Impact of a Tutored Theoretical-Practical Training to Develop Undergraduate Students’ Skills for the Detection of Caries Lesions: Study Protocol for a Multicenter Controlled Randomized Study

Background: Tutored laboratorial activities could be a manner of improving the competency development of students. However, its impact over conventional theoretical classes has not yet been tested. Additionally, different university contexts could influence this issue and should be explored. Objective: To assess the impact of a tutored theoretical-practical training for teaching undergraduate students to detect caries lesions as compared with theoretical teaching activities. The impact of these teaching/learning activities will be assessed in terms of efficacy, cost/benefit, retention of knowledge/acquired competences, and student acceptability. Methods: Sixteen centers (7 centers from Brazil and 9 centers from other countries throughout the world) are involved in the inclusion of subjects for this protocol. A randomized controlled study with parallel groups will be conducted. One group (control) will be exposed to a 60- to 90-minute conventional theoretical class and the other group (test) will be exposed to the same theoretical class and also a 90-minute laboratory class, including exercises and discussions based on the evaluation of a pool of images and extracted teeth. The mentioned outcomes will be evaluated immediately after the teaching activities and also in medium- and long-term analyses. To compare the long-term outcomes, students who enrolled in the university before the participating students will be interviewed for data collection and these data will be used as a control and compared with the trained group. This stage will be a nonrandomized phase of this study, nested in the main study. Appropriate statistical analysis will be performed according to the aims of this study. Variables related to the centers will also be analyzed and used to model adjustment as possible sources of variability among results. Results: This ongoing study is funded by a Brazilian national funding agency (CNPq- 400736/2014-4). We expect that the tutored theoretical-practical training will improve the undergraduate students’ performance in the detection of caries lesions and subsequent treatment decisions, mainly in terms of long-term retention of knowledge. Our hypothesis is that tutored theoretical-practical training is a more cost-effective option for teaching undergraduate students to detect caries lesions. Conclusions: If our hypothesis is confirmed, the use of laboratory training in conjunction with theoretical classes could be used as an educational strategy in Cariology to improve the development of undergraduate students’ skills in the detection of caries lesions and clinical decision-making

Clinical Relevance of Studies on the Accuracy of Visual Inspection for Detecting Caries Lesions: A Systematic Review

Although visual inspection is the most commonly used method for caries detection, and consequently the most investigated, studies have not been concerned about the clinical relevance of this procedure. Therefore, we conducted a systematic review in order to perform a critical evaluation considering the clinical relevance and methodological quality of studies on the accuracy of visual inspection for assessing caries lesions. Two independent reviewers searched several databases through July 2013 to identify papers/articles published in English. Other sources were checked to identify unpublished literature. The eligible studies were those which (1) assessed the accuracy of the visual method for detecting caries lesions on occlusal, approximal or smooth surfaces, in primary or permanent teeth, (2) used a reference standard, and (3) reported data about sample size and accuracy of the methods. Aspects related to clinical relevance and the methodological quality of the studies were evaluated. 96 of the 5,578 articles initially identified met the inclusion criteria. In general, most studies failed in considering some clinically relevant aspects: only 1 included study validated activity status of lesions, no study considered its prognosis, 79 studies did not consider a clinically relevant outcome, and only 1 evaluated a patient-centred outcome. Concerning methodological quality, the majority of the studies presented a high risk of bias in sample selection. In conclusion, studies on the accuracy of the visual method for caries detection should consider clinically relevant outcomes besides accuracy; moreover, they should be conducted with higher methodological quality, mainly regarding sample selection

The economic impact of two diagnostic strategies in the management of restorations in primary teeth : a health economic analysis plan for a trial-based economic evaluation

Background Different approaches have been used by dentists to base their decision. Among them, there are the aesthetical issues that may lead to more interventionist approaches. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants—CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less-invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic approaches for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth and extrapolating these findings to a longer time horizon. Methods A trial-based economic evaluation will be conducted, including three cost-effectiveness analyses (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/NCT03520309), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children’s restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is 2 years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analyses (CEA) will be performed. For CEAs, the effects will be the number of operative interventions (primary CEA analysis), the time to these new interventions, the percentage of patients who did not need new interventions in the follow-up, and changes in children’s oral health-related quality of life (secondary analyses). For CUA, the effect will be tooth-related quality-adjusted life years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. Using Markov models, a longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon. Discussion The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after 2 years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, these trial-based economic evaluations may bring actual evidence of the economic impact of such interventions. Trial registration NCT03520309. Registered May 9, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment

Comparação entre as abordagens lateral direita e mediana ventral em cadelas submetidas à ovariossalpingo-histerectomia

A fim de comparar as abordagens abdominais, pela linha mediana ventral e lateral direita em cadelas pré-púberes e adultas submetidas a ovariossalpingo-histerectomia, utilizaram-se 28 cadelas hígidas, distribuídas em dois grupos experimentais de igual número: grupo abordagem mediana ventral (AMV) e grupo abordagem lateral direita (ALD), com sete animais adultos e sete animais pré-púberes em cada grupo. O procedimento cirúrgico foi dividido em nove manobras cirúrgicas distintas, e o tempo para conclusão de cada uma delas, suas facilidades e dificuldades, assim como o tempo cirúrgico total, foram determinados. O tempo médio desde o início da incisão da pele até a entrada na cavidade peritoneal foi menor nas cadelas adultas (P≤0,001) e pré-púberes (P≤0,001) do grupo AMV, mas o tempo médio para identificação uterina foi menor nas cadelas pré-púberes (P≤0,001) do grupo ALD. O tempo cirúrgico total foi menor utilizando-se a abordagem lateral direita (grupo ALD) nas cadelas adultas (P≤0,001) e pré-púberes (P≤0,001). Seu uso não se relacionou com complicações cirúrgicas e facilitou a identificação uterina, possibilitando redução no tempo cirúrgico total. Assim, a abordagem lateral direita demonstrou ser uma alternativa segura em cadelas adultas e pré-púberes submetidas à OSH eletiva

