Comparative Analysis of Quality of Life of Patients with Dermatological Problems: Teledermatology Versus Face-to-Face Dermatology.

The health-related quality of life (HRQoL) of the patients cared for with teledermatology (TD) services was analyzed as compared with face-to-face dermatology (F-F/D) at the hospital. This study was a controlled, non-blinded, intra-level, and multicenter randomized clinical trial, with a 6-month follow-up. A total of 450 patients were randomly assigned to two different groups. The Spanish version of the generic EuroQol-5-dimensions-5-Levels (EQ-5D-5L) questionnaire and the specific Skindex-29 questionnaire were used at 0 and 6 months. The number of primary care visits (2.24 TD; 1.68 F-F/D) and number of hospital visits (0.01 TD; 1.48 F-F/D) were statistically significant. It was observed that from month 0 onwards, the users included in the F-F/D group self-perceived a lower HRQoL than the users included in the TD group (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). At the end of the study, the patients included in the F-F/D group still obtained lower scores in their perception of HRQoL, as compared to those included in the other type of follow-up (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). TD was an effective diagnosis and follow-up tool. At the end of the study period, the HRQoL of the patients in both groups was significantly higher as compared to their baseline levels. Additionally, both the general and specific HRQoL perceived by the TD patients was higher than the F-F/D group from the start of the study.

Patients' Experiences and Communication with Teledermatology versus Face-to-Face Dermatology.

(1) Background: Teledermatology (TD) has exponentially grown since the onset of COVID-19, as the Face-to-Face Dermatology (F-F/D) modality changed within Public Health Systems. Although studies have been conducted on health results, we did not find any that analyzed the experiences of individuals who received care through TD. Therefore, the main objective of the study was to analyze the experiences of dermatology patients and the communication with health personnel. (2) Methods: A multicenter, controlled, randomized, non-blinded clinical trial was designed. Data were collected during the six months of follow-up. Four-hundred and fifty patients participated in the present study, who were assigned to two different groups: TD and F-F/D. The sociodemographic and clinical characteristics of the participants were collected. The 'Generic Short Patient Experiences Questionnaire' (GS-PEQ) was used to assess patients' experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. (3) Results: After six months of follow-up, 450 patients completed the study (TD = 225; F-F/D = 225) of which 53.3% were women, with an average age of 52.16 (SD = 19.97). The main reasons for the consultations were skin lesions (51.56%) located on the head and neck (46.8%), followed by the legs (20.7%). According to the GS-PEQ, TD users indicated having a greater confidence in the professional skills of the doctors (p < 0.01). However, the F-F/D group indicated having received more adequate information about their diagnosis/afflictions (p < 0.01), were more involved in the decisions related to their treatment (p < 0.01), and more satisfied with the help and treatment received (p < 0.01). Regarding the HCCQ, the TD group obtained better assessments with respect to if the patients had been treated in a rude and hasty manner, if the health professionals had addressed them with a smile, and if these could adequately manage the reason for the consultation (p < 0.01). (4) Conclusions: The results of the study generally showed positive experiences and communication. The TD group indicated having received less information about the diagnosis, were less involved in the decisions, and were less satisfied with the help and treatment received. However, they indicated having more confidence on the professional skills of the doctors, and that the work at the institution was better organized. In addition, they perceived better communication skills of the health professionals, although less respect for their privacy.

Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems.

(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34-55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.

Improving Humanization Skills through Simulation-Based Computers Using Simulated Nursing Video Consultations.

During the COVID-19 confinement, we converted our clinical simulation sessions into simulated video consultations. This study aims to evaluate the effects of virtual simulation-based training on developing and cultivating humanization competencies in undergraduate nursing students. A quasi-experimental study was conducted with 60 undergraduate nursing students. A validated questionnaire was used to evaluate the acquisition of humanization competencies (self-efficacy, sociability, affection, emotional understanding, and optimism). The development of humanization competencies in this group composed of undergraduate nursing students was evaluated using virtual simulation-based training, comparing the levels obtained in these competencies at baseline (pre-test) and after the virtual simulation experience (post-test). After the virtual simulation sessions, students improved their levels in humanization total score and the emotional understanding and self-efficacy competencies, obtaining large effects sizes in all of them (rB = 0.508, rB = 0.713, and rB = 0.505 respectively). This virtual simulation modality enables training in the humanization of care with the collaboration of standardized patients in the form of simulated nursing video consultations and the performance of high-fidelity simulation sessions that comply with the requirements of best practices. Therefore, this methodology could be considered as another choice for virtual simulation. Additionally, this virtual modality could be a way to humanize virtual simulation.

Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study.

The use of telemedicine has greatly increased, largely derived from the COVID-19 pandemic, which has created the need for a guide aimed towards the adequate management of a modality of health care: the video consultation. A Delphi study composed of three rounds was conducted with 16 experts in holding video consultations and managing non-technical skills from different specialties and nationalities to conceive a consensus on the criteria needed for properly managing video consultations by healthcare professionals. The consensus criteria were defined by three dimensions (preparation of video consultation, video consultation process, and post-video consultation) and their corresponding items. Excellent consensus data was obtained; therefore, use is recommended by any healthcare professional who is going to utilize a video consultation, in order to manage it effectively.

Surgical extrusion with biologically oriented preparation: An alternative to extraction.

Surgical extrusion should be considered as an alternative treatment in patients with structurally compromised teeth that retain coronal integrity and have favorable root anatomy. The procedure described is straightforward and can be performed quickly. A situation in which it was used to treat a maxillary premolar with substantial structural loss but well-preserved periodontal attachment is presented. The biologically oriented preparation technique is a conservative method of tooth restoration.

Cone-beam Computed Tomographic Study of Root Anatomy and Canal Configuration of Molars in a Spanish Population.

INTRODUCTION: The aim of this study was to identify morphologic peculiarities of roots and analyze the root canal configuration in maxillary and mandibular first and second molars by means using cone-beam computed tomographic (CBCT) imaging in a Spanish population. METHODS: A total of 284 maxillary molars and 242 mandibular molars from 112 patients were examined in vivo by CBCT imaging; only untreated molars with healthy and fully matured apices were included in this study. Details regarding the number of roots, number of canals, and root canal configuration were recorded. RESULTS: Maxillary first and second molars had 3 roots in 97.2% and 79%, respectively. In mandibular molars, the frequency of 2 roots was 94% in first molars and 83% in second molars. The canal configuration of the palatal root was 100% Vertucci type I (1-1) in first and second molars. The distobuccal root showed a Vertucci type I configuration in 97% of first and 100% of maxillary second molars. The mesiobuccal root for first molars showed a Vertucci type II configuration (2-1) in 56.5% cases and Vertucci type IV (2-2) in 23.2%. For maxillary second molars, the Vertucci type I configuration reached 52.7%. In mandibular molars, the mesial root showed higher variability. Most frequent was the presence of 2 canals, Vertucci type II for first and second molars. In the distal root, the most common configuration was Vertucci type I in both molars. CONCLUSIONS: The greater percentage of fused roots was observed in maxillary molars. Vertucci type II configuration was more frequent than type IV in the mesial root of mandibular molars and the mesiobuccal root of maxillary molars. A third canal in the mesial root of first mandibular molars (6.7%) was higher than expected.

Use of melatonin in oral health and as dental premedication.

Anxiety is a common problem in dentistry which could affect the correct treatment and involve failure. Oral premedication is needed to treat several anxious patients. Many people are so highly anxious that oral sedation is not effective and need to be under deep sedation or even general anaesthesia in order to receive dental care. In these patients, due to a high level of anxiety, even the insertion of an intravenous catheter can be difficult. Benzodiazepines have been the most commonly used anxiolytic in these cases, but many may be associated with paradoxical reactions. Melatonin has a good potential to be used in this field as alternative to benzodiazepines because it may induce a natural sleepiness and improve sedation. The purpose of this paper was to summarize what is known about the use of melatonin in oral health and as dental premedication in anxious dental patients. Databases were searched for the relevant published literature to 30 April 2015. The following search items were used in various combinations: melatonin, premedication, anxiety, dental, sedation and anaesthesia. Few articles were found about this aspect, and the use of melatonin is still a controversial aspect in dental field. More detailed/specific studies are necessary to extend the therapeutic possibilities of melatonin as premedication in dentistry.

Bacterial leakage in root canals filled with AH Plus and dentine bonding agents.

