Clinical Sessions Research Articles

Nursing Students’ Satisfaction with Clinical Simulation: A Cross-Sectional Observational Study

Clinical Simulation improves results in the students’ learning tests and allows for preserving acquired knowledge for longer periods of time, promoting more significant learning. This study was conducted to analyze Nursing students’ satisfaction with Clinical Simulation in three centres attached to a university from southern Spain. Methods: A quantitative, non-experimental and cross-sectional descriptive study was carried out. The students included were attending their third year of the Nursing undergraduate course and had already taken part in training sessions by means of Clinical Simulation. The Satisfaction Scale with High-Fidelity Clinical Simulation in Students (SSHF) was used for data collection. This scale has been validated and has 33 items grouped into eight factors. The SPSS software (version 28), was used for data analysis, establishing p-values < 0.05 for the statistically significant differences. Results: The participants were 180 students, with a mean age of 22.17 years old. Of them, 90.56% belonged to the female gender. A mean score of 3.82 out of 5 was obtained in the SSHF items. The items that obtained the highest scores were the following: benefits of Clinical Simulation as it relates theory with practise; possibility of learning based on the mistakes made; and comfort and respect while the sessions were developed. The item that obtained the lowest score was “timing for each simulation case”. We found significant differences in the results obtained according to each attached centre. Conclusions: The students showed high satisfaction levels regarding High-Fidelity Clinical Simulation in each of the three attached centres included in the study. Nevertheless, they stated the need to invest more time in Clinical Simulation sessions.

A Trans-Theoretical Systematization of Clinical Interventions Based on Dynamical Systems Research (DSR)

The scientific literature focused on the categorization of therapists’ interventions in clinical sessions, and their effects on patients, is not very extensive and often autoreferential. The most relevant findings clearly show the eclecticism of clinicians, grounding only 10–14% of their interventions on the specific theoretical approach to which they belong. Despite that, a trans-theoretical systematization of clinical interventions is lacking. The present work aims to verify the feasibility of a trans-theoretical categorization of clinical interventions based on Dynamical Systems Research in psychotherapy (DSR). For this purpose, the authors present the results of three literature reviews. The first sections of this paper present the literature on the historical development of clinical interventions within the psychodynamic and cognitive-behavioral approaches. In the fourth section, the review of the DSR literature in psychotherapy and the systematization of clinical interventions according to such a unifying framework are introduced. Clinical interventions can be aimed at increasing the patient’s stability and flexibility, with the final objective of promoting H-L Synchronization and S-F Oscillations. The connections between the DSR-based categorization and the literature pertaining to the psychodynamic and cognitive-behavioral approaches are highlighted. Finally, in the conclusions, the limitations and potential developments of this scientific area are discussed.

Clinical Simulation Program for the Training of Health Profession Residents in Confidentiality and the Use of Social Networks.

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Liquid nitrogen cryotherapy effectively and safely improves response of thick Actinic Keratoses lesions by 5-aminolevulinic acid-based photodynamic therapy: a randomized, prospective, single-blind trial

BackgroundActinic keratoses (AK) may progress into squamous cell carcinoma. Many combination therapies were used to improve the clearance rate. However, there are limited studies on the efficacy and safety of lesion-directed Liquid nitrogen cryotherapy combined with field-directed photodynamic therapy (PDT). ObjectiveThis study is aimed to determine the efficacy and safety of Liquid nitrogen cryotherapy combined with PDT in Chinese patients with actinic keratosis. MethodsA total of 61 patients with AK were selected at the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College between August 2018 and August 2023. They were randomly divided into PDT plus Liquid nitrogen cryotherapy group(LN-PDT)and control PDT group(C-PDT)with 30 patients and 31 patients, respectively. 27 patients in the LN-PDT group and 28 patients in the C-PDT group completed the clinical sessions. Efficacy, adverse effects, and cosmetic outcomes were recorded and compared between the two groups. Results3 months after the final treatment, the clearance rates for total AK lesions were 97.4%(449/461) in the LN-PDT group and 93.4%(456/488)in the C-PDT group (P < 0.05). For grade I AK lesions, the clearance rates were 99.2% (234/237) for the LN-PDT group and 98.3% (237/241) for the C-PDT group (P >0.05). For grade II lesions, the clearance rates were 97.5% (156/160) for the LN-PDT group and 91.9% (172/186) for the CPDT group (P < 0.05). For grade III lesions, the clearance rates of the LN-PDT and C-PDT groups were 87.5% (58/64) and 78.7% (47/61), respectively (P < 0.05). The two groups had no significant differences in pain, erythema, edema, hyperpigmentation and scarring. Cosmetic outcomes mainly were excellent or good in both groups with no significant difference. ConclusionLiquid nitrogen cryotherapy combined with PDT showed higher efficacy on grade II and grade III AK lesions than PDT alone. The two groups have similar adverse effects and cosmetic outcomes.

Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study.

In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce. This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning. A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined. In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6%), of which 63 (36.4%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned. This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context.

The Incidence of Clinical Injuries among Undergraduate Dental Students: A Prevention Protocol

Dental students are frequently exposed to percutaneous injuries (PCIs) due to the nature of their clinical work, which involves sharp instruments and close patient contact. The COVID-19 pandemic further emphasized the need for stringent biosafety measures and the use of personal protective equipment (PPE). Despite these precautions, injuries remain prevalent, highlighting the need for comprehensive education and training in biosafety and infection control. This study investigates the incidence and causes of injuries among undergraduate dental students during clinical sessions. This study was conducted at the Department of Dentistry, National and Kapodistrian University of Athens, focusing on injuries reported from 2021 to 2024. Data were collected through self-reported clinical records. The primary variables assessed included the type of injury, the instrument involved, the clinical procedure performed, and the immediate actions taken post-injury. Serological testing was conducted on students and patients to assess the risk of the transmission of bloodborne pathogens. The findings reveal a high prevalence of injuries, with needles being the most common cause (51.4%), followed by other tools such as dental probes (25.7%) and burs (8.6%). The most frequent injury type is piercing (74.2%), primarily affecting the fingers (88.6%). Periodontal treatments, restorative procedures, and endodontic treatments are the main activities leading to injuries, with 17.1% of injuries being caused by each. No statistically significant results are recorded. Despite regular medical records for most patients treated by injured students, serological testing shows significant positivity rates for HCV and HBV. Notably, most injured students demonstrate their commitment to safety by adhering to recommended post-exposure protocols, including wound cleaning, disinfecting, and serological testing. Furthermore, the impact of COVID-19 heightened the importance of personal protective equipment (PPE) and reinforced occupational health standards. Our study highlights the critical need for enhanced biosafety awareness and training among undergraduate dental students to reduce injury risks.

The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools.

While prior studies have explored staffing infrastructure for primary care practices in general, little is known about the range of academic primary care practice models and supports available for academic general internists. To characterize the range of practice arrangements and expectations for attending academic physicians in general internal medicine (GIM) practices at the top 22 medical schools across the USA. Cross-sectional survey administered electronically between October 30, 2022, and December 28, 2022. Clinical leaders in GIM at the top 22 primary care medical schools, as identified by the 2023 US News and World Report Rankings. Clinical load, productivity expectations, cross-coverage, and team-based care models. Twenty-two leaders responded, representing 68% (15/22) of medical schools surveyed. The practices were mostly in urban locations (18/22, 82%) and 86% (19/22) included residents. Practices ranged from 7 to 200 PCPs and from 3 to 112 clinical FTEs. A full-time (1.0 FTE) clinical role for academic attending GIM physicians entailed a median of 9 (IQR 8, 10) weekly half-day clinic sessions, with a median panel size expectation of 1600 (IQR 1450, 1850) patients and a median yearly RVU expectation of 5200 (IQR 4161, 5891) yearly RVUs generated. Staff support was most commonly present for prescription refills and patient portal message checks. It was less commonly available for time sensitive form completion. Occasional clinical coverage for other physicians was an expectation at all practices. In this study, we characterize the organization of and supports available in academic GIM practices affiliated with the top primary care medical schools. Our findings provide comparative information for leaders of academic GIM practices seeking to enhance primary care delivery for their faculty and trainees. They also highlight areas where standardization may be beneficial across academic GIM.

