Dental Students’ Perceived Preparedness to Treat Patients in Clinic After a Fixed Prosthodontics Course: Survey Results of a Case Study

Previous research regarding dental students has found modest predictive value in preclinical didactic course grades in predicting clinical performance, but systematic assessment of students' feedback on their perceived preparedness has received little attention as a preclinical assessment methodology. The aim of this study was to assess the perceptions of the dental students at one U.S. academic dental institution regarding their preparedness for clinical performance following the preclinical fixed prosthodontics course. Third- and fourth-year dental students participated in a survey about their perceived preparedness to diagnose and treat patients with fixed prosthodontics needs in the school's dental clinics. The respondents (79 out of 161 students, for a response rate of 49%) rated each item on a five-point Likert scale. Responses about which preclinical procedures of the course prepared students the least and the best were consistent for the third- and fourth-year students. Less than 60% of all responding students felt prepared for planning complex cases and performing laboratory-related procedures. The findings of this study indicate that improvement is required in teaching students about laboratory procedures and problem-solving to adequately prepare them for clinical treatment of patients with fixed prosthodontics needs

Utilization of Blended Learning to Teach Preclinical Endodontics

Blended learning (BL) is the integration of classroom learning with an online environment. The purpose of this study was to determine whether dental students who experienced BL in a preclinical endodontic course demonstrated better manual skills, conceptual knowledge, and learning experience compared to those experiencing traditional learning. All eighty-one students (100 percent) in a preclinical endodontics course agreed to participate and were assigned to either the traditional or BL group. A root canal procedure was used to determine the level of manual skills gained by each group. Pre- and post-intervention quizzes were given to all students to evaluate conceptual knowledge gained, and the students' perspectives on the methods were evaluated with a survey. The BL group scored better than the traditional group on the manual skills exercise at a statistically significant level (p=0.0067). There were no differences in the post-intervention quiz scores between the two groups, and the students' opinions were positive regarding BL. With BL, the students were able to learn and demonstrate dental skills at a high level

A Risk-Based Screening Approach to Patients Needing Surgery During the De-Escalation Phase of COVID-19 Pandemic

Since the outbreak of COVID-19 pandemic, many national and international surgical societies have produced guidelines regarding the management of surgical patients. During the mitigation phase of the pandemic, most documents suggested to consider postponing elective procedures, unless this might have impacted the life expectancy of patients. As awareness and knowledge about COVID-19 are gradually increasing, and as we enter a phase when surgical services are resuming their activities, surgical strategies have to adapt to this rapidly evolving scenario. This is particularly relevant when considering screening policies and the associated findings. We herein describe a risk-based approach to the management of patients with surgical diseases, which might be useful in order to limit the risks for healthcare workers and patients, while allowing for resuming elective surgical practice safely

Prioritization criteria of patients on scheduled waiting lists for abdominal wall hernia surgery: a cross-sectional study

Elective herniorrhaphy; Incisional hernia; Inguinal herniaHerniorrafia electiva; Hernia incisional; Hernia inguinalHerniorràfia electiva; Hèrnia incisional; Hèrnia inguinalPurpose: Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria. Methods: A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia. Results: The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1-14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010). Conclusion: Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair

A case of pylephlebitis complicating an acute appendicitis: Uncommon cholangitis-like situation

Appendicitis; Cholangitis presentation; PhylephlebitisApendicitis; Presentación de colangitis; PileflebitisApendicitis; Presentació de colangitis; PileflebitisIntroduction Pylephlebitis represents an uncommon but serious condition with significant mortality which can complicate intrabdominal sepsis of any etiology. One of the most common predisposing infections is appendicitis. Presentation of case A 21-year-old male with 4 days of epigastric and right upper quadrant pain with associated fever and chills with hyperbilirubinemia and leukocytosis in blood test was orientated as cholangitis at first diagnostic. Poor response to antibiotic treatment with persistent fever and bacteriemia with E. coli and S. constellatus isolated in blood cultures led to complete the study with a CT scan which revealed an acute appendicitis complicated with thrombosis of the superior mesenteric vein (SMV) up to the splenoportal confluence. Appendectomy, treatment with broad-spectrum antibiotic and anticoagulation treatment led to full recovery. Follow-up after 6 months showed almost complete SMV patency. Discussion Pylephlebitis can present as a clinical cholangitis-like picture with hyperbilirubinemia with or without liver abscess formation. CT scan seems to be the most sensitive diagnostic test as it identifies the underlying focus of infection, the extension of the thrombosis and detects liver abscesses. Surgical removal of the source of infection as appendectomy and adequate antibiotic treatment adjusted by culture should be initiated promptly. Anticoagulant treatment should be considered in the case of poor clinical outcome or thrombosis progression. Conclusion Pylephlebitis should be suspected mainly in patients with appendicitis and diverticulitis with erratic behavior despite surgical removal and/or antibiotic treatment with abnormal liver tests and persistent bacteriemia. CT scan is the preferred image study

