Social and functional inclusion of an undergraduate student with unilateral upper limb agenesis: a case study.

INTRODUCTION: The inclusion of health professionals who have some type of disability brings benefits, such as the increase in empathy that facilitates the relationship with patients. In this work, we present a case study on the inclusion of an undergraduate Dentistry student with upper limb agenesis. PURPOSE: In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field. This process included the use of assistive technologies to allow the manipulation of instruments used in the practice of dental clinical activities, enabling future Dentists with upper limb agenesis to have an equal education in relation to their academic peers. CASE SELECTION: The case study presented in this work consists of the follow-up of G., a 23-year-old female Dentistry student. The developed adaptations were made using a low-temperature thermoplastic. The expert team that participated in this process was formed by three occupational therapists and three Dentistry professors. The process included several stages, being the last one the integration, in which training sessions were performed. OUTCOMES: The process was accessed using two main tools: quantitative questionnaires and qualitative interviews. After the proposed intervention, the volunteer presented a gradual evolution in her occupational performance with the use of most adaptations, promoting her functional training. DISCUSSIONS: Most adaptations allowed G. to perform the activities satisfactorily, with the precision inherent to these tasks, even with little training time. CONCLUSIONS: This case study demonstrates the high applicability of the proposed technologies.

In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field, as assessed in this study caseThe inclusion process of Dentistry students can include the use of assistive technology to allow the manipulation of instruments for the practice of clinical activitiesOur study suggests that the assistive adpatations promote a gradual evolution in the students' occupational performance, functional training and motor qualification.

Feasibility and acceptability of asynchronous VOT among patients with MDR-TB.

BACKGROUND: We conducted a feasibility and acceptability study of video-observed therapy (VOT) among patients with multidrug-resistant TB (MDR-TB) and other types of drug-resistant TB (DR-TB) in the Philippines.METHODS: Patients aged ≥13 years were approached to use VOT. A smartphone with VOT mobile application to video-record medication intake was provided. Healthcare workers (HCWs) monitored adherence by watching videos via a web-based dashboard. Good adherence was defined as intake of >90% of expected doses. Feasibility and acceptability were assessed using a semi-structured questionnaire on a Likert scale.RESULTS: Of 308 patients, 110 (36%) patients chose VOT; 67 completed treatment using VOT and 43 stopped VOT prior to treatment outcome; 74/110 (67%) had good adherence. The treatment success rate was 88% and the loss to follow-up rate was 8.1%. Among HCWs, 90% (9/10) had a positive perception of VOT. All HCWs agreed that VOT data accurately reflect medication intake of the patients; 88/89 (99%) mentioned benefits of VOT, notably convenience, sense of comfort, privacy and security.CONCLUSIONS: VOT is feasible and acceptable for both patients and HCWs. This study could provide guidance to the country programme to launch VOT for treatment of patients with MDR-TB and other DR-TB.

Using super-resolution generative adversarial network models and transfer learning to obtain high resolution digital periapical radiographs.

Periapical Radiographs are commonly used to detect several anomalies, like caries, periodontal, and periapical diseases. Even considering that digital imaging systems used nowadays tend to provide high-quality images, external factors, or even system limitations can result in a vast amount of radiographic images with low quality and resolution. Commercial solutions offer tools based on interpolation methods to increase image resolution. However, previous literature shows that these methods may create undesirable effects in the images affecting the diagnosis accuracy. One alternative is using deep learning-based super-resolution methods to achieve better high-resolution images. Nevertheless, the amount of data for training such models is limited, demanding transfer learning approaches. In this work, we propose the use of super-resolution generative adversarial network (SRGAN) models and transfer learning to achieve periapical images with higher quality and resolution. Moreover, we evaluate the influence of using the transfer learning approach and the datasets selected for it in the final generated images. For that, we performed an experiment comparing the performance of the SRGAN models (with and without transfer learning) with other super-resolution methods. Considering Mean Square Error (MSE), Peak Signal to Noise Ratio (PSNR), Structural Similarity Index (SSIM), and Mean Opinion Score (MOS), the results of SRGAN models using transfer learning were better on average. This superiority was also verified statistically using the Wilcoxon paired test. In the visual analysis, the high quality achieved by the SRGAN models, in general, is visible, resulting in more defined edges details and fewer blur effects.

Patient-cost survey for tuberculosis in the context of patient-pathway modelling.

SETTING: Eight tuberculosis treatment sites in Cavite Province, the Philippines, including two sites specialising in management of multidrug-resistant tuberculosis (MDR-TB).OBJECTIVE: To evaluate costs incurred by TB patients and to determine the proportion of households that faced catastrophic costs, then to consider cost survey responses alongside results of detailed patient-pathway modelling.DESIGN: Clustered cross-sectional survey using a field testing version of the WHO TB patient-costing tool and protocol; face-to-face interviews with 194 patients conducted in May-August 2016. Costs included direct-medical, direct non-medical and indirect costs using the human capital approach. Patients were deemed to incur catastrophic expenditure if TB-related costs exceeded 20% of annual household income. Patient pathways were modelled following multiple health staff interviews.RESULTS: Estimated mean cost incurred by patients with drug-susceptible TB was US$321 vs. $2356 for MDR-TB patients. Catastrophic costs were suffered by 28% of drug-susceptible and 80% of MDR-TB patients, with lost income being the largest contributor. Patient-pathway modelling suggested most patients had under-reported health visits.CONCLUSION: Survey results indicate that patient costs are large for all patients in Cavite, particularly for MDR-TB patients. Patient-pathway modelling suggests these costs are an underestimate due to poor recollection of health visits, suggesting that the WHO instrument and protocol could be improved to better capture the diagnostic journey.