Interprofessional education in dental education: An international perspective.

Interprofessional collaborative care (IPC) is defined as working within and across healthcare disciplines and is considered essential to achieve a more inclusive, patient-centred care, provide a means to support patient safety and address global healthcare provider shortages. Interprofessional education (IPE) provides the knowledge and experience students need to achieve these goals. ADEE/ADEA held a joint international meeting 8-9 May 2017, with IPE being one of four topic areas discussed. The highly interactive workshop format, where "everyone was an expert," supported discussion, sharing and creative problem-solving of over seventy-one participants from twenty-nine countries. IPE participants broke out into five groups over a two-day period discussing three main areas: challenges and barriers to implementing IPE within their institution or country; discussion of successful models of introducing and assessing IPE initiatives, and exploring best practices and next steps for implementation for each group member. A mind-mapping model was used to graphically display participants' thoughts and suggestions. Key themes, revealed through the visual mind maps and discussion, included the following: IPE should lead to and enhance patient-centred care; student involvement is key to IPE success; faculty development and incentives can facilitate adoption and implementation of IPE; the role of a "champion" and leadership structure and commitment is important to move IPE forward; and IPE must be tailored to the unique issues found in each country. Overall, there was a high level of interest to continue both collaboration and discussion to learn from others beyond the London meeting.

The Opioid Analgesic Reduction Study (OARS) Pilot: A Double-Blind Randomized Multicenter Trial.

BACKGROUND: With addiction rates and opioid deaths increasing, health care providers are obligated to help stem the opioid crisis. As limited studies examine the comparative effectiveness of fixed-dose combination nonopioid analgesia to opioid-containing analgesia, a comparative effectiveness study was planned and refined by conducting a pilot study. METHODS: The Opioid Analgesic Reduction Study (OARS) pilot, a stratified, randomized, multisite, double-blind clinical trial, was designed to test technology and procedures to be used in the full OARS trial. Participants engaged in the full protocol, enabling the collection of OARS outcome data. Eligible participants reporting to 1 of 5 sites for partial or full bony impacted mandibular third molar extraction were stratified by biologic sex and randomized to 1 of 2 treatment groups, OPIOID or NONOPIOID. OPIOID participants were provided 20 doses of hydrocodone 5 mg/acetaminophen 300 mg. NONOPIOID participants were provided 20 doses of ibuprofen 400 mg/acetaminophen 500 mg. OARS outcomes data, including pain experience, adverse effects, sleep quality, pain interference, overall satisfaction, and remaining opioid tablets available for diversion, were collected via surveys, electronic medication bottles, eDiary, and activity/sleep monitor. RESULTS: Fifty-three participants were randomized with 50 completing the OARS pilot protocol. Across all outcome pain domains, in all but 1 time period, NONOPIOID was better in managing pain than OPIOID (P < 0.05 level). Other outcomes suggest less pain interference, less adverse events, better sleep quality, better overall satisfaction, and fewer opioid-containing tablets available for diversion. DISCUSSION: Results suggest patients requiring impacted mandibular third molar extraction would benefit from fixed-dose combination nonopioid analgesia. KNOWLEDGE TRANSFER STATEMENT: Study results suggest fixed-dose nonopioid combination ibuprofen 400 mg/acetaminophen 500 mg is superior to opioid-containing analgesic (hydrocodone 5 mg/acetaminophen 500 mg). This knowledge should inform surgeons and patients in the selection of postsurgical analgesia.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies.

OBJECTIVES: To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs). METHODS: A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping). RESULTS: SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01). CONCLUSIONS: Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings. KNOWLEDGE TRANSFER STATEMENT: Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Continuous ambulatory peritoneal dialysis. Technique of catheter insertion and management of associated surgical complications.

Fifty-seven patients initiated continuous ambulatory peritoneal dialysis. All patients were generally pleased with this form of dialysis and particularly enjoyed the greater mobility and decreased dietary restriction. Complications associated with continuous ambulatory peritoneal dialysis include peritonitis, pericatheter infection, catheter malfunction, dialysate leak, and hernias of the abdominal wall.

Urinary mercury levels before and after amalgam restoration.

Urinary mercury levels and excretion rates were measured to determine the effect of dental amalgam restoration on the mercury body burden. No consistent increase in urinary mercury concentrations was found among subjects who had a single restoration, but a continuously increasing statistically significant (P < 0.05) trend, that was 33% above background levels, was detected between 9 and 12 days after restoration, in the subject with four restorations in a single day. The current findings suggested that even though amalgam restorations can cause an increase in mercury body burden, the elevation above background levels is small and thus the risks associated with the use of this material are considered minimal for the general population.

Pilot study on the feasibility of a computerized speech recognition charting system.