OBJECTIVE: The aim of this study was to compare the efficacy of different dentine adhesives in delaying the coronal bacterial leakage of Enterococcus faecalis in filled root canals. Materials and methods. Ninety-five lower incisors of patients >65 years of age were instrumented using the ProTaper system and were irrigated with 1 mL of 2.5% sodium hypochlorite (NaOCl) alternated with 1 mL 17% EDTA between each file change. Final irrigation was performed with 5 mL of 17% EDTA and then flushed with 5 mL of distilled water. The teeth were randomly divided into five experimental groups (n = 15/group) and one of the following dentine adhesives was applied: (1) AdheSE; (2) Excite DSC; (3) Clearfil Protect Bond; (4) One Coat 7.0; or (5) Control group without adhesive. After filling the root canals, the samples were mounted on a double chamber device to evaluate the bacterial filtration of E. faecalis during a period of 240 days. The results underwent non-parametric Kaplan-Meier survival analysis and comparisons among groups were done using the Log-Rank test. RESULTS: At 240 days, E. faecalis was detected in samples of all groups in the lower chamber. The highest survival value was obtained by One Coat 7.0, giving statistically significant differences from the other groups, whereas Clearfil Protect Bond, AdheSE and Excite DSC showed similar behaviours, likewise similar to the Control group. CONCLUSIONS: One Coat 7.0 adhesive system provides the longest survival value to delay E. faecalis coronal leakage in filled root canals.

Decalcifying effects of antimicrobial irrigating solutions on root canal dentin

Objective: The aim of this study was to determine the decalcifying efficacy of 7% maleic acid (MA), 2% chlorhexidine (CHX), and combinations of 7% MA + 0.2% cetrimide (CTR) and 2% CHX + 0.2% CTR, in four time periods. Study Design: Four specimens per tooth were obtained from a 2-mm thick slice of the cervical third of the root of ten human incisors. At 1, 2, 3 and 5 minutes of immersion, the concentrations of Ca2+ were measured by atomic absorption spectrophotometry. The results were analyzed using the Mann-Whitney U-test. Results: Statistically significant differences were seen for the extracted calcium in all time periods. The amount of calcium extracted by 7% MA was the highest at all four immersion times, followed by 7% MA + 0.2% CTR. Two percent CHX and its combination with 0.2% CTR extracted virtually no calcium. Conclusions: The decalcifying capacity of 7% MA and 2% CHX diminished when combined with 0.2% CTR (AU)

No disponible

Decalcifying effects of antimicrobial irrigating solutions on root canal dentin.

OBJECTIVE: The aim of this study was to determine the decalcifying efficacy of 7% maleic acid (MA), 2% chlorhexidine (CHX), and combinations of 7% MA + 0.2% cetrimide (CTR) and 2% CHX + 0.2% CTR, in four time periods. STUDY DESIGN: Four specimens per tooth were obtained from a 2-mm thick slice of the cervical third of the root of ten human incisors. At 1, 2, 3 and 5 minutes of immersion, the concentrations of Ca2+ were measured by atomic absorption spectrophotometry. The results were analyzed using the Mann-Whitney U-test. RESULTS: Statistically significant differences were seen for the extracted calcium in all time periods. The amount of calcium extracted by 7% MA was the highest at all four immersion times, followed by 7% MA + 0.2% CTR. Two percent CHX and its combination with 0.2% CTR extracted virtually no calcium. CONCLUSIONS: The decalcifying capacity of 7% MA and 2% CHX diminished when combined with 0.2% CTR.

Comparación de sellado apical de técnica gutapercha termoplastificada a baja temperatura y condensación lateral con dos conos maestros diferentes / Apical seal comparison of low-temperature thermoplasticized gutta-percha technique and lateral condensation with two different master cones

Objetivo: comparar el sellado apical en conductos mesio-vestibulares de molares obturados con gutapercha termoplastificadaa baja temperatura o con técnica de condensación lateral usando un cono maestro de gutapercha de conicidad .06 o .02. Como objetivo secundario se evaluó la penetración del espaciador en los conductos cuando se utilizó un cono de conicidad .02 o .06.Metodología: cuarenta y cuatro conductos mesio-vestibulares curvos (25-40º) fueron preparados con instrumentos rotatorios del niquel-titanio de conicidad .06 y distribuidos aleatoriamente en dos grupos control (n=4) y tres grupos experimentales (n=12) para obturarlos con el sistema Ultrafil® 3D o técnica de condensación lateral de gutapercha en frío con conos maestros de conicidad .06 o.02. AH-Plus fue utilizado como cemento sellador. La profundidad de penetración del espaciador fue registrada en milímetros. Las raíces fueron cubiertas con dos capas de barniz de uñas, sumergidas en tinta china durante 7 días, seccionadas transversalmente y examinadas con un estereomicroscopio. Para determinar si existían diferencias en la penetración del espaciador entre grupos se utilizó el test de la T de Student. La prueba de Kruskal-Wallis fue utilizada para determinar si existían diferencias en la penetración del tinte.Resultados: no hubo diferencias en la microfiltración entre los tres grupos de estudio (p= 0.396), que mostraban una media muy similar (0.42. 0.75 y 0.42). La comparación de la profundidad de penetración del espaciador en los grupos obturados mediante condensación lateral fue significativamente superior cuando se usó un cono de conicidad .02 (p= 0.001).Conclusión: el sistema Ultrafil®3D y la técnica de condensación lateral de la gutapercha con conos maestros de conicidad.06 o .02 fueron igualmente eficaces en el sellado apical de conductos curvos. El espaciador penetró en el conducto significativamente más cuando se empleó un cono de conicidad .02