Gujarati translation and adherence testing of Stretching and Strengthening of Rheumatoid Arthritis of the Hand (SARAH)

ABSTRACT Context: Stretching and strengthening for rheumatoid arthritis of the hand (SARAH) is a progressive and individually designed recommended treatment exercise program. Aims: The aim was to translate the SARAH hand exercise program into Gujarati and assess the adherence rate, usefulness, and understanding of the Gujarati SARAH exercise program. Methods and Materials: Mixed-method qualitative study was conducted among 25 participants at the outpatient departments of Institute Nadiad and Niruj Rheumatology Clinic, Gujarat, and via professional contact, a telephonic semi-structured interview was conducted among 13 participants using an interview guide, and interviews were audio-recorded following transcription verbatim. Overall adherence rates of 25 participants to a 12-week exercise program were determined using the cross-sectional method. Statistical Analysis Used: IBM SPSS software version 23.0 was used for analyzing quantitative data, and NVivo Plus version 11 was used for qualitative data. Results: The adherence rate was 97.22%. Participants completed all 72 sessions (n = 7) with an adherence rate of 100%. The least number of sessions completed was 25 (n = 2), with an adherence rate of 34% due to a lack of interest in exercising on a daily basis. Qualitative findings showed that the booklet is understandable, useful, and beneficial in terms of reducing symptoms and improving activities of daily life as well as occupational work. Conclusion: The translated strengthening and stretching for rheumatoid arthritis in the hand exercise booklet is effective and beneficial to patients who exercise at home. Participants can self-track their exercise by using dairy, which eliminates travel costs and attendance at clinic sessions.

Biopsychosocial Factors That Influence Depression, Anxiety, and Neuropsychological Functions in the Aging Process.

Aging is a process inherent to the human condition that is characterized by various biological, psychological, and social changes that can lead to certain mental health problems. This study aimed to understand and characterize how biological, psychological, and social factors influence mental health symptoms and neuropsychological function in the aging process. A sample consisting of 616 participants (73.8% female) aged between 50 and 90 years, (mean [SD]: 69.6 [17.2] years). Data collection involved a neuropsychological assessment carried out by a psychologist in a clinical interview session and the self-completion of a questionnaire. Regression models revealed that depressive symptoms are explained by anxiety, psychological and environmental quality of life, and sleep habits. Anxiety symptoms are explained by depression, physical quality of life, and sleep habits. Statistically significant differences were identified between participants with and without anxiety in neuropsychological terms at the level of agnosia and praxis. Statistically significant differences were identified between participants with and without depression in neuropsychological terms at the level of memory, language, agnosia and praxis, and executive function (eg, prefrontal tests). Depression and anxiety symptoms are associated and could negatively influence the aging process. Aging should be understood in an ecological way taking into account the action of biological, psychological, social, and environmental factors, as well as the relationship and influence between the different levels and factors. This knowledge is important for diagnosis, for clinical practice, and for the development and definition of public policies to promote healthy aging.

Implementing a multidisciplinary approach for older adults with multiple sclerosis: geriatric neurology in practice

BackgroundOlder adults with multiple sclerosis (MS) face unique challenges arising from age-related changes in MS pathophysiology and overlapping geriatric syndromes. There is a need for geriatrics-focused multidisciplinary care for the rapidly growing older MS population. Objectiveto design and implement a geriatric multidisciplinary clinic for older adults with MS. MethodsWe describe the development of a multidisciplinary approach to geriatric MS care within a single institution through the implementation of the Aging with MS Clinic. The clinic model was conceived through collaboration between neurology and geriatric medicine to provide comprehensive care for older adults with MS who are uniquely affected by overlapping symptoms of aging and MS (e.g., frailty, falls, functional decline, multiple comorbidities, polypharmacy, cognitive impairment, nutritional deficits, barriers to access healthcare). Multidisciplinary specialists were recruited to staff the clinic, and initial patient satisfaction outcomes were collected. ResultsThe team of multidisciplinary specialists staffing the clinic consists of a MS advanced practice practitioner, MS pharmacist, physical therapist, neuropsychologist, dietitian, and social worker. A clinic template was devised where 4 patients with MS over age 60 are seen by each specialist during each a half-day clinic session. Initial patient satisfaction surveys from 25 participants showed overwhelmingly positive feedback. A majority of participants (92%) agreed that the clinic was well-organized, while 89% felt they benefitted from attending. Additionally, 70% of participants reported that the clinic improved their overall quality of care. ConclusionThe Aging with MS clinic outlines a model for comprehensive geriatric assessment and care in older adults with MS by a team of multidisciplinary specialists. Initial feedback from patients who attended the clinic conveyed improved quality of care.

