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Journal of the American College of... Jun 2024The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand...
BACKGROUND
The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI.
STUDY DESIGN
A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, suicidality). Semi-structured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI.
RESULTS
Of 7,233 residents (85.5% response rate) 5,133 had data available on work-life conflicts. 44.3% reported completing non-educational task-work at home, 37.6% were dissatisfied with time for personal life (e.g., hobbies), 51.6% with maintaining healthy habits (e.g., exercise), and 48.0% with performing routine health maintenance (e.g., dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p<0.05). After adjusting for other risk factors (e.g., duty-hour violations, and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p<0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (e.g., therapy); (2) explicitly supporting life outside of work (e.g., prioritizing time with family); and (3) allowing meaningful autonomy in scheduling (e.g., planning for major life events).
CONCLUSIONS
Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.
PubMed: 38920301
DOI: 10.1097/XCS.0000000000001135 -
Annals of the Academy of Medicine,... Mar 2024Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health... (Comparative Study)
Comparative Study
INTRODUCTION
Children from low-income (LI) families often suffer from poor health, with sub-optimal health practices. This cross-sectional study examined the differences in health habits and health-related quality of life (HRQoL) of LI preschool children compared to non-low-income preschool peers (PPG).
METHOD
Using data from the social-health Circle of Care-Health Development Screening Programme (CoC-HDSP) in Singapore, 118 LI children and 304 PPG children aged 18 months to 6 years old and their families were recruited from 13 government-funded preschools. Health practices examined included screen time habits, sleep, nutrition, dental health and the children's HRQoL using PedsQL 4.0 Generic Core Scales.
RESULTS
Majority of the children were aged 4-6 years in kindergarten 1 and 2. There were more Malay children in the LI than the PPG (61.9% versus [vs] 29.3%, P<0.001). Low-income children were more likely to have lower-educated parents (P<0.001). The completed vaccination rate in the LI group was lower than those in PPG (84.7% vs 98.0%, P<0.001). More in the LI group utilised emergency services for acute illnesses (P<0.05). Fewer LI children had ever visited a dentist (47.4% vs 75.4%, P<0.001), and more LI children consumed sweetened drinks daily (33.3% vs 8.6%, P<0.001). The LI group reported poorer-quality sleep (48.3% vs 27.2%, P<0.001), though both groups exceeded the daily recommended screen viewing duration. The LI group scored higher in the social (mean 92.4±12.2 vs 84.3±15.3, P<0.001) and emotional (mean 85.2±15.1 vs 76.6±17.3, P<0.001) domains of the PedsQL 4.0 when compared to PPG.
CONCLUSION
Low-income children have poorer health practices, receive less preventive paediatric care, and utilise more emergency services for acute illnesses. These findings are important for developing interventions that work towards improving the health of LI children.
Topics: Humans; Singapore; Cross-Sectional Studies; Child, Preschool; Quality of Life; Poverty; Female; Male; Child; Health Behavior; Oral Health; Infant; Screen Time; Sleep
PubMed: 38920242
DOI: 10.47102/annals-acadmedsg.2023168 -
Acta Odontologica Latinoamericana : AOL Apr 2024Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to...
UNLABELLED
Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to properly refer patients to colleagues/dentists and vice versa.
AIM
To analyze the association between apical lesions and sinus changes and to evaluate the agreement between the diagnoses of an endodontist, a radiologist, an oral and maxillofacial surgeon, and an otolaryngologist.
MATERIALS AND METHOD
385 axial, coronal, and sagittal MSCT scans were selected using an image archiving andcommunication system (PACS). The examinations had been performed between 2018 and 2022.
RESULTS
Apical lesions were observed in 36.10% of sinusitis cases, 73.8% of unilateralsinusitis cases, 48.7% of sinus floor discontinuity cases, and 67.2% of cases in which endodontic treatment had been performed. Agreement between the diagnoses made by the endodontist and those made by the other investigators was high for most study variables (k > 0.60). The exceptions were mucosal thickening, for which agreement between the endodontist and the other investigators was intermediate (k=0.397), and the presence of periapicallesions (k=0.010), previous endodontic treatment (k=0.013), and mucosal thickness (k=0.024), for which agreement between endodontists and radiologists was low. Conclusions: There was an association between sinus changes and apical lesions.
