Does the white coat influence satisfaction, trust and empathy in the doctor-patient relationship in the General and Family Medicine consultation? Interventional study.

OBJECTIVES: To understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation. SETTING: An interventional study was conducted with a representative sample of the population attending primary care in central Portugal. PARTICIPANTS: The sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included. INTERVENTIONS: Every other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the 'Trust in physician' scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician. OUTCOMES: Planned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation. RESULTS: The sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001). CONCLUSIONS: There was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID number: NCT03965416.

Análise imuno-histoquímica das proteínas RANK, RANKL e OPG em dentes de ratos reimplantados / Immunohistochemical analysis of the RANK protein, RANKL and OPG teeth reimplanted in rats

O sistema RANK/RANKL/OPG contribui para a compreensão do processo e regulação da formação e reabsorção do osso, tendo sido o maior avanço na biologia óssea com relação a osteoclastogênese. RANKL e OPG inibem RANK regulando a formação, ativação e sobrevivência de osteoclastos na remodelação óssea. O objetivo desse estudo foi investigar a expressão dos marcadores RANKL/RANK/OPG em dentes de ratos reimplantados, bem como observar a relação entre a expressão desses marcadores com o processo de reabsorção dentária e óssea. Foram utilizados 30 incisivos superiores direitos de 30 ratos machos, adultos, da linhagem Wistar (Rattus norvegicus albinus). Os dentes foram avulsionados e divididos em dois grupos que permaneceram extra-alveolar em ar seco: G1 (n=15) - 5 minutos e G2 (n=15) - 60 minutos, e em seguida foram reimplantados e analisados nos intervalos de 1, 3 e 7 dias. Finalizado os períodos experimentais, ocorreu a eutanásia dos animais. Cortes longitudinais com 5μm de espessura foram obtidos e corados pela técnica H/E para a análise histológica e cortes com 3μm de espessura foram submetidos à reação imuno-histoquímica mediante a utilização de anticorpos primários para ratos como OPG, RANK e RANKL. Os resultados demonstraram que o sistema RANK/RANKL/OPG participa ativamente, tanto do processo de reparo de dentes de ratos reimplantados, quanto das reabsorções dentárias e ósseas; que RANKL apresentou maior imunomarcação em ambos os grupos, participando em todas as fases da reabsorção óssea e dentária; e o aumento da expressão de RANKL foi observada em ambos os grupos em todos os intervalos de tempo, comprovando que a resposta inflamatória no ligamento periodontal ocorre no início do processo de reparo; e que a fraca expressão de RANK e OPG e o aumento da expressão de RANKL sugere uma diminuição da reabsorção ativa e aumento da reabsorção reparada no osso e no cemento, sendo maior no osso.

The RANK / RANKL / OPG sy stem plays an important role in bone formation and resorption . This finding has been regarded as one of the m ost important advances in the understanding of bone biology with respect to osteoclastogenesis. The aim of this study was to investigate the expression of RANKL / RANK / OPG markers in reimplanted teeth of rats, and to observe the relationship between the expression of these markers and tooth and bone resorption. Thirty male Wistar rats (Rattus norvegicus albinos) had their maxillary right incisors extrac ted, and were divided into 2 groups acted teeth were kept y air before reimplantation: G1 (n = 15) - 5 minutes, and G2 (n = 15) - 60 minutes . After reimplantation, teeth were analyzed at intervals of 1, 3 and 7 da ys. After these experimental periods, the animals were euthanized. Longitudinal sections with 5μm thick were obtained and stained with Hematoxylin and Eosin for histological analysis, while 3μm thick sections were subjected to immunohistochemical analysis of OPG, RANK and RANKL. The results showed that the RANK / RANKL / OPG system actively participates in both the repair process, as well as tooth and bone resorption . Extra - alveolar time of 60 minutes before replantation caused minor expressions of RANKL and OPG, not influencing the expression of RANK; RANKL immunostaining showed higher in both groups when compared to other biomarkers, participating in all phases of bone and tooth resorption; RANKL was associated to both osteoclastogenesi and cellular proliferation, and was expressed in both groups.

