Standardized Oral Examination Research Articles

Improving detection of oral lesions: Eye tracking insights from a randomized controlled trial comparing standardized to conventional approach.

Early detection of oral cancer (OC) or its precursors is the most effective measure to improve outcome. The reasons for missing them on conventional oral examination (COE) or possible countermeasures are still unclear. In this randomized controlled trial, we investigated the effects of standardized oral examination (SOE) compared to COE. 49 dentists, specialists, and dental students wearing an eye tracker had to detect 10 simulated oral lesions drawn into a volunteer's oral cavity. SOE had a higher detection rate at 85.4% sensitivity compared to 78.8% in the control (p = 0.017) due to higher completeness (p < 0.001). Detection rate correlated with examination duration (p = 0.002). A standardized approach can improve systematics and thereby detection rates in oral examinations. It should take at least 5 min. Perceptual and cognitive errors and improper technique cause oral lesions to be missed. Its wide implementation could be an additional strategy to enhance early detection of OC.

Influence of systemic sclerosis on periodontal health: A case-control study.

Patients with systemic sclerosis (SSc) present various clinical and radiological oral manifestations. However, precise evaluation of the oral features associated with diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) is limited. The objective of this study was to evaluate the periodontal ligament (PDL) surface in SSc patients in comparison with controls. Assessment of oral-health-related quality of life (OHRQoL) and the levels of different biomarkers in the gingival crevicular fluid (GCF) was performed. SSc patients and matched controls underwent standardized oral examination and cone-beam computed tomography (CBCT). Levels of interleukin-6 (IL-6), chemokine (C-X-C motif) ligand 4 (CXCL-4) and matrix metalloproteinase-9 (MMP-9) in the GCF were determined by enzyme-linked immunosorbent assay. PDL surface was measured on CBCT axial views. OHRQoL was quantified using the Mouth Handicap in SSc Scale (MHISS). Thirty-nine SSc patients and 39 controls were included. SSc patients exhibited increased PDL surface, higher number of missing teeth as well as elevated IL-6, MMP-9 and CXCL-4 levels. Reduced mouth opening was observed in dcSSc but not in lcSSc patients. MHISS score was higher in dcSSc than in lcSSc patients. Although worse periodontal parameters were found in both subgroups compared with controls, dcSSc patients presented lower gingival inflammation. SSc is associated with PDL space widening, impaired oral health and OHRQoL.

Clinical label-free endoscopic imaging of biochemical and metabolic autofluorescence biomarkers of benign, precancerous, and cancerous oral lesions.

Early detection is critical for improving the survival rate and quality of life of oral cancer patients; unfortunately, dysplastic and early-stage cancerous oral lesions are often difficult to distinguish from oral benign lesions during standard clinical oral examination. Therefore, there is a critical need for novel clinical technologies that would enable reliable oral cancer screening. The autofluorescence properties of the oral epithelial tissue provide quantitative information about morphological, biochemical, and metabolic tissue and cellular alterations accompanying carcinogenesis. This study aimed to identify novel biochemical and metabolic autofluorescence biomarkers of oral dysplasia and cancer that could be clinically imaged using novel multispectral autofluorescence lifetime imaging (maFLIM) endoscopy technologies. In vivo maFLIM clinical endoscopic images of benign, precancerous, and cancerous lesions from 67 patients were acquired using a novel maFLIM endoscope. Widefield maFLIM feature maps were generated, and statistical analyses were applied to identify maFLIM features providing contrast between dysplastic/cancerous vs. benign oral lesions. A total of 14 spectral and time-resolved maFLIM features were found to provide contrast between dysplastic/cancerous vs. benign oral lesions, representing novel biochemical and metabolic autofluorescence biomarkers of oral epithelial dysplasia and cancer. To the best of our knowledge, this is the first demonstration of clinical widefield maFLIM endoscopic imaging of novel biochemical and metabolic autofluorescence biomarkers of oral dysplasia and cancer, supporting the potential of maFLIM endoscopy for early detection of oral cancer.

