Levels Of Clinical Experience Research Articles

Stress and Confidence of Undergraduate Dental Students With Different Levels of Clinical Experience in Managing Endodontic Emergencies: A Cross-Sectional Study.

To describe the stress and confidence of dental students during the management of an endodontic emergency (EE) and investigate the associated factors. This cross-sectional study included 227 undergraduate dental students undergoing clinical training (i.e., in the fourth, fifth, or sixth year) who responded to questions asking for their overall level of stress during an EE and their level of confidence in their ability to manage 50 steps of EE management related to communication and technical skills, and clinical examination and decision-making. Managing EE was perceived as slightly or fairly stressful by 70% of the fourth- to sixth-year students. The fourth- and fifth-year students felt significantly greater stress (p = 0.026) and lower confidence (p < 0.001) than the sixth-year students, as did women (p < 0.001 for both). No significant difference in stress or confidence levels was observed across the clinical training environments evaluated. Just over half of the students reported being confident about discussing a case with their teacher. The situations in which students felt least confident were patient management, crack detection, lymph node palpation, locoregional or intrapulpal anaesthesia, and intraoral drainage, and those in which students gained the most confidence in the sixth year compared to the lower grades were clinical decision-making. Managing EE was perceived as slightly or fairly stressful for most students, and stress decreased, while confidence increased in the 3 years of clinical training. Although these findings are positive for the existing training program, there is still work to be done to improve students' learning experiences, especially on teacher receptiveness.

Displaced cortical vein sign on CT in infants: a reliable predictor to distinguish low-attenuation subdural collections from benign enlargement of subarachnoid spaces.

Differentiating benign enlargement of subarachnoid spaces (BESS) from low-attenuation subdural collections on CT imaging of infants can be challenging. This distinction is crucial in infants, as subdural collections may raise the concern for abusive head trauma (AHT). To evaluate the utilization of the displaced cortical vein sign on CT as a predictor of pathological subdural collections confirmed by MRI and to assess the reproducibility of this finding among radiologists with different levels of clinical experience. A total of 104 imaging exams were independently reviewed by junior- and senior-level radiologists (52 head CTs and 52 corresponding brain MRI exams). These exams included 43 MRI-confirmed cases of subdural collections and 9 MRI-confirmed cases of BESS from patients aged 0-2 years. The presence of pathological collections and sulcal flattening, and the displaced cortical vein sign were recorded for both reviewers along with attenuation and signal characteristics of the collections. Confirmed diagnosis of AHT was determined by chart review. The sensitivity, specificity, and inter-observer reliability were analyzed between reviewers. The average patient age was 6.4 months with a median age of 4 months. The sensitivity values of the displaced cortical vein sign on CT for the presence of subdural collections were 69.6% and 79.0% for the two reviewers, respectively. The specificity of this finding was 100% for both reviewers, with no false negative cases. Interobserver reliability was the highest for the depiction of the displaced cortical vein sign on CT (κ=0.63, 95% CI 0.45-0.82) and MRI (κ=0.96, 95% CI 0.87-1.00). All cases where at least 1 reviewer noted the displaced cortical vein sign on CT and were later confirmed to be traumatic subdural collection on MRI were concluded to have high concern for AHT upon chart review. In total, 23.3% (11 out of 52) of cases confirmed to have subdural collections on MRI were found to have calvarial fractures associated with their presentation. The displaced cortical vein sign on head CT is a specific and reproducible finding associated with subdural collections. Our data suggest that this sign is a more reliable and readily identifiable indicator of pathological subdural collections compared to other traditional imaging findings, such as flattening of the cerebral sulci.

Trends of primary health care practitioners toward bleeding management in Saudi Arabia: a cross-sectional analysis

