Assessment Of Clinical Performance Research Articles

Clinical reasoning performance assessment: using situated cognition theory as a conceptual framework.

Developing valid assessment approaches to clinical reasoning performance has been challenging. Situated cognition theory posits that cognition (e.g. clinical reasoning) emerges from interactions between the clinician and situational (contextual) factors and recognizes an opportunity to gain deeper insights into clinical reasoning performance and its assessment through the study of these interactions. The authors apply situated cognition theory to develop a conceptual model to better understand the assessment of clinical reasoning. The model highlights how the interactions between six contextual factors, including assessee, patient, rater, and environment, assessment method, and task, can impact the outcomes of clinical reasoning performance assessment. Exploring the impact of these interactions can provide insights into the nature of clinical reasoning and its assessment. Three significant implications of this model are: (1) credible clinical reasoning performance assessment requires broad sampling of learners by expert raters in diverse workplace-based contexts; (2) contextual factors should be more explicitly defined and explored; and (3) non-linear statistical models are at times necessary to reveal the complex interactions that can impact clinical reasoning performance assessment.

Assessment of clinical performance of an ultrasensitive nanowire assay for detecting human papillomavirus DNA in urine

ObjectiveTo evaluate whether HPV DNA in urine has potential advantages as an alternative biomarker for HPV-based cervical cancer screening. MethodsAmong patients with Cobas HPV test results, a total of 67 HPV-positive (n = 42) and -negative (n = 25) women who agreed to participate in this study were willing to provide paired cervical and urine samples, and we observed concordance between sample types from each patient in identifying HPV genotypes using the nanowire assay. ResultsWe detected high-risk strains of HPV DNA in unprocessed urine specimens using polyethyleneimine-conjugated nanowires (PEI-NWs). Concordance for high-risk HPV (hrHPV) between paired urine and cervical samples was 90.4% (κ = 0.90; 95% CI: 0.80–100.00). The virological sensitivity and specificity for detection of HPV DNA from a small urine sample (200 μL) were 81.3% (κ = 0.83; 95% CI: 62.1–100.0) and 98.0% (κ = 0.83; 95% CI: 94.2–100.0) for HPV16 group, 100.0% (κ = 0.65; 95% CI: 100.0–100.0) and 95.3% (κ = 0.65; 95% CI: 90.1–100.0) for HPV18 group, and 96.4% (κ = 0.97; 95% CI: 89.6–100.0) and 100.0% (κ = 0.97; 95% CI: 100.0–100.0) for other hrHPV group, respectively. ConclusionsThe nanowire assay demonstrated excellent ability to identify HPV DNA from urine specimens. We observed an excellent agreement in the detection of high-risk HPV between paired urine and cervical samples, even with small urine sample volume.

An Assessment of the Correlation between Tests of Clinical Competence and Tests of Cognitive Knowledge amongst Nigerian Resident Doctors in Surgery.

Background:Assessment of clinical competence involves the assessment of cognition and assessment of clinical performance (behaviour in practice). The limitations of the traditional long case examination (LCE) in the assessment of clinical performance led to its replacement with the objective structured clinical examination (OSCE) by many institutions.Aims:To determine and compare the abilities of the OSCE and LCE to predict candidates’ performance in the tests of cognitive knowledge in the fellowship examination of the National Postgraduate Medical College of Nigeria in the Faculty of Surgery.Materials and Methods:The results of the OSCE, LCE, written papers, picture tests (PTs), vivas, and the total clinical score (TCS) of surgical residents who took part in the fellowship examination over six consecutive examination periods were compared by using the Pearson’s correlation coefficient. A P-value less than.01 was considered as significant.Results:The OSCE had a weak but statistically significant positive correlation (.175) with the LCE. Both the OSCE and LCE had similar correlations with the total written papers (TWP) and PTs. The viva had a higher correlation with the OSCE than the LCE. The TCS when compared with either the OSCE or LCE alone had a higher correlation with most of the tests of cognitive knowledge.Conclusion:Neither the OSCE nor the LCE showed any superiority over the other in terms of the ability to predict performance in the tests of cognition. The TCS appears superior to either the OSCE or the LCE as a predictor of the candidates’ overall knowledge of surgery. Therefore, both the OSCE and the LCE should be retained as part of the examination.