Standardized oral examinations allow for assessment of medical student clinical knowledge and decrease racial grading differences in a surgery clerkship

BackgroundOral examinations are not consistently included in third-year medical student clerkships. When included, they are often unstructured, leaving room for variations in difficulty or scoring. Previous research has demonstrated differences in clinical grade achievement, with underrepresented in medicine students receiving significantly lower grades than White students. MethodsWe designed a structured oral examination for third-year medical students on the surgery clerkship. Students completed 2 oral examination scenarios and were evaluated on their ability to complete a history and diagnostic workup, interpret laboratory and imaging results, and devise a treatment plan. Scores from our examination were compared to previous, unstructured oral examination scores and to student demographics. Students and faculty were surveyed regarding their experience. ResultsThird-year medical students demonstrated strong knowledge of multiple surgical diseases. The greatest number of errors occurred in treatment planning (P < .001). Third-year medical students receiving honors clerkship grades achieved higher percentages of correct items on their oral examination. (94.8% vs 90.4%) (P = .02). Evaluation of prior unstructured oral examinations found underrepresented in medicine students received lower scores than White students (P = .04). After implementation of our structured examination, no difference was seen between the scores of underrepresented in medicine and White students (P = .99). ConclusionWe implemented a standardized oral examination for third-year medical students on the surgery clerkship with student and faculty satisfaction and demonstrated the ability to determine domains of knowledge weakness. The application of our structured oral examination helped to address nonspecific grading practices and eliminate oral examination grade differences between underrepresented in medicine and White students.

The role of the dental surgeon in the early diagnosis of oral cancer: a concise systematic review

Introduction: Oral cancers (OC) represent more than 90% of cases. It is estimated that more than 400,000 new cases of oral cancer are diagnosed each year worldwide. OC is preventable as most of the different identified risk factors, such as tobacco use, alcohol consumption, and betel nut chewing, are behaviors that increase the likelihood of the disease. Surgical biopsy remains the gold standard, but adjunctive tools have been developed to aid diagnoses, such as vital toluidine blue staining and autofluorescence imaging. Objective: To emphasize and present the importance of the dental surgeon in the early diagnosis and prevention of oral cancer. Methods: The survey was conducted from July 2021 to August 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the rules of Systematic Review-PRISMA. Study quality was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: Early detection and treatment of OC were found to be important predictors for improving survival and reducing mortality. A thorough clinical inspection of the oral cavity can detect up to 99% of oral cancers. Other diagnostic types have been developed to help overcome the limits of standard oral clinical examination, highlighting toluidine blue staining, light-based detection techniques, and salivary biomarkers. Self-examination is an effective strategy to reduce the levels of mortality and morbidity caused by this pathology. A gain of 8.09% more in sensitivity and 11.36% more in specificity was observed with the fluorescence test. Conclusion: The findings clearly showed that early diagnosis of oral cancer is essential to increase the chances of cure and survival of patients, avoiding invasive surgical intervention. Currently, there are several diagnostic tools for screening and visual devices for the early detection of oral lesions through auxiliary methods, logically maintaining biopsy as the gold standard.

English

Oral cancer is the sixth most common malignant tumour, and it is the leading cause of morbidity and mortality due to its capacity to spread and invade. Oral cancer occurs at a different rate in different areas of the world, ranging from 2 to 10 per 100,000 people each year. Oral cancer is prevalent in South Asian nations such as Sri Lanka, India, Pakistan, and Bangladesh. In India, the frequency is 7-17 per 100,000 people each year, with 75,000 - 80,000 new cases per year. Identifying oral cancer in its early stages has a significant impact on survival rates when compared to detecting it later. Despite this, almost half of all diagnosed patients die within five years. A variety of well-established cancer screening programmes have been demonstrated to lower the patient morbidity and mortality dramatically. Regular check-ups, which include a thorough inspection of the whole mouth, are critical for detecting malignant and pre-cancerous problems early on. Unfortunately, early detection of oral precancerous and cancerous lesions has proved difficult due to the lesions' asymptomatic nature, doctors' casual approach to benign lesions, and the fact that 50 % of patients had regional or distant metastases at the time of diagnosis. Oral cancer is one of the most common cancers that leads to defacement and death. Despite recent advancements in therapeutic modalities, the prognosis has not improved. Patient’s mortality rates are positively associated with the point of presentation, with 60 % of people diagnosed with late-stage illness. Early diagnosis is important for oral cancer patient’s survival rate, as it decreases morbidity and mortality. According to the World Health Organization, the bulk of oral cancer patients are diagnosed late in the disease's progression, with a mediocre 5 - year survival rate of 50 %. As a result, careful treatment of oral cancer necessitates early diagnosis and intervention. Surgical biopsy is the gold standard for medical purposes, but it requires clinical assistance. Other screening methods that are simple to use, non-invasive, and expensive are the norms for any test to be accepted as a histopathology choice. The older cancer diagnosis modalities took longer, had more inter-observer bias, and were less descriptive. A standard oral examination with digital palpation is used in traditional techniques of screening for oral possibly malignant illnesses and oral cancers. Conventional inspection has been shown to be a poor discriminator of oral mucosal lesions. A variety of visual aids have been developed to help clinicians spot anomalies in the oral mucosa and in recent years, scientific and clinical developments have aided in the early detection and treatment of this disease. This review reflects on some of the older diagnostic modalities and screening methods for oral cancer diagnosis, as well as some of the recent more sophisticated techniques. KEY WORDS Diagnostic Aids, Oral Cancer, Premalignant Lesions

