Procedural Errors Research Articles

Automatic screening of retinal lesions for detecting diabetic retinopathy using adaptive multiscale MobileNet with abnormality segmentation from public dataset

ABSTRACT Owing to the epidemic growth of diabetes, ophthalmologists need to examine the huge fundus images for diagnosing the disease of Diabetic Retinopathy (DR). Without proper knowledge, people are too lethargic to detect the DR. Therefore, the early diagnosis system is requisite for treating ailments in the medical industry. Therefore, a novel deep model-based DR detection structure is recommended to fix the aforementioned difficulties. The developed deep model-based diabetic retinopathy detection process is performed adaptively. The DR detection process is imitated by garnering the images from benchmark sources. The gathered images are further preceded by the abnormality segmentation phase. Here, the Residual TransUNet with Enhanced loss function is used to employ the abnormality segmentation, and the loss function in this structure may be helpful to lessen the error in the segmentation procedure. Further, the segmented images are passed to the final phase of retinopathy detection. At this phase, the detection is carried out through the Adaptive Multiscale MobileNet. The variables in the AMMNet are optimized by the Adaptive Puzzle Optimization to obtain better detection performance. Finally, the effectiveness of the offered approach is confirmed by the experimentation procedure over various performance indices.

Enhancing Patient Procedures through Process Improvement: A Systematic Review of Patient-Centered Care Approaches

Patient-centered care is increasingly recognized as a fundamental component of high-quality healthcare, emphasizing the need for healthcare systems to optimize patient procedures. This systematic review explores the role of process improvement methodologies in enhancing patient procedures while aligning with patient-centered care approaches. A comprehensive search of studies published between 2016 and 2023 was conducted across multiple databases, focusing on healthcare interventions using Lean, Six Sigma, and Total Quality Management methodologies. The findings demonstrate that process improvement techniques significantly reduce waiting times, procedural errors, and inefficiencies, ultimately improving patient satisfaction and safety. Moreover, integrating patient-centered care approaches ensures that patients’ needs, preferences, and values are central to healthcare decision-making, further enhancing procedural effectiveness. However, challenges such as resistance to change and resource limitations were noted. This review underscores the importance of combining process optimization with patient-centered care to achieve sustainable improvements in patient outcomes and procedural efficiency. Future research should focus on the long-term impact of these methodologies and the role of technology in further advancing patient-centered approaches.

Medical Malpractice Litigation Following Revision Total Hip and Knee Joint Arthroplasty: A Review of Reported Legal Claims in the U.S. in the Past 20 Years

IntroductionThe increasing incidence of primary total hip (THA) and knee (TKA) arthroplasty has been accompanied by a subsequent rise in revision surgeries. Revision total joint arthroplasty (TJA) is associated with major litigation risk, primarily due to procedural and post-surgical errors. However, the understanding of the causes and outcomes of revision TJA malpractice cases remains unstudied. This study aimed to analyze litigated malpractice claims against orthopaedic surgeons performing revision TJA using a national legal database. MethodsA database was queried for a nationwide analysis of medical malpractice litigation in revision TJA from 2000 to 2023. Data on the time, duration, and locations of the litigations, allegations of surgical negligence, the damages cited, the outcomes of the trials, and indemnities were collected. ResultsOf 110 TJA malpractice cases identified over two decades, 32 cases involving revision THA and TKA surgeries were included in the final analysis. The cases were equally divided between THA and TKA, spanning 16 states, with the highest proportions in New York, Connecticut, and Louisiana. “Procedural error” (28%; n = 9) was the most frequently cited negligence, followed by “post-surgical error” (25%; n = 8) and “failure to treat” (19%; n = 6). The most common damages were “continued pain/mobility limitations” (28%; n = 9) and “infections” (19%; n = 6). Most cases resulted in a verdict for the defense (63%; n = 20). The average indemnity was $5,713,635, with considerable variability. ConclusionThis study presents the leading causes of litigated malpractice claims over the past two decades in the United States in revision TJA as perceived procedural and post-surgical errors, with the most common damages reported being “persistent pain/mobility limitations” and “infections.” Given the rising incidence of revision TJA, orthopaedic surgeons may utilize these trends to better inform patients about the potential risks and outcomes of surgery and mitigate litigation risks.