Topics: Humans; Female; Male; Middle Aged; Multidetector Computed Tomography; Adult; Periapical Diseases; Maxillary Sinusitis; Aged; Young Adult; Adolescent; Diagnosis, Differential
PubMed: 38920129
DOI: 10.54589/aol.37/1/79 -
Clinical Oral Investigations Jun 2024We perform special-need dental treatment at outpatient department (OPD), under general anesthesia (GA) when necessary, and provide domiciliary dental care. We aim to... (Review)
Review
OBJECTIVES
We perform special-need dental treatment at outpatient department (OPD), under general anesthesia (GA) when necessary, and provide domiciliary dental care. We aim to evaluate the profile and the characteristics of special needs patients (SNPs).
MATERIALS AND METHODS
We consecutively enrolled 3117 SNPs from January 1, 2019 to December 31, 2022. Eighty patients with rare or genetic diseases were excluded. Demographic data were retrospectively collected.
RESULTS
There were totally 3037 SNPs (mean age: 48.2 years; range, 1-100; male-to-female ratio, 1.5); 89.1% (n = 2705) SNPs received dental care at the OPD (OPD-SNPs), 7.9% (n = 239) received dental treatment under GA, and 3.0% (n = 93) received domiciliary dental care. Among those SNPs who received dental treatment under GA (n = 239), 91.2% (n = 218) were mental/intellectual disabled, and most underwent cavity filling (69.5%) and dental extractions (56.5%). OPD-SNPs with mental/intellectual disabilities (n = 1340) received significantly more items of dental treatment than those without (n = 1365). SNPs with more severe disabilities received more fluoride application and ultrasonic scaling (both p < 0.001, trend tests). Interestingly, among OPD-SNPs with mental/intellectual disabilities (n = 1340), more severe patients received more fluoride application (p < 0.001) and ultrasonic scaling (p < 0.001) but fewer root canal treatment (p = 0.007, trend test).
CONCLUSIONS
GA benefited SNPs with more dental procedures, including invasive items. SNPs with mental/intellectual disabilities can tolerate more measures and SNPs with more severe mental/intellectual disabilities received more preventive measures but less invasive measures. Similarly, more severe SNPs with other disabilities received more preventive measures but not invasive measures.
CLINICAL RELEVANCE
Our findings may provide useful information for special needs dentists and for doctor-patient communication.
Topics: Humans; Male; Female; Retrospective Studies; Middle Aged; Adult; Aged; Taiwan; Dental Care for Disabled; Adolescent; Aged, 80 and over; Child; Anesthesia, General; Infant; Child, Preschool; Academic Medical Centers
PubMed: 38918223
DOI: 10.1007/s00784-024-05795-z -
International Journal of Surgery Case... Jun 2024Vitamin B12 deficiency can manifest through various oral manifestations such as glossitis, glossodynia, recurrent ulcers, cheilitis, dysgeusia, lingual paresthesia,...
INTRODUCTION AND IMPORTANCE
Vitamin B12 deficiency can manifest through various oral manifestations such as glossitis, glossodynia, recurrent ulcers, cheilitis, dysgeusia, lingual paresthesia, burning sensations, and pruritus. These oral signs can serve as early indicators of systemic conditions such pernicious anemia.
CASE PRESENTATION
A 67 year old northern African female presented at the oral surgery service with complaints of a sore mouth and difficulty eating certain types of food. Her medical history revealed hypothyroidism and no history of gastrectomy. She was diagnosed with pernicious anemia in 2014 and is under hydroxocobalamin injection 5000μg/month since then. Dental history indicated extraction of all teeth, and in 2014, the patient was diagnosed with oral lichen planus. There were no contributory oral habits. Intraoral examination revealed a band like erythematous lesion on the palate with two superficial ulcerations, diagnosed as related to her pernicious anemia. The patient was prescribed a mouthwash containing sodium bicarbonate and corticosteroid to reduce inflammation and alleviate pain. A low level laser therapy was also considered to reduce the burning sensations.