ABSTRACT Objectives High rates of morbidity and mortality are a result of trauma being a significant health burden in Saudi Arabia. We evaluated the current trends of primary healthcare (PHC) physicians in Saudi Arabia toward patients with bleeding and their referral awareness for percutaneous endovascular arterial embolization (EAE). Methods We formulated a 13-question survey to assess PHC physicians’ knowledge regarding decision-making and appropriate approaches to manage patients with traumatic and non-traumatic abdominopelvic and lower limb bleeding. We conducted in-person surveys with various specialists with varying levels of clinical experience in Saudi Arabia. Results Overall, 112 PHC physicians were assessed. Of them, 43.75% had ≥5 years of independent practice experience, and 72.3% and 27.7% encountered bleeding patients rarely and routinely, respectively. General practitioners scored lower across all questions than other PHC physicians. Physicians with >10 years of practice had higher median scores in decision-making questions (p = 0.159). Internists and gynecologists (p = 0.046) and physicians (p = 0.050) in tertiary-care settings had significantly higher median scores on decision-making questions. Pediatricians (p = 0.091) and PHC physicians (p = 0.440) at private institutions had higher median scores on approach appropriateness questions. Conclusions PHC physicians in Saudi Arabia require a better understanding of the indications of EAE to avoid referral and triage errors, inefficient use of healthcare resources, and suboptimal patient outcomes.

Enhancing postpartum hemorrhage training by integrating case-problem based learning with simulation: a quasi experimental study

Background Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide, and effective training in PPH rescue techniques is crucial. This study aims to evaluate the effectiveness of combining case-based learning (CBL) and problem-based learning (PBL) with simulation teaching methods in improving midwifery trainees’ technical proficiency in managing PPH. Methods This quasi-experimental study involved 76 trainees who received PPH training at Peking University Third Hospital from March to July 2023. They were divided into two groups: the control group (n = 50) followed traditional simulation training methods, and the research group (n = 26) used a combination of CBL-PBL and scenario simulation. After the training, all participants completed a theoretical examination and questionnaire to assess their satisfaction with the program and self-assessment of clinical management skills in PPH. Statistical analysis was performed using unpaired t-tests and chi-square tests to compare the groups. Results The combination of CBL-PBL and scenario simulation was highly satisfactory compared to traditional simulation training, significantly enhancing self-assessed skills in clinical thinking (100% vs. 61.8%, p = .03), operant skills related to PPH (100% vs. 57.4%, p < .01), relevant knowledge pertaining to PPH (100% vs. 58.7%, p < .01), and management abilities (97.1% vs. 39%, p < .01) among midwifery trainees in the research group, who also scored significantly higher on post-training assessments of PPH knowledge than control groups(91.7 ± 6.0 vs 76.0 ± 7.1, p < .01). A majority of trainees expressed a preference for regular simulation exercises (98.7%) and detailed discussions on PPH cases (93.4%) in future training sessions. Conclusion Combining CBL-PBL with simulation practice is a more effective teaching method for PPH management training in maternity staffs with a certain level of clinical experience, compared to traditional methods. Future studies should explore the implementation of regular PPH rescue skill training in real clinical settings to support these findings.

Generative Adversarial Network Based Contrast Enhancement: Synthetic Contrast Brain Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a vital tool for diagnosing neurological disorders, frequently utilising gadolinium-based contrast agents (GBCAs) to enhance resolution and specificity. However, GBCAs present certain risks, including side effects, increased costs, and repeated exposure. This study proposes an innovative approach using generative adversarial networks (GANs) for virtual contrast enhancement in brain MRI, with the aim of reducing or eliminating GBCAs, minimising associated risks, and enhancing imaging efficiency while preserving diagnostic quality. In this study, 10,235 images were acquired in a 3.0 Tesla MRI scanner from 81 participants (54 females, 27 males; mean age 35 years, range 19-68 years). T1-weighted and contrast-enhanced images were obtained following the administration of a standard dose of a GBCA. In order to generate "synthetic" images for contrast-enhanced T1-weighted, a CycleGAN model, a sub-model of the GAN structure, was trained to process pre- and post-contrast images. The dataset was divided into three subsets: 80% for training, 10% for validation, and 10% for testing. TensorBoard was employed to prevent image deterioration throughout the training phase, and the image processing and training procedures were optimised. The radiologists were presented with a non-contrast input image and asked to choose between a real contrast-enhanced image and synthetic MR images generated by CycleGAN corresponding to this non-contrast MR image (Turing test). The performance of the CycleGAN model was evaluated using a combination of quantitative and qualitative analyses. For the entire dataset, in the test set, the mean square error (MSE) was 0.0038, while the structural similarity index (SSIM) was 0.58. Among the submodels, the most successful model achieved an MSE of 0.0053, while the SSIM was 0.8. The qualitative evaluation was validated through a visual Turing test conducted by four radiologists with varying levels of clinical experience. The findings of this study support the efficacy of the CycleGAN model in generating synthetic contrast-enhanced T1-weighted brain MR images. Both quantitative and qualitative evaluations demonstrated excellent performance, confirming the model's ability to produce realistic synthetic images. This method shows promise in potentially eliminating the need for intravenous contrast agents, thereby minimising the associated risks of their use.