Discrimination Associated with Artificial Intelligence Technologies

As is known, there has been a significant increase in the use of AI technologies in various fields related to the work of both public and private sectors. Despite its importance in economic, health, security, and educational fields, the use of AI technologies has led to several ethical and legal risks. For example, there are risks of bias or discrimination when building AI systems, challenges related to privacy and data protection, including issues that arise from errors in health protocol procedures and their impact on patient health. This paper aims to highlight a number of practical applications of bias or discrimination associated with the use of AI technologies, concluding with the importance of having clear ethical governance to address the emerging risks of using AI applications.

Dental outpatient departments and patient safety: Priority for a safe care

Patient safety is an essential aspect of healthcare, including dentistry. Dental Outpatient Departments (OPDs) pose unique challenges, where the risk of infections, procedural errors, and patient discomfort can compromise safety. This review examines patient safety issues in dental OPDs, focusing on common hazards, preventive measures, and evolving strategies to ensure safer care. Infection control, medical emergencies, equipment sterilization, and patient data protection are key concerns. The complex interplay of patient management, dental procedures, and clinician awareness requires robust protocols to mitigate risks. Dental professionals must be vigilant in managing cross-contamination risks, such as through the use of personal protective equipment (PPE) and strict hand hygiene practices. Moreover, regular staff training in handling medical emergencies, such as allergic reactions or fainting, is crucial for effective management.This article also explores the role of technological advancements in enhancing patient safety, such as digital record-keeping, which minimizes documentation errors, and advanced diagnostic tools that reduce invasive procedures. Additionally, patient-centered approaches, including improved communication and informed consent practices, foster trust and reduce misunderstandings. The implementation of evidence-based guidelines and adherence to professional standards further contribute to a culture of safety. By synthesizing current research, this review aims to highlight best practices for improving patient safety in dental OPDs and underscores the importance of continuous monitoring and improvement in these settings. Addressing these safety concerns is critical not only to improve patient outcomes but also to ensure that dental OPDs remain a safe and trusted environment for all.

Retrieval of a Separated Instrument using Combination of Ultrasonics and Braiding Technique- A Case Report

The fracture of endodontic instruments represents a procedural error that poses a significant challenge to root canal therapy. A separated instrument, especially a broken file, obstructs the root canal and hinders effective cleaning and shaping. When bypassing the separated instrument proves difficult, mechanical devices should be employed for retrieval. With minimal equipment and patience, it is feasible to recover the separated instrument from the canal. The application of ultrasonics in endodontics has demonstrated reliability in retrieving broken instruments from the root canal. Ultrasonic tips can effectively loosen the instrument fragment, which can then be removed using the Braiding technique. This case report illustrates both the successful retrieval of a separated instrument and a failure case using the same method, providing insight into its advantages and limitations.

A-181 The Effectiveness Module to Reduce Laboratory Error Reporting Rates

Abstract Background In a hospital in central Taiwan, the number of tests conducted in 2022 was 1.88 million, there were 26 cases of laboratory error reports, with an error rate of 14 cases per million. Error reports may lead to diagnostic errors, posing a significant risk to patient safety. Therefore, our team aims to establish a simple and universal module that can be applicable to various laboratory operations to minimize errors. Methods Initially, we conducted an analysis of error causes, identifying 25 cases of human error and 1 case of computer system error. Human errors were categorized according to the laboratory process, including 4 specimen identification errors, 3 procedural errors, 9 typing errors, 7 validation of analytical data errors, and 2 instances of failure to communicate issues during handover. The proximate cause of human error was non-compliance with SOPs, and the root cause was inadequate SOPs leading to inconsistent practices. We reviewed the workflow, implemented corrective actions, revised SOPs, and provided training for personnel. Additionally, three important strategies were introduced: 1.High-Frequency Audits: Corrective actions were included in the internal audit checklist, initially increasing the frequency to at least once a month for the first 3 months, followed by at least once every 6 months within the next 6 months. If no further occurrences were noted, audits could be conducted annually or not. Each audit should be completed within 20 minutes to avoid excessive burden, with direct observation of operations and random questioning being the preferred audit methods. 2. Audit deficiencies should be documented: Personnel were requested to conduct cause analysis and improvements. This not only expressed the supervisor's commitment to improvement but also provided an opportunity to discover reasons why countermeasures cannot not be implemented, allowing for strategic adjustments until successful implementation. 3.Case-Based Training: Benchmark cases were developed into teaching materials, and compiled errors regularly for looking for patterns or trends to identity key steps. Make these key steps the focus of your educational training. Results In 2023, 1.94 million tests were conducted, there were 4 error reports, with an error rate of 3 cases per million, all were attributed to human error. In another hospital in southern Taiwan, laboratory error reports were primarily due to human error. From June 2022 to July 2023, a total of 3.46 million tests were conducted, there were 14 error reports and an error rate of 5 cases per million. After implementing the same improvement module from August to December 2023, a total of 1.56 million tests were conducted, there were 2 error reports and an error rate of 2 cases per million, all were attributed to human error. Conclusions We applied this improvement module to two hospitals in central and southern Taiwan, resulting in a significant reduction in error rate. The key factors of effectiveness were utilizing high-frequency audits to ensure sustained results, and demonstrating the positive attitude of supervisors during the process. This motivated personnel to demand higher standards from themselves, ultimately showcasing remarkable improvements.

