Diagnostic Impression Research Articles

Conquering Calcification: How PriciGuide® system is Transforming Endodontics. A Case Report

Introduction: Traumatic injuries are a common cause of pulp canal obliteration (PCO), frequently affecting the maxillary central incisors. PCO presents significant challenges for root canal treatment due to procedural complexities and risks of iatrogenic errors. The PriciGuide® system, offers an innovative solution for guided endodontics, enhancing precision, visibility, and efficiency.Case Report: A 26-year-old male presented with a discoloured upper front tooth, tender on percussion and non-responsive to cold tests. Radiographic evaluation revealed a widened periodontal ligament (PDL) space, and the tooth was diagnosed with PCO and symptomatic apical periodontitis. The patient opted for root canal treatment using the PriciGuide® system. Cone-beam computed tomography (CBCT) and a diagnostic impression were used to create a customized guide. The PriciGuide® system facilitated precise access cavity preparation, and the root canal was instrumented with Hyflex CM files and irrigated with sodium hypochlorite with Twin Kleen enhanced by passive ultrasonic activation. The tooth was obturated with gutta-percha and restored with an all-ceramic crown. At a one-year follow-up, the tooth remained asymptomatic both clinically and radiographically.Conclusion: The PriciGuide® system effectively addressed the challenges of root canal treatment in a tooth with PCO, ensuring precise access, preservation of tooth structure, and optimal treatment outcomes. This case highlights the system's potential to advance guided endodontics and improve clinical success rates in complex cases

Immediate Complete Overdenture: optimizing patient’s quality of life with endodontic - prosthodontic approach

Background: Immediate complete overdentures are designed for placement denture immediately following the extraction or decapitation of natural teeth. This procedure overcome the challenges associated of esthetic problems, including functional difficulties and psychological issues. Purpose: The article aims to highlight the advantages of endodontic-prosthodontic approach through immediate overdenture, such as the preservation of alveolar bone and improvement in patient’s psychological well-being and quality of life. Case: A 60-years-old female came into Universitas Airlangga Dental Hospital with the chief complaint of missing multiple teeth with upper front teeth becoming loose and desire to replace them because of difficulty in chewing food. Case Management: Diagnostic impressions were taken using irreversible hydrocolloid material, then poured in the dental stone to create final impression. The treatment plan included endodontic treatment, scaling and root planning for 11. The vertical dimension of occlusion was established using a bite rim and mounted on an articulator. Then, the immediate overdenture was created by arranging artificial teeth. Before the denture insertion, 11 was decapitated and filled the orifice with glass ionomer cement. Extraction of 21, 22, 23 was carried out and after ensuring hemostasis, the immediate overdenture was inserted. To finalize the denture insertion, occlusion was assessed using articulating paper. Control was done after day 1,3 and 7 after denture insertion. Conclusion: This case report describes the effectiveness of immediate overdentures as a valuable treatment option through endodontic-prosthodontic approach. By providing a functional and aesthetic solution while minimizing the edentulous period, immediate dentures significantly enhance patient’s quality of life.

Characteristics of Young Children Associated with Diagnostic Utility of the Autism Diagnostic Observation Schedule: A DBPNet Study.

The aim of this study is to identify characteristics of children for whom a developmental-behavioral pediatrician's (DBP) diagnostic impressions of autism spectrum disorder (ASD) or non-ASD were changed by Autism Diagnostic Observation Schedule (ADOS) results. A prospective study of children 1½ to <6 years consecutively referred to 8 sites for possible ASD. Cognitive/developmental, language, and adaptive testing varied, as each site followed its usual clinical approach. DBPs documented diagnosis as ASD or non-ASD and their degree of diagnostic certainty (1-10) pre- and post-ADOS. Cases where DBP diagnostic impression did not change after ADOS administration ("Stable Group," n = 314) were compared with those for whom it did change ("Changed Group," n = 35), followed by matched random sample comparisons. There were no significant differences in child characteristics (age, gender, race, ethnicity, insurance, caregiver education) between the Stable and Changed groups. DBPs' diagnostic certainty was significantly lower, both pre- and post-ADOS, in the Changed versus Stable group. Change was associated with milder symptoms of ASD and less impaired language. In an age- and gender-matched comparison, significant differences remained for diagnostic certainty and severity of social communication impairments. Cognitive scores were significantly higher in the Changed Group. Because of significantly higher caregiver education and a trend toward more privately insured children among the Changed Group, samples (n = 35 each) were then matched on those characteristics, revealing the same differences for diagnostic certainty, severity of ASD symptoms, and language skills. Young children with milder ASD symptoms and less impaired language may benefit most from the administration of the ADOS.