Performance evaluation of the Panther Fusion® respiratory tract panel

BackgroundRespiratory tract infections are among the most common infections during winter season. Rapid diagnostics is required for clinical decision making regarding isolation of patients and appropriate therapy. ObjectivesThe aim of this study was to evaluate the analytical and clinical performance characteristics of the Panther Fusion® respiratory panel using published laboratory-developed real-time PCR assays (LDT). Study designAnalytical sensitivity of Panther Fusion® Flu A/B/RSV was assessed by testing dilutions of cell culture isolates. Clinical performance assessment included the complete Panther Fusion® respiratory panel (Flu-A/B/RSV, PIV 1-4 and AdV/hMPV/RV) and consisted of a retrospective and a prospective study-arm. The retrospective evaluation included 201, stored (−80 °C) samples collected between February 2006 and January 2017. Prospective evaluation was performed on 1045 unselected pretreated respiratory tract samples from patients presented to our hospital between November 2017 and May 2018. ResultsAnalytical sensitivity was generally slightly lower for the Panther Fusion® assays. Clinical specificity and sensitivity was between 96 %–100 % and 71.9 %–100 %, respectively. Discrepant results were found in 146 samples of which 88 samples tested LDT positive / Panther Fusion® negative and 58 samples were LDT negative / Panther Fusion® positive. A total of ten discrepant samples with Ct-values <30 were sequenced to confirm the presence of 7 RV-C not-detected by LDT and 1 RV-A and 2 ADV-2 not detected by Panther Fusion®. ConclusionsThe Panther Fusion® provides a random-access system with continuous loading and much shorter sample-to-answer times compared to LDT, albeit with a slightly less clinical sensitivity compared to the LDT.

The Effect of Web-Based Preoperative and Postoperative Patient Care Education on Nursing Students: A Randomized Controlled Study.

This study examined the effect of Web-based preoperative and postoperative patient care education among undergraduate nursing students. This was an experimental, randomized controlled study. The study included 305 nursing students (experimental group: n = 155, control group: n = 150), who were assessed with the following instruments: the Preoperative and Postoperative Care Knowledge Test, Preoperative and Postoperative Care Skill Control List, Clinical Decision Making in Nursing Scale, and Nursing Student Clinical Performance Evaluation Scale. t Tests and χ tests were used to evaluate the data. There was no statistically significant difference between the students' posttest knowledge levels, clinical performance assessment, or clinical decision-making scores. The experimental group was found to perform the skills of "check patient's documents and prophylactic antibiotics when going to surgery" (χ = 4.88; P = .02), "controls the surgical safety checklist (before surgery) before going to surgery" (χ = 10.41; P = .00), and "observes surgical site/dressing (χ = 7.77; P = .00)" at a statistically significantly higher level. The education provided in the Web-based education was equivalent to that provided in traditional education. Thus, Web-based education appears to be a useful tool to educate student nurses in preoperative and postoperative patient care.

Clinical assessment of growth performance, bone morphometry, bone quality, and serum indicators in broilers affected by valgus-varus deformity

