Patient Cooperation Research Articles

Comparison of intravenous dexmedetomidine alone versus dexmedetomidine ketamine combination on sedation intubation response safety profile and patient satisfaction during awake fiberoptic nasotracheal intubation

Awake fiberoptic intubation requires adequate airway anaesthesia along with good sedation to achieve patient cooperation during intubation without respiratory depression and hypoxia.The purpose of this study was to compare dexmedetomidine alone and dexmedetomidine with ketamine in order to achieve an ideal regimen during awake fiberoptic intubation by providing sedation, good intubating conditions, better hemodynamic stability, and patient satisfaction.This prospective, randomised, double-blind clinical trial included 60 patients who were scheduled for elective surgery under general anaesthetic and required nasotracheal intubation. Patients were randomly assigned to two groups of 30 each, with ages ranging from 18 to 65 years and ASA grades I and II. All patients received an inj. dexmedetomidine bolus at 1 mcg/kg over 10 min. followed by a study drug depending on the group. In Group A, patients will receive an inj. ketamine 15 mg bolus and a 20 mg/hr ketamine infusion, whereas those in Group B will receive a normal saline bolus and infusion till completion of intubation. Sedation by Ramsay sedation scale (RSS), intubation response (by coughing score and grimace score), hemodynamic stability was observed during awake fiberoptic intubation, and patients' satisfaction by visual analogue score (VAS) and recall of events were assessed post operatively at 24 hours. In Group A with greater hemodynamic stability compared to Group B, RSS and Post-Operative Vas Score were more successfully attained. A combination of dexmedetomidine and ketamine provides the optimum sedation, hemodynamic stability, and patient satisfaction during awake fiberoptic intubation.

Elastodontic treatment with oral bio-activators in young children.

Elastodontic therapy can correct bad oral habits and malocclusions in young patients by guiding jaw growth, eliminating functional disorders, and improving tooth position. The aim of this study was to assess the effects of bio-activator therapy on the presence of atypical swallowing with tongue thrust in growing patients. A retrospective study was conducted. Data regarding the early orthodontic treatment of 40 consecutive patients with atypical swallowing and tongue thrust (23 males and 17 females) were assembled from January 2019 to January 2020. All patients (≥7 and ≤15 years of age) were monitored for 1 year in a private practice in Isernia, Italy. The mean age at commencement of orthodontic treatment was 8.5 years (range=7.1-14.9 years), and the mean total duration of therapy was 1 year (range=11 months-1 year). Final lateral radiographs demonstrated a mean of improvement of 8° for upper and lower incisor proclination (I/SN) and 3.5° for incisor mandibular plane angle (IMPA) in 36 patients, and 5° of I/SN and 2° of IMPA in the remaining 4 children after 1 year of treatment. Bad oral habits in younger patients must not be ignored. The duration of treatment can differ depending on the severity of the open bite and the patient's cooperation. This study demonstrates the short-term efficacy of these myofunctional appliances in the treatment of atypical swallowing. In order to quickly eliminate factors which endanger healthy development of dento-skeletal structure, it is important to closely monitor patients during their development phase.

Manual small-incision cataract surgery under topical anesthesia.

Manual small-incision cataract surgery is one of the most common surgical procedures in ophthalmology. Most cataract surgeries are performed under local anaesthesia. Peribulbar or retrobulbar anaesthesia is commonly used to achieve analgesia and akinesia during surgery but it has various complications. Our aim was to study patient comfort and surgeon's perspective in terms of patient cooperation in MSICS under topical anaesthesia using only proparacaine 0.5% eye drops without any periocular block or intracameral drug. Also to popularise Topical MSICS similar to Topical Phacoemulsification. A prospective analytical study of 33 patients who underwent MSICS surgery from March 2022 to June 2022 using Topical proparacaine eye drops 0.5% was done and patient's comfort and surgeon's perspective in terms of patient cooperation was studied on a scale of 1-5. Out of 33 patients who underwent surgery, the average comfort score based on patient feedback was 3.45± 0.96 and average patient cooperation score based on surgeon assessment was 3.42 ± 1.07 on a scale of 1-5. We concluded that MSICS using only topical proparacaine 0.5% eye drops, can provide sufficient patient comfort and can avoid complications related to peribulbar anaesthesia. Hence it can be used in large scale cataract surgeries and also provides economical utilisation of resources, lesser complications and early post operative recovery without compromising surgical outcome.