Salivary Characteristics, Individual Casual Parameters, and Their Relationships with the Significant Caries Index among Korean Children Aged 12 Years

This study aimed to investigate the salivary characteristics and individual daily living patterns in Korean children aged 12 years and evaluate their relationships according to the significant caries (SiC) index. The study sample consisted of 52 healthy Korean children. The subjects were allocated into a low caries-affected (low CA) group and a high caries-affected (high CA) group, according to the SiC index. Children underwent a standardized oral examination, and parents completed the questionnaires. Stimulated salivary samples were collected to evaluate the salivary pH, salivary flow rate, and salivary levels of Mutans streptococci (MS) and Lactobacilli (LB). The low CA group did not significantly differ from the high CA group for salivary flow rate and salivary pH. However, there were significant differences in salivary MS levels between the two groups (p < 0.05). Among the individual casual parameters, the prevalence of a sugar-associated primary energy source between meals was significantly higher in the high CA group than in the low CA group (p < 0.05). Within the limitations of this study, different levels of salivary MS and the consumption of different foods were observed in the low CA and high CA groups. The implications of these findings should be considered for caries susceptibility.

Construct Validation of the American Board of Anesthesiology's APPLIED Examination for Initial Certification.

The American Board of Anesthesiology administers the APPLIED Examination as a part of initial certification, which as of 2018 includes 2 components-the Standardized Oral Examination (SOE) and the Objective Structured Clinical Examination (OSCE). The goal of this study is to investigate the measurement construct(s) of the APPLIED Examination to assess whether the SOE and the OSCE measure distinct constructs (ie, factors). Exploratory item factor analysis of candidates' performance ratings was used to determine the number of constructs, and confirmatory item factor analysis to estimate factor loadings within each construct and correlation(s) between the constructs. In exploratory item factor analysis, the log-likelihood ratio test and Akaike information criterion index favored the 3-factor model, with factors reflecting the SOE, OSCE Communication and Professionalism, and OSCE Technical Skills. The Bayesian information criterion index favored the 2-factor model, with factors reflecting the SOE and the OSCE. In confirmatory item factor analysis, both models suggest moderate correlation between the SOE factor and the OSCE factor; the correlation was 0.49 (95% confidence interval [CI], 0.42-0.55) for the 3-factor model and 0.61 (95% CI, 0.54-0.64) for the 2-factor model. The factor loadings were lower for Technical Skills stations of the OSCE (ranging from 0.11 to 0.25) compared with those of the SOE and Communication and Professionalism stations of the OSCE (ranging from 0.36 to 0.50). The analyses provide evidence that the SOE and the OSCE measure distinct constructs, supporting the rationale for administering both components of the APPLIED Examination for initial certification in anesthesiology.

Pregraduation online curriculum delivery of internal medicine course during the COVID-19 pandemic: Experience of a medical college in Saudi Arabia