Aim: To compare the apical sealing in mesio-buccal canals of extracted molars obturated with low-temperature thermoplasticizedgutta-percha or cold lateral condensation techniques using a .06 or a .02 mm/mm tapered gutta-percha master cone. The secondary aim was to evaluate the depth of spreader penetration in root canals using a .06 or a .02 mm/mm tapered gutta-percha master cone.Methodology: Forty-four mesio-buccal curved canals (25-40º) were instrumented with .06 nickel-titanium rotary instrumentsand randomly distributed into two control groups (n=4) and three experimental groups (n=12) for obturation by the Ultrafil® 3D system or by cold lateral condensation with .06 or .02 tapered master cone. Canal sealer AH-Plus® was used. The depth of spreader penetration was recorded in millimetres. Roots were covered with two layers of nail polish, immersed in India ink for 7 days, transversally sectioned and examined with a stereomicroscope. Student’s t test was used to determine whether there was a difference in spreader penetration between groups. Kruskal-Wallis test was used to determine whether there was a difference in leakage.Results: There were no differences among the three groups (p=0.396), which showed a very similar mean microleakage (0.42, 0.75 and 0.42). The difference in spreader penetration between the groups filled by cold lateral condensation was significant (p=0.001)Conclusion: The Ultrafil® 3D system and cold lateral condensation techniques with .06 or .02 tapered master cones were equally effective in the apical sealing of curved canals. The spreader penetrated deeper using a .02 mm/mm tapered gutta-percha master cone

Apical seal comparison of low-temperature thermoplasticized gutta-percha technique and lateral condensation with two different master cones.

AIM: To compare the apical sealing in mesio-buccal canals of extracted molars obturated with low-temperature thermoplasticized gutta-percha or cold lateral condensation techniques using a .06 or a .02 mm/mm tapered gutta-percha master cone. The secondary aim was to evaluate the depth of spreader penetration in root canals using a .06 or a .02 mm/mm tapered gutta-percha master cone. METHODOLOGY: Forty-four mesio-buccal curved canals (25-40 degree) were instrumented with .06 nickel-titanium rotary instruments and randomly distributed into two control groups (n=4) and three experimental groups (n=12) for obturation by the Ultrafil 3D system or by cold lateral condensation with .06 or .02 tapered master cone. Canal sealer AH-Plus was used. The depth of spreader penetration was recorded in millimetres. Roots were covered with two layers of nail polish, immersed in India ink for 7 days, transversally sectioned and examined with a stereomicroscope. Student s t test was used to determine whether there was a difference in spreader penetration between groups. Kruskal-Wallis test was used to determine whether there was a difference in leakage. RESULTS: There were no differences among the three groups (p=0.396), which showed a very similar mean microleakage (0.42, 0.75 and 0.42). The difference in spreader penetration between the groups filled by cold lateral condensation was significant (p=0.001) CONCLUSION: The Ultrafil 3D system and cold lateral condensation techniques with .06 or .02 tapered master cones were equally effective in the apical sealing of curved canals. The spreader penetrated deeper using a .02 mm/mm tapered gutta-percha master cone.

The effectiveness of different acid irrigating solutions in root canal cleaning after hand and rotary instrumentation.

The goal of this study was to evaluate the cleaning ability of three acid irrigating solutions after hand and rotary instrumentation. Eighty human teeth were randomly divided in eight groups. Four groups were prepared with hand instrumentation and other four with ProTaper. The irrigating solutions were 15% citric acid plus 2.5% NaOCl; 15% EDTA plus 2.5% NaOCl; 5% orthophosphoric acid plus 2.5% NaOCl; and 2.5% NaOCl alone as control. Canal walls were observed with scanning electron microscopy, and photomicrographs were taken in apical, middle, and coronal thirds. A scoring system for debris and smear layer was used. Acid solutions with 2.5% NaOCl were effective in the elimination of smear layer or debris, and no significant differences were showed in smear layer removal between techniques. However, 2.5% NaOCl did not remove smear layer or debris, and no significant differences in debris were observed between manual and rotary techniques.