Declarative knowledge in oral health: The case of the term 'centric occlusion'.

INTRODUCTION: The lack of academic agreement in the practical or clinical use of declarative knowledge can generate unnecessary confusion and miscommunication. The concept Centric Occlusion (CO) is part of the body of declarative knowledge in dentistry, but its definition remains unclear. OBJECTIVE: To ascertain the CO concept in articles published in dental journals as a study case for the dentistry "corpus" of declarative knowledge. METHODOLOGY: The alternative definitions of CO used by the GPT (Glossary of Prosthodontic Terms) from 1956-1977, 'CO as a synonym for maximum intercuspal contact (MIC)', or by the GPT from 1987-2017, 'CO may or may not coincide with MIC', were searched in the articles. The association between the CO definition used and variables such as article aims, journal scope and authors specialty was assessed. RESULTS: Eight hundred and twelve articles were analysed. The widespread use of CO as synonym of MIC was the main finding and was significantly associated to the Orthodontics field. The CO definition according to the GPT 1987-2017 was less frequently observed but appeared in all dentistry fields, showing a significant association with the Oral Rehabilitation field. The difficulty of incorporating the current definition of CO (by GPT) into the main clinical discussions was evidenced all the long of the review process. CONCLUSION: The lack of consensus in the concept use was confirmed by the present study case, showing the influence of specific fields in Oral Health declarative knowledge. This methodology can provide a tool to the academy to assess controversial terms or concepts in Oral Health education, thus facilitating the critical and reflexive learning by students.

[Proposal of an informed consent form to obtain audiovisual material from patients]. / Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico.

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Smart System with Artificial Intelligence for Sensory Gloves.

This paper presents a new sensory system based on advanced algorithms and machine learning techniques that provides sensory gloves with the ability to ensure real-time connection of all connectors in the cabling of a cockpit module. Besides a microphone, the sensory glove also includes a gyroscope and three accelerometers that provide valuable information to allow the selection of the appropriate signal time windows recorded by the microphone of the glove. These signal time windows are subsequently analyzed by a convolutional neural network, which indicates whether the connection of the components has been made correctly or not. The development of the system, its implementation in a production industry environment and the results obtained are analyzed.

Mind the Gap: a Competency-Based Scoping Review of Aesthetic and Reconstructive Reported Simulation Training Models.

BACKGROUND: Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. METHODS: Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. RESULTS: A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. CONCLUSIONS: This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Organizational and welfare mode of breast centers network: a survey of Sicilian radiologists.

The European Society of Breast Cancer Specialists has created quality indicators for breast units to establish the minimum standards of care for patients. In Italy, each region differs, indeed, in terms of health care and services warranted to patients suffering from breast cancer. Since Sicilian Regional Administration today is still disregarding implementation of the provisions contained in the proposal of the Ministry of Health entitled "Guidelines on Organizational and Health Care Methods of Breast Centers Network" in November 2015 the Sicilian Regional Group of the Italian Society of Radiology (SIRM) decided to carry out a survey to see the position of the Sicilian Healthcare System and define the gap to bridge over. Sicilian breast imaging radiologists were asked to fill in a questionnaire concerning the type of job relationship (public or private sector), qualification (Manager, Department Manager, Freelancer) and years of experience on breast imaging. With regard to technological requirements, were answered the questions about the number, type, age and completeness of accessories of the equipment supplied in the Sicilian healthcare facilities. The data showed that over 64% of breast imagers in Sicilian centers work in breast units, whereas only 18% are involved in screening programs. A majority of radiologists (81%) working in the breast health care system is very experienced (more than 10 years of experience in the field). The result provided concerning the medical and technical staff demonstrates an uneven situation, but overall an inadequate value compared with the required guidelines especially in interventional procedures. The aim of this paper is to illustrate the method used and the results obtained. These data have to be shared with policy makers to enhance quality improvement in Sicilian Breast Center Network.

Effectiveness of Intralesional Triamcinolone in the Treatment of Keloids in Children.