Suspected Pseudobulbar Affect in Neurodegenerative Disease.

To investigate the association between suspected pseudobulbar affect (PBA), clinical diagnosis, cognitive testing, and self-reported mood in older adults presenting for evaluation of dementia. Patients presenting to an outpatient memory disorders clinic (N=311). We used traditional and novel network modeling approaches to examine associations between neuropsychological (NP) tests, patient and clinician rating scales, and the Center for Neurological Study-Lability Scale (CNS-LS) among patients with suspected AD (n=133) and other neurocognitive diagnosis (n=178). We then examined differences in test performance between patients with and without suspected PBA (CNS-LS cut-off of ≥ 13), while accounting for demographic and psychiatric covariates with propensity score matching. Group differences were assessed with Bayesian models. Prevalence of suspected PBA in AD was slightly less than half (44.4%) and at a similar rate in other dementias (e.g., 46.9% in CVD and 45.5% in LBD). In network models, the CNS-LS was associated with higher anxiety and better word list recall. After accounting for covariates, AD patients with suspected PBA performed better on word list recall βM=0.40, 95% CI [0.15, 0.66], and committed fewer false positive errors on recognition βM=-1.51, 95% CI [-2.34, -0.59] than AD patients without suspected PBA. There were no differences in patients with any other diagnostic impression, nor group differences on other NP measures. Patients with suspected PBA and AD diagnosis had better memory recall and recognition than those without suspected PBA, suggesting that impaired emotional regulation may be an early sign of AD in patients with less prominent memory decline. Better understanding PBA in neurodegenerative diseases, including prevalence and comorbidity with psychiatric conditions, could help with early identification, education, and initiation of treatment.

Degeneración combinada subaguda de la médula y gastritis atrófica: revisión de la literatura

Introduction: Subacute combined degeneration of the spinal cord is a consequence of vitamin B12 deficiency. Its clinical presentation includes paresthesia, and proprioception and vibratory sensation loss, which can become disabling. Case presentation: we report the case of an elderly patient who experienced initial paresthesia which progressed to paraparesis, as well as some memory loss. Based on his physical examination a diagnostic impression of myelitis was made. Further investigation evidenced cyanocobalamin deficiency. Conclusion: patient was treated with vitamin B12 supplementation, obtaining an adequate response. There are numerous causes of vitamin B12 deficiency, however, its treatment is simple, and its early initiation can prevent severe neurological symptoms leading to disability.

Automatic Classification of Conclusions from Multi-Tracer Reports of PET Brain Imaging in Cognitive Impairment.

The goal of this paper is to build an automatic way to interpret conclusions from brain molecular imaging reports performed for investigation of cognitive disturbances (FDG, Amyloid and Tau PET) by comparing several traditional machine learning (ML) techniques-based text classification methods. Two purposes are defined: to identify positive or negative results in all three modalities, and to extract diagnostic impressions for Alzheimer's Disease (AD), Fronto-Temporal Dementia (FTD), Lewy Bodies Dementia (LBD) based on metabolism of perfusion patterns. A dataset was created by manual parallel annotation of 1668 conclusions of reports from the Nuclear Medicine and Molecular Imaging Division of Geneva University Hospitals. The 6 Machine Learning (ML) algorithms (Support Vector Machine (Linear and Radial Basis function), Naive Bayes, Logistic Regression, Random Forrest, and K-Nearest Neighbors) were trained and evaluated with a 5-fold cross-validation scheme to assess their performance and generalizability. The best classifier was SVM showing the following accuracies: FDG (0.97), Tau (0.94), Amyloid (0.98), Oriented Diagnostic (0.87 for a diagnosis among AD, FTD, LBD, undetermined, other), paving the way for a paradigm shift in the field of data handling in nuclear medicine research.