Commentary: Rule out lacrimal duct obstruction before every intraocular procedure.

The age of presentation often overlaps for a person with acquired cataracts and acquired nasolacrimal duct obstruction (NLDO). Hence, there is more probability of having an asymptomatic NLDO and a cataract in the same person. Ipsilateral NLDO is considered an important risk factor for postoperative endophthalmitis in an intraocular procedure. Therefore, it becomes mandatory to rule out ipsilateral NLDO in all patients planned for cataract surgery.[1] Overall, the reported incidence of NLDO is 3–6.6%, with a mean age range of 48–59.5 years.[12] The ophthalmic evaluation of cataract surgery focuses on the factors affecting the visual acuity outcomes, like the health of tear-film, cornea, and anterior and posterior segments. Similarly, the ocular investigations are also targeted mainly at calculating and computing the refractive indices directly involved in the outcome of cataract surgery. Regurgitation on pressing lacrimal sac (ROPLaS) and lacrimal irrigation are generally not included in the routine examination of most ophthalmic cases. Hence, an asymptomatic lacrimal patient with a cataract tends to get his/her NLDO missed. ROPLaS and/or lacrimal irrigation must be included in the preoperative workup of a cataract patient to avoid the chance of postoperative endophthalmitis.[3] Lacrimal irrigation is an invasive diagnostic procedure requiring the desired skill-set to avoid any iatrogenic injury to the delicate lacrimal drainage system and interpret the results. Moreover, the patient and examiner must be in specific positions for lacrimal irrigation rather than sitting on an examination chair and slit lamp. Each step requires patient co-operation, like topical anesthesia, gaze positioning of the patient, punctum dilatation (preferably superior), lacrimal cannula insertion in horizontal canaliculus, and perception of gently forced injection of fluid in nose or throat. A significant part of lacrimal irrigation is dependent on the patient’s co-operation and systemic condition. ROPLaS, on the other hand, is a simple test that can be easily performed in the sitting position (any position) of the patient without consuming much time in the workup period. All those beneficial parameters are vital in high-volume centers and screening camps in remote areas. The examiner desires no special instrumentation or patient co-operation. In a survey involving members of the Oculoplastics Association of India, ROPLaS (59.6%) was opted as the preferred modality compared to lacrimal irrigation/syringing (32.6%), for checking NLDO before cataract surgery.[3] The sensitivity and specificity of ROPLaS have been reported to be 93.2% and 99.3%, respectively.[1] They recommended preoperative lacrimal irrigation to be unnecessary in case of a negative ROPLaS test. A recent retrospective, single-center study from India, including a large sample size (87,144 eyes), compared postcataract surgery endophthalmitis rates among eyes undergoing syringing (48,071 eyes) or ROPLAS (39,073 eyes) test before cataract surgery.[4] They found that the rates of post-cataract endophthalmitis (PCE) were comparable among the eyes undergoing either syringing test or ROPLAS before cataract surgery. This study was performed to avoid lacrimal irrigation, an aerosol-generating procedure, during COVID-19 times. However, when the safety of a vision-restoring surgical procedure (elective cataract surgery) is in question, more details in the ophthalmic examination will add to the safety value. As per the current study by Kim et al.,[5] the ROPLaS and lacrimal irrigation are both recommended to be performed in the preoperative workup of a cataract patient.[5] In their study, the ROPLaS was performed by an ophthalmologist, while a trained ophthalmic technician performed the lacrimal irrigation. We want to emphasize that ophthalmologists should first train the technician adequately before performing an invasive procedure (lacrimal irrigation) on a patient. This would ensure the desired outcomes from the lacrimal irrigation procedure without iatrogenic trauma to the lacrimal punctum and canaliculus. Additionally, a history of significant epiphora ± discharge goes a long way in suspecting lacrimal obstructions. Slit-lamp examination of the tear film and inferior conjunctival fornix is a must to rule out any debris/discharge. The fluorescein dye staining provides basic information about the health of corneal epithelium, and the simultaneous observation of the fluorescein dye disappearance test can provide an additional dimension in ruling out lacrimal duct obstruction. We believe that if a patient has a positive ROPLaS test, lacrimal irrigation is not necessary. However, in a patient with negative ROPLaS, lacrimal irrigation should be performed before any intraocular procedure to avoid the most-dreaded complication of endophthalmitis due to a treatable cause - NLDO.