Gender and age biases in the assessment of speech accuracy: A study of speech-language clinicians' ratings of /s/ accuracy.

Typically developing children assigned male at birth (AMAB) and children assigned female at birth (AFAB) produce the fricative /s/ differently: AFAB children produce /s/ with a higher spectral peak frequency. This study examined whether implicit knowledge of these differences affects speech-language pathologists'/speech and language therapists' (SLPs'/SLTs') ratings of /s/ accuracy, by comparing ratings made in conditions where SLPs/SLTs were blind to children's sex assigned at birth (SAB) to conditions in which they were told this information. SLPs (n = 95) varying in clinical experience rated the accuracy of word-initial /s/ productions (n = 87) of eight children with speech sound disorder in one of four conditions: one in which no information about the children was revealed, one in which children's SAB was revealed, one in which children's age was revealed, and one in which both were revealed. Despite there being no statistically significant differences between AFAB and AMAB children's /s/ production in researcher-determined accuracy or in one acoustic characteristic, spectral centroid, SLPs in all four conditions judged the /s/ productions of AFAB children as more accurate than AMAB children. Listeners were significantly less likely to judge the productions of AMAB children to be inaccurate in the conditions in which age or age and SAB were revealed. These effects were consistent across SLPs with greatly varying levels of clinical experience. Knowing or imputing children's age and SAB can affect ratings of /s/ accuracy. Clinicians should be mindful of these potential effects. Future research should understand how expectations about sociolinguistic variation in speech affect appraisals of their speech and language. What is already known on the subject Adult men and women produce /s/ differently. A consensus is that these differences reflect sociolinguistic gender marking, rather than being the passive consequence of vocal-tract differences. Recent studies have shown that children assigned female at birth (AFAB) and those assigned male at birth (AMAB) produce /s/ differently in ways that mirror the differences between adult men and women, and which presumably reflect gender marking. What this paper adds to existing knowledge We asked whether US-based speech-language pathologists' (SLPs) ratings of the accuracy of /s/ differ depending on whether they are rating an AFAB or an AMAB child, and whether these differences are greater in conditions in which people are told the sex assigned at birth of the child being rated. We found that SLPs were more likely to judge AFAB children's /s/ productions to be more accurate than AMAB children's, even though the productions from the AMAB and AFAB children that were used as stimuli were matched for accuracy as determined by trained researchers. What are the clinical implications of this work? SLPs/speech-language therapists should be sensitive to the influence of social variables when assessing /s/. SLPs/speech-language therapists might rate children's productions differently depending on whether they believe they are rating an AFAB or an AMAB child.

A lung biopsy path planning algorithm based on the double spherical constraint Pareto and indicators’ importance-correlation degree

Lung cancer has the highest mortality rate among cancers. The commonly used clinical method for diagnosing lung cancer is the CT-guided percutaneous transthoracic lung biopsy (CT-PTLB), but this method requires a high level of clinical experience from doctors. In this work, an automatic path planning method for CT-PTLB is proposed to provide doctors with auxiliary advice on puncture paths. The proposed method comprises three steps: preprocessing, initial path selection, and path evaluation. During preprocessing, the chest organs required for subsequent path planning are segmented. During the initial path selection, a target point selection method for selecting biopsy samples according to biopsy sampling requirements is proposed, which includes a down-sampling algorithm suitable for different nodule shapes. Entry points are selected according to the selected target points and clinical constraints. During the path evaluation, the clinical needs of lung biopsy surgery are first quantified as path evaluation indicators and then divided according to their evaluation perspective into risk and execution indicators. Then, considering the impact of the correlation between indicators, a path scoring system based on the double spherical constraint Pareto and the importance-correlation degree of the indicators is proposed to evaluate the comprehensive performance of the planned paths. The proposed method is retrospectively tested on 6 CT images and prospectively tested on 25 CT images. The experimental results indicate that the method proposed in this work can be used to plan feasible puncture paths for different cases and can serve as an auxiliary tool for lung biopsy surgery.