The objective of this study was to determine the feasibility of developing and using a voice recognition computerized charting system to record dental clinical examination data. More specifically, the study was designed to analyze the time and error differential between the traditional examiner/recorder method (ASSISTANT) and computerized voice recognition method (VOICE). DMFS examinations were performed twice on 20 patients using the traditional ASSISTANT and the VOICE charting system. A statistically significant difference was found when comparing the mean ASSISTANT time of 2.69 min to the VOICE time of 3.72 min (P less than 0.001). No statistically significant difference was found when comparing the mean ASSISTANT recording errors of 0.1 to VOICE recording errors of 0.6 (P = 0.059). 90% of the patients indicated they felt comfortable with the dentist talking to a computer and only 5% of the sample indicated they opposed VOICE. Results from this pilot study indicate that a charting system utilizing voice recognition technology could be considered a viable alternative to traditional examiner/recorder methods of clinical charting.

The Rural Dental Health Program: long-term impact of two dental delivery systems on children's oral health.

This paper addresses the long-term effect of two dental delivery systems established during the Rural Dental Health Program (RDHP) in 1975. At that time 725 children in grades K-2 were assigned randomly to an enriched dental health education program or regular health education program and to a SCHOOL- or COMMUNITY-based dental delivery system. Seven years after funding for RDHP ended, children originally assigned to the COMMUNITY group utilized more professional services and showed a higher level of dental knowledge than children assigned to the SCHOOL group. In addition, COMMUNITY-based children had, on average, twice as many sealed teeth. While the follow-up study did not reveal any statistically significant difference in the clinical oral health indices (DMFS, gingival index, calculus index, plaque index, periodontal probing depth, and orthodontic treatment priority index) the COMMUNITY-based children's higher level of professional dental service utilization, greater number of sealed teeth, and increased dental knowledge should lead to a higher level of oral health in the long run.

Impact of quality assurance program: providing practice assessment.

Participation in a self-administered quality assessment (SAQA) program led to changes in New Jersey dentists' perceptions of practice quality. Ninety-four percent indicated they discovered practice deficiencies. This study suggests that using a self-administered quality assessment program, such as the SAQA program, can lead to a better understanding of a practice's strengths and weaknesses.

Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection.

No comprehensive national study has ever been completed on the oral health status of people with disabilities, their patterns of use of oral health services and access-to-care barriers. The authors describe the Special Olympics, Special Smiles program, conducted as part of the New Jersey Summer Special Olympics Games, and assess a pilot-tested model for collecting epidemiologic data. The results of this initial data collection are also compared with the goals of the U.S. Public Health Service, as outlined in the Healthy People 2000 publication.

Financial planning and computer modeling in dental practice.

The financial plan describes the practice's financial strategy, projects the strategy's future effect on the practice, and establishes goals by which the practice's manager can measure subsequent performance. The act of putting together a financial plan is called the financial planning process. It is a process that consists of analyzing the practice; projecting future outcomes of decisions that have to be made regarding finances, investments, and day to day operations; deciding which alternatives to undertake; and measuring performance against goals that are established in the financial plan. Computer financial planning models can aid the practice manager in projecting future outcomes of various financial, investment, and operational decisions. These models can be created inexpensively by noncomputer programmers with the aid of computer software on the market today. The financial planning process for a hypothetical practice was summarized, and the financial model used to test out various alternatives available to the practice was described.

Comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. A two-year caries clinical trial on children in New Jersey and Puerto Rico.

PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.

An application of outcomes assessment in dental education.

The outcomes assessment process developed by the New Jersey Dental School is described. The paper identifies required resources, presents selected outcome measures, reviews strengths and weaknesses of the process, and reports how ongoing assessment activities have evolved. Documentation produced as part of the outcomes assessment process is also described, allowing health professions schools to implement a similar process.

Implementing and evaluating a patient instructor program.

A Patient Instructor (PI) program designed to improve students' data-gathering and interpersonal skills is evaluated. Each student in two consecutive classes of third-year students (class of 1996, n = 60; class of 1997, n = 72) interviewed four patient instructors (PIs) during a three-hour rotation. Each PI portrayed one of six scenarios. PIs assessed students using content checklists and an abbreviated Arizona Clinical Interview Rating Scale (ACIR). After the interview, each PI gave student constructive feedback regarding interpersonal behavior and ability to identify salient content items from the patient's history. Significant improvement was observed on content checklists (p < 0.01) between the first and second rounds. Significant improvement was also noted on the ACIR (p < 0.01) between rounds one, two and three. The results indicate that data-gathering and interpersonal skills can be enhanced by using patient instructors. Student evaluation of the program was positive.

Community-based dental programs: University of Medicine and Dentistry of New Jersey-New Jersey Dental School.

The dental school plans to incorporate CODE into the curriculum so that more students have community-based dental educational experiences. Future plans also include increasing standardization of reports, clinical and administrative procedures, resources, and processes across the sites in order to lower managerial overhead. This process will be aided by further enhancement of computerized information systems and electronic links. The major lesson learned is that new extramural programs can be created and sustained by pooling school resources with those from the private and public sectors. Funding sources and opportunities available to one party alone are insufficient. While one-time funding was used to build and furnish the NJDS extramural sites, the clinics were established only after business plans demonstrated the availability of funds to sustain their operations. The Statewide Network of Community Oral Health Care and CODE models are still evolving, but they are replicable not only in dental education but in other types of health services. The details of the partnerships and funding streams will vary from site to site, but through outreach and careful negotiation with potential partners and detailed contracts, the community service and educational missions of a health professions school can have a successful outcome.

