Evidence Based Practice: Assessing the educational outcome

Healthcare providers and patients strive for optimal outcomes with a growing trend to embed the principles of evidence-based practice (EBP) into mainstream care delivery by practicing dentists. The foundations of future best practice are built at dental school. How do we evaluate the outcome of an EBP syllabus? This study describes the use of the KACE assessment tool to assess the learning outcomes of final year DDS students who had completed an EBP program. The use of a validated instrument to measure four dimensions, knowledge, attitudes about it, familiarity with sources for accessing evidence and confidence in critical appraisal skills can be an important outcomes assessment tool. 90 dental students from the final year completed the questionnaire in 2016. 84% demonstrated good knowledge of evidence hierarchy. 92% agreed of the value to future practice and improvement in quality of patient care with 88% agreeing with the value of it as an integral part of a dental school curriculum. Students demonstrate confidence in appraising study design, recognizing bias, generalizability and value of the research report. However, even with electronic access to databases, when it came to accessing evidence over 75% would ask a friend with less than 25% consulting the Cochrane Database. The outcome of the training had been positive in providing the skills for EBP. The use of a validated tool ensured the graduating students received a good foundation to provide their future patients with the best clinical evidence for optimal and cost-effective dental care

Underhull Material Transport Rig: Aircraft Carrier Maintenance Processes

The clearance under a ship in the Newport News Shipbuilding dry dock is approximately 62 inches. As a result, workers are either crouched or hunched over as they carry materials and equipment underneath the ship to their work zone. This can cause physical strain on workers’ bodies, leading to safety and health problems. This design project solves the problem by creating a transport system that uses a cart suspended from two trolleys that ride on a track attached to the bottom of the hull. A working prototype was built, demonstrated, and tested. This prototype cart maneuvered through a straight and a 90 degree curved section of rail. Scaffolding was built to simulate the bottom of the ship\u27s hull. The main constraints for this system included - setup time, ground clearance, and load capacity. The setup time could not exceed 8 hours, the lowest point of the system must be at least two feet off the ground, and it must be able to carry a load of 150 lbs, with a factor of safety of 2.5. The approach taken was to suspend the system from the bottom of the hull. Design decisions included the type of track or rail, the type of trolley, the cart design, the connection of the cart to the trolley, and cart stabilization methods. A successful prototype of this design was built and tested. The prototype meets all of the design specifications. Two improvements that could be made to the design include a way to move the cart without manually pushing it and a way to switch the cart between different tracks. This project impacts Newport News Shipbuilding by creating a safe and efficient way to transport materials while under the hull of a ship.https://scholarscompass.vcu.edu/capstone/1127/thumbnail.jp

Charles W. Bolen Faculty Recital Series: Dazzling Divas, November 3, 2009

Center for the Performing ArtsNovember 3, 2009Tuesday Evening8:00 p.m

Acute Effects of Neuromuscular-Training with Handheld-Vibration on Elbow Joint Position Sense

Context: Clinicians use exercises in rehabilitation to enhance sensorimotor-function, however evidence supporting their use is scarce. Objective: To evaluate acute effects of handheld-vibration on joint position sense (JPS). Design: A repeated-measure, randomized, counter-balanced 3-condition design. Setting: Sports Medicine and Science Research Laboratory. Patients or Other Participants: 31 healthy college-aged volunteers (16-males, 15-females; age=23+3y, mass=76+14kg, height=173+8cm). Interventions: We measured elbow JPS and monitored training using the Flock-of-Birds system (Ascension Technology, Burlington, VT) and MotionMonitor software (Innsport, Chicago, IL), accurate to 0.5°. For each condition (15,5,0Hz vibration), subjects completed three 15-s bouts holding a 2.55kg Mini-VibraFlex dumbbell (Orthometric, New York, NY), and used software-generated audio/visual biofeedback to locate the target. Participants performed separate pre- and post-test JPS measures for each condition. For JPS testing, subjects held a non-vibrating dumbbell, identified the target (90°flexion) using biofeedback, and relaxed 3-5s. We removed feedback and subjects recreated the target and pressed a trigger. We used SPSS 14.0 (SPSS Inc., Chicago, IL) to perform separate ANOVAs (p\u3c0.05) for each protocol and calculated effect sizes using standard-mean differences. Main Outcome Measures: Dependent variables were absolute and variable error between target and reproduced angles, pre-post vibration training. Results: 0Hz (F1,61=1.310,p=0.3) and 5Hz (F1,61=2.625,p=0.1) vibration did not affect accuracy. 15Hz vibration enhanced accuracy (6.5±0.6 to 5.0±0.5°) (F1,61=8.681,p=0.005,ES=0.3). 0Hz did not affect variability (F1,61=0.007,p=0.9). 5Hz vibration decreased variability (3.0±1.8 to 2.3±1.3°) (F1,61=7.250,p=0.009), as did 15Hz (2.8±1.8 to 1.8±1.2°) (F1,61=24.027, p\u3c0.001). Conclusions: Our results support using handheld-vibration to improve sensorimotor-function. Future research should include injured subjects, functional multi-joint/multi-planar measures, and long-term effects of similar training