Calculating the Notional Learning Hours (NLH) for Final-year Medical Students in a Clinical Surgery Clerkship Course

Background: The main objective of this study is to design a method to calculate the notional learning hours (NLH) of final year medical students doing a surgical clerkship course. Secondary objectives include derivation of the Oman Qualification Framework (OQF) credits and setting a benchmark of NLH in clinical courses.Methods: This is an observational cross-sectional study which uses a quantitative way to estimate students’ NLH. A questionnaire was designed and filled by final year medical students at the end of their surgical rotation. Ethical clearance was obtained. The data were uploaded and analyzed using SPSS 25. The NLH was then calculated and mapped on the OQF template.Results:Ninety-seven students participated in the study. Students spent an average of 1.20 (0.99) hours/day to study their clinical sessions and 2.86 (1.4)/day to study for their theory sessions. The mean weekend hours of study on Friday and Saturday were 3.1 hours (2.6), and 3.2 hours (2.5), respectively. The average preparation for the end rotation and the final MD exams were 9.7 (3.3) and 10.4 (3.6) hours, respectively. We calculated the NLH of our students by adding the above data to the contact teaching hours from our course timetable. We compared our results with worldwide medical schools.Conclusion: The NLH of our surgical clerkship students was calculated and subsequently the OQF credits were derived. This suggested method is evidence-based and could be used as a guide by other clinical clerkship courses.

Improving Recruitment Of Older Patients For Patient And Public Involvement And Engagement Work (PPIE): Ensuring A Representative Voice

Abstract Background Older people are under-represented in research, despite this demographic being the biggest users of healthcare resources. Service design needs to be patient-centred and therefore engaging this underserved group is crucial, albeit challenging. We describe a quality improvement project aimed at improving recruitment of patients into a local PPIE group in a perioperative geriatric service. Methods Clinicians opportunistically consent patients for the PPIE group during their perioperative geriatric clinic consultations. A baseline level of recruitment was established before implementing a series of PDSA cycles. The interventions were firstly, to adapt the paper clinic proforma making the consent section clearer, secondly to give weekly reminders to clinicians, and finally discussing PPIE with patients while they wait for their appointment. A focus group with clinicians was run using nominal group technique to explore barriers and potential solutions to recruitment. Results An average of three patients were being recruited per month from April 2022 to September 2023. Two weeks following the first intervention, no new patients were consented. Two weeks following the second intervention, this improved to two new patients. Following the third intervention, five new patients were recruited after two clinic sessions. From the focus group, the top three barriers to recruitment were forgetting, clinical responsibilities taking priority, and lack of awareness by new staff. The highest rated solution was utilising non-clinical staff to recruit patients in the waiting room. Conclusion During busy clinics, it is easy for clinicians to forget about issues not directly related to the patient in front of them. However, PPIE is vital in co-designing healthcare. There are both staff and patient-related barriers in recruiting and maintaining a PPIE group in older patients. From our project, we found a combination of passive (e.g. a tickbox proforma) and active recruitment by dedicated staff the best way to improve PPIE.

Medical students’ satisfaction towards videos as flipped classroom materials

A video with the complete workflow of colorimetric assay of serum glucose was shot and launched on the college Learning Management System (LMS) for first year medical students. The aim of this project was to assess students’ satisfaction with videos as flipped classroom (FC) materials. Year 1 medical students were instructed to watch the video through an available link before the practical session and answer a questionnaire measuring their satisfaction at the end of the session. 162 students responded to the questionnaire. 85.8% of students said that FC videos should be used for other practical/ clinical sessions. Students’ satisfaction indicates that videos may be useful as FC materials.

Desirable clinical settings in general dentistry: moving towards the improvement of the educational program