Utility of serial troponin testing for emergency department patients with syncope.

For emergency department (ED) patients with syncope, cardiac troponin can identify acute coronary syndrome (ACS) and prognosticate for 30-day serious adverse events. However, it is unclear if serial testing improves diagnostic yield and prognostication. This was a secondary analysis of data from two prospective studies conducted to develop the Canadian Syncope Risk Score. Adults (age ≥ 16 years) with syncope were enrolled, and patient characteristics, vital signs, physician diagnostic impression, electrocardiogram and troponin results, and adjudicated 30-day serious adverse event were collected. The primary outcome was the detection of a serious adverse event within 30 days of ED disposition. The secondary outcome was comparison of ED length of stay among patients with single versus serial troponin measurements. 4996 patients [mean age 64.5 (SD 18.8) years, 52.2% male] were included: 4397 (89.8%) with single troponin [232 (5.3%) with serious adverse event in the ED and 203 (4.6%) after ED disposition]; 499 (10.2%) patients with > 1 troponin measurement [39 (7.8%) with serious adverse event in ED and 60 (12.0%) after ED disposition]. Among those with serial measurements, 10 patients (2.0%) had a rise from below to above the 99th percentile threshold, of whom 4 patients (0.8%) suffered serious adverse event: two with arrhythmias diagnosed on electrocardiogram, one with ACS and one suffered respiratory failure. Nine patients (1.8%) had Canadian Syncope Risk Score risk reclassification based on serial measurement, and none suffered 30-day serious adverse event. Median ED length of stay was significantly longer for patients with serial testing (5.6 vs. 3.8 h, p < 0.001). The initial troponin measurement was sufficient for serious adverse event detection and in-ED risk stratification. Serial troponin testing does not improve the diagnostic yield or prognostication and should be reserved for patients with ongoing symptoms or electrocardiogram findings suggestive of cardiac ischemia.

ALK -rearranged Mesenchymal Neoplasms With Prominent Foamy/Pseudolipogenic Cell Morphology : Expanding the Phenotypic Spectrum of ALK Fusion Neoplasms and Report of Novel Fusion Partners.

The category of ALK -rearranged mesenchymal neoplasms has been evolving rapidly, with reports of morphologically diverse lesions of cutaneous, soft tissue, and visceral origin. While some of these represent morphologically defined entities harboring recurrent ALK fusions (inflammatory myofibroblastic tumor and epithelioid fibrous histiocytoma), others are unclassified by morphology with variable overlap with the tyrosine kinase family of neoplasia and their underlying ALK fusions cannot be suspected based on morphology. We herein report 3 cases that expand the anatomic, morphologic, and genotypic spectrum of ALK -rearranged unclassified neoplasms. Patients were all adults aged 46 to 69 (median: 63) who presented with a mass located in the gingiva, subcutis of the back, and submucosal posterior pharyngeal wall. The tumor size ranged from 1 to 2.7 cm (median: 1.6). Conservative surgery was the treatment in all patients. Follow-up was available for one patient who remained disease-free at 14 months. Histologically, all tumors displayed large polygonal cells with foamy to granular and lipogenic-like microvacuolated copious cytoplasm and medium-sized round nuclei with 1 or 2 prominent nucleoli. Mitoses and necrosis were not seen. The initial diagnostic impression was PEComa, inflammatory rhabdomyoblastic tumor and unclassified pseudolipogenic neoplasm. Strong cytoplasmic ALK was detected by immunohistochemistry in all cases. Other positive markers include Cathepsin K (2/2), desmin (1/3), focal MyoD1 (1/1), focal SMA (1/3), and focal EMA (1/2). Targeted RNA sequencing revealed ALK fusions with exon 20 (2 cases) and exon 19 (one case) of ALK fused to RND3 (exon 3), SQSTM1 (exon 6), and desmin (intron 6). Methylation profiling in the desmin-fused case (initially diagnosed as inflammatory rhabdomyoblastic tumor) revealed an inflammatory myofibroblastic tumor match with a low confidence score of 0.5 and a flat copy number variation (CNV) profile. No NF1 mutation was detected in this case, altogether excluding an inflammatory rhabdomyoblastic tumor. Our study highlights and expands the morphologic and anatomic diversity of ALK- fused neoplasms and documents novel fusion partners ( RND3 and desmin).