The large economic losses caused by leg disorders have raised concerns in the broiler industry. Several types of leg disorders in broilers have been identified, such as tibial dyschondroplasia (TD), femoral head necrosis (FHN), and valgus-varus deformity (VVD). In this study, phenotypic changes associated with VVD were examined using clinical diagnosis, anatomical examination, measured growth performance, bone traits, and serum indicators. The incidence of VVD among the chicken population at a commercial facility in Tangshan China was 1.75% (n = 52,000), distributed about 1:1 (n = 122), between females and males. A majority of chickens were characterized by a unilaterally abnormality, while appropriately 17.6% by bilateral abnormality. Approximately 97.9% of affected broilers were classified as the "valgus" type. Growth traits, including body weight, shank length, and shank girth, were significantly lower in chickens with VVD, while tibia and metatarsal bone indexes were about 1.3-fold higher in the affected birds than in the normal birds. Bone mineral density, bone breaking strength, and several serum indicators were significantly different between affected and normal broilers. Sparse and disarranged bony trabecular was observed in abnormal broilers by histological analysis. Generally, leg disorders are associated with compromised growth, bone quality, bone structure, and lipid metabolism. This study provides a reference for clinical diagnosis of VVD and lays a foundation for exploring its underlying mechanisms.

Clinical Performance Scores of Internationally Educated Physical Therapists during Clinical Education in a Bridging Programme.

Purpose: We describe the numerical ratings assigned by clinical instructors to the performance of internationally educated physical therapists (IEPTs) during their clinical internships while enrolled in a bridging programme. Method: We conducted a secondary analysis of the quantitative data for IEPT learners attending the Ontario Internationally Educated Physical Therapist Bridging Program using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) tool. We extracted the scores from each IEPT's ACP form at the midterm and final evaluations for two internships and conducted a descriptive analysis. Results: We obtained 318 data sets for 61 IEPTs. By the final point of the second internship, (1) items about communication pertaining to ethical professional relationships, conducting oneself within legal and ethical requirements, and respecting the individuality and autonomy of the client had high mean ratings; (2) most items rated achieved advanced intermediate performance and many indicated entry-level performance; and (3) most IEPTs (84%) either had high scores throughout or improved from lower scores to at least advanced intermediate performance. Conclusions: Items relating to professional conduct and effective communication in professional relationships were relatively high among the IEPTs. By the end of the second internship, most IEPTs in this bridging programme had improved their clinical performance toward or up to the entry-level standard for Canadian physiotherapists.

Impact of video feedback system on medical students\u2019 perception of their clinical performance assessment

BackgroundProviding feedback on student performance in the clinical performance assessment (CPA) is meaningful in that it helps students understand their strengths and weaknesses. This study compared students’ perception of their CPA scores before and after providing personalized video feedback.MethodsTwo identical online surveys of Year 1 medical students (N = 103) that had undergone CPA were conducted to evaluate students’ perceptions about their CPA scores before and after video feedback. Students were given their test scores with assessment analysis reports immediately after completing the CPA. Top-scored students from each station agreed to provide their video-recorded performance to the rest of the students.ResultsAfter comparing their performance video and top-scored video at each station, medical students were more aware of their CPA total score, clinical performance examination (CPX) total score, score of each CPX station, section score for the CPX station, history taking section score, physical examination section score, and doctor-patient relationship section score. Moreover, students became more convinced of their own weaknesses from their history taking and patient education section after viewing video feedback than before.ConclusionThe use of the video feedback system might help students recognize their CPA results and identify their strengths and weaknesses.

A comparative study of OSCE and traditional methods of evaluation in nursing: A narrative review

Introduction: Objective Structured Clinical Examination (OSCE) is a modern type of examination used in health sciences and it has been widely used in the assessment of students' clinical performance and skills competency. The Traditional method refers to a traditional way of evaluating a practical skills and knowledge of the students as in essay type i.e, written form, viva, procedure or history collection of the client. Aim: The aim of this narrative review is to find information on the effectiveness of OSCE versus Traditional methods of evaluation.Methodology: Types of studies- Descriptive- Comparative study, Quasi-experimental design- one group pre-test post-test design.Types of participants: Nursing students.Setting: Nursing Colleges.Outcome: This narrative review result shows that OSCE method is an effective method for evaluation compare to a Traditional method.

