Trueness and precision of complete arch dentate digital models produced by intraoral and desktop scanners: An ex-vivo study.

OBJECTIVES: The study aimed to compare the trueness and precision of five intraoral scanners (Emerald S, iTero Element 5D, Medit i700, Primescan, and Trios 4) and two indirect digitization techniques for both teeth and soft tissues on fresh mandibular and maxillary cadaver jaws. METHODS: The maxilla and mandible of a fully dentate cadaver were scanned by the ATOS industrial scanner to create a master model. Then, the specimens were scanned eight times by each intraoral scanner (IOS). In addition, 8 polyvinylsiloxane (PVS) impressions were made and digitized with a Medit T710 desktop scanner. Stone models were then poured and again scanned with the desktop scanner. All IOS, PVS, and stone models were compared to the master model to calculate the mean absolute surface deviation for mandibular teeth, maxillary teeth, and palate. RESULTS: For mandibular teeth, the PVS trueness was only significantly better than the Medit i700 (p < 0.001) and Primescan (p < 0.05). In maxillary teeth, the PVS trueness was significantly better than all IOSs (p < 0.05-0.001); the stone trueness was significantly better than Emerald S (p < 0.01), Medit i700 (p < 0.001) and Primescan (p < 0.01). In the palate, PVS and stone trueness were significantly lower than the iTero Element 5D (p < 0.01) and Trios 4 (p < p < 0.01). Stone trueness was significantly lower than the Medit i700 (p < 0.05). The precision in the palate was significantly lower for PVS and stone than for Emerald S (p < 0.01, p < 0.05), iTero Element 5D (p < 0.01, p < 0.01), Primescan (p < 0.001, p < 0.001), and Trios 4 (p < 0.001, p < 0.01). Significant differences in trueness between the IOSs were observed only in the mandibular teeth. The Medit i700 performed worse than Emerald S (p < 0.01) and iTero Element 5D (p < 0.01). For mandibular teeth, the Medit i700 was significantly more precise than Primescan (p < 0.01) and the Emerald S (p < 0.05). The Trios 4 was significantly less precise than Emerald S (p < 0.05). The precision of Medit i700 was significantly worse than iTero Element 5D (p < 0.01) for maxillary teeth, as well as the Primescan (p < 0.01) and Trios 4 (p < 0.05) for the palate. CONCLUSIONS: In general, indirectly digitized models from PVS impressions had higher trueness than IOS for maxillary teeth; precision between the two methods was similar. IOS was more accurate for palatal tissues. The differences in trueness and precision for mandibular teeth between the various techniques were negligible. CLINICAL SIGNIFICANCE: All investigated IOSs and indirect digitization could be used for complete arch scanning in mandibular and maxillary dentate arches. However, direct optical digitization is preferable for the palate due to the low accuracy of physical impression techniques for soft tissues.

Prevalence of and risk factors for depression among female Syrian refugees and Jordanians with chronic disease: a pilot study.

BACKGROUND: Chronic disease and depression are primary contributors to morbidity among displaced and local populations. AIMS: This study aims to address the prevalence for and risk factors of comorbid depression among Jordanian and Syrian women with known chronic disease. METHODS: To provide evidence for mental health intervention planning, we conducted a cross-sectional survey to investigate determinants of depression among female Syrian refugees and Jordanians with chronic disease living in Amman. A total of 272 female Syrian refugees and Jordanians with chronic disease were recruited from 4 clinics across Amman from June to August 2017. We compared demographic and health characteristics and depression level and identified predictors of depression via multivariable ordinal regression. RESULTS: Moderate to high levels of depression were reported in 55.9% of the participants, with a prevalence of 41.1% among Jordanians and 70.6% among Syrians. Syrians with chronic disease had 2.73 times greater odds of higher levels of depression than their Jordanian peers. After adjusting for age, income, spouse employment status, gastrointestinal or genitourinary disorder status, and perceived self-efficacy, Syrians were not at significantly greater odds of reporting higher levels of depression. Risk factors for higher depression levels included having an unemployed spouse, diagnosis of gastrointestinal or genitourinary disorder and low perceived self-efficacy. CONCLUSION: Depression is frequently comorbid with chronic physical conditions and has a deleterious impact on health status. Mental health interventions and chronic disease management tailored to differences among local and displaced communities may reduce disease burden and disability.