Multitasking during Medication Management in a Nursing Home: A Time Motion Study.

Multitasking, defined as performing two or more interventions simultaneously, increases the cognitive burden of clinicians. This may, in turn, lead to higher risk of medication and procedural errors. Time motion study (TMS) data for nurses in nursing homes revealed an extensive amount of multitasking while managing medications. Further investigation of multitasked nursing interventions will provide a foundation for optimizing medication management workflows. Using a continuous observational TMS method, this study aimed to describe pairs of multitasked nursing interventions associated with medication management interventions, including preparing and administering medications, assessing medication effects, instructing on medications, and documenting medication administration. An external nurse observer used 57 predefined Omaha System nursing interventions embedded within TimeCaT (version 3.9), TMS data recording software to collect observation data in a single nursing home. A total of 120 hours of time-stamped observation data from nine nurses were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. The majority (74%) of medication management interventions were multitasked, resulting in 2,003 pairs of multitasked interventions. Of the 57 Omaha System nursing interventions, 35 were involved in these multitasking pairs. When nurses multitasked, the average duration of medication preparation was longer (non-multitasked: 81 seconds; multitasked: 162 seconds, p < 0.05), while the average duration of medication administration record documentation was shorter (non-multitasked: 93 seconds; multitasked: 66 seconds, p < 0.05). The findings reveal the complexity of medication management in nursing homes with numerous and diverse multitasking pairs. Findings provide a platform for in-depth study of medication management multitasking in the clinical context, and inform future efforts to create clinical and informatics solutions to optimize medication management workflow. This method may be also applied to examine medication management and multitasking in other clinical settings.

Enhanced 2D Hand Pose Estimation for Gloved Medical Applications: A Preliminary Model.

(1) Background: As digital health technology evolves, the role of accurate medical-gloved hand tracking is becoming more important for the assessment and training of practitioners to reduce procedural errors in clinical settings. (2) Method: This study utilized computer vision for hand pose estimation to model skeletal hand movements during in situ aseptic drug compounding procedures. High-definition video cameras recorded hand movements while practitioners wore medical gloves of different colors. Hand poses were manually annotated, and machine learning models were developed and trained using the DeepLabCut interface via an 80/20 training/testing split. (3) Results: The developed model achieved an average root mean square error (RMSE) of 5.89 pixels across the training data set and 10.06 pixels across the test set. When excluding keypoints with a confidence value below 60%, the test set RMSE improved to 7.48 pixels, reflecting high accuracy in hand pose tracking. (4) Conclusions: The developed hand pose estimation model effectively tracks hand movements across both controlled and in situ drug compounding contexts, offering a first-of-its-kind medical glove hand tracking method. This model holds potential for enhancing clinical training and ensuring procedural safety, particularly in tasks requiring high precision such as drug compounding.

Evaluation of microleakage of mineral trioxide aggregate and biodentine as apical barriers in simulated young permanent teeth