Teores de minerais em polpas e cascas de frutos de cultivares de bananeira

O objetivo deste trabalho foi determinar a percentagem de matéria seca, o teor de minerais e a capacidade de fornecimento de minerais, com base na ingestão dietética de referência na polpa e na casca de frutos verdes e maduros de 15 cultivares de bananeira. Utilizaram-se quatro cachos por cultivar e seis frutos por unidade amostral. Foram coletadas amostras frescas da polpa e da casca, para digestões sulfúricas (0,2 g) e nitroperclóricas (0,5 g). Foram determinados: no extrato sulfúrico, o N total pelo método Kjeldahl; e, no extrato nitroperclórico, P, K, Ca, Mg, Cu, Mn, Fe, Zn e Se. O P foi determinado por colorimetria, e os demais nutrientes, por espectrofotometria de absorção atômica. O teor de minerais na polpa e na casca foi expresso com base na média dos dois estádios. Há diferenças entre cultivares de bananeira quanto à concentração de macro e micronutrientes na polpa e na casca, mas não entre frutos verdes e maduros. A cultivar Terrinha apresentou a maior percentagem de matéria seca na polpa, e as cultivares Marmelo e Maçã, na casca. Para N, P, Fe, Zn e Cu, a casca apresentou duas vezes o teor da polpa. O teor de K e Mn na casca foi de aproximadamente quatro vezes o da polpa. A polpa da cultivar Caipira (AAA) e a casca das cultivares Prata e Pacovan (AAB) apresentam os maiores teores de minerais

Influence of tail biting on weight gain, lesions and condemnations at slaughter of finishing pigs

The present study assessed the association of tail-biting lesions in finishing pigs with weight gain, occurrence of locomotion or respiratory disorders and abscesses during finishing period, and carcass condemnation at slaughter. The study was carried out on 4 different farms. For each animal with a tail biting lesion, two control pigs were selected. The total number of animals in the study was 312, with 104 of them being tail-bitten. Tail lesions were classified according to the degree of severity into four scores: score 0 -normal tail withou lesion; score 1-3 - increasing lesion severity, and score 4 - healed lesions. Overall, the occurrence of severe tail lesions (score 3) varied from 55 to 73% of tail-bitten pigs among farms. On all farms, healing of tail lesions was observed in 95% to 100% of the animals at the evaluation performed within 41-43 days after the commencement of the study. In two out of the four evaluated farms, pigs with score of 3 showed lower weight gain (P<0.05) compared with score 0 pigs. Before slaughter, the occurrence of locomotion problems and nodules/abscesses was associated (P<0.05) with the presence of tail-biting lesions. At slaughter, tail-biting lesions were associated (P<0.05) with the presence of abscesses, lung lesions (pleuritis and embolic pneumonia) or arthritis in carcasses. Carcass condemnation was associated with the presence of tail-biting lesions (P<0.05). Overall, carcass condemnation rate was 21.4%, of which animals with tail-biting lesions accounted for 66.7% of condemnations. Among the animals diagnosed with cannibalism at farm level, only two had not healed their lesions at slaughter. The fact that there were a lot of carcass condemnations, despite the fact that tail-bitten animals had no more active lesions, suggests that different situations may be observed between the field and slaughter, reinforcing the need to analyze pigs both at farm and slaughter to allow proper assessment of losses related to tail biting. Collectively, the observations of the present study show that complications associated with tail-biting found in slaughterhouses are probably underestimating field prevalence

Incidência de infecção do sítio cirúrgico e fatores de risco associados na clínica cirúrgica de pequenos animais

A infecção do sítio cirúrgico (ISC) apresenta-se como um complicador que possui muitos fatores de risco associados, e a maior parte das informações utilizadas nessa área pela medicina veterinária provém da medicina humana. Objetivou-se com este trabalho determinar a taxa de ISC no HVT-UFV, assim como correlacionar sua incidência com os seguintes fatores de risco: quantidade de pessoas presentes durante a cirurgia, classificação do potencial de contaminação da ferida cirúrgica e utilização de antimicrobiano profilático e ou terapêutico. Para isso, foram colhidas informações sobre a ocorrência de ISC, bem como os fatores de risco citados de 401 prontuários. Esses dados passaram por análise estatística, e foram obtidos os seguintes resultados: 21 pacientes diagnosticados com ISC, o que gerou uma taxa de infecção de 5,24% e associação entre incidência de ISC e cirurgias com risco de contaminação maior que 5%. Os demais fatores de risco avaliados não apresentaram associação, porém, em valores absolutos, foi detectada maior ocorrência de infecção nos procedimentos com maior quantidade de pessoas na sala de cirurgia. Portanto, foi possível observar a importância da obtenção fidedigna de dados e a necessidade do desenvolvimento de um sistema de vigilância epidemiológica voltado para a medicina veterinária