Alternative Therapies for Treatment of Keratoconjunctivitis Sicca Associated with Sjogren\u27s Syndrome

Background: Sjogren’s syndrome is a chronic, systemic autoimmune disorder, which often results in significant ocular surface disease. Dry eye associated with Sjogren’s syndrome is a multifactorial disease which leads to decreased function of the lacrimal glands and altered tear composition. There currently are numerous anti-inflammatory methods used for treatment of this disease. Case Report: This case report will focus on the use of amniotic membrane placement and autologous serum tears to facilitate a successful scleral contact lens fit allowing for reduced ocular inflammation and discomfort associated with Keratoconjunctivitis sicca due to Sjogren’s syndrome. Conclusion: Clinical management of keratoconjunctivitis sicca due to Sjogren’s syndrome can be challenging. Diagnosis often requires numerous in office testing including Schirmer I/II, TBUT, sodium fluorescein stain, and osmolarity. Such testing can be repeated over time to monitor for improvement with addition of each new therapy. Various treatment modalities such as topical lubricants, cyclosporine, autologous serum tears, or amniotic membranes have been proven to provide short-term benefits and excellent maintenance of symptoms. Utilizing such treatments to promote an ideal scleral contact lens fit provides lasting benefits of corneal clarity and stable vision

Pilot Implementation of a Heat Illness Prevention Program in the Southeastern US

Objective: To evaluate the ease of application of a heat illness prevention program (HIPP). Design: A mixed-method research design was used: questionnaire and semi-structured interview. Setting: Eleven South Florida high schools in August (mean ambient temperature=84.0°F, mean relative humidity=69.5%) participated in the HIPP. Participants: Certified Athletic Trainers (AT) (n=11; age=22.2+1.2yr; 63.6% female, 36.4% male; 63.6%) implemented the HIPP with their football athletes which included a pre-screening tool, the Heat Illness Index Score- Risk Assessment. Data Collection and Analysis: Participants completed a 17-item questionnaire, 4 of which provided space for open-ended responses. Additionally, semi-structured interviews were voice recorded, and separately transcribed. Results: Three participants (27.7%) were unable to implement the HIPP with any of their athletes. Of the 7 participants (63.6%) who implemented the HIPP to greater than 50% of their athletes, a majority reported that the HIPP was difficult (54.5%) or exceedingly difficult (18.2%) to implement. Lack of appropriate instrumentation (81.8%, n=9/11), lack of coaching staff/administrative support (54.5%, n=6/11), insufficient support staff (54.5%, n=6/11), too many athletes (45.5%, n=5/11), and financial restrictions (36.4%, n=4/11) deterred complete implementation of the HIPP. Conclusions: Because AT in the high school setting often lack the resources, time, and coaches’ support to identify risk factors, predisposing athletes to exertional heat Illnesses (EHI) researchers should develop and validate a suitable screening tool. Further, ATs charged with the health care of high school athletes should seek out prevention programs and screening tools to identify high-risk athletes and monitor athletes throughout exercise in extreme environments