BackgroundApexification is a procedure that promotes apical closure by forming mineralized tissue in the apex region of a nonvital young permanent tooth. Calcium silicate-based cement like Mineral trioxide aggregate (MTA) and Biodentine are commonly employed as apical barriers to facilitate this process. Microleakage, defined as the leakage along the junction between the canal wall and filling material, is a crucial aspect to assess in MTA and Biodentine applications as apical barriers, as it directly impacts the prevention of bacterial seepage and maintenance of structural integrity. The current study aims to assess the microleakage of MTA and Biodentine when used as apical barriers in simulated young permanent teeth.MethodsFrom a total of 128 extracted teeth, 114 were selected for the study and randomly allocated into three groups: G1 (MTA), G2 (Biodentine), and G3 (Control), with 38 teeth per group. After excluding 5 teeth from each group due to issues such as canal calcification, breakage during sectioning, and procedural errors, 33 teeth were analyzed to ensure equal distribution. To simulate young permanent teeth, samples were instrumented using a person-reamer with a diameter of 1.7 mm. A 4 mm thick apical plug of MTA and Biodentine was placed in G1 and G2, respectively, while G3 was the control group. Apical microleakage in all experimental groups was assessed using a dye penetration method. Specimens were longitudinally sectioned and examined under a stereomicroscope with graded eyepiece.ResultsThe Kruskal-Wallis test revealed variations in mean apical microleakage among the groups: G1 recorded 0.67, G2–0.16, and G3–1.62, with G2 showing the lowest value and G3 group exhibiting the highest.ConclusionsBiodentine was found to excel in its ability to create a secure seal and function effectively as an apical barrier in simulated young permanent teeth. These results underscore its potential as a highly efficient material for dental applications, particularly in scenarios requiring reliable sealing and barrier formation in the root canal system of developing permanent teeth.

HỌC THUYẾT VI PHẠM VÔ HẠI TRONG TƯ PHÁP HÌNH SỰ HOA KỲ VÀ VI PHẠM TỐ TỤNG KHÔNG LÀM THAY ĐỔI BẢN CHẤT VỤ ÁN TẠI VIỆT NAM

During the investigation, prosecution, and adjudication of criminal cases, there is carry the risk of procedural violations and errors. When conducting appellate or cassation trials, it is crucial to determine the seriousness or harmlessness of any procedural offences to decide whether to cancel the judgment for re-investigation or re-trial. The authors introduce the doctrine of “harmless error” in the United States criminal justice system and analyzes the “procedural violations that do not change the nature of the case” in Vietnam. Finally, the authors recommend developing regulations on this type of violation in Vietnam’s criminal procedure lane.

ANALISIS ATURAN ASOSIASI KESALAHAN STATISTIKA SISWA KELAS X-11 SMA NEGERI 10 SAMARINDA BERDASARKAN KRITERIA WATSON

Mathematics plays an important role in forming systematic thinking patterns, logic, and financial management skills. However, many students have difficulty in understanding mathematical concepts due to various factors, which affect the success of learning. This study aims to identify and classify common errors of class X-11 students of SMA Negeri 10 Samarinda in solving statistics problems using mixed quantitative and qualitative methods. solving statistics problems using mixed methods, namely quantitative and qualitative. Using the apriori algorithm with a minimum support of 20% and 80% confidence, four types of errors were found that were often made by students, namely incorrect data errors, procedural errors, missing conclusions, and skill hierarchy problems. Data analysis and interviews showed a strong correlation between these errors, where errors in data collection often lead to data manipulation and incorrect conclusions. To overcome this problem, the school has implemented more effective learning strategies, such as additional guidance, material adjustments, and contextual approaches. These strategies are expected to improve students' conceptual understanding, reduce errors, and improve academic achievement in statistics.

Retrieval of Separated Endodontic Instrument

Endodontic instrument fracture is a procedural error that creates a significant barrier to routine root canal therapy. A separated instrument results in insufficient cleaning and shaping of the root canals. Inadequate biomechanical preparation has an impact on the result and outcome of root canal treatment. Therefore, retrieval of separated instruments should be considered important. There are many instrument retrieval kits and techniques available for this purpose. In this case report, a separated rotary file was successfully retrieved using a Masserann kit .

Evaluation of root and root canal morphology in maxillary premolar teeth: A cone-beam computed tomography study using two classification systems in a Japanese population