Background: The COVID-19 pandemic has challenged medical education and resulted in a rapid and unexpected global shift toward online education. The study presents the experience of the College of Medicine of King Saud University in delivering a comprehensive internal medicine course for final-year medical students, which includes the implementation of novel methods of assessment. Methods: A 2-week revision of the internal medicine course was conducted for 70 pregraduation medical students. Lectures and focused case-based tutorials were conducted online. Novel assessment methods included brief written essays summarizing the tutorials, open-book short-answer question (SAQ) examination, and a virtual standardized oral examination (vSOE). A questionnaire was sent to the students (n = 70) on the contents of the course, clarity of objectives, duration, and online platform. Results: The response rate was 99.3%. Students scored higher in the SAQs compared with traditional multiple-choice tests (mean score: 92.3% vs. 69.8%). The vSOE was efficient, and grades were comparable to traditional objective structured clinical examination. The majority of students (93%) reported the scientific content as good or excellent, whereas approximately 30% found the course goals lacked a clear description. The majority (76%) found the course length appropriate, and 94% reported the online platform installation and operation easy or very easy. Conclusions: The comprehensive online internal medicine course was successfully delivered to pregraduation students. Innovative online examination methods can be a reasonable alternative in the case of lockdown. This modality of teaching and assessment was considered useful and met the expectations of students.

Oral Manifestations of Wolf-Hirschhorn Syndrome: Genotype-Phenotype Correlation Analysis.

Background: Wolf-Hirschhorn syndrome (WHS) is a rare disease caused by deletion in the distal moiety of the short arm of chromosome 4. The objectives of this study were to report the most representative oral findings of WHS, relate them with other clinical characteristics of the disease, and establish possible phenotype-genotype correlation. Methods: The study was conducted at 6 reference centers distributed throughout Spain during 2018–2019. The study group consisted of 31 patients with WHS who underwent a standardized oral examination. Due to behavioral reasons, imaging studies were performed on only 11 of the children 6 years of age or older. All participants had previously undergone a specific medical examination for WHS, during which anatomical, functional, epilepsy-related, and genetic variables were recorded. Results: The most prevalent oral manifestations were delayed tooth eruption (74.1%), bruxism (64.5%), dental agenesis (63.6%), micrognathia (60.0%), oligodontia (45.5%), and downturned corners of the mouth (32.3%). We detected strong correlation between psychomotor delay and oligodontia (p = 0.008; Cramér’s V coefficient, 0.75). The size of the deletion was correlated in a statistically significant manner with the presence of oligodontia (p = 0.009; point-biserial correlation coefficient, 0.75). Conclusion: Certain oral manifestations prevalent in WHS can form part of the syndrome’s phenotypic variability. A number of the characteristics of WHS, such as psychomotor delay and epilepsy, are correlated with oral findings such as oligodontia and bruxism. Although most genotype-phenotype correlations are currently unknown, most of them seem to be associated with larger deletions, suggesting that some oral-facial candidate genes might be outside the critical WHS region, indicating that WHS is a contiguous gene syndrome.

The validity of the Community Periodontal Index of Treatment Needs (CPITN) in epidemiological studies of periodontal diseases

Objectives: The aim of this study was to evaluate the validity of partial CPITN (PCPITN) and full-mouth CPITN (FCPITN) indexes from CPITN index versions used in the diagnosis of periodontal disease.&#x0D; Method: The study included 1,000 patients over the age of 20. The clinical attachment loss examination and clinically assisted full-mouth periodontal examination (gold standard) including the depth of the periodontal pocket on probing and dental stones were performed. PCPITN and FCPITN index versions were compared with the gold standard oral examination. Sensitivity, specificity and diagnostic estimation tables were statistically created from the obtained data.&#x0D; Results: For Gingivitis, the sensitivity of the PCPITN index was found to be 68.88%, specificity was 85.94% and the field value under the Receiver Operating Characteristic (ROC) curve was 0.6893. For periodontitis, FCPITN index sensitivity was 89.28%, specificity was 96.56% and field value under the ROC curve was 0.931.&#x0D; Conclusion: Although FCPITN and PCPITN indexes have a near moderate value in the diagnosis of gingivitis, they were found to be more effective in the diagnosis of periodontitis. We think that the FCPITN index is particularly effective in the diagnosis of periodontitis.&#x0D; &#x0D; How to cite this article:&#x0D; Tanık A, Gül M. The validity of the Community Periodontal Index of Treatment Needs (CPITN) in Epidemiological Studies of Periodontal Diseases. Int Dent Res 2020;10(2):44-48. https://doi.org/10.5577/intdentres.2020.vol10.no2.3&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

First-Year Results of the American Board of Anesthesiology's Objective Structured Clinical Examination for Initial Certification.