Exploring the bidirectional relationship between chronic disease and depression among female Syrian refugees and Jordanians: a qualitative analysis.

BACKGROUND: Nearly 700 000 Syrian refugees currently reside in Jordan. Chronic disease and neuropsychiatric conditions are leading contributors of morbidity among refugee and host communities. The bidirectional relationship between depression and chronic disease is not well studied among displaced Syrian or Jordanian women. AIMS: This qualitative study explores the bidirectional relationship between chronic illness and comorbid depression, as well as related themes, among Jordanian and Syrian women with known chronic disease-populations that receive medical care through distinct and evolving health care structures-to assist providers and policy makers in creating culturally sensitive interventions. METHODS: Forty Jordanian women and Syrian refugees with chronic disease were interviewed at four clinical settings in Amman, Jordan. Data collection occurred from June-August 2017. Content analysis was completed with Dedoose, a qualitative coding software. RESULTS: The majority of Syrian women endorsed a relationship between their chronic disease and depression. Some women felt too depressed to take medication for chronic conditions, while others felt depression contributed to chronic illnesses. Syrian women reported less perceived social support than Jordanian women. Although some Syrians were unable to afford medications, they reported fewer negative health care experiences than Jordanians. Both populations endorsed female-specific hardships impacting their mental health, including the demands of motherhood, household duties, and marital strife. CONCLUSION: This study explores the intersection of depression and chronic disease among Syrian and Jordanian women. By documenting stressors and experiences accessing health care, mental health and chronic disease interventions can be integrated and tailored to these populations.

Evaluating the Impact of Student-run Asylum Clinics in the US from 2016-2018.

Individuals applying for asylum must demonstrate a well-founded fear of persecution. By documenting signs of torture and other forms of abuse, medical evaluations can provide forensic evidence to support asylum claims. The backlog of pending immigration cases in the United States recently exceeded one million. Student-run asylum medicine clinics conduct forensic evaluations to assist in the asylum adjudication process. The Physicians for Human Rights National Student Advisory Board administered surveys to student-run clinics in the US in 2017 and 2018. Retrospective analysis evaluated the completion rates of forensic evaluations, caseload capacities, and training frequencies. Student-run asylum clinics completed 38.8% more forensic evaluations in 2017 than in 2016. In 2016, 33% of clinics received forensic evaluation requests that exceeded their capacity, a figure that rose to 50% in 2017. The number of clinicians trained by asylum clinics increased nearly fourfold between 2016 and 2017, and the number of students trained grew by 81%. A recent surge in armed conflict has contributed to record numbers of asylum applications in the US. The results of this survey reveal the burgeoning capability of student-run asylum clinics to provide evaluations, a trend that underscores medical students' ability to significantly impact human rights issues. Student-run asylum clinics are poised to fill an increasingly important role in supporting victims of torture and persecution.

Patient-Controlled Analgesia for Cancer-Related Pain: Clinical Predictors of Patient Outcomes.

Background: Patient-controlled analgesia (PCA) is an effective approach to treat pain. However, data regarding patterns of PCA use for cancer pain are limited. The purpose of this study was to define the patterns of PCA use and related outcomes in hospitalized patients with cancer. Methods: We identified 90 patients with cancer admitted to a single academic center who received PCA for nonsurgical, cancer-related pain and survived to discharge between January 2013 and January 2014. Data collected included patient demographics, cancer diagnosis, type of cancer-related pain, PCA use, opioid-specific adverse events, and 30-day readmission rates for pain. Univariable and multivariable linear regression models were used to analyze the association between patient and clinical variables with PCA duration. Logistic regression models were used to evaluate the relationship between patient and clinical variables and 30-day readmission rates. Results: The median length of hospitalization was 10.2 days with a median PCA duration of 4.4 days. Hematologic malignancies were associated with longer PCA use (P=.0001), as was younger age (P=.032). A trend was seen toward decreased 30-day readmission rates with longer PCA use (P=.054). No correlation was found between 30-day readmission and any covariate studied, including age, sex, cancer type (solid vs hematologic), pain type, palliative care consult, or time from PCA discontinuation to discharge. Conclusions: This study suggests that there is longer PCA use in younger patients and those with hematologic malignancies admitted with cancer-related pain, with a trend toward decreased 30-day readmission rates in those with longer PCA use.