Travel Prevention Using Telepsychiatric Services: A Review

Background: Telepsychiatry is a type of mental health service delivery using information and communication technology for patients living far from psychiatrists It can reduce the number of travelers looking for mental health services. This study aimed to review articles that reported the percentage of prevented travels or referrals using telepsychiatry.Methods: The PubMed database was searched in September 2019 for this review study. Data were extracted from admitted studies based on a series of variables consisting of author, country, modality, referral setting, urgency, study design, sample size, and percentage of prevented travel. Descriptive statistics were used to analyze data.Results: Eight studies were included. Half of these studies were conducted in Australia. Real-time telepsychiatry modality was used in most of the studies (75%). The hospital was the most referral setting in the studies (62.5%). The type of telepsychiatry services delivered in 75% of the studies was elective. The study design of 62.5% of studies was prospective. The number of included participants in the studies ranged from 28 to 1943. The percentage of avoided travels ranged from 12 to 79.Conclusion: Successful telepsychiatry systems could prevent unnecessary referrals and travels. However, the effective use of telepsychiatry services depends on various factors, including the type and period of the disease, the therapist’s efficacy in terms of correct diagnosis and treatment, and patient cooperation.

Research on Development Status and Trend of Mechanical Prosthetics

With the progress of social economy and science and technology, there are more opportunities for the development of medical industry. Moreover, the life span of human beings is increasing, and the requirements for quality of life are getting higher and higher, which makes clinical medicine and rehabilitation medicine face greater challenges. Orthodontics and appliances are an important part of rehabilitation medicine. Amputees and disabled limbs, by wearing appropriate mechanical prostheses and orthotics, can effectively improve the limb function, help to recover and return to normal social life. Therefore, mechanical prosthesis plays an important role in rehabilitation medicine. Fitting artificial limbs and orthotics requires the coordination and cooperation of doctors, patients and rehabilitation teachers, and only in this way can their effectiveness be maximized. Based on this, this paper first expounds the function, classification and characteristics of mechanical prosthesis, and then expounds the present situation and future development trend of mechanical prosthesis technology in China.

Diagnostic Yield and Safety of CP-EBUS-TBNA and RP-EBUS-TBLB under Moderate Sedation: A Single-Center Retrospective Audit.

Convex probe endobronchial ultrasound transbronchial needle aspirations (CP-EBUS-TBNAs) and radial probe endobronchial ultrasound transbronchial lung biopsies (RP-EBUS-TBLBs) can be performed under moderate sedation or general anesthesia. Moderate sedation is more convenient, however patient discomfort may result in inadequate tissue sampling. General anesthesia ensures better patient cooperation but requires more logistics and also carries sedation risks. We aim to describe the diagnostic yield and safety of CP-EBUS-TBNAs and RP-EBUS-TBLBs when performed under moderate sedation at our center. All patients who underwent CP-EBUS-TBNA and/or RP-EBUS-TBLB under moderate sedation, between January 2015 and May 2017, were reviewed. Primary outcomes were defined in regard to the diagnostic yield and safety profile. A total of 336 CP-EBUS-TBNAs and 190 RP-EBUS-TBLBs were performed between January 2015 and May 2017. The mean sedation doses used were 50 mcg of intravenous fentanyl and 2.5 mg of intravenous midazolam. The diagnostic yield of the CP-EBUS-TBNAs and RP-EBUS-TBLBs were 62.5% and 71.6%, respectively. Complication rates were low with: transient bleeding 11.9%, transient hypoxia 0.5%, and pneumothorax 0.1%. None required escalation of care, post procedure. Performing CP-EBUS-TBNAs and RP-EBUS-TBLBs under moderate sedation is safe and provides good diagnostic yield. These procedures should, therefore, be considered as first-line sampling techniques.