BACKGROUND: The current treatment of keloids includes surgery, intralesional steroids, and radiotherapy, among others. Radiotherapy is not recommended in children due to its effects on growing tissues. Our aim was to study intralesional triamcinilone therapy of keloids in children and analyze the impact of body location, age of the lesion, and etiology of the keloid on clinical response. METHODS: We conducted a prospective clinical trial with patients 1 to 14 years of age evaluated for keloid treatment. A soft tissue ultrasound was performed to measure the keloid volume, prior to intralesional infiltration with triamcinolone acetonide. A posttreatment ultrasound quantified the volume differences attributed to therapy. For the analysis, Mann-Whitney/Wilcoxon test for paired samples and a multiple regression analysis were performed. RESULTS: Twenty-one patients with a total of 25 keloids were enrolled, with a median age of 12 years (range 6-14 yrs). The initial lesional volume was 1.25 cc (range 0.2-6.3 cc) and the final volume was 0.2 cc (range 0.0-1.53 cc), corresponding to 82.7% of size reduction (p < 0.001). Regarding the relationships between response and body location, etiology and age of the lesion, the multiple regression analyses obtained p-values of 0.46, 0.16, and 0.87, respectively. One patient failed to improve. Average follow-up was 30 months. CONCLUSIONS: Triamcinolone acetonide is highly effective for the treatment of pediatric keloids. There is no relationship between clinical response and the factors evaluated, such as lesion location, etiology and age of the keloid.

Watch One, Do One? A Systematic Review and Educational Analysis of YouTube Microsurgery Videos, and a Proposal for a Quality Assurance Checklist.

Background Educational resources on the internet are extensively used to obtain medical information. YouTube is the most accessed video platform containing information to enhance the learning experience of medical professionals. This study systematically analyzed the educational value of microsurgery-related videos on this platform. Methods A systematic review was conducted on YouTube from April 18 to May 18, 2020, using the following terms: "microsurgery," "microsurgical," "microsurgical anastomosis," "free flap," and "free tissue transfer." The search was limited to the first 100 videos, and two independent reviewers screened for eligible entries and analyzed their educational value using validated scales, including a modified version of the DISCERN score (M-DISCERN), Journal of the American Medical Association (JAMAS) benchmark criteria, and the Global Quality Score (GQS). Evaluation of video popularity was also assessed with the video power index (VPI). Results Of 356 retrieved videos, 75 (21%) were considered eligible. The educational quality of videos was highly variable, and the mean global scores for the M-DISCERN, JAMAS, and GQS for our sample were consistent with medium to low quality. Conclusions A limited number of videos on YouTube for microsurgical education have high-educational quality. The majority scored low on the utilized criteria. Peer-reviewed resources seem to be a more reliable resource. Although the potential of YouTube should not be disregarded, videos should be carefully appraised before being used as an educational resource.

Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study.

Vasculopathy, immunological abnormalities, and excessive tissue fibrosis are key elements in the pathogenesis of progressive systemic sclerosis (SSc). Extracorporeal shock waves (ESW) have anti-inflammatory and regenerative effects on different tissues. We hypothesized that ESW can reduce endothelial cell damage and skin fibrosis in patients with SSc. We enrolled 30 patients affected by SSc, 29 females and 1 male. Rodnan Skin Score (RSS) and Visuo-Analogical Scale (VAS) for skin wellness were performed before and immediately after ESW therapy (ESWT) and at 7, 30, 60, and 90 days after the treatment. Sonographic examination of the patients' arms was performed before and 7, 30, 60, 90 days after treatment. Blood samples were obtained before and 30 and 60 days after treatment to measure serological levels of von Willebrand factor, vascular endothelial growth factor, intracellular adhesion molecule-1, monocyte chemotactic protein-1. The number of endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) were determined at the same time points. After ESWT we observed a rapid and persistent reduction of RSS and decrease of VAS. There was no difference in skin thickness before and after ESWT; however, we observed a more regular skin structure and an improvement in skin vascularization 90 days after treatment. EPCs and CECs increased 60 and 90 days after treatment, while serological biomarkers showed no variation before and after therapy. In conclusion, ESWT resulted in an improvement of VAS, RSS, and of skin vascular score, and in an increase of CECs and EPCs.

Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico / Proposal of an informed consent form to obtain audiovisual material from patients

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Action tagging in a multi-user indoor environment for behavioural analysis purposes.