Management of Spinal Myeloid Sarcoma in a 23-Year-Old Woman With a History of Acute Myeloid Leukemia

Myeloid sarcoma (MS) is an uncommon extramedullary tumor comprising immature myeloid cells, primarily associated with acute myeloid leukemia (AML). Spinal involvement is observed in fewer than 1% of cases. We present an unusual case of extramedullary MS in a patient with AML. A 23-year-old woman with a history of AML presented with neurological symptoms, including limb pain, weakness, and numbness. Imaging revealed an intramedullary enhancing mass at the cervical level. Partial laminectomy and microsurgical resection were performed, followed by laminoplasty. Immunohistochemistry supported the diagnosis, confirming MS. The patient was subsequently transferred to the hematologic department and received tailored treatment. The diverse clinical manifestations of spinal MS pose diagnostic challenges. In this case, an atypical intramedullary location led to incorrect initial diagnostic impressions. Comprehensive evaluations, including repeated biopsies and immunohistochemistry, were crucial for an accurate diagnosis. Treatment strategies vary based on systemic involvement, and prompt diagnosis is important for favorable outcomes. MS, especially in the spine, presents diagnostic and therapeutic complexities. Timely recognition, an accurate diagnosis through comprehensive evaluations, and tailored treatment strategies are crucial for positive outcomes in this rare hematologic entity.

Persistence of the omphalomesenteric duct in adults: Case report and literature review

Introduction: Multiple pathologies can affect the umbilical cord, either due to infectious causes or malformation causes (acquired or congenital). However, the persistence of the omphalomesenteric duct and the urachus are the most frequent congenital malformations, especially in the pediatric setting, but not in the case of adults. Case report: The case of a 68-year-old male patient from a rural area, a farmer, with an enterocutaneous fistula, who received surgical treatment, is presented. He went to the consultation due to yellowish fluid leaking from the umbilical region, pain, and erythema, with a history of prostatectomy, osteoarthritis, and arterial hypertension. He was admitted with a diagnostic impression of cellulitis vs wall abscess. According to the assessment by the surgical team, a clear discharge of intestinal fluid was observed through the navel, for which reason emergency surgical resolution was decided for exploratory laparotomy. The patient reports discharge of yellowish fluid from the navel since childhood; there is a high suspicion of a picture compatible with the persistence of the omphalomesenteric duct in the adult. The patient underwent surgery with the following finding: A fully patent omphalomesenteric duct (enteroumbilical fistula) was found 70 cm from the ileocecal valve, plus incidental appendectomy. He was discharged on the eighth day of hospitalization, with a favorable evolution, outpatient treatment, and outpatient control. In addition, a bibliographical review in scientific databases such as Pubmed, Scopus, Proquest, Lilacs, Scielo, and Google Academic. Conclusions: surgical treatment with a favorable evolution, outpatient treatment, and outpatient control

Association between neuropsychological assessment and amyloid status in a clinical setting.

Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases. Participants (N = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status. AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile). Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A RARE COMPLICATION: ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) INDUCED BY SEVERE PNEUMOCYSTIS CARINII PNEUMONIA (PCP)

Introduction: Pneumocystis pneumonia (PCP) represents a prevalent opportunistic infection among individuals with HIV, posing a significant risk of mortality. The occurrence of acute respiratory distress syndrome (ARDS) as a consequence of PCP further accentuates the gravity and intricacy of this pulmonary infection. Objective: This case report aims to discuss the management of the rare complication of ARDS induced by severe PCP in a 36-year-old man with HIV. Case Presentation: A 36-year-old male teacher, presented with worsening dyspnea, intermittent fever, and a productive cough persisting for two weeks, along with weight loss and fatigue. Initial diagnostic impressions included pulmonary tuberculosis with pneumonia. Treatment involved oxygen therapy, fluid administration, and medication. Laboratory tests showed leukocytosis, elevated blood glucose, and abnormal liver function. Subsequent investigations confirmed HIV infection. Chest X-ray revealed severe bilateral pneumonia and possible ARDS, leading to transfer to the Intensive Care Coronary Unit for further management. Discussion: The diagnosis of severe Pneumocystis jirovecii pneumonia (PCP) underscores the importance of recognizing PCP as a significant clinical concern, especially in HIV patients. Diagnostic challenges, such as late HIV diagnosis, highlight the need for timely screening and intervention. Management involved a multidisciplinary approach, including pulmonologists and cardiologists. Despite treatment adjustments, some patients experience clinical deterioration, necessitating careful management strategies like antiretroviral (ARV) therapy and respiratory support. This case underscores the complexity of managing PCP-related ARDS and the crucial role of timely intervention and comprehensive care. Conclusion: Severe PCP led to ARDS in an HIV-infected patient due to inflammation and lung damage, exacerbated by the immunocompromised state. Timely diagnosis and treatment are crucial to prevent complications and improve outcomes in such cases.

Utility of visual rating scales in primary progressive aphasia

IntroductionDifferential diagnosis among subjects with Primary Progressive Aphasia (PPA) can be challenging. Structural MRI can support the clinical profile. Visual rating scales are a simple and reliable tool to assess brain atrophy in the clinical setting.The aims of the study were to establish to what extent the visual rating scales could be useful in the differential diagnosis of PPA, to compare the clinical diagnostic impressions derived from routine MRI interpretations with those obtained using the visual rating scale and to correlate results of the scales in a voxel-based morphometry (VBM) analysis.MethodPatients diagnosed with primary progressive aphasia (PPA) according to current criteria from two centers—Ospedale Maggiore Policlinico of Milan and Hospital Clínic de Barcelona—were included in the study. Two blinded clinicians evaluated the subjects MRIs for cortical atrophy and white matter hyperintensities using two protocols: routine readings and the visual rating scale. The diagnostic accuracy between patients and controls and within PPA subgroups were compared between the two protocols.ResultsOne hundred fifty Subjects were studied. All the scales showed a good to excellent intra and inter-rater agreement. The left anterior temporal scale could differentiate between semantic PPA and all other variants.The rater impression after the protocol can increase the accuracy just for the logopenic PPA. In the VBM analysis, the scores of visual rating scales correlate with the corresponding area of brain atrophy.ConclusionThe Left anterior temporal rating scale can distinguish semantic PPA from other variants. The rater impression after structured view improved the diagnostic accuracy of logopenic PPA compared to normal readings. The unstructured view of the MRI was reliable for identifying semantic PPA and controls. Neither the structured nor the unstructured view could identify the nonfluent and undetermined variants.