Biomechanical behavior of an implant system of carbon fiber-reinforced polyether ether ketone (PEEK) bars with different designs: finite elements analysis

We used finite elements analysis to assess the biomechanical behavior of lower protocol bars made of Polyether Ether Ketone (PEEK) reinforced by carbon fiber, with different designs on All-on-four® system, subjected to physiological occlusal loads. The models were built to have an I-shaped or an inverse T-shaped section. We also assessed the stress distribution on the peri implant bone, implants, prosthetic intermediates, prosthetic intermediate screws, and prosthetic screws. In the simulations, strength peaks were similar for both inverse T and I shaped models; however, the I-shaped bars showed larger resistance in comparison with the inverse T shape. Since it is a new material in dentistry, further research is necessary for a better assessment of PEEK's mechanical and clinical performance.

ACR Ultrasound Liver Reporting and Data System: Multicenter Assessment of Clinical Performance at One Year

PurposeThe aim of this study was to evaluate the clinical performance of the ACR’s Ultrasound Liver Reporting and Data System (US LI-RADS™) for detecting hepatocellular carcinoma (HCC) in patients at high risk for HCC. MethodsIn this retrospective, multicenter study, 2,050 patients at high risk for HCC (1,078 men and 972 women; mean age, 57.7 years) at five sites in the United States had undergone screening liver ultrasound from January 2017 to February 2018, and US LI-RADS observation categories and visualization scores were assigned on a clinical basis. Ultrasound reports and patient records were retrospectively reviewed and follow-up imaging studies and/or pathologic reports recorded. Descriptive statistics were generated, and multivariate logistic regression analysis was used to analyze the relationship of clinical and reader-based predictors of limited visualization. Diagnostic performance data were calculated in the subset of patients with confirmatory testing. ResultsThe most common indications for HCC screening were cirrhosis (n = 1,054 [51.4%]), noncirrhotic hepatitis B virus infection (n = 555 [27.1%]), and noncirrhotic hepatitis C virus infection (n = 234 [11.4%]). US LI-RADS observation categories assigned were US-1 (negative) in 90.4% (n = 1,854), US-2 (subthreshold) in 4.6% (n = 95), and US-3 (positive) in 4.9% (n = 101). Visualization scores were A (no or minimal limitations) in 76.8% (n = 1,575), B (moderate limitations) in 18.9% (n = 388), and C (severe limitations) in 4.2% (n = 87). Confirmatory tests, including multiphase contrast-enhanced CT or MRI (n = 331) or histopathology (n = 18), were available for 349 patients (17.0%). The sensitivity of US LI-RADS in this subset of patients was 82.4%, specificity was 74.2%, positive predictive value was 35.3%, and negative predictive value was 96.1%. ConclusionsApproximately 90% of US LI-RADS screening examinations were negative, 5% subthreshold, and 5% positive. Visualization scores were diagnostically acceptable in the vast majority (>95%) of examinations. US LI-RADS emphasized sensitivity and negative predictive value, which are key characteristics of a screening test.

Knowledge, attitude and practices of clinical quality and performance assessment among emergency medical services personnel in South Africa: A mixed methods study.

Deficits in healthcare quality are becoming an increasing concern globally. Within the low- to middle-income country (LMIC) setting insufficient quality has become a bigger barrier to reducing mortality than insufficient access, where 60% of deaths from conditions amenable to healthcare, are due to poor quality care. Measuring quality is key towards improving the effectiveness of healthcare in this setting. A mixed methods sequential-explanatory study was conducted, to describe what Emergency Medical Service (EMS) practitioners understood about quality systems within the LMICs, using South Africa as an example. Part 1 consisted of a cross-sectional survey (n = 169), the results of which were utilised to develop a semi-structured interview guide for Part 2. Interviews of participants from Part 1 explored the results of the survey (n = 20) and were analysed through content analysis to develop core categories central to the understanding of quality assessment in the LMICs. Despite relatively poor knowledge of organisational-specific quality systems, understanding of the core components and importance of quality systems was demonstrated. The role of these systems in the LMICs was supported by participants, where the importance of context, system transparency, reliability and validity were essential towards achieving ongoing success and utilisation. The role of leadership and communication towards the effective facilitation of such a system was equally identified. Within EMS, quality systems are in their infancy. It could be argued that this is somewhat more pronounced in the LMICs, where knowledge of organisational quality systems was found to be poor. Despite this, there was a strong general understanding of the importance of quality systems, and the role they have to play in this setting.