Effect of Nasopharyngeal Respiratory Training Combined with Nursing Guidance on the Intraoperative Cooperation of Patients Undergoing the First Gastroscopy

Effect of Nasopharyngeal Respiratory Training Combined with Nursing Guidance on the Intraoperative Cooperation of Patients Undergoing the First Gastroscopy

Custom-made acrylic beads for Forsus reactivation

The usage of the fixed functional appliances has increased over the years, mainly on the account of minimal demand for patient cooperation with these appliances. Though Forsus appliance provides sufficient activation for skeletal and mandibular correction with crimpable hooks, additional activation may be required in few cases. This clinical tip presents with a efficient and cost effective way for Forsus activation using customized acrylic beads.

The facilitated sensemaking model as a framework for nursing intervention on family members of mechanically ventilated patients in the intensive care unit.

Adverse psychological outcomes are prevalent among family members of intensive care unit (ICU) patients. The facilitated sensemaking model (FSM) provides a framework for understanding how intensive care nurses can help these family members overcome situations in which a loved one is critically ill, and reduce adverse psychological outcomes through the facilitated sensemaking process. This study aimed to implement FSM-based research performed by ICU nurses and patients' family members to investigate the impact of the facilitated sensemaking intervention on the psychological status of ICU families. The intervention was performed by nurses on 80 family members of mechanically ventilated patients, 40 in the control group and 40 in the experimental group. The control group only received routine medical services, while the experimental group received the nursing intervention based on FSM in addition to routine medical services. Anxiety, depression, and post-traumatic stress disorder (PTSD) were measured with the Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Post-Traumatic Stress Disorder Check-List-Civilian Version (PCL-C), respectively. SPSS version 25.0 was applied to analyze the data; what is more, some statistical methods, including descriptive statistical analysis, chi-square test and t-test were further adopted. Before the intervention, there were no significant differences in anxiety, depression, and PTSD of family members of ICU mechanical ventilation patients between the two groups (p > .05). After the intervention, the score of anxiety, depression, and PTSD of family members in the control group and the experimental group were 41.50 ± 5.738 versus 36.50 ± 4.385, p < .001; 45.28 ± 8.089 versus 42.13 ± 5.725, p < .05; and 30.55 ± 7.595 versus 27.55 ± 4.696, p < .05, respectively. The nursing intervention based on FSM significantly alleviated anxiety, depression, and PTSD of mechanical ventilation patients' family members. The nursing intervention based on FSM significantly alleviated anxiety, depression, and PTSD of mechanical ventilation patients' family members. However, there was only a statistically significant difference in the avoidance and numbness symptom cluster of PTSD via the PCL-C. Therefore, the observation time after the implementation of the FSM intervention needs to be extended in the future to clarify the effect of the intervention. Further efforts by advanced practice nurses and the cooperation of patients' families are required to incorporate this intervention into ICU practice.