Dermatoglyphic palmar pattern variations in congenitally deaf and mute subjects

Background: Dermatoglyphics have the unique merit of retaining all their peculiarities unchanged throughout life, and afford in consequence an incomparably surer criterion of identity than any other bodily feature. The rationale for studying dermatoglyphic features is derived from the fact that development of dermal ridges and congenital deafness seems to develop at around the same time. Methods: The material for the study consisted of palm prints of congenitally deaf and mute children of 100 subjects with congenital deafness and muteness between 5-21 years of age and 50 control of similar age group with normal hearing and speech were chosen. The principal patterns of thenar/ I interdigital, interdigital II, interdigital III, interdigital IV and hypothenar area were noted. Position of axial triradius, ‘atd’ angle, pattern of palmar Flexion Creases, presence as well as pattern of the Simian Line and the Sydney Line were recorded. Results: The percentage of open field was maximum in subjects in thenar / interdigital area I. and in interdigital area IV. The mean a-b, c-d and atd angle ridge palmar ridge count was less in subjects in comparison to controls. Highly statistically significant results were obtained between subjects and control for the simian crease pattern when both hands were considered together in which the percentage of transitional type was more than the typical simian crease in subjects. Conclusion: When combined with other clinical and investigative features, dermatoglyphic study can serve as a diagnostic impression and can be advocated as a useful screening device.

Interactive Pathology Tutorial in Neoplastic Hematology Disorders for Medical Hematology-Oncology Fellows.

Hematology-oncology (HO) fellows receive limited instruction in the process of establishing a diagnosis for hematologic neoplasms, and learning neoplastic hematology often occurs in limited encounters. In the current study, we developed a web-based interactive pathology tutorial in neoplastic hematologic disorders for HO fellows to work up simulated cases and establish the diagnosis. An online system ("Pathology Playground") was utilized to load case materials including microscopic images and ancillary studies. Twelve high-yield simulated cases of common leukemias and lymphoma were included. At the beginning of each case, trainees review the clinical history and slide images, and then, they are given the option to request additional pathology work-up. Based on the results, they can enter their diagnostic impression. If the diagnosis is correct, the user is shown a short educational presentation. If the diagnosis is not correct, the user gets notified by the message "Incorrect." The tutorial was integrated in the educational curriculum of our HO fellowship program, and bimonthly teaching sessions were held to review two cases each time. During the sessions, trainees request ancillary studies to complete the diagnostic work-up using the software and interpret the findings. As the case is being worked up by the trainee, the hematopathologists and HO fellowship program director discuss the findings, the appropriate work-up tools, and the implications on management. All of our six HO fellows attended the sessions, and a survey from the trainees showed high ease of use of the system and they viewed it as a very useful educational tool. A pre-test and post-test were administered for one of the sessions, and the result showed improvement in the average from 62 to 73%. Expanding the use of this online interactive tutorial and incorporating additional cases would enhance its value as a learning resource.

Performance of a commercially available Generative Pre-trained Transformer (GPT) in describing radiolucent lesions in panoramic radiographs and establishing differential diagnoses.

To evaluate the performance of a commercially available Generative Pre-trained Transformer (GPT) in describing and establishing differential diagnoses for radiolucent lesions in panoramic radiographs. Twenty-eight panoramic radiographs, each containing a single radiolucent lesion, were evaluated in consensus by three examiners and a commercially available ChatGPT-3.5 model. They provided descriptions regarding internal structure (radiodensity, loculation), periphery (margin type, cortication), shape, location (bone, side, region, teeth/structures), and effects on adjacent structures (effect, adjacent structure). Diagnostic impressions related to origin, behavior, and nature were also provided. The GPT program was additionally prompted to provide differential diagnoses. Keywords used by the GPT program were compared to those used by the examiners and scored as 0 (incorrect), 0.5 (partially correct), or 1 (correct). Mean score values and standard deviation were calculated for each description. Performance in establishing differential diagnoses was assessed using Rank-1, -2, and - 3. Descriptions of margination, affected bone, and origin received the highest scores: 0.93, 0.93, and 0.87, respectively. Shape, region, teeth/structures, effect, affected region, and nature received considerably lower scores ranging from 0.22 to 0.50. Rank-1, -2, and - 3 demonstrated accuracy in 25%, 57.14%, and 67.85% of cases, respectively. The performance of the GPT program in describing and providing differential diagnoses for radiolucent lesions in panoramic radiographs is variable and at this stage limited in its use for clinical application. Understanding the potential role of GPT systems as an auxiliary tool in image interpretation is imperative to validate their clinical applicability.