Development of the TeamOBS-PPH: Targeting Clinical Performance in Postpartum Hemorrhage

(Acta Obstet Gynecol Scand. 2018;97:677–687) The most frequent cause of maternal death worldwide is major postpartum hemorrhage (PPH), defined as blood loss of 1000 mL or more within 24 hours of delivery. If a clinical team performs well, the risk of maternal death from PPH can be significantly reduced. Previous studies of PPH management have focused primarily on assessment of outcome, nontechnical performance, and technical performance. There is a paucity of literature, however, on the evaluation of clinical performance during PPH, which assesses the quality of the actual patient care provided. This study aimed to develop a tool for the assessment of clinical performance during PPH and to evaluate the reliability and validity of that tool using video recordings of PPH management of obstetric teams in both real-life situations and simulations.

The Development of an Assessment Tool to Measure the Clinical Performance of Orthopedic Residents

Introduction. Residency programs have been developed to provide formal instruction and mentorship after professional education to accelerate the development of the physical therapists' knowledge, skills, and clinical decision making for patient management. An assessment tool that could be used during the assessment and treatment of patients would provide valuable information regarding the progression of the multiple skills required for a high level of clinical practice throughout residency education. The purpose of this study was to develop a reliable and valid tool to assess the multiple clinical skills used in the examination, evaluation, and treatment of patients with common musculoskeletal conditions. Methods. To meet the purpose, a sequential interrater reliability and known-groups validity study was performed. The original clinical performance assessment tool was developed using the practice dimensions outlined by the Orthopaedic Physical Therapy Description of Specialty Practice. The tool underwent 3 rounds of reliability testing. In addition, known-groups validity was established using residency graduates and experienced matched controls. Results. The overall reliability of the 64-item assessment tool was found to be high. Fifty-four of the items on the examination had high to perfect reliability and 10 items demonstrated moderate reliability. Furthermore, the tool was accurate in determining physical therapists with residency training versus experienced matched controls, establishing known-groups validity. Discussion and Conclusion. The assessment tool was able to evaluate clinical performance during patient care activities in both residency trained physical therapists and therapists without advanced instruction with a moderate to high interrater reliability on all items.

Trainees' perspectives of assessment messages: a narrative systematic review.

This study was designed as a narrative systematic literature review of medical specialist trainees' perspectives of the assessment messages they receive in the context of clinical performance assessments. The aim of the study was to determine if trainees value the information they receive through the formats designed to promote their development and, if not, the reasons for this. The authors searched the ERIC, EMBASE, Ovid MEDLINE and PsycINFO databases for articles published up to 16 June 2018 that present original data on trainees' perspectives of the assessment messages they receive in the context of work-based assessments (WBAs) and in-training assessments (ITAs) used within their training programmes. All authors screened 938 abstracts and 139 full-text articles were assessed after this. Descriptions of quantitative data and thematic analysis of qualitative data were used to present the opinions of trainees. Thirty-three articles met the inclusion criteria. Twenty-six articles (79%) described trainees' perspectives in the context of WBA and the remaining articles referred to ITA formats. Wide-ranging opinions were reported. The analysis categorised these into three themes: trainees value developmental assessment messages; trainees become disengaged when assessment messages are not developmental, and trainees' views depend on the environment, the assessor and themselves. Some trainees reported that the assessment messages were valuable and provided input on their performance to guide their development, but many disagreed. In particular, the trainee's own level of engagement with the assessments influenced his or her perspectives on the messages received. Trainees do not universally perceive that clinical performance assessments provide them with the valuable developmental input on their performance they were designed to do. Factors related to the environment, the assessor and themselves influence their perspectives.

