3Kγ is a crucial signaling element in leukotaxis and other leukocyte functions. We hypothesize that his mutation led to his chronic infections and pelvic pain.

Lingual and inferior alveolar nerve injuries after third molar removal.

Trigeminal nerve injury is a rare, but serious complication of a common procedure, which results in a clinically relevant problem that deserves attention. The emergence of microsurgical repair of trigeminal injury has provided clinicians with treatment options for patients who experience persistent neurosensory deficits. The area of microsurgical repair of trigeminal nerves is now in its adolescence. While great strides have been made in the field since its conception, it is certain that a new generation of oral and maxillofacial surgeons wil bring further progress to the field. In the future, better quantitative sensory testing methods, more accurate imaging modalities, and advances in surgical technique will certainly improve the management of patients with impacted third molars. As clinicians, every day we are confronted with the management of impacted third molars. It is important to evaluate each patient individually with an appropriate clinical and radiographic exam. Every patient should be informed of the relative risks and benefits of third molar removal and a joint decision should be reached between the clinician and patient regarding ideal treatment. However, even with ideal management, complications will occur. If a patient does present with signs of a nerve injury the clinician should carefully document the neurosensory deficit and monitor the patient over time. If the patient exhibits a significant sensory deficit for more than one month a referral for evaluation to a tertiary care center capable of surgical repair of the injury is recommended. The occurrence of a "trigger" or Tinel's like sign is improtant as an indication for surgery but may not occur for a month after injury.

Therapeutic intervention for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta-analysis.

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been treated with several different interventions with limited success. This meta-analysis aims to review all trials reporting on therapeutic intervention for CP/CPPS using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). METHODS: We searched Medline, PubMed, the Cochrane Pain, Palliative & Supportive Care Trials, the Cochrane Register of Controlled Trials, CINAHL, ClinicalTrials.gov, and the NIDDK website between 1947 and December 31, 2011 without language or study type restrictions. All RCTs for CP/CPPS lasting at least 6 weeks, with a minimum of 10 participants per arm, and using the NIH-CPSI score, the criterion standard for CP/CPPS, as an outcome measure were included. Data was extracted from each study by two independent reviewers. Gillbraith and I-squared plots were used for heterogeneity testing and Eggers and Peters methods for publication bias. Quality was assessed using a component approach and meta-regression was used to analyze sources of heterogeneity. RESULTS: Mepartricin, percutaneous tibial nerve stimulation (PTNS), and triple therapy comprised of doxazosin + ibuprofen + thiocolchicoside (DIT) resulted in clinically and statistically significant reduction in NIH-CPSI total score. The same agents and aerobic exercise resulted in clinically and statistically significant NIH-CPSI pain domain score reduction. Acupuncture, DIT, and PTNS were found to produce statistically and clinically significant reductions in the NIH-CPSI voiding domain. A statistically significant placebo effect was found for all outcomes and time analysis showed that efficacy of all treatments increased over time. Alpha-blockers, antibiotics, and combinations of the two failed to show statistically or clinically significant NIH-CPSI reductions. CONCLUSION: Results from this meta-analysis reflect our current inability to effectively manage CP/CPPS. Clinicians and researchers must consider placebo effect and treatment efficacy over time and design studies creatively so we can more fully elucidate the etiology and role of therapeutic intervention in CP/CPPS.

What factors are associated with functional sensory recovery following lingual nerve repair?

PURPOSE: To identify factors associated with functional sensory recovery (FSR) after lingual nerve repair. MATERIALS AND METHODS: This retrospective cohort study was composed of subjects who underwent lingual nerve repair from 2004 through 2010. The predictor variables were demographic, anatomic, and operative measurements. The primary outcome measurement was FSR (ie, FSR achieved, yes or no). The secondary outcome measurements were time to FSR and an improvement of at least 2 levels on the British Medical Research Council scale of neurosensory function. Descriptive, bivariate, and multiple logistic regression statistics were computed to identify associations between the predictor variables and FSR. A Cox proportional hazards model was used to identify associations between the predictors and time to FSR. P ≤ .05 was considered statistically significant. RESULTS: The sample was composed of 55 subjects with a mean age of 30.7 ± 11.2 years. The mean duration from injury to repair was 151.6 days (range, 41 to 384 days). Most patients (74.5%) achieved FSR postoperatively, with a mean time to FSR of 262.8 days (median, 208 days). Eighty-six percent of subjects showed an improvement of at least 2 levels on the British Medical Research Council scale. In multiple regression models, younger subjects were more likely to achieve FSR (odds ratio, 1.10; 95% confidence interval, 1.01 to 1.18; P = .02); subjects with better preoperative neurosensory function achieved FSR faster (hazard ratio, 1.9; 95% confidence interval, 1.2 to 3.1; P = .01). CONCLUSION: Most patients undergoing lingual nerve repair achieved FSR. Younger subjects were more likely to achieve FSR. Subjects with better preoperative neurosensory function achieved FSR faster.

Minimum data elements for research reports on CFS.

Chronic fatigue syndrome (CFS) is a debilitating condition that has received increasing attention from researchers in the past decade. However, it has become difficult to compare data collected in different laboratories due to the variability in basic information regarding descriptions of sampling methods, patient characteristics, and clinical assessments. The issue of variability in CFS research was recently highlighted at the NIH's 2011 State of the Knowledge of CFS meeting prompting researchers to consider the critical information that should be included in CFS research reports. To address this problem, we present our consensus on the minimum data elements that should be included in all CFS research reports, along with additional elements that are currently being evaluated in specific research studies that show promise as important patient descriptors for subgrouping of CFS. These recommendations are intended to improve the consistency of reported methods and the interpretability of reported results. Adherence to minimum standards and increased reporting consistency will allow for better comparisons among published CFS articles, provide guidance for future research and foster the generation of knowledge that can directly benefit the patient.