BackgroundThe main task of dental schools is to prepare professional dentists with a high social responsibility. This study provided some practical suggestions from experts regarding desirable clinical settings, in order to establish an infrastructure for practical studies in Endodontics, Periodontics, Oral and Maxillofacial Surgery, Restorative Dentistry, Pediatric Dentistry, Oral and Maxillofacial Medicine, Prosthodontics, Oral Health, and Social Dentistry.MethodsThis research was conducted using a modified Delphi technique in two rounds. The first round involved qualitative content analysis. Participants in interviews were selected purposeful and maximum diversity across the country. To determine the validity and reliability of the data, the four axes proposed by Lichon and Guba were utilized. The second round involved a researcher-made questionnaire, which consisted of 55 questions. This questionnaire was distributed to all dental schools across the country. The validity of the questionnaire were evaluated and by experts and then reviewed. The reliability of the tool was determined to be 0.96 using the alpha coefficient method.ResultsThe final codes from the interviews of the first round were divided into two categories: settings and educational programs. The final results of research were placed into 2 section: educational settings and instructors, and educational infrastructures. 70% participants agreed to use the college’s clinical morning sessions. More than 80% agreed to start up a main clinic with the proposed structure and professors. The use of the hospitalization area also had an agreement of more than 80%. Additionally, community areas such as health service centers, welfare centers, special patient centers, factories, schools, etc. obtained an agreement of over 70%.ConclusionsThe results of this study are presented in the form of suggestions for improving the general dentistry program in relation to educational setting, educators, and educational infrastructures. The common agreement among participants regarding educational settings and their diversity, educational programs, and desired instructors reviewed in the research shows the necessity of reviewing and changing their educational programs in Endodontics, Periodontics, Oral and Maxillofacial Surgery, Restorative Dentistry, Pediatric Dentistry, Oral and Maxillofacial Medicine, Prosthodontics, Oral Health, and Social Dentistry.

Management of medically unexplained symptoms in children and young people: a secondary analysis of a 10-year audit of referrals to a Paediatric Psychology Service

This study evaluated service use of children and young people with medically unexplained symptoms (MUS) referred to a Paediatric Psychology Service between 2008 and 2017. Univariate analyses of activity data...

Brief Report: Baseline HRV Time Domain Parameters Predict Trauma and Depression Symptom Change in Veterans with PTSD Undergoing Biofeedback.

Heart rate variability (HRV) is an index of cardiac autonomic function and an objective biomarker for stress and health. Improving HRV through biofeedback has proven effective in reducing symptoms of posttraumatic stress disorder (PTSD) and depression in veteran populations. Brief protocols involving fewer sessions can better maximize limited clinic resources; however, there is a dearth of knowledge on the number of clinical sessions needed to significantly reduce trauma and depression symptoms. We conducted a series of linear regression models using baseline, post-intervention, and follow-up data from intervention group participants (N = 18) who engaged in a pilot waitlist-controlled study testing the efficacy of a 3-session mobile app-adapted HRV biofeedback intervention for veterans with PTSD. Based on Nunan et al. (Pacing and Clinical Electrophysiology 33:1407-1417, 2010) short-term norms, we found that pre-intervention RMSSD in the normal range significantly predicted PTSD and depression symptom improvement. Findings suggest the utility of baseline RMSSD as a useful metric for predicting HRV biofeedback treatment outcomes for veterans with PTSD and comorbid depression. Those with below-normal baseline RMSSD may likely need additional sessions or an alternative treatment to show clinically meaningful symptom improvement.

Impact of Attendance to a Pharmacist-Managed Medication Adherence Clinic on Glycemic Control and Risk Factors for Non-Completion Among Persons with Type 2 Diabetes Mellitus in Selangor, Malaysia.

Diabetes mellitus (DM) is a chronic metabolic disorder affecting millions globally. Adherence to treatment is crucial for effective management. To compare clinical outcomes, specifically changes in haemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels, between DM patients who completed the pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) sessions and those who did not, and to identify risk factors associated with non-completion of DMTAC. This multicenter, retrospective study included patients with DM attending DMTAC at five Ministry of Health centers from January 2018 to December 2020. Patients were categorized based on their completion of DMTAC sessions: those who completed at least four sessions and those who did not as per DMTAC protocol. The changes in HbA1c and FBS levels between the groups were analyzed. Logistic regression was employed to identify risk factors for non-completion of DMTAC. A total of 198 patients were included, comprising 49% male with a mean age of 56.52, ±12.91 years. The complete group consisted of 49% (n=99) of the patients, while the did not complete group included 50.5% (n=100). A statistically significant reduction in FBS levels from initial to final measurements was observed in the complete group compared to the did not complete group (P=0.024). Female gender, higher education levels, and a longer duration since DM diagnosis were significantly associated with non-completion of DMTAC. Diabetic patients attending at least four DMTAC sessions showed potential improvements in FBS levels. To enhance attendance at DMTAC sessions, healthcare professionals should focus on patients identified with risk factors for non-completion of DMTAC.

The decomposition rate and bleaching efficacy of in-office bleaching gels with different pHs: a randomized controlled trial.