Impact of Phase I Pew National Dental education Program on U.S. schools of dental medicine.

This paper presents the results of four telephone surveys conducted by the Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, as part of its evaluation of the Pew National Dental Education Program (PNDEP), a five year, +4F8.7 million program established by The Pew Charitable Trusts to help dental schools respond to the changing health care environment. The four annual surveys were conducted between 1985 and 1988. The interviews were conducted with the deans from nearly all dental schools operating in the United States at the time of study or the principal investigators of the schools funded under Phase I and Phase II PNDEP grants. Their purpose was to determine the level of each school's involvement in PNDEP and in specific strategic planning activities, as well as to evaluate the impact of the Pew Program on both the individual schools and dental education nationwide. All systematic differences between schools funded (FD) PNDEP and those not funded (NFD) were examined. Overall, schools gained a better understanding of their environment. Schools also reported increased participation in and commitment to planning among their different constituencies (e.g., faculty, administration, students, alumni). By the end of Phase I, more PNDEP Phase I funded schools reported being involved in implementing strategic plans. Funded schools also were more likely to report PNDEP increased their understanding of strategic planning, improved communication, and helped encourage the emergence of new leaders.

[Multicenter study of intracoronary stent implantation in Rio de Janeiro]. / Estudo multicêntrico do implante de stent intracoronário no Rio de Janeiro.

PURPOSE: To evaluate retrospectively stent implantation (SI) in patients with coronary artery disease (CAD) performed in 7 hospitals in Rio de Janeiro. METHODS: From June/94 to December/96 2,220 procedures were performed among which we analyzed 783 SI in 660 (29.7%) patients using coronary angiography without digital subtraction. Several types of stents were used: Palmaz-Schatz (40.9%), Gianturco-Roubin (29.1%) e NIR (22.0%). Indications for SI: 1--de novo lesion (67.9%); 2) restenotic lesion (16.0%); 3) sub-optimal results after PTCA (8.2%); 4) abrupt or threatened closure after PTCA (4.9%); 5) chronic occlusion (3.0%). All stents were implanted using high pressure balloon inflation without intracoronary ultrasound guidance. Sub-acute stent thrombosis prevention, in the majority of patients (87.8%) was done with ticlopidine and aspirin. RESULTS: Early outcome: a) the success rate of SI in 770 lesions was 98.0% in 646 (97.9%) patients; b) the clinical success rate in 634 patients was 96.0%; c) the major complications were acute myocardial infarction (1.1%); coronary artery bypass graft (1.4%) and death (0.8%); d) vascular complications with surgical correction and/or bleeding occurred in 3.0%. Late outcome: a) the clinical follow-up of 399 (60.4%) and the coronary angiographies of 121 patients (30.3%) showed in-stent lesion in 79 (19.8%); b) other event rates: myocardial infarction (1.5%); coronary bypass (2.3%); death: 1.0% and other PTCA or similar procedure (12.5%). CONCLUSION: This multicentric study showed that SI for CAD can be performed with safety, high early success rate, few complications and low rate of cardiac events during the late follow-up.

[Tricuspid catheter-balloon valvuloplasty. Report of 4 cases]. / Valvoplastia tricúspide por cateter balão. Relato de quatro casos.

Tricuspid stenosis was treated in four patients by percutaneous balloon valvotomy. A mean pressure gradient equal or higher than 3 mmHg across the tricuspid valve using Doppler echocardiography and the increase of this pressure gradient during inspiration were the most significant criteria for diagnosis and quantification of tricuspid stenosis. There was a considerable hemodynamic improvement with reduction of the tricuspid valve gradient and relief of symptoms after balloon tricuspid valvotomy.

[Cardiac performance and hemodynamic response under the effect of isoproterenol and D-isosorbitol in patients with dilated cardiomyopathy]. / Desempenho cardíaco e resposta hemodinâmica sob ação do isoproterenol e D-isosorbitol em portadores de miocardiopatia dilatada.

The authors studied cardiac performance of 36 patients with dilated cardiomiopathy through cardiac catheterization and left ventriculography in comparison with a control group. It has been verified that the end systolic volume (ESV) is more sensitive than ejection fraction (EF) as an indicator of the presence and degree of systolic dysfunction. Isoproterenol (IP) (18 patients) and D-isosorbitol (IS) (18 patients) have been used in the evaluation of hemodynamic response of DM. It has been verified equivalent responses such as: 1--decrease of ESV and end diastolic pressure (EDP); 2--increase of stroke volume and EF. The contractility indexes of left ventricle, however, showed different responses to the 2 substances: 1--with IP there was an increase of peak dp/dt and common peak isovolumetric pressure (CPIP 45 mmHg); 2--with IS there was no variation. The authors conclude that: 1--IP or similar drugs may be used during cardiac catheterization to evaluate the contractile reserve of the myocardium; 2--IS may be used in ambulatorial treatment of DM to improve ventricular function through a tendency to normalize intracardiac pressure-volume relation.