EU population is getting older, so that ICT-based solutions are expected to provide support in the challenges implied by the demographic change. At the University of Parma an AAL (Ambient Assisted Living) system, named CARDEA, has been developed. In this paper a new feature of the system is introduced, in which environmental and personal (i.e., wearable) sensors coexist, providing an accurate picture of the user's activity and needs. Environmental devices may greatly help in performing activity recognition and behavioral analysis tasks. However, in a multi-user environment, this implies the need of attributing environmental sensors outcome to a specific user, i.e., identifying the user when he performs a task detected by an environmental device. We implemented such an "action tagging" feature, based on information fusion, within the CARDEA environment, as an inexpensive, alternative solution to the problematic issue of indoor locationing.

An Identification Procedure for Behavioral Analysis in a Multi-User environment.

As the average age of the EU population increases, ICT solutions are going to play a key role in order to find answers to the new challenges the demographic change is carrying on. At the University of Parma an AAL (Ambient Assisted Living) system named CARDEA has been developed during the last 10 years. Within CARDEA, behavioral analysis is carried out, based on environmental sensors. If multiple users live in the same environment, however, data coming from sensors need to be properly tagged: in this paper, a simple technique for such tagging is proposed, which exploits the same wireless transmission used for transmitting data, thus not requiring additional hardware components and avoiding more complex and expensive (radio)localization techniques. Preliminary results are shown, featuring a satisfactory accuracy.

Freshwater drowning in a child: A case study demonstrating the role of post-mortem computed tomography.

In recent years, modern imaging techniques have gained ground in forensics. A crucial question is whether virtual autopsy is capable of replacing traditional autopsy. Forensic diagnosis of freshwater drowning (FWD) is based on the evidence of findings from external inspection (e.g. frothy fluid exuding from the mouth and nostrils), internal examination (e.g. pulmonary congestion, enlargement of heart chambers) and biochemical analysis (haemodilution), findings which are non-specific. The detection of diatoms in organs of the systemic circulation may be of some assistance, but this analysis is rarely performed and is of debatable validity. An 18-month-old child was found dead at home in a swimming pool. Considering the family's wishes to avoid autopsy, the district attorney authorised a whole-body post-mortem computed tomography scan (PMCT). The main imaging findings were frothy fluid in the upper airways, fluid in the trachea and main bronchi, many pulmonary nodular ground glass opacities (GGO) in non-dependent regions and haemodilution. CT imaging did not show any other forensically relevant abnormality.A high concordance was found between the CT findings reported in the literature in cases of FWD and the imaging results. Thus, after the exclusion of other causes of death, advised by the forensic pathologist, the district attorney closed the case and the death was attributed to FWD. This case report demonstrates that PMCT imaging in cases of suspected FWD can provide some important findings for the diagnosis of FWD as the cause of death.

[Labor process and workers' health in charcoal production in Minas Gerais, Brazil]. / Processo de trabalho e saúde dos trabalhadores na produção artesanal de carvão vegetal em Minas Gerais, Brasil.

This study is a tentative approach to the relationship between environmental and occupational health and development in a specific situation: charcoal production in the Jequitinhonha Valley, the poorest region in the State of Minas Gerais, Brazil. The study focuses on the labor process, involving heavy exploitation, hazardous working conditions, and extremely precarious living conditions. Working conditions and activities are described and related to the workers' health situation. Social policies and decisive participation by the various social stakeholders are necessary to change this reality.

La seguridad del paciente en la formación del estudiante de odontología / Patient safety in undergraduate dental education

La presente comunicación se propone compartir con la comunidad educativa odontológica la importancia de la decisión y los fundamentos de incluir la enseñanza de los conceptos sobre seguridad del paciente en la formación de grado del futuro odontólogo (AU)

The purpose of this communication is to share with the dentistry educating community the importance of the decision and the fundamental for the inclusion of "patient safety" concepts in the undergraduate dental education curriculum (AU)

Shock wave over hand muscles: a neurophysiological study on peripheral conduction nerves in normal subjects.