IMPULSE OSCILLOMETRY IDENTIFIES DISTINCT ASTHMA PHENOTYPES ON CLUSTER ANALYSIS

IMPULSE OSCILLOMETRY IDENTIFIES DISTINCT ASTHMA PHENOTYPES ON CLUSTER ANALYSIS

NON-INVASIVE ESTHETIC REHABILITATION OF ANTERIOR DIASTEMA WITH DIRECT COMPOSITE RESTORATION

Diastema is a gap between adjacent teeth that occur physiologically from the teeth eruption. However, diastema between the maxillary central incisors in an adult can be an aesthetic problem and sometimes impair speech. Diastema treatment with low or enlarged superior labial frenulum includes frenectomy, orthodontic treatment, veneers, crown, and bridge or resin-based composite direct restorations. This case report will discuss the rehabilitation of diastema in an aesthetic zone of maxillary central incisors due to low frenulum attachment. It was done by a minimally invasive approach using direct composite restoration, completed within several hours after the study model was analyzed, and much less expensive than other forms of treatment. The protocol involved model analysis, smile design, mock-up, silicon index creation, and composite selection. Patient cooperation and understanding of the limitations are critical to long-term treatment success. The direct composite resin is a fast, simple method yet durable to achieve good improvement of small diastema in the aesthetic zone. And stable after three years.

Effect of Dexmedetomidine Added to Lidocaine Cartridge on the Level of Patient Sedation, Cooperation, and Patient and Surgeon Satisfaction during Mandibular Third-Molar Extraction Surgery: A Randomized Double-Blind Controlled Trial.

Background Various methods have been introduced for anxiety control during third-molar extraction surgery. Dexmedetomidine (DEX) is known to have analgesic, anxiolytic, and sympatholytic properties with minimal adverse effects. This study aimed to evaluate the impact of the local injection of the combination of DEX and Lidocaine on patients' anxiety and the surgeon's satisfaction during third-molar extraction surgery. Methods A total number of 26 healthy volunteers with symmetrical bilateral impacted mandibular third-molar teeth indicated for surgical removal were included in this double-blind randomized controlled trial. A single experienced surgeon performed two surgical extraction procedures within at least four-week time intervals using anesthetic cartridges containing “DEX + LIDO” or “LIDO alone” used randomly on each side for each patient. The Visual Analog Scale and the SDFQ index were used to evaluate patients' anxiety and surgeon satisfaction during the procedure. Results SDFQ reports showed that patients in the “DEX” group were 1.5 times more relaxed than those in the “LIDO alone” group. As a result, the level of sedation was considered statistically significant between the two groups (Wilcoxon test, P value <0.019). Wilcoxon test results also showed significant differences between the two groups regarding patients' overall cooperation in terms of interfering movement and verbal presentation of discomfort (P value <0.05); however, this difference was not considered significant regarding nonverbal signs of discomfort (P value >0.05). Moreover, both the surgeon and the patients reported a significantly higher satisfaction rate in the DEX group (paired T-test, df = 25, P value <0.05). Conclusions It was inferred from the outcomes of the present study that the application of DEX added to the LIDO local anesthesia cartridge could significantly benefit anxious patients with previous unpleasant dental treatment experiences. Trial Registration. This trial is registered with the clinical trial registration number: IRCT20200406046966N.

Perfusion Index after Supraclavicular Brachial Plexus Block as an Early Predictor of Successful Block

Objective: Supraclavicular brachial plexus block is a highly popular upper extremity anesthetic technique. Theoretically, after local anesthetic agent is injected, temporary vasodilatation, sensory loss and motor weakness ensue. The assessment of successful block relies on subjective data of sensory block and patient co-operation. The present study hypothesized that perfusion index (PI) is an early predictor and provide a cut-off value for the successful block. Materials and Methods: Sixty-two patients undergoing upper extremity operation under ultrasound-guided supraclavicular brachial plexus block were included. PI values were assessed on the operated limb at baseline, 0, 1, 3, 5, and 10 minutes after block. The patients were divided into three groups. Upon incision, patients that reported pain but tolerated the operation after anesthetic supplement were in the supplement group, patients that reported persistent pain after anesthetic supplement were in the failed group, and patients that did not required any supplement were in the complete group. The three groups were monitored with PI values. Results: The supraclavicular brachial plexus block of fifty-nine patients (95.16%) were successfully blocked, which 42 patients (67.74%) had complete block and 17 patients (27.42%) needed supplemental treatment. Three patients (4.84%) had failed block and were converted to general anesthesia. The PI value was continuously rising from baseline in successfully blocked patients. PI value at three minutes after local anesthetic injection showed block success at cut-off value of 3.6, respectively. Conclusion: Successful block could be determined early by the increase of PI value from baseline. A PI value of more than 3.6 at 3-minute after block is a good early predictor of successful block. Keywords: Perfusion index; Ultrasound-guided regional anesthesia; Brachial plexus block; Supraclavicular block; Regional anesthesia; Peripheral anesthesia