Comparison of Endodontic Retreatment in Teeth Obturated With Resilon or Gutta-Percha: A Review of Literature.

INTRODUCTION: Retreatment of endodontically treated teeth is a challenge that requires complete removal of the previous filling material. Several techniques are indicated for this procedure. The present review tries to identify the most efficient method for extirpation of Resilon (RS) root fillings and to compare the speed and efficacy of RS and gutta-percha (GP) root filling removal. METHODS AND MATERIALS: Three trained evaluators conducted a search through three major databases (PubMed, Cochrane Library and Lilacs) over the articles published in the period from 2001 to 2014. The search keywords were Epiphany Sealer, Resilon, Retreatment and Removal Procedure. RESULTS: Twelve articles were included in the final sample (three in vitro studies and nine randomized trials). CONCLUSION: The ProTaper (manual or rotatory) system in combination with chemical solvents is the most efficient method for removing Resilon root filling. Retreatment of Resilon is more rapid and associated with less remnants of debris.

Perfil de acadêmicos de Odontologia sobre biossegurança / Profile of dental students about biosafety

Objetivo: A formação do profissional da Odontologia requer preparo e esclarecimento quanto ao uso das medidas universais de biossegurança em virtude da exposição a agentes infectocontagiosos. Este estudo descritivo teve como objetivo avaliar o nível de conhecimento de uma população de acadêmicos de Odontologia a respeito de biossegurança, além de identificar as dúvidas mais frequentes sobre medidas preventivas no ambiente odontológico e avaliar o interesse desses acadêmicos em relação ao tema biossegurança. Materiais e métodos: A amostra foi constituída por 358 alunos de três universidades. Foi aplicado um questionário contendo perguntas objetivas e subjetivas em alunos dos 1º, 5º e últimos períodos. Resultados: Observou-se que 92.6% dos alunos conheciam o significado de biossegurança e 92.3% relatou o uso de EPI pelo seu CD e para o paciente. Frente a um atendimento na clínica, 291 (82.7%) alunos responderam que saberiam se cuidar e 59 (16.8%) que não, sendo 94.9% destes últimos, alunos do primeiro período. Entre os alunos do primeiro período, 38.4% responderam não ser importante considerar o paciente como potencial portador de doença. Conclusões: Conclui-se que, é importante ministrar conteúdos básicos sobre biossegurança nos períodos pré-clínicos, visando a entrada dos alunos às atividades clínicas com maior segurança. Ressalta-se ainda a importância da fiscalização e atualização periódicas de práticas, e conhecimentos das medidas preventivas adequadas que permitam o exercício de atividades acadêmicas em segurança em todos os períodos do curso.

Aim: The professional formation in Dentistry requires preparation andknowledge regarding the use of universal biosafety measures againstexposure to infectious agents. This descriptive study aimed to evaluate the level of knowledge of dentistry students about biosafety, and identify the most frequent doubt about preventive measures in dental care environment, also assess the student’s interest bybiosafety. Material and methods:The sample consisted of 358 students from three universities. A questionnaire with subjective and objective questionswas applied to students at 1st, 5th and last periods. Results: It was observed that 92.6% of students knew themeaning of biosafety and 92.3% reported the use of PPE for their dentist and for the patient. When as ked if theywould know to take care in clinicalenvironment, 291 (82.7%) students answered that they would know how to care and 59 (16.8%) not, 94.9% of the latter were students of the first period, in this group, 38.4% of students responded not be important to consider the patient as a potential transmitter ofdisease. In the total sample, 98.6% considered to be important the topic of the research. Conclusions: It was concluded that it is important introduce basic content on biosafety in the pre-clinical periods, aimin g at the entry of students to the clinical activities moresafely. It is emphasized the importance of supervision and periodic update of practices and knowledge about preventive measures facilitating the exercise of academic activities in safety at all course periods.