To evaluate the decomposition rate of active hydrogen peroxide (HP) and bleaching efficacy during in-office bleaching using high-concentration HP gels with different pHs. A randomized, parallel, double-blind controlled trial was conducted with 40 volunteers randomized into four groups (pH 5.4; pH 7.0; pH 7.7, and pH 8.0). During the first session in-office bleaching, approximately 0.01g of the gel was collected and titrated with potassium permanganate to obtain the concentration of active HP and pH values were measured using an electrode. Bleaching efficacy was assessed using a spectrophotometer [∆Eab, ∆E00, and WID], Vita Classical and Vita Bleachedguide scales [∆SGU]. The decomposition rate of HP concentration and pH values change were calculated using ANOVA one-way. The bleaching efficacy was assessed using two-way repeated measures ANOVA. Tukey's test was applied as a post-hoc test (p < 0.05). All gels experienced decreasing HP concentration over time. pH 5.4 gel showed greatest reduction after 50min (p < 0.001). pH 8.0 and 7.7 gels remained stable; pH 5.4 remained acidic, while pH 7.0 turned acidic (p < 0.001). No significant difference in bleaching degree was observed among gels. They all showed a similar and clinically important color change after two clinical sessions, remained stable 1-month post-treatment (p > 0.05). All bleaching gels kept at least 70% of their HP content after 50min, suggesting that there is a surplus of HP. They provided similar whitening efficacy 1-month after bleaching. It is possible that lower HP concentrations may be equally effective in achieving desired results while reducing the potential for side effects. RBR-35q7s3v.

Discriminative performance of ocular surface staining and lid wiper epitheliopathy in dry eye disease: An investigator-masked, prospective registry-based, diagnostic accuracy study

PurposeTo evaluate the diagnostic performance of corneal and conjunctival staining, and lid wiper epitheliopathy (LWE) in detecting dry eye disease, as defined by the global consensus Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) criteria. MethodsA total of 2066 community residents (1285 females; mean ± SD age, 40 ± 19 years) were recruited in an investigator-masked, prospective registry-based, diagnostic accuracy study. Dry eye symptomology and ocular surface parameters were assessed in a single clinical session. The Sjögren's International Collaborative Clinical Alliance (SICCA) corneal and conjunctival staining scoring and Korb lid wiper epitheliopathy (LWE) grading were evaluated by an independent masked assessor. ResultsOverall, 807 (39 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease, of which 178 (9 %) participants were classified as moderate-to-severe disease. The discriminative abilities of superior and inferior LWE (C-statistics, 0.724 and 0.712, respectively) were greater than corneal and conjunctival staining (C-statistics, 0.573 and 0.627, respectively). The Youden-optimal diagnostic cut-offs for the SICCA corneal and conjunctival staining scores were both ≥1, and the optimal thresholds for the Korb superior and inferior LWE grades were both ≥1. LWE was more commonly detected in both mild-to-moderate and moderate-to-severe dry eye disease, and demonstrated more consistent correlation with other ocular surface parameters across a broader range of disease severity. ConclusionsLWE demonstrates superior diagnostic performance relative to corneal and conjunctival staining. These findings would support the routine incorporation of LWE evaluation as part of the diagnostic workup of dry eye disease.

DBScope as a versatile computational toolbox for the visualization and analysis of sensing data from deep brain stimulation

Different neurostimulators for deep brain stimulation (DBS) come already with the ability to chronically sense local field potentials during stimulation. This invaluable new data has the potential to increase our understanding of disease-related brain activity patterns, their temporal evolution, and their modulation in response to therapies. It also gives the opportunity to unveil new electrophysiological biomarkers and ultimately bring adaptive stimulation therapies closer to clinical practice. Unfortunately, there are still very limited options on how to visualize, analyze, and exploit the full potential of the sensing data from these new DBS neurostimulators. To answer this need, we developed a free open-source toolbox, named DBScope, that imports data from neurostimulation devices and can be operated in two ways: via user interface and programmatically, as a library of functions. In this way, it can be used by both clinicians during clinical sessions (for instance, to visually inspect data from the current or previous in-clinic visits), and by researchers in their research pipelines (e.g., for pre-processing, feature extraction and biomarker search). All in all, the DBScope toolbox is set to facilitate the clinical decision-making process and the identification of clinically relevant biomarkers. The toolbox is already being used in clinical and research environments, and it is freely available to download at GitHub (where it is also fully documented).