Can clinicians identify community-acquired pneumonia on ultralow-dose CT? A diagnostic accuracy study

BackgroundWithout increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians’ assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist’s assessments as reference standard.MethodsThis was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations.ResultsAll clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians’ CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77–88), specificity = 70% (95%CI: 59–81), positive predictive value = 80% (95%CI: 74–84), negative predictive value = 78% (95%CI: 73–82).ConclusionThis study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.

Digital Comparison of Occlusal Vertical Contacts Between Direct Composite and Indirect Cad/Cam Restorations: An in vivo quantitative assessment

Objective: Clinical assessment of the static occlusal vertical contacts for direct composite and indirect Cad/Cam restorations, and evaluation of the clinical experience level's effect on contact registration. Methods: Sixty restorations on maxillary and mandibular molar teeth were investigated. Postgraduate students performed indirect Cad/Cam restorations (Cerasmart, GC Corp., n=20), and both undergraduate and postgraduate students performed direct composite restorations (Ganeial A’chord, GC Corp., n=20 for each). A single supervisor digitally analyzed the occlusal vertical contacts immediately after by using an intraoral scanner (iTero Element-5D, AlignTech) and OrthoCAD software. The tightness of contacts was assessed by counting the pixel numbers in Photoshop CC (Adobe) software. The statistical analyses were performed by Shapiro-Wilk, One-way ANOVA, Tamhane’s T2 test, Kruska-Wallis test, and Dunn tests (p

Effect of clinician's experience and expertise on the inter- and intra-observer reliability of the computed tomography-based classification systems in posterior malleolus fractures.

Three computed tomography (CT)-based classifications, including Haraguchi, Bartoníček-Rammelt, and Mason-Molloy systems, have been developed to better determine the characteristics of posterior malleolus fractures (PMFs). The aims of this study were (1) to determine the intra- and inter-observer reliability of the computed tomography-based classification systems and (2) to investigate the clinical experience and expertise on their reliabilities. Sixty-seven preoperative ankle CT scans of 67 adult patients with "ankle fracture with the involvement of the posterior malleolus"'' were retrospectively identified. CT images were assessed by 10 observers with different levels of clinical experience from 2 different specialties, including orthopedics and radiology. The observers were asked to classify PMFs according to 3 CT-based classifications on 2 separate occasions with a 4-week interval. Cohen's κ values were measured for 2 raters and Fleiss' κ values were measured for 3 raters and more. Overall, each classification had moderate to very good intraobserver reliability (κ=0.41 to 0.95, P < .01) as well as moderate interobserver reliability for each of the 2 separate assessments (κ=0.41 to 0.60, P < .01 for the first occasion; κ=0.44 to 0.59, P < .01 for the second occasion). Interobserver agreement among the foot and ankle surgeons regarding the Haraguchi and Bartoníček classifications was substantial for both assessment periods, whereas there was a moderate agreement for the Mason classification. Orthopedic residents showed moderate interobserver agreement in each period for both Bartoníček and Mason classifications. Radiology experts illustrated slight and fair agreements in the 2 assessments for Mason classification, moderate agreement in both assessments for Haraguchi classification, and substantial to moderate agreement in the first and second assessments for Bartoníček classification, respectively. Computed tomography-based classification system for PMFs demonstrated moderate interobserver reliability as well as moderate to very good intraobserver reliability. Moreover, foot and ankle specialists exhibit enhanced K values for both inter and intraobserver reliability for each classification system, consistency seems to increase as the interest in the field condenses.

Effect of different instrumental techniques and clinical experience on shade matching.