In 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate an Objective Structured Clinical Examination (OSCE) into its initial certification examination system. Previously, the ABA's staged examination system consisted of 2 written examinations (the BASIC and ADVANCED examinations) and the Standardized Oral Examination (SOE). The OSCE and the existing SOE are now 2 separate components of the APPLIED Examination. This report presents the results of the first-year OSCE administration. A total of 1410 candidates took both the OSCE and the SOE in 2018. Candidate performance approximated a normal distribution for both the OSCE and the SOE, and was not associated with the timing of the examination, including day of the week, morning versus afternoon session, and order of the OSCE and the SOE. Practice-based Learning and Improvement was the most difficult station, while Application of Ultrasonography was the least difficult. The correlation coefficient between SOE and OSCE scores was 0.35 ([95% confidence interval {CI}, 0.30-0.39]; P < .001). Scores for the written ADVANCED Examination were modestly correlated with scores for the SOE (r = 0.29 [95% CI, 0.25-0.34]; P < .001) and the OSCE (r = 0.15 [95% CI, 0.10-0.20]; P < .001). Most of the candidates who failed the SOE passed the OSCE, and most of the candidates who failed the OSCE passed the SOE. Of the 1410 candidates, 77 (5.5%) failed the OSCE, 155 (11.0%) failed the SOE, and 25 (1.8%) failed both. Thus, 207 (14.7%) failed at least 1 component of the APPLIED Examination. Adding an OSCE to a board certification examination system is feasible. Preliminary evidence indicates that the OSCE measures aspects of candidate abilities distinct from those measured by other examinations used for initial board certification.

STATUS KESEHATAN GIGI &amp; MULUT MASYARAKAT KABUPATEN TIMOR TENGAH UTARA BERDASARKAN FORMAT PEMERIKSAAN WHO ORAL HEALTH SURVEYS BASIC METHODS 5th EDITION

One of the aims of Oral Health Global Goals 2020 is to reduce missing tooth or tooth loss due to dental caries, according with the fact that oral health problems that predominate in the world especially in Indonesia are tooth loss due to caries. Therefore an effort is needed to reduce the missing component through the implementation of good health services that are obtained from good planning, good planning is obtained from the existence of good data as well , good oral health status data obtained from data collectors, instruments and standardized oral examination formats good too. The oral examination format from WHO Oral Health Basic Methods 5th Edition is the latest examination format to record various indicators of oral health status but has not been widely used in determining the oral health status of individuals or communities in Indonesia . Research purposes is to know the community oral health status of the North Central Timor District people in accordance with the latest examination format from WHO Oral Health Surveys Basic Methods 5th Edition. This is a descriptive survey research with a cross sectional design , which was carried out by taking 208 respondents from the community of 5 villages in North Central Timor District, such as Hauteas, Tes, Sainiup, North Oenenu and Homusu village..The data obtained through direct examination by the dentist in the respondent's oral cavity to determine their oral health status and recorded in the WHO Oral Health Surveys Basic Methods 5th Edition examination format. The data will be analyzed descriptively in accordance with the provisions set by WHO. The oral health status of North Central Timor people are: Dentition status, on average there are 8 carious crowns and 10 exposed roots, both carious and not carious. Periodontal status, on average they had 5 teeth with gingival bleeding , whereas for gingival pocket, on average they had 6 teeth with deep gingival pocket 4- 5 mm . Loss of attachment status, on average there are at least 1 sextant with various conditions for periodontal tissue attachment loss, such as 4-5 mm, 6-8 mm, 9-11 mm , and ≥ 12 mm attachment loss from the cemento enamel junction. There is no fluorosis status . Dental erosion status, about 16.19% of them had enamel erosion, and 4.37% had dentine erosion. The average number of teeth with enamel erosion are 12 teeth and those with erosion to the dentin on average are 7 teeth .Oral mucosal lesions, about 3.9% of them had stomatitis aphthous recurrent (SAR), and 1.3% of the people had suspected oral cancer. Denture status, only 0.43 % of the population uses partial removable teeth, and only in the maxilla, the rest there is no denture.Intervention urgency status, about 60.3% of the population need oral health care, but not urgent, about 15.53% of the population do not or do not need oral health care, about 5.24% of the population need oral health care urgently. There are oral health problems among NorthCentral Timor District people, such as carious crowns, exposed roots, gingival bleeding, gingival pocket, loss of attachment periodontal, dental erosion, oral mucosal lessions, and dentureless edentulous, so they need oral intervention.