CLINICAL DISCUSSION
Pernicious anemia (PA) is an autoimmune disease characterized by the gradual atrophy of the gastric mucosa, predominantly affecting the body and fundus of the stomach, leading to vitamin B12 deficiency. Its insidious onset often masks its presence. Patients have no anemic symptoms. However, they can present with oral manifestations related to vitamin B12 deficiency. Those oral signs can precede hematological symptoms helping in early diagnosis of PA.
CONCLUSION
Dentists and other oral health care providers must be aware of this condition and its oral manifestations. Investigating vitamin B12 levels should be considered in patients presenting with oral ulcers, oral erythema or burning sensations without an apparent origin.
PubMed: 38917702
DOI: 10.1016/j.ijscr.2024.109931 -
Computers in Biology and Medicine Jun 2024Computer vision falls under the broad umbrella of artificial intelligence that mimics human vision and plays a vital role in dental imaging. Dental practitioners... (Review)
Review
Computer vision falls under the broad umbrella of artificial intelligence that mimics human vision and plays a vital role in dental imaging. Dental practitioners visualize and interpret teeth, and the structure surrounding the teeth and detect abnormalities by manually examining various dental imaging modalities. Due to the complexity and cognitive difficulty of comprehending medical data, human error makes correct diagnosis difficult. Automated diagnosis may be able to help alleviate delays, hasten practitioners' interpretation of positive cases, and lighten their workload. Several medical imaging modalities like X-rays, CT scans, color images, etc. that are employed in dentistry are briefly described in this survey. Dentists employ dental imaging as a diagnostic tool in several specialties, including orthodontics, endodontics, periodontics, etc. In the discipline of dentistry, computer vision has progressed from classic image processing to machine learning with mathematical approaches and robust deep learning techniques. Here conventional image processing techniques solely as well as in conjunction with intelligent machine learning algorithms, and sophisticated architectures of dental radiograph analysis employ deep learning techniques. This study provides a detailed summary of several tasks, including anatomical segmentation, identification, and categorization of different dental anomalies with their shortfalls as well as future perspectives in this field.
PubMed: 38917534
DOI: 10.1016/j.compbiomed.2024.108800 -
Pilot and Feasibility Studies Jun 2024Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated,...
BACKGROUND
Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need. The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible.
METHODS
This mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1-8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination.
DISCUSSION
The ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.
PubMed: 38915111
DOI: 10.1186/s40814-024-01519-y -
BMC Oral Health Jun 2024Healthy dietary behaviors are fundamental for maintaining optimal health. Understanding the dietary behaviors of dentists is vital for designing effective interventions...
BACKGROUND
Healthy dietary behaviors are fundamental for maintaining optimal health. Understanding the dietary behaviors of dentists is vital for designing effective interventions to foster healthier behaviors. However, investigations into dietary behaviors and their associations among dental professionals have been limited.
OBJECTIVE
To investigate the dietary behaviors of dental professionals, along with the associated factors influencing their dietary options.
MATERIALS AND METHODS
A self-administered online questionnaire was constructed to collect data from three groups of dental professionals: undergraduates (UG), postgraduates (PG), and practicing dentists (DT). The questionnaire encompassed inquiries regarding demographic characteristics, knowledge assessment, evaluation of attitudes, and examination of dietary behaviors. Data analysis procedures included descriptive statistics, Spearman's rank correlation, and multiple linear regression.
RESULTS
A total of 842 individuals participated in the study (UG: 264, PG: 247, DT: 331). Attitude emerged as the strongest association of healthy dietary behaviors across all groups (UG: ß=0.370, PG: ß=0.512, DT: ß=0.642; P < 0.001), while alcohol consumption showed a negative correlation with healthy dietary behaviors (UG: ß=-0.135, PG: ß=-0.220, DT: ß=-0.216; P < 0.001).
CONCLUSION
Significant variations in dietary behaviors across diverse educational levels of dental professionals were observed. Attitude emerged as the predominant factor influencing dietary behaviors, while knowledge was found to have a weak association. Tailored interventions addressing individual challenges at different career stages should be considered to enhance dietary behaviors and overall well-being in dental practice settings.