Many factors can affect the aesthetics of dental restorations, including the instrumental techniques used in shade matching, and can lead to clinical failure. The aim of this study was to investigate the effectiveness of using the cross-polarization digital photograph technique and intraoral scanners for shade matching, and also evaluate the effect of the level of clinical experience on shade matching success. Color analysis was performed on the maxillary right central incisors of 10 subject models with Vita Easyshade. Intraoral scanning was performed 10 times on each model using TRIOS 3 and color analysis was performed from the same spot. Then cross-polarized and non-polarized photographs of the models were taken with standard settings using a gray reference card. Each shade tab of the Vita System 3D-Master scale was also photographed with two different polarization techniques. Four groups (n = 12), including prosthodontics faculty staff, postgraduate students in prosthodontics, undergraduate students, and dental technicians matched the shade tabs and the model photographs obtained with both techniques on a standardized computer screen. Finally, the color differences between the shade tabs and maxillary central incisors matched by observers from four different groups were recorded using a colorimeter, Classic Color Meter, in accordance with the CIELAB system and CIEDE2000 (ΔE00) values were calculated. The data were compared with the acceptability threshold of 1.80 for ΔE00. The data obtained from the observers were analyzed with IBM SPSS Statistics 26.0 Release Notes program. Independent Samples t-test was used to compare normally distributed data according to binary groups. The level of significance was 0.05. A statistically significant difference was found in the shade matching on photographs taken with different techniques in postgraduate students (p = 0.02). Also, there was a statistically significant difference in success between the groups that made shade matching based on photographs obtained with the non-polarization technique (p = 0.00). The undergraduate students achieved statistically significantly lower results than all other groups (ΔE00 = 5.57±1.07). The kappa value between the intraoral scanner and spectrophotometer results was 0.10, and this value was not statistically significant (p = 0.32). The cross-polarization technique used especially for shade matching is not superior to the non-polarization technique. Academic and clinical experience might be correlated with shade-matching success with the non-polarization technique. The clinical acceptability threshold could not be achieved in the shade matchings made on digital photographs taken with both techniques. Shade matching performed with an intraoral scanner did not yield reliable results.

Current perception and barriers to implementing lung ultrasound in Canadian neonatal intensive care units: a national survey.

Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs.A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level.

Factors Related to Nurse’s Response Time in Management of Upper GI Bleeding among Chronic Liver Disease Patients

Background: In emergency care, the most important thing to note is the speed of nurses in responding or acting on the first patient who enters the emergency room. This speed is often referred to as response time. Nurse response time is always a measure of the service quality of a hospital or health center. Response times depend on the speed available as well as the quality of assistance to save lives and prevent infirmity. Objectives: Patients visiting to the hospital should be treated promptly and that leads to improvement in the quality of services and patient safety. The study aimed to determine the factors related to the response time of nurses in management of upper GI bleeding among chronic liver disease patients at Institute of Liver and Biliary Sciences, New Delhi, India.Methods: Carrying out the research is from February to March 2022. Analytical survey design with a cross- sectional approach. The research subjects were 20 nurses. measuring tools, namely questionnaires. analysis used bivariate analysis used the Chi-Square Test.Results: This shows that there is a relationship between education and response time with a value of p-value =.008, knowledge and response time with a value of p-value = .003.Conclusion: The level of knowledge and clinical experience determines Nurses to make prompt decision and ability to provide assessment and nursing actions. As the Nurses getting higher education levels and experience also increasing, on average they remain engaged in their work for longer time, so they are more productive and nurses have attended more training to improve their skills.

Hong Kong consensus recommendations on the management of pancreatic ductal adenocarcinoma.

This project was undertaken to develop the first set of consensus statements regarding the management of pancreatic ductal adenocarcinoma (PDAC) in Hong Kong, with the goal of providing guidance to local clinicians. A multidisciplinary panel of experts discussed issues surrounding current PDAC management and reviewed evidence gathered in the local context to propose treatment recommendations. The experts used the Delphi approach to finalise management recommendations. Consensus was defined as ≥80% acceptance among all expert panel members. Thirty-nine consensus statements were established. These statements cover all aspects of PDAC management, including diagnosis, resectability criteria, treatment modalities according to resectability, personalised management based on molecular profiling, palliative care, and supportive care. This project fulfils the need for guidance regarding PDAC management in Hong Kong. To assist clinicians with treatment decisions based on varying levels of evidence and clinical experience, treatment options are listed in several consensus statements.

Performance of dental students, orthodontic residents, and orthodontists for classification of midpalatal suture maturation stages on cone-beam computed tomography scans – a preliminary study