Background/purposeInadequate knowledge increases the risk of overlooking root canals and causing procedural errors that can lead to root canal treatment failure. This study aimed to analyze the root and root canal morphology in maxillary premolar teeth using two classification systems assessed by cone-beam computed tomography (CBCT) in a large Japanese population. Materials and methodsThis study evaluated 1443 maxillary teeth including 726 first and 717 s premolars, from 642 Japanese individuals aged 16–84 years. CBCT images were analyzed according to the Vertucci and Ahmed classification systems, focusing on the root and root canal morphology. Variations were analyzed based on gender and age using the chi-square test (P < 0.05). ResultsMaxillary first premolars were predominantly single-rooted (64.9%) and had two root canals (86.2%). Females exhibited a higher prevalence of single-rooted (71.0%) compared to males (49.8%) (P < 0.05). Additionally, single root canals occurred significantly more frequently in females (14.0%) than in males (7.5%) (P < 0.05). Maxillary second premolars mostly had a single root (97.8%) with a single root canal (72.1%). The frequency of second premolars with two root canals significantly increased with age (P < 0.001). The three-rooted configuration occurred in 1.2% and 0.3% of the first and second premolars, respectively. ConclusionMaxillary premolars in a Japanese population showed significant anatomical variations, highlighting the importance of understanding anatomical characteristics specific to age and gender. Ahmed's system provides a more comprehensive description of the morphological variations.

Medical Malpractice Litigation Trends Following Primary Total Hip and Knee Joint Arthroplasty: An Updated Nationwide Analysis

BackgroundTotal joint arthroplasty (TJA) is the most common procedure associated with malpractice claims within orthopaedic surgery. Although prior research has assessed prevalent causes and outcomes of TJA-related lawsuits before 2018, the dynamic healthcare environment demands regular re-evaluations. This study aimed to provide an updated analysis of the predominant causes and outcomes of TJA-related malpractice lawsuits and analyze the outcomes of subsequent appeals following initial jury verdicts. MethodsA legal database was queried for cases between 2018 and 2022 involving primary hip and knee TJA in the United States. Cases were listed as original rulings or appeals and reviewed for the alleged negligence, damages incurred, demographics, and verdicts. Appeals were further assessed for appellant details, preliminary judgment, and outcomes. The findings were compared to previous litigation data using descriptive statistics. ResultsThe final cohort comprised 59 cases: 33 (56%) total knee arthroplasty (TKA) and 26 (44%) total hip arthroplasty (THA). The TKA cases primarily cited pain (24%), while the THA cases cited nerve injuries (31%). Negligence largely stemmed from procedural error (47%), postsurgical error (27%), and failure to inform (14%). Case outcomes were in favor of the defense in 66% of cases. Overall, 90% of primary verdicts led to appeals, with 71% by the plaintiff. Initial rulings were upheld in 87% of plaintiff appeals, whereas 53% of defendant appeals retained the initial judgment. ConclusionsThe primary cause of litigation shifted from infection to ongoing/worsening pain in TKA cases over time. While nerve injury TKA cases have decreased, it remains the most cited damage after THA. Defense verdicts are common, but there is an increasing number of verdicts against defendants. Plaintiffs are more likely to appeal, but are less successful in appellate courts. These findings allow surgeons and policymakers to address emerging litigation trends in TJA to mitigate risks and improve the overall quality of TJA.

LEADING-EDGE DEVELOPMENTS IN GUIDED ENDODONTICS: UTILIZING NEXT-GENERATION TOOLS

Guided endodontics has revolutionized root canal therapy by integrating advanced technologies to improve precision, safety, and outcomes. This method combines imaging technologies like cone beam computed tomography (CBCT) with computer-assisted navigation systems to enhance the accuracy of root canal treatments. Key stages include initial diagnostic imaging, 3D virtual treatment planning, and the use of customized guides or templates during procedures. These guides help accurately identify canal orifices, reducing procedural errors and improving access to complex root structures. Benefits include better treatment predictability, reduced procedure time, and lower risk of complications. Recent advancements, such as high-resolution CBCT, advanced 3D printing for custom guides, and improved virtual planning, have enhanced the precision of access cavity preparations. Innovations like low-profile clinical templates address challenges with restricted mouth openings, while improved intraoral scanning and virtual planning streamline preparation processes. Despite higher costs and increased planning time, guided endodontics is increasingly seen as a standard method, offering substantial improvements in clinical practice and patient outcomes. This review consolidates these advancements, emphasizing their impact on precision, efficiency, and future research directions in endodontics.

Surgical skill simulation training to proficiency reduces procedural errors among novice cardiac device implanters: a randomized study.