Preparing for the ‘Blues’: Building Midwives’ Capacity for the Delivery of Perinatal Mental Health Care and Services in Ghana

Background: There is limited empirical evidence on the use of standardized and validated assessment tools such as PHQ-9 and GAD-7 by midwives in Ghana to screen perinatal women for symptoms of anxiety and depression and provide the needed support accordingly. Preliminary studies have reported a lack of sufficient knowledge, skills, and preparedness among medical staff, including midwives for the task of screening pregnant women for mental health disorders [21]. This study intends to inform midwives of the availability of tools to assist them make appropriate diagnostic impression of depression and anxiety and to provide a clear pathway to support the perinatal women in their care. Overall, the aim of this study is to promote the exchange of ideas and collaboration among stakeholders to ensure that the training and practice of midwifery in Ghana become more robust and meet global standards. Additionally, it is meant to inform, prepare competent, resourceful, knowledgeable, and most importantly adaptable midwives who can contribute to and promote the overall health of the women in their care. Objective: To address the gap in maternal mental health practice by equipping midwives with the requisite knowledge and skills on the use of globally validated and reliable assessment tools for depression and anxiety to support the perinatal women in their care. Methods: The study involved different two sections. In the first section, a structured questionnaire was used to collect data from 319 participants (midwives) to explore their knowledge on perinatal depression and anxiety assessment tools whiles the second component involved equipping midwives with the requisite mental health assessment skills through a two-week seminar that was organised and facilitated by the research team. Feedback on the level of confidence, suitability, and competence as well as the resourcefulness of the use of the tools was collected from participants (midwives) after three (3) months. The study was conducted in selected hospitals across all 16 regions in Ghana. The regions have several government and private hospitals that provide primary and specialised health care services to the public. They include teaching hospitals, regional hospitals, municipal hospitals, district hospitals as well as clinics within the sub-districts. Basic descriptive quantitative analysis was used based on frequency tables, pie chart and graphical illustration to interpret the data. Results: The study revealed that lack of resources and inadequate capacity-building to practically equip midwives are a major setback for the delivery of perinatal mental health services. It also identified perceived discrimination and stigmatisation on the part of the perinatal women as a major barrier in the provision of maternal mental health services. However, the participants demonstrated having adequate knowledge on the impact of perinatal anxiety and depression on birth and maternal outcomes. Nonetheless, there remains a huge deficit in their ability to use the validated and reliable assessment tools in recognizing clinical cues related to anxiety and depression among perinatal women. Surprisingly, over 50% of the midwives were unfamiliar with the commonly used assessment tools for depression and anxiety such as the GAD-7 and PHQ-9. Additionally, nearly 40% of the participants lack the requisite assessment skills for assessing perinatal anxiety and depression. In furtherance, over 97% of the participants demonstrated an appreciable level of confidence in terms of using the PHQ-9 and the GAD-7 following the post-assessment tool seminar. Conclusion: Perinatal mental health should be made a critical component of perinatal care, with midwives being well situated to recognize the manifestations of deteriorating mental health among the perinatal women in their care and provide the needed support and required level of supervision. It is therefore imperative to train midwives on basic mental health assessment skills and encourage them to incorporate mental health care into the delivery of routine perinatal care and services.

Clinical comparative study on the accuracy of palatal rugae in models obtained by different impression materials and intraoral scanning.