BackgroundAssessment of midpalatal suture maturation on cone-beam computed tomography (CBCT) scans is performed by visual inspection and is therefore subjective. The extent to which the assessment of midpalatal suture maturation is affected by rater experience has not been adequately explored in the existing literature, thus limiting the availability of evidence-based findings. This study compared the outcomes of classification by dental students, orthodontic residents, and orthodontists.MethodsThree different groups of students, orthodontic residents, and orthodontists evaluated 10 randomly chosen CBCT scans regarding midpalatal suture maturation from a pool of 179 patients (98 female and 81 male patients) aged 8 – 40 years which were previously classified by evaluating CBCT scans. The pool was set as benchmark utilizing midpalatal suture maturation classification by one examiner (OsiriX Lite version 11.0; Pixmeo SARL, Bernex, Switzerland). For assessment of intra-rater reliability of the examiners of each group the randomly chosen subjects were reclassified for midpalatal suture maturation after a wash-out period of two weeks by using the same software. Statistical analysis was performed to evaluate intra- and interrater reliability of the three groups with differing experience level.ResultsGroupwise intra-rater reliability assessment between the classification and reclassification was weak for examiners with a low level of experience (k = 0.59). Orthodontists had highest degree of agreement with regard to benchmark classification with an inter-rater reliability to be considered as moderate (k = 0.68).ConclusionsAssessment of midpalatal suture maturation on CBCT scans appears to be a subjective process and is considerably related to the experience level of the examiner. A high level of clinical experience seems to be favorable but does not necessarily ensure accurate results.

Multidisciplinary Obstetric Simulation Training: Experience at KK Women's and Children's Hospital (KKH), Singapore, a Tertiary Referral Centre.

Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It is a valuable tool that can be adapted for targeted audiences of different specialities at all experience levels from medical students to senior consultants. Methods In this study, pre- and post-course questionnaires of learners with varying levels of clinical experience from Obstetrics and Gynaecology (O&G), Anaesthesia, Neonatology, Emergency Medicine, midwifery, and nursing who undertook two simulation courses (namely the Combined Obstetrics Resuscitation Training course, CORE, and the CORE Lite), which comprised lectures and simulation drills with manikins and standardized patients, between 2015 and 2023 were compared. This also included a period when training was affected by the coronavirus disease 2019 (COVID-19) pandemic. Results The results showed that both simulation courses increased confidence levels amongall learners in the management of obstetric emergencies. Pre-course, participants were most confident in the management of neonatal resuscitationand severe pre-eclampsia, followed by postpartum haemorrhage.They were least confident in the management of vaginal breech delivery, uterine inversion, and twin delivery. Post-course, participants were most confident in the management of neonatal resuscitation and shoulder dystocia, followed by postpartum haemorrhage. They were least confident in the management of uterine inversion and maternal sepsis, followed by vaginal breech delivery and twin delivery. Whilst we saw a huge improvement in confidence levels for all obstetric emergencies, the greatest improvement in confidence levels was noted in vaginal breech delivery,twin delivery,and uterine inversion. Conclusion The simulation courses were effective in improving the confidence in the management of obstetric emergencies. While it may be difficult to measure the improvement in clinical outcomes as a result of simulation courses alone, the increase in confidence levels of clinicians can be used as a surrogate in measuring their preparedness in facing these emergency scenarios.

Bridge to Practice: A Qualitative Evaluation of Joint Medical Program (JMP) International Medical Graduates Perceived Preparedness for Professional Practice.

This study sought to examine the views of international graduates regarding how they perceived the Joint Medical Program Bachelor of Medicine (JMP BMed) undergraduate training prepared them to practice in a health system different from that in which they had studied. Eighteen international graduates of the JMP between 2010 and 2017 inclusive agreed to be interviewed face-to-face. JMP BMed international graduates were interviewed using 18 standardized questions to elicit perceptions of their preparedness to practice and reflections on their training experience. The interview data were qualitatively analyzed, and the main themes were identified and categorized. Overall, the international graduates of the JMP BMed curriculum felt well-prepared for tasks associated with communication, self-directed learning, and approaching mental health issues. Conversely, they perceived the level of clinical exposure and experience as inadequate in preparing them for the expected level of medical knowledge and responsibility. They also felt underprepared for navigating a different health system. The strengths and weaknesses identified in the JMP BMed program in its preparation of international graduates, particularly those who chose to practice in their country of origin, are of relevance for all medical schools that enrol international students. Greater awareness of the needs of international medical students returning home to practice may be of value for future curriculum planning purposes to ensure that medical schools optimally prepare their graduates to practice with confidence in a range of healthcare systems.