In cardiac device implantation, having both surgical skills and ability to manipulate catheter/lead/wire is crucial. Few cardiologists, however, receive formal surgical training prior to implanting. Skills are mostly acquired directly on-the-job and surgical technique varies across institutions; suboptimal approaches may increase complications. We investigated how novel proficiency-based progression (PBP) simulation training impacts the surgical quality of implantations, compared to traditional simulation (SIM) training. In this international prospective study, novice implanters were randomized (blinded) 1:1 to participate in a simulation-based procedure training curriculum, with proficiency demonstration requirements for advancing (PBP approach) or without (SIM). Ultimately, trainees performed the surgical tasks of an implant on a porcine tissue that was video-recorded and then scored by two independent assessors (blinded to group), using previously validated performance metrics. Primary outcomes were the number of procedural Steps Completed, Critical Errors, Errors (non-critical), and All Errors Combined. Thirty novice implanters from 10 countries participated. Baseline experiences were similar between groups. Compared to SIM-trained, the PBP-trained group completed on average 11% more procedural Steps (P < 0.001) and made 61.2% fewer Critical Errors (P < 0.001), 57.1% fewer Errors (P = 0.140), and 60.7% fewer All Errors Combined (P = 0.001); 11/15 (73%) PBP trainees demonstrated the predefined target performance level vs. 3/15 SIM trainees (20%) in the video-recorded performance. Proficiency-based progression training produces superior objectively assessed novice operators' surgical performance in device implantation compared with traditional (simulation) training. Systematic PBP incorporation into formal academic surgical skills training is recommended before in vivo device practice. Future studies will quantify PBP training's effect on surgery-related device complications.

Analisis Kesalahan Mahasiswa Dalam Menyelesaikan Soal Pembuktian Teorema Binomial Pada Sifat Simetrik

This research was conducted to observe students' error in working on problems proving the binomial theorem on the symmetric properties of binomial coefficients. This type of research is qualitative research. This research uses a test method, namely by working on questions followed by interviews. This research involved students from the Tadris Mathematics Study Program at Al Falah As Sunniyah Kencong Jember University in the second semester of the 2023/2024 academic year with a total of 17 students. The 17 students were grouped into 3 cognitive abilities, namely high, medium and low cognitive. The subjects of this research consisted of three students with each student representing each cognitive ability group. The results of the research show that the types of language interpretation errors are made by subjects with high and moderate cognitive abilities, namely not writing the correct sentences when drawing conclusions. Conceptual errors were made by subjects with medium and low cognitive abilities in the form of errors in the proof steps. Procedural errors were made by subjects with moderate and low cognitive abilities, namely not having carried out complete calculations when applying the theorem in numerical form. Technical errors were made by subjects with low cognitive abilities, namely writing the same steps repeatedly. Errors in drawing conclusions were made by subjects with high, medium and low cognitive abilities. The three subjects considered the verification process to be complete. All errors are caused by a lack of understanding of the concept, carelessness in the proof process and not being careful in reading the questions.

Glide Path in Endodontics: A Literature Review of Current Knowledge.

The introduction of nickel-titanium rotary instruments revolutionized shaping procedures as they were able to produce a well-tapered preparation while reducing operator fatigue. The major drawback of rotary instruments was the high risk of fracture due to bending and torsional stress. Thus, the creation of a glide path has been advocated and recommended by most rotary instrument manufacturers. The aim of the present review is to summarize existing knowledge on glide path preparation and identify areas where further research is needed. The primary goal is to provide a comprehensive overview of the techniques and instruments used in glide path preparation, highlighting their advantages and limitations. The secondary goal is to explore the effect of glide path creation on the overall success of endodontic treatment, particularly in terms of reducing procedural errors and improving treatment outcomes. An online search on PubMed, ScienceDirect, UCLA, and Scopus databases was conducted, and 116 articles were identified. Eligible articles were divided into nine categories based on what they researched and compared. The categories included centering ability and/or root canal transportation, cyclic fatigue resistance, glide path and shaping time, tortional stress resistance, apical extrusion of debris and/or bacteria, defects in dentine walls, file separation, postoperative pain assessment, and scouting ability and performance. Establishing a glide path reduces root canal transportation, especially with rotary methods. Reciprocating and heat-treated files offer higher fatigue resistance and shorter preparation time. Instruments with shorter pitch lengths have greater torsional strength. Preparation and coronal preflaring reduce apical debris and bacteria. Glide paths do not affect dentine microcracks, file separation, or defects but reduce immediate postoperative pain and improve cutting ability. Randomized trials are needed to assess their impact on treatment outcomes.

Standardized patient interactions improve dental student confidence following procedural errors.

Standardized patient interactions improve dental student confidence following procedural errors.