Modules for the Technical Skills Section of the OSCE Component of the American Board of Anesthesiology APPLIED Examination

To assess communication and professionalism, as well as technical skills related to patient care, the American Board of Anesthesiology (ABA) has begun administering an Objective Structured Clinical Examination (OSCE) portion of the APPLIED Examination in addition to the Standard Oral Examination component. We created video modules and a curriculum for anesthesiology resident OSCE preparation for the Interpretation of Monitors and Interpretation of Echocardiography components. The modules can be used individually by trainees or included as part of an OSCE workshop led by faculty educators with seven individual stations matching the content of the actual ABA examination. These modules are recommended for all levels of anesthesiology trainees so that they can gain exposure to the format and the fast pace of the examination. Sixty-six junior and senior anesthesiology residents, fellows, and junior faculty successfully participated in these modules. Seventy-three percent of the participants agreed that after completing these modules, they now had a good understanding of the Interpretation of Monitors and Interpretation of Echocardiography technical skills stations. More than 90% of participants reported that the modules were useful, and more than 70% reported that they now felt prepared for these stations of the OSCE. Developing technical skills stations for deliberate practice and preparation for the ABA OSCE is resource intensive. Finding time and faculty to facilitate OSCE preparation is also challenging. With the video modules and scripts included in this publication, residents can practice independently or as part of larger preparation course.

Disparities in untreated caries among children and adults in the U.S., 2011\u20132014

BackgroundThe Affordable Care Act of 2010 increased dental coverage for children in the United States, (U.S.) but not for adults. Few studies in current scholarship make use of up-to-date, nationally representative data to examine oral health disparities in the U.S. population. The purpose of this study is to use nationally representative data to determine the prevalence of untreated caries among children and adults of different socioeconomic and racial/ethnic groups and to examine the factors associated with untreated caries among children and adults.MethodsThis study used the 2011–2014 National Health and Nutrition Examination Survey (NHANES) demographic, oral health questionnaire, and oral health dentition examination data (n = 7008 for children; n = 9673 for adults). Participants that had a standardized oral health examination and at least one natural primary or permanent tooth considering 28 tooth spaces were included in this study. Our main outcome measure was untreated coronal caries defined as decay on the crown or enamel surface of a tooth that had not been treated or filled. Population estimates were calculated to determine the prevalence of untreated caries among children and adults in the United States. Frequencies and Pearson’s chi-square tests were used to compare those with and without untreated caries. Multivariate logistic regression models were used to evaluate the factors associated with untreated caries. We conducted analyses among children and adults separately.ResultsFrom 2011 to 2014, 12.4 million children and 57.6 million adults in the United States had untreated caries. Age, family income level, recent dental visit, and financial and non-financial barriers were significantly associated with untreated caries in both children and adults. Race/ethnicity, gender and education level were also significantly associated with untreated caries among adults. The odds of untreated caries associated with financial barriers were 2.06 for children and 2.84 for adults while the odds of untreated caries associated with non-financial barriers were 2.86 for children and 1.67 for adults.ConclusionsDemographic and socio-economic disparities in untreated caries exist among children and adults.

The Usage of Mock Oral Examinations for Program Improvement

Mock oral examinations are often used to prepare residents for the American Board of Surgery certifying examination. Another potential use of these examinations is to identify programmatic weaknesses. Results from a multi-institutional mock oral examination were evaluated to determine if specific areas of weakness within each of the participating programs could be identified to facilitate program development. A mock oral examination was administered annually consisting of 3 examination rooms per resident with 3 cases in each room. Case categories included core general surgery and subspecialties and cases were changed yearly. Each case included facets of patient management from history and physical examination, and differential diagnosis to postoperative care and professional behaviors. General Surgery programs at 3 academic medical centers-Northwestern University, Rush University, and University of Illinois at Chicago. A total of 259 resident examinations of fourth- and fifth-year general surgery residents over a 7-year period. A total of 2331 individual resident cases were evaluated with an overall case pass rate of 50.2% across all 3 programs. The weakest case category for each program was different (A = vascular 40.0% pass, B = trauma 41.4% pass, and C = breast 30.0% pass). All programs scored above their mean in gastrointestinal and abdominal surgery and below their mean in vascular surgery. Within vascular surgery, the weakest facet of patient management also differed between programs (A = select tests 44.3% pass, B = complications 57.0% pass, and C = history and physical 55.4% pass). A standardized mock oral examination is able to identify topic areas of relative strength and weakness that differ between programs. These results can be used to define focused areas for improvement within training programs, guide rotation schedules, and improve didactic curricula.