Standardism Performance of Dental Workers and Infection Control Status of Corrective Patient Instruments

Objective: This study aims to understand the performance of standardism through the performance of orthodontic workers and the infection control of orthodontic patients, and to contribute to the improvement of oral health of orthodontic patients and provide it as academic basic data. Methods: A study was conducted on 111 dental workers working at dental clinics in Gwangju Metropolitan City and Gyeonggi-do from March 1, 2023. The number of students participating in the study was calculated as the G. power 3.1 program, with an effect size of 0.3, a significant level of 0.05, and a power of 0.95. Participants in the survey understood the purpose of the study and agreed to participate in the study, and a self-written survey was conducted. The questionnaire was measured on a Likert 5-point scale, and 5 points were given to "very important" on the Likert 5-point scale and 1 point to "not important" so the higher the score, the higher the degree of practice. Results: Number of sterilizations of braces * In cross-analysis of clinical experience, sterilization was most common once a week, followed by sterilization once every two weeks. It can be said that there is no significant difference in the number of times and clinical experience. Conclusion: Clinical experience and regression analysis of instrument sterilization showed minimal levels of clinical experience, contaminated instrument management, hand hygiene, personal protective equipment, respiratory etiquette, and instrument sterilization methods.

Nurses' Knowledge Regarding Incontinence-Associated Dermatitis.

Incontinence-associated dermatitis (IAD), is a skin injury brought on by protracted exposure to urine or feces in the gluteal, sacral, or perianal regions. Therefore, this study aimed to evaluate nurses' level of knowledge, attitudes, social pressure, and intention to prevent IAD and to explore the factors that explain nurses' intention to prevent incontinence-associated dermatitis. A cross-sectional study was conducted among staff nurses from two designated hospitals in Riyadh, Saudi Arabia. The Knowledge, Attitudes, and Practices of the Incontinence-associated Dermatitis Questionnaire with 22 items (KAP-IAD-Q) on a five-agreement rating scale (1=not agreeable to 5=highly agreeable) was used. Also, the intention to use deep vein thrombosis (DVT) preventive measures was rated on a seven-point Likert scale, ranging from 1=strongly disagree to 7=strongly agree. The participants showed that they had a sufficient knowledge (M= 48.2 ± 9.9) and, a positive attitude toward IAD prevention average score of 6.6 (SD ± 9.9) related to IAD etiology and risk factors. The perceived behavior to prevent IAD average was 5.1 (SD ± 3.9), showing that nurses had confidence and control in preventing IAD. The intention average score was 5.3 (SD ± 3.1), which indicates that nurses had the intention to prevent IAD. Furthermore, knowledge, attitude, social pressure, and perceived behavior to prevent IAD had a positive strong association with intention to prevent IAD (r= 0.547, p < 0.01; r= 0.564, p < 0.01; r= 0.579, p < 0.01; and r = 0.709, p < 0.01) respectively. The study highlights the critical role of knowledge, attitudes, social pressure, and perceived behavior in shaping nurses' intentions to prevent IAD. The findings demonstrate that nurses generally have a positive attitude and strong intention to prevent IAD, influenced by their level of education, hospital type, and clinical experience.

Level of Awareness of Certified Non-critical Care Physicians in Diagnosing, Managing, and Disposing Anaphylactic Cases.

Anaphylaxis is known as an acute, severe hypersensitivity reaction that rapidly initiates after exposure to a triggering agent. It is a life-threatening condition, and early recognition and swift intervention are crucial to saving patients' lives. Objective: The objective of this study is to assess the ability of certified non-critical care physicians to recognize, manage, and dispose cases of anaphylaxis. A survey consisting of 19 questions was developed by expert emergency consultants to evaluate physicians' knowledge regarding the recognition, management, and disposition of anaphylactic episodes. Responses were collected through in-person surveys conducted with physicians from various specialties and varying clinical experience levels at a tertiary care center in the Eastern Province of Saudi Arabia. In this cross-sectional study, a total of 173 physicians completed the survey, with 81.5% being consultants and 18.5% specialists. Only 5.2% correctly identified all three proposed anaphylaxis clinical scenarios, 16.8% identified two scenarios correctly, and 51.4% identified only one scenario. While 42.8% recognized the first-line management of anaphylaxis, only 24.3% and 24.9% knew the correct epinephrine dose and route, respectively. Regarding the disposition of patients experiencing an anaphylactic episode, 61.9% of responders opted to dispose the case to the emergency department. Our study reveals a knowledge gap among non-critical care physicians practicing in a tertiary care center concerning the identification and management of anaphylaxis. Raising awareness of this life-threatening condition is imperative to address this serious issue.