Non-pharmacological prevention and treatment of delirium in the intensive care unit

Delirium is an acute brain dysfunction that is a common and difficult-to-eliminate problem in the ICU. It is an important factor leading to prolonged hospital stay, increased treatment costs, and long-term cognitive impairment. Nonetheless, compared with the treatment of respiratory failure and its primary disease, the prevention and treatment measurements of delirium have not received enough attention, and its management strategies are still controversial. Evidence-based medicine currently does not support pharmacological approaches to preventing or treating delirium. Instead, it adopts a combination of multiple nonpharmacological methods to manage delirium in ICU patients through standardized evaluation and monitoring under the guidance of doctors and the cooperation of patients and their families.

INCIDENCE OF POLYPHARMACY AND DRUG RELATED PROBLEMS AMONG ELDERLY IN TERTIARY CARE HOSPITAL – A DESCRIPTIVE STUDY

Objective: Drug-related problems are most common in Geriatrics. The increasing number of available drugs and drug users as well as more drug regimens led to many drug related problems which increases the health-care cost, mortality, morbidity, and also decreases the quality of life. The main objective of this study is to assess the incidence of polypharmacy and drug-related problems among elderly admitted in tertiary care hospital. Methods: The study was conducted in a tertiary care hospital after obtaining ethical clearance from the Institutional Ethical Committee. The medication information along with medical data and patient demographics such as name of the patient, age, sex, chief complaints, laboratory data, diagnosis along with therapeutic data such as name of the prescribed drugs, dose, dosage, frequency, route of administration, duration of treatment, and any new or existing drug-related problems were noted in a case collection form by bed-side counseling, case sheets, laboratory reports and were documented. The drug-related problems (DRPs) were categorized using Pharmaceutical Care Network Europe classification v 9.0 classification. Statistical analysis was done using Chi-square test. Results: of 151 Participants considered for the study 97 (64.24%) were males and 54 (35.76%) were females. The incidence rate of DRPs was found to be 86.09% and 1.45 DRPs per patient. In a total number of sample population, patients with DRPs were 120 and without DRPs were 21. Conclusion: DRPs mostly observed in geriatric population as they receive multiple medications for multiple disease conditions and active role of clinical pharmacist is necessary to identify and resolve them. DRPs identified must be accepted by the physicians and cooperation of patients and physician is necessary to resolve DRPs. Further studies are required to prove that the polypharmacy plays a major role in developing DRPs.

Relationship between Psychological Factors with Cooperation and Satisfaction in Fixed Orthodontic Patient

Introduction: Cooperation in orthodontics is one of the most important predictors of treatment outcome. Evaluation of patient satisfaction is a suitable criterion for the evaluation of treatment quality of the patients and the relationship between physician and patient. In this study, the link between some personality traits of patients and their cooperation in orthodontic treatment is assessed.&#x0D; Materials &amp; Methods: In this descriptive study, 135 patients who were referred to the orthodontic department at the School of Dentistry of Isfahan Azad University for fixed orthodontic treatment were selected. The correlation between 5 psychological factors of Costa and McCrae personality theory with the level of cooperation and satisfaction of patients during orthodontic treatment was assessed by NEO-FFI questionnaire, and OPCS questionnaire to measure patient cooperation 2 months and 6 months after treatment and satisfaction questionnaire. Data were analyzed using Pearson, Spearman and Regression correlation coefficients.&#x0D; Results: The mean cooperation score was not significantly different between 2 months and 6 months after starting treatment (p value = 0.66). The satisfaction score of treatment was directly related to the score of the responsible factor of responsibility (p value &lt; 0.01) but was not significantly related to the scores of other personality traits factor (p value &gt; 0.05). Cooperation score 2 months and 6 months after starting treatment was not significantly related to personality trait factor scores (p value &gt; 0.05). There was no significant relationship between cooperation score 2 months (p value = 0.57) and 6 months after starting treatment (p value = 0.99) with treatment satisfaction score.&#x0D; Conclusion: There is no relationship between orthodontic patients' cooperation and their personality type. A direct relationship between orthodontic patients' satisfaction and the score of the personality factor of responsibility was seen.