Topics: Humans; Female; Male; Adult; Dentists; Surveys and Questionnaires; Feeding Behavior; Educational Status; Health Behavior; Middle Aged; Diet; Health Knowledge, Attitudes, Practice; Diet, Healthy
PubMed: 38914973
DOI: 10.1186/s12903-024-04502-4 -
Australian Health Review : a... Jun 2024BackgroundIn Australia, medications can be prescribed by medical practitioners, dentists, nurses, and dispensed by pharmacists. Until recently, pharmacists have been...
BackgroundIn Australia, medications can be prescribed by medical practitioners, dentists, nurses, and dispensed by pharmacists. Until recently, pharmacists have been limited to prescribing Schedule 2 and 3 medications, and optometrists, podiatrists, and nurse practitioners can prescribe medications under their scope of practice in some areas of Australia. Recently, the New South Wales (NSW) Government initiated a trial where approved pharmacists in NSW and Australian Capital Territory have an expanded scope of practice to prescribe further medications for urinary tract infections, dermatology conditions (mild to moderate atopic dermatitis, herpes zoster (shingles), impetigo, and mild plaque psoriasis), and resupply of contraceptives. This protocol is for a sub-study of the larger research trial and will explore the perspectives of Aboriginal and Torres Strait Islander peoples and communities including clinicians, healthcare services, and community members about the expanded scope of pharmacists' practice.Methods and analysisYarning circles (group) and individual yarns (semi-structured interviews) will be conducted with leaders, clinicians working with Aboriginal and Torres Strait Islander peoples (general practitioners, nurses, Aboriginal health workers, community pharmacists), Aboriginal Elders, and community members to understand perspectives of the risks, benefits, opportunities, and issues associated with pharmacists prescribing for these specific conditions. Ethics approval was obtained through the Aboriginal Health and Medical Research Council of NSW.ConclusionThe findings of this sub-study will clarify Aboriginal and Torres Strait Islander peoples' unique perspectives, including perception of risks and opportunities.
PubMed: 38914421
DOI: 10.1071/AH24110 -
Journal of Dentistry Jun 2024To assess quality, clinical acceptance, time-efficiency, and consistency of a novel artificial intelligence (AI)-driven tool for automated presurgical implant planning...
OBJECTIVES
To assess quality, clinical acceptance, time-efficiency, and consistency of a novel artificial intelligence (AI)-driven tool for automated presurgical implant planning for single tooth replacement, compared to a human intelligence (HI)-based approach.
MATERIALS AND METHODS
To validate a novel AI-driven implant placement tool, a dataset of 10 time-matching cone beam computed tomography (CBCT) scans and intra-oral scans (IOS) previously acquired for single mandibular molar/premolar implant placement was included. An AI pre-trained model for implant planning was compared to human expert-based planning, followed by the export, evaluation and comparison of two generic implants-AI-generated and human-generated-for each case. The quality of both approaches was assessed by 12 calibrated dentists through blinded observations using a visual analogue scale (VAS), while clinical acceptance was evaluated through an AI versus HI battle (Turing test). Subsequently, time efficiency and consistency were evaluated and compared between both planning methods.
RESULTS
Overall, 360 observations were gathered, with 240 dedicated to VAS, of which 95 % (AI) and 96 % (HI) required no major, clinically relevant corrections. In the AI versus HI Turing test (120 observations), 4 cases had matching judgments for AI and HI, with AI favoured in 3 and HI in 3. Additionally, AI completed planning more than twice as fast as HI, taking only 198 ± 33 s compared to 435 ± 92 s (p < 0.05). Furthermore, AI demonstrated higher consistency with zero-degree median surface deviation (MSD) compared to HI (MSD=0.3 ± 0.17 mm).
CONCLUSION
AI demonstrated expert-quality and clinically acceptable single-implant planning, proving to be more time-efficient and consistent than the HI-based approach.
CLINICAL SIGNIFICANCE
Presurgical implant planning often requires multidisciplinary collaboration between highly experienced specialists, which can be complex, cumbersome and time-consuming. However, AI-driven implant planning has the potential to allow clinically acceptable planning, significantly more time-efficient and consistent than the human expert.
PubMed: 38914182
DOI: 10.1016/j.jdent.2024.105146