BACKGROUND AND PURPOSE: shock waves are defined as a sequence of single sonic pulses largely used in the treatment of bone and tendon diseases and recently on muscular hypertonia in stroke patients. Our purpose is to investigate the short and long term effect of extra-corporeal shock wave therapy (ESWT) on the peripheral nerve conduction and central conductions from the treated muscles in normal human subjects in order to define safety criteria. METHODS: we studied 10 patients normal subjects. Motor and sensory nerve conduction velocity and F response from right ipothenar eminence (abductor digiti minimi) of the hand was recorded. Furthermore MEP latency and amplitude and central conduction from the same muscles by transcranial magnetic stimulation was evaluated. In all subjects each neurophysiological measures were monitored before, immediately after, 15 minutes and after 30 minutes from the active ESWT treatment (1600 shots with an energy applied of 0.030 mj/mm(2)). RESULTS: no significant short or long term changes were noted in sensory and motor peripheral nerve conduction and in central motor conduction in all the subjects evaluated after ESWT. CONCLUSIONS: the ESWT has no effect on sensory and motor peripheral nerve conduction and in central motor conduction. The ESWT using low level of energy represent a safety method for treating the muscles in human subjects without involvement of motor or sensory nervous trunks. Different mechanisms of action of ESWT are discussed.

Evaluación de la microcirculación con sidestream dark field (SDF) Microscan® como método de monitorización en microcirugía en modelo porcino / Microcirculation assessment with sidestream dark field (SDF) Microscan® as flap monitoring method in microsurgery in a porcine model

Objetivo: Determinar la factibilidad de la monitorización en microcirugía por medio de la evaluación no invasiva de la microcirculación con sidestream dark field (SDF) y compararla con otros métodos. Materiales y métodos: Estudio experimental. En 8 cerdos se elevó colgajo pectoral y se disecó pedículo. Se llevó a cabo una instalación sucesiva de dispositivos cutáneos para la evaluación de la microcirculación: SDF para evaluar flujo, y near infrared spectroscopy (NIRS) para evaluar saturación de O2 (SatO2). Posteriormente se evaluó la oclusión venosa, arterial y total con pinzamiento durante 180 s. Resultados: SDF en oclusión venosa: disminución del flujo: 51 s (59-62); SDF en oclusión arterial: disminución del flujo: 3 s (1-5); SDF en oclusión vascular total: disminución del flujo: 3,5 s (2-5). NIRS en oclusión venosa: disminución de la SatO2:15,2 ± 5,3%; NIRS en oclusión arterial: disminución de la SatO2 23,9 ± 13,8%; NIRS en oclusión vascular total: disminución de la SatO2 23,85 ± 13,9%. Doppler en oclusión venosa: no desapareció; Doppler en oclusión arterial y oclusión vascular total: desapareció a los 2 s. En cada una de las mediciones, los cambios clínicos fueron más tardíos que los observados con SDF. Conclusión: Es factible la monitorización en microcirugía por medio de la evaluación de la microcirculación con Microscan®. Este método permite realizar el diagnóstico de oclusión vascular más tempranamente que con NIRS y evaluación clínica.

Aim: Determine the feasibility of using SDF Microscan® as a non-invasive method for monitoring free flap microcirculation, and compare it to other methods. Materials and methods: Experimental study. In 8 pigs a pectoral myocutaneous flap was raised. Microcirculation was evaluated using: SDF Microscan®, near infrared spectroscopy (NIRS), clinical examination and Doppler. Venous, arterial and total occlusion was performed by clamping the vascular pedicle. Mean time to blood flow impairment diagnosis was measured. Results: SDF in venous occlusion: reduced microcirculatory flow index at: 51 s (59-62). SDF in arterial occlusion: reduced microcirculatory flow index at: 3 s (1-5). SDF in total vascular occlusion: reduced microcirculatory flow index at: 3.5 s (2-5). NIRS in venous occlusion: SatO2 decrease was 15.2 ± 5.3%. NIRS in arterial occlusion: SatO2 decrease was 23.9 ± 13.8%. NIRS in total vascular occlusion: SatO2 decrease was 23.85 ± 13.9%. Doppler in venous occlusion: The signal did not disappear. Doppler arterial and total vascular occlusion disappears at 2 s. The clinical changes were later than SDF. Conclusion: Microcirculation monitoring is feasible using SDF Microscan® in a pig model. This method allows to detect blood flow disruption earlier than NIRS and clinical evaluation.