Coronary CT angiography derived fractional flow reserve: view from radiologist

The diagnosis of coronary artery disease depends on a comprehensive assessment including morphological and functional information. Coronary CT angiography derived fractional flow reserve (CT-FFR) could obtain morphological and functional information from a single coronary CT angiography (CCTA) scan, achieving a "one-stop" assessment of coronary artery disease. CT-FFR is a non-invasive imaging examination to assess the hemodynamic changes of focal coronary lesions and suitable for patients with moderate to severe coronary artery stenosis or mild coronary artery stenosis combined with other high-risk characteristics, to assist in determining whether the lesions cause myocardial ischemia, and to guide clinical decisions and predict the risk of cardiovascular events. The application of CT-FFR relies on satisfied image quality of CCTA, and requires the cooperation of radiologists, clinicians and patients. This paper describes from the aspects of the measurement and analysis of CT-FFR, the diagnostic value of CT-FFR, the value of CT-FFR in assisting clinical decision making and prognosis, the comparison of CT-FFR with other functional cardiovascular imaging techniques and the future perspectives.

Managing compromised first permanent molars in children: minimally invasive treatment protocols for practitioners

Employing minimally invasive operative techniques to manage compromised first permanent molars is discussed as a treatment regimen to achieve a favourable medium-to long-term prognosis in modern paediatric dental management. It is known that patient cooperation, stage of dental development and eruption state, as well as chronological age and severity of tissue breakdown of the compromised tooth have an influence on the prognosis of treatment.CPD/Clinical Relevance: Understanding the various prognostic factors involving compromised first permanent molar teeth is essential if optimum treatment is to be provided.

An alternative method for measuring total respiratory resistance during quiet breathing: a feasibility and validation study.

Determining the respiratory system's mechanical properties with minimal patient effort has been an important field of investigation addressing patients unable to perform pulmonary function testing and in light of the preventive measures due to the recent pandemic. The current study aimed to present an alternative method for total respiratory resistance measurement during tidal breathing, compare it with airway resistance (Raw), measured by body plethysmography, and validate the procedure in three groups of subjects with normal, constrictive and obstructive respiratory patterns in spirometry. We developed an alternative method of assessing total respiratory resistance during quiet breathing. After manufacturing the appropriate hardware apparatus, we applied a steady extrinsic resistance (ΔR) for 100-200 m/s during tidal breathing. Α theoretical mathematical model allowed measurement of total respiratory resistance (Rtot) during inspiration (Rin) and expiration (Rex). To validate the method, 15 individuals were enrolled and assigned to the normal, obstructive and restrictive groups based on their spirometry patterns. All groups participated in two sets of measurements, the plethysmographic and novel method. Finally, respiratory resistance measurements were compared between groups and methods. The method was successfully developed, and Rtot measurements were recorded in five normal subjects and in five obstructive and restrictive subjects. Mean Rin and mean Rex were 4.99 cm H2O/L/sec and 4.42 cm H2O/L/sec in the healthy, 4.87 cm H2O/L/sec, and 6.63 cm H2O/L/sec in the obstructive and 5.97 cm H2O/L/sec and 4.12 cm H2O/L/sec in the restrictive group, respectively. Rex was notably higher than Rin in the obstructive group and was positively correlated with Raw (p<0.005, r=0.47). This method provides the theoretical background for a plausible alternative tool for accessing a mechanical parameter of the respiratory system, which is easy to perform and requires only passive patient cooperation while enabling rough differentiation between obstructive and restrictive disorders. The model's feasibility potential in a real-life setting was studied in a small sample, and additional implementation and validation of the method in a larger population are guaranteed.