Palatal rugae are frequently used in the evaluation of tooth movement after treatment in orthodontics and as a stable region in superimposition. It is important to note that the impression method and material used to record the rugae region affect the accuracy of the impression. The aim of this study is to compare the accuracy of palatal rugae, in three-dimensional (3D) by employing both conventional and digital impression methods. In this study, 22 patients (12 females, 10 males) mean age of 13.5 ± 1.7years old were selected with complete permanent dentition. Three different impressions were taken from the maxillae of the patients: conventional impression using silicone rubber impression material, conventional impression using alginate impression material, and optical impression using an intraoral scanner. The impressions' digital data were analyzed by the GOM Inspect (Version 2018, Braunschweig, Germany), a 3D analysis software. The Root Mean Square (RMS) values of the total ruga region were evaluated in this software. The data were statistically analyzed using the Jamovi program. The Kruskal-Wallis test and Mann-Whitney U test were performed due to the non-normal distribution of the data. There is no statistically significant difference between the comparison points of the right and left rugae's medial and lateral points and total rugae regions' RMS values. Although there was no statistically significant difference, the total RMS values of alginate and digital scan measurements showed closer results than the RMS values of silicone and digital scan measurements. The study found that there was no statistically significant difference in the total RMS values of the ruga region between traditional and digital impression methods. The treatment period in orthodontics is long. Different impression materials and methods can be used for diagnostic, mid-treatment, and final impressions. For superimpositions and treatment and post-treatment palatal ruga evaluations, traditional and digital impression methods are clinically acceptable and can be used as alternatives to each other.

Electrodiagnostic reporting preferences of referring physicians: An exploratory survey.

Electrodiagnostic (EDX) studies play a crucial role in the evaluation of patients with peripheral nervous system disorders. Accurate and succinct communication of test results is critical to patient safety and clinical decision-making. The objective of this study was to explore EDX reporting preferences of referring physicians to improve quality of communication and patient care. An online survey was developed, and a purposive sampling strategy was used to recruit physicians in the authors' professional networks. Quantitative and qualitative survey data underwent frequency and thematic analyses, respectively. There were 40 respondents, including: 21 non-surgical specialists, 12 surgical specialists, and 7 family physicians. Sections rated as most critical were diagnostic impression (97%) and summary/interpretation (72%). Only 18% reported numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without nerve conduction study waveforms. Regarding the format of the data summary and diagnostic impression sections, the majority of respondents preferred bullet points rather than paragraphs. The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights important preferences and how they compare to recommended reporting guidelines, which may help improve communication and ultimately patient care. Future efforts should explore larger sample sizes with all key stakeholders in the EDX process to better understand reporting styles and preferences with greater nuance and context.

MMPI-2-RF validity scales add utility for predicting treatment engagement during partial psychiatric hospitalizations.

Partial psychiatric hospitalizations are resource-intensive clinical services designed to stabilize patients in the short term, prevent inpatient hospitalizations, and encourage long-term recovery. Typically, providers base their referral decisions on categorical diagnoses and subjective impressions of patient distress without closely considering the evidence for reporting biases. The present study followed veterans (n = 430) participating in partial psychiatric hospitalization services. We evaluated the extent to which clinical diagnoses at intake predicted treatment variables and changes in later mental health care utilization. Using hierarchical linear regressions with bootstrap confidence intervals, Minnesota Multiphasic Personality Inventory-2-Restructured Form content-based validity scales demonstrated incremental utility for predicting patient outcomes beyond intake diagnoses. Elevated Fp-r ("Infrequent Psychopathology Responses") scores independently predicted an increased number of times arriving late for partial hospitalization programming, self-report of worse current functioning at intake, and a relative increase in mental health care encounters in the 12 months following discharge. Low K-r ("Adjustment Validity") scores independently predicted self-report of worse current functioning at both intake and later discharge from partial hospitalization. Thus, indicators of severe psychopathology overreporting as well as the unlikely disavowal of emotional adjustment (i.e., high Fp-r, low K-r) predicted engagement with health care services and self-presentations of symptoms over and above the diagnostic impressions from referring providers. We discuss how indicators of content-based invalid responding on the Minnesota Multiphasic Personality Inventory-2-Restructured Form have real-world value for understanding patient behavior and shaping clinical interventions among vulnerable populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).