Uso del portafolio en la formación preclínica del graduando en odontología / Use of the portfolio in the students dental preclinical training

Introducción: Las escuelas de medicina del mundo están reformulando sus estructuras curriculares, contenidos y estrategias para integrar las tendencias actuales de la educación superior. Esto implicará un cambio en la evaluación: las técnicas tradicionales ya no serán congruentes con los nuevos modelos curriculares, si se requiere una contribución al aprendizaje. La bibliografía señala al portafolio como una herramienta que permite la evaluación del desempeño y estimula el aprendizaje. Su uso en la educación médica de pregrado no se ha explorado extensamente y se halla poca evidencia sobre su aplicación específica en odontología. Materiales y métodos: Bajo una investigación educativa de acción, se puso en práctica en la asignatura 'Prostodoncia I', del segundo año de la carrera de odontología. La utilización de esta herramienta tuvo como objetivo que docentes y alumnos se conciencien sobre la responsabilidad compartida de enseñar y aprender valorando las potencialidades de la implementación del portafolio. Se realizó a partir de reuniones docentes, entrevistas y encuestas a los alumnos. Resultados: La opinión de los estudiantes en las encuestas expresa que el portafolio mejoró su aprendizaje significativamente y fue una buena herramienta de enseñanza, contribuyendo a la reflexión en su trabajo académico. Los profesores reconocieron la importancia de un espacio para el acercamiento al alumno, permitiendo realizar un análisis de sus producciones y su relación con los contenidos de la asignatura. Conclusiones: Se demostró que el portafolio se considera una herramienta que permite enriquecer las prácticas educativas, generando conocimientos desde las construcciones de los alumnos y las intervenciones de los profesores

Introduction: The schools of medicine in the world are reformulating their contents, strategies and curricular structures to integrate current trends in higher education. This will involve a change in the evaluation: traditional techniques are no longer consistent with the new curriculum models, if required a contribution to learning. The literature points to the portfolio as a tool for performance evaluation and stimulates learning. Its use in undergraduate medical education has not been explored extensively, finding little evidence of their specific application in dentistry. Materials and methods: It was decided its application in coincidence with the educational objectives of a course from the second year of the career of dentistry. The use of this tool, as a subject in the curriculum of the career of dentistry has the purpose that teachers and pupils get conscience about responsibility they must shake learning and teaching but giving value to the potentialities in the implementation of portfolio. It was done since meetings with teachers, interviews and surveys to the pupils. Results: student opinion surveys state that the portfolio significantly improved their learning and it was a good teaching tool, helping to reflect on their academic work. The teachers recognized the importance of space for student-centered approach, allowing analysis of its productions and its relation to the contents of the subject. Conclusions: After analyzing the results, it was demonstrated that portfolio is considered a tool that let enrich educational practices, creating new knowledge since pupils' constructions and teachers' participations

Estar atentos, estar dispuestos / To be aware, to be willing to

Al cumplirse cien años del aún vigente “Informe Flexner” los educadores de las ciencias de la salud de todo el mundo generaron reflexiones y nuevas metas para las mismas. Son muchos los cambios producidos desde la presentación de Abraham Flexner en 1910 pero muy importantes son los ocurridos sobre el fin del siglo XX. La aparición de las tecnologías de la información y de la comunicación fueron precipitantes. Este ensayo pretende dar muestra de la evolución y alertar que esa combinación nos obliga a los docentes a estar informados y atentos a su influencia en el ámbito de la educación superior y entender que debemos estar dispuestos a cambios personales y a brindar una mayor colaboración para producir los cambios institucionales que nos permitan entregar a la sociedad mejores egresados.

To celebrate one hundred years of the still current "Flexner report" worldwide health science educators generated reflections and new goals for them. There have been many changes since the submission of Abraham Flexner in 1910 but more important are the ones which took place at the end of the 20th century. The emergence of information and communication technologies were swift. This essay is intended to alert that that combination forces us teachers to be informed and aware of its influence in the field of higher education and understand that we must be prepared to personal changes and to provide greater collaboration to produce the institutional enabling us to deliver better graduates to society.