Self Awareness of Oral Potentially Malignant Disorders and Oral Cancer Among High-Risk Patients

BackgroundThis study aims to investigate self-awareness of individuals, regarding oral potentially malignant disorders and oral cancer, who are at higher risk of developing them because of their adverse habits.MethodsDemographic data from 500 patients was noted and subjects were interviewed for adverse habits, using a structured questionnaire. As part of the interview, six questions regarding awareness of OPMD and oral cancer were asked and responses were noted on 3-point-scale (yes/no/ not sure). The subjects’ awareness of risk factors and their knowledge of clinical symptoms as possible indicators of OPMD and oral cancer were also assessed. A standardized oral mucosal examination was performed according to WHO (1997) guidelines. Awareness of the presence/absence of OPMD was assessed using 4 questions which were confirmed by histopathologic analysis.ResultsAwareness of oral cancer was 70.4%, but only 33.4% for OPMD. Statistically significant differences in awareness among different age groups, gender, level of education, monthly income and type of tobacco use were observed. The majority of subjects were not aware of the symptoms of oral cancer and of OPMD. 77% and 60% subjects were aware that tobacco and alcohol consumption are risk factors for oral cancer but only 14% and 8.6% were aware of these as risk factors for OPMD. 45.4% of the study population had OPMD while 50.6% were aware of it.ConclusionsKnowledge of oral cancer and OPMD was poor among subjects with high risk of developing oral cancer, indicating an urgent need to implement public health education and promotion strategies

Adopting the American anesthesia oral examination in China: value and roadblocks

The quality and standardized training and certification of young physicians is key to the quality of health care in the future. In contrast to the American system, there is no nationwide and standardized oral examination in the training and certification process for anesthesiologists in China. The adoptability of the American anesthesia oral examination in China, as well as potential roadblocks, has not been specifically discussed. In this commentary, we share our experience of introducing the American oral examination to an audience of Chinese anesthesiologists and propose a pragmatic approach for adopting the anesthesia oral examination in China. This initiative has the potential to reform the current anesthesia training and certification process and improve the quality of anesthetic care in China.

Feasibility and Usefulness of a Standardized Oral Examination (SOE) Emphasizing Cognitive Processes for Surgery Clerkship Students

Min, Hyeyoun MD*; Chen, Xiaodong MS, PhD; Breen, Elizabeth M. MD, FACS Author Information

Prevalence and predictors for periodontitis among adults in China, 2010

Background Although the interrelationship between poor oral health and chronic diseases is well established, few related studies are available in China. In this study, the prevalence of severe periodontitis and its association with chronic diseases among adults in China have been explored. Design During China's 2010 Chronic Disease and Risk Factor Surveillance (CCDRFS) survey among adults aged 18 and older, 3 out of 162 surveillance points and the entire sample from each point (600×3=1,800 subjects) were selected as pilot study sites in which oral examination was performed. Basic demographic information, chronic diseases status, and results of oral examination were collected from 2010 CCDRFS data. A standard oral examination was conducted by trained staff. Periodontitis was defined as moderate (4–5 mm pockets) or severe (≥6 mm pockets). Chronic disease status was determined by using standard methods and criteria. Multivariate logistic analysis was used to identify the independent association of various factors with severe periodontitis. Results Of 1,800 subjects, 1,728 subjects (96%) provided complete information. The prevalence of severe periodontitis was 1.9% (32/1,728) (95% CI=1.2–2.5). In multivariate model, participants with diabetes were 2.4 times (OR=2.4, 95% CI=1.1–5.6) more likely to have severe periodontitis. Being male was significantly associated with severe periodontitis (OR=3.5, 95% CI=1.6–7.7). Living in a rural area was related to an increased chance of having severe periodontitis (OR=2.1, 95% CI=1.0– 4.9). Attainment of at least 6 years of education was inversely associated with severe periodontitis (OR=0.3, 95% CI=0.1–0.8). Conclusion According to this pilot project, prevalence of severe periodontitis was low. Control measures should be particularly emphasized for high-risk groups such as less educated people (<6 years of education), people living in rural areas, men, and diabetes patients. Population-based studies, including oral examination by trained staff, are feasible and should be done in order to understand the burden of periodontitis and to provide an effective response to this key oral health issue.