The impact of standardized patient interviews on communication skills among pre-clinical medical students in an accelerated Baccalaureate/MD program: a mixed methods study.

Objectives: To investigate whether participation in formative standardized patient interviews (SPIs) earlier in the curriculum of a 6-year accelerated BA/MD program would improve students’ communication skills, as well as to explore self-perceptions of the development of those skills. Methods: We randomly selected 23 Year 2 students to participate in an Intervention, and then purposively selected 23 matching students for a Control group. All participants underwent the usual educational experiences; however, participants in the Intervention group also experienced four video-recorded SPIs over the course of the academic year. Formative feedback was provided to the students by the standardized patients, and subsequently by faculty who viewed the videos. Participants in the Intervention group and their faculty periodically completed self-report surveys. During the first semester of Year 3, all students underwent a series of three SPI-based Clinical Performance Assessments (CPAs), assessing communication skills, professionalism, and history taking. We then compared the CPA scores of the Intervention and the Control groups. We also examined survey responses quantitatively and qualitatively to determine faculty and students’ self-perceptions. Results: The Intervention group scored significantly higher than the Control group in the total score for the three CPAs. Survey responses showed that early participation in SPIs enhanced students’ comfort level and skills in interviewing “real” patients. Conclusions: This study suggests that earlier implementation of pre-clinical SPIs provides valuable formative assessment to students on their communication and patient interviewing skills, and prepares them for future standardized and “real” patient encounters.

“Shadow” OSCE examiner. A cross-sectional study comparing the “shadow” examiner with the original OSCE examiner format

OBJECTIVES:Feedback is a powerful learning tool, but a lack of appropriate feedback is a very common complaint from learners to teachers. To improve opportunities for feedback on objective structured clinical examinations (OSCEs), a modified examiner role, termed the “shadow” examiner, was tested. This study aims to present and analyze comparisons between the “shadow” examiner and the original OSCE examiner format.METHODS:In 2011, experiments were carried out with modifications to the examiner’s role to define the “shadow” examiner format. From February 2012 to May 2014, research was conducted with 415 6th-year medical students. Of these students, 316 were randomly assigned to assessments by both “shadow” and “fixed” examiners. Pearson correlation analysis with linear regression, Student’s t-tests and Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domain.RESULTS:High correlations between the “shadow” and “fixed” examiners’ global scores were observed. The results of the analysis of specific domains demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between the mean examiner global scores were found. The Bland-Altman analysis showed that the “shadow” examiners’ affective scores were significantly higher than those of the “fixed” examiners, but the magnitude of this difference was small.CONCLUSION:The modified examiner role did not lead to any important bias in the students’ scores compared with the original OSCE examiner format. This new strategy may provide important insights for formative assessments of clinical performance.

Reliable Assessment of Medical Student Performance on the Obstetrics and Gynecology Clerkship

PURPOSE: To determine the number of assessors needed to reliably assess medical students' overall clinical performance during the OB/GYN clerkship. BACKGROUND: Reliable assessment of students' clinical performance during clerkships provides important information for decisions regarding grades and advancement. However, the assessment ratings students receive can vary based on many factors, and there are no clear data regarding the number of assessors needed to obtain a reliable assessment of students' clinical performance on the OB/GYN clerkship. METHODS: During the 2015-2016 OB/GYN clerkship, faculty and residents completed one assessment per student. Using the overall performance score for each student, we performed generalizability analysis to determine the number of assessors needed to achieve an acceptable threshold of reliability (G=0.7). RESULTS: Students’ mean overall performance score was 6.38±1.21 (scale of 1-10). 90.1% of variance in scores was attributed to assessors and 9.9% was attributed to students. The generalizability estimate for eight assessors was G=0.469. For other clerkships, G coefficients for eight assessors ranged from 0.000-0.795. Decision studies suggest that 17 assessors were needed to achieve G=0.7 for the OB/GYN clerkship, compared to 4-12 assessors for other clerkships. DISCUSSION: Much of the variation in students’ overall performance scores can be attributed to assessors rather than students. We suggest clerkships with high variability among assessment scores find alternative ways to interpret these scores. For example, we currently use each assessor's Z score to determine the number of standard deviations each student's assessment lies from the assessor's mean student evaluation score to adjust for assessor stringency or leniency.

A clinical assessment of visual performance of combining the TECNIS® Symfony Extended Range of Vision IOL (ZXR00) with the +3.25 D TECNIS Multifocal 1-piece IOL (ZLB00) in subjects undergoing bilateral cataract extraction.

PurposeTo combine the increased depth of focus of the TECNIS® Symfony intraocular lens (IOL) with a TECNIS Multifocal (MF) low-add IOL (+3.25) to enable a patient to be less dependent on corrective lenses.SettingClinic in Canada.DesignSingle-center, prospective, open-label.Materials and methodsFifty patients were enrolled for bilateral surgery. Patients were implanted with TECNIS Symfony Extended Range of Focus lens in the dominant eye, and TECNIS low-add +3.25 MF IOL in the non-dominant eye. Patients were ≥18 years of age and had best-corrected visual acuity >20/30 in both eyes, pupil size >3.5 mm, and <1.5 D of corneal astigmatism. Patients were evaluated preoperatively, operatively, and postoperatively on Day 1, Day 7, Month 1, and Month 3. Postoperative evaluations at Month 3 were completed by 32 of 50 patients enrolled, and included distance, intermediate and near visual acuity (VA), and subjective outcomes.ResultsThree months postoperatively, binocular results without correction revealed 97% (29/30) of patients had distance VA of 20/20 or better, 97% (29/30) had intermediate VA of 20/25 or better, and 94% (28/30) had near VA of 20/25 or better. At Month 3, the majority of patients reported “none” for visual symptoms of glare (30/30, 100%), halo (29/30, 96.6%), starbursts (29/30), or other – blur (30/30, 100%).ConclusionThree months postoperatively, the combination of the increased depth of focus of the TECNIS Symfony IOL with a TECNIS MF low-add (+3.25) IOL may provide excellent uncorrected VA at near, intermediate, and far distances with minimal ocular symptoms.

Assessment of Antagonist Enamel Wear and Clinical Performance of Full-Contour Monolithic Zirconia Crowns: One-Year Results of a Prospective Study.

To assess the clinical performance and survival of full-contour monolithic zirconia (MZ) crowns and enamel wear produced over a 1-year period. 60 patients requiring full-coverage restorations for endodontically treated posterior teeth opposed by healthy unrestored antagonistic teeth were selected. MZ crowns were fabricated. Vinyl polysiloxane impressions of the antagonist teeth were made, and the stone casts were digitized using a 3D laser scanner. Wear of the opposing natural teeth was evaluated at baseline (1 week), 6 months, and 1year after crown cementation. Superimposition of the follow-up scans on the baseline scans were performed to evaluate wear. Survival and function of the restorations were evaluated by the modified USPHS rating criteria at the same timeframes. Comparison of the baseline and the follow-up wear values was statistically tested using the paired t-test. Statistical significance was noted between the wear values at 6 months (15.5 μm) and at 12 months (16.3 μm) (p < 0.05). The Wilcoxon signed rank sum test was performed to evaluate each parameter of the modified USPHS criteria and to analyze the change in the follow-up scores of the restorations. The survival rate for the crowns was 100%. Results were classified as "excellent" over a 1-year follow up. MZ crowns showed promising results related to antagonist enamel wear and survival/clinical performance.