Monitoring the Suspension of Surgical Procedures

Introduction: A surgical suspension generates a series of hassles and dissatisfaction of the patient and his family. Preparations for surgery involve an entire remodeling of the professional, social and family schedule, as well as other factors such as expectations regarding the results and the fear of the unknown. Objective: A quantification and identification of the reasons for surgical cancellations was realized for a better understanding and guidance to the leadership team's actions on this issue. Thus, their monitoring is important in the search for actions to make the surgery center´s processes more effective, favoring possibilities for improvement in the quality of hospital services. This way, the objective of this research was to identify the main causes for the cancellations of surgical procedures. Method: Study of documentary and retrospective type, quantitative, performed in the surgical center of a hospital in the city of Juazeiro do Norte, CE, Brazil. Data collection was performed through digital files of the 'syshosp' system used to record performed and suspended surgical procedures. Data were collected from January to December 2014 and analyzed using simplified statistics and presentation through a table. Results: The justifications for cancellation of procedures related to the organizational aspects of the institution were highlighted as main reasons for surgical suspension:  the priority for urgency, lack of material resources / equipment required for the surgical procedure and no hospitalization of surgical patients. There were also those related to the lack of staff, being most of them because of the surgeon's inability to attend and absence of anesthesiologist causing the impossibility of building the surgical team. Finally, the suspensions regarding priority for emergencies are highlighted. It was observed that the main determinants for surgical suspensions were those related to the organization of the hospital, with a total of 267 (51.1%), standing out among these: technical problems (16.1%), no admission (42, 3%), lack of material (13.5%) and the priority for urgency (21%). Discussion: The Brazilian Ministry of Health (Ministério da Saúde) defines the surgery suspension rate by the number of suspended surgeries divided by the total of scheduled surgeries in a given period and multiplied by 1003. During the studied period, there were 6591 scheduled surgeries 6069 surgeries were performed and there were 522 suspensions. Thus, the overall average rate of suspension obtained was 7.9%. Compared to other studies and the goals of the institution (5%), it is clear that this is a high rate, but manageable. Conclusion: It was observed that the suspensions of surgeries must be carefully monitored and analyzed by the entire team involved in order to disseminate this indicator and its possible consequences to all. The process of identification of consequences is still weak and needs to be strengthened to an effective action plan. It was revealed that the main cause of surgical cancellations during the surveyed year was related to the organization of the hospital, emphasizing the importance of updating the interaction of processes with the sectors that influence this indicator and preparation of strategic planning with everybody´s involvement so you can minimize the data, as it directly affect the patient, professionals and the hospital, resulting from the patient´s dissatisfaction to the longer permanency of the patient in hospital

Childhood Depression in Family Narratives

BACKGROUND: The family narratives are true contextual cues in the representation of the experiences of illness of depressive child. The family members use healthcare services in an attempt to understand the disease so that describe the everyday practices in the living with the child. OBJECTIVE: This original article aims to present childhood depression with its various nuances and its many consequences in the family context. METHODS: The universe of this study involved 24 families in the age group ranging from 45 to 70 years who searched the care services at Children's Psychosocial Care Center (CAPSi). Through the records, a survey of the family members was performed, from case reports, in the course of medical and psychological consultations. This is a purposive sample, which was selected by approximation the inclusion criteria, a sample of 12 family members of both sexes. The attention focused on the use of narrative interview - which is recognized as a genre of sociolinguistic research - fully recorded. RESULTS: The family member has its convivial trajectory with the disease through a specific identity and enunciation with the child. The family narratives show up symbolic portraits to the rescue of the guiding elements of the depressive situation. The family narratives are shown as spaces of reinterpretation of pain and psychological distress. The disorder explained in the narratives of childhood depression inserted in understanding plays a crucial role in exposing the intensity of pain and psychological distress. CONCLUSION: It is fundamental important in clinical care the psychiatric practice inserted into the historical and social context of the family members who have their own living narrative with the disease

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Análisis del manejo de la colelitiasis en el paciente sometido a cirugía bariátrica|

INTRODUCCIÓ. La cirurgia bariàtrica és actualment el tractament més efectiu de l’obesitat, aconseguint a llarg termini una adequada pèrdua de pes, millora o resolució de les comorbiditats relacionades amb l’obesitat La colelitiasi en els pacients candidats a cirurgia bariàtrica té una incidència que ha estat reportada fins a d’un 48% (taxa de malaltia simptomàtica de 10-60%) s’han publicat taxes de fins a un 53% de desenvolupament de colelitiasi posterior a la cirurgia bariàtrica (colelitiasi simptomàtica del 2,9-14,7%). OBJECTIUS. 1) Analitzar la incidència de colelitiasi en els pacients candidats a cirurgia bariàtrica a la Unitat de cirurgia endocrina, bariàtrica i metabòlica de l’Hospital Universitari Vall d’Hebron entre els anys 2.009-2.020; 2) Analitzar el maneig de la colelitiasi preoperatòria en els pacients candidats a cirurgia bariàtrica a la Unitat de cirurgia endocrina, bariàtrica i metabòlica de l’Hospital Universitari Vall d’Hebron entre els anys 2.009-2.020; 3) Analitzar la incidència de la colelitiasi simptomàtica postoperatòria en els pacients sotmesos a cirurgia bariàtrica a la Unitat de cirurgia endocrina, bariàtrica i metabòlica de l’Hospital Universitari Vall d’Hebron entre els anys 2.009-2.020; 4) Analitzar la influència de la pèrdua de pes en el desenvolupament de colelitiasi simptomàtica de novo en els pacients que han estat sotmesos a cirurgia bariàtrica. DISSENY DE L’ESTUDI: Aquesta tesi va ser estructurada en dos treballs per respondre els objectius plantejats per a la investigació. Treball 1, Anàlisi de la incidència i del maneig de la colelitiasi en els pacients que han estat sotmesos a cirurgia bariàtrica mitjançant una revisió retrospectiva de la base de dades prospectiva dels pacients sotmesos a cirurgia bariàtrica a la Unitat de cirurgia endocrina, bariàtrica i metabòlica de l’Hospital Universitari Vall d’Hebron; Treball 2, Anàlisi de la influència de la pèrdua de pes en la incidència de colelitiasi simptomàtica de novo en els pacients que han estat sotmesos a cirurgia bariàtrica mitjançant una revisió sistemàtica de la literatura i metaanàlisi. RESULTATS. Treball 1: La incidència de colelitiasi al moment de la cirurgia bariàtrica va ser 10,5% (44,4% amb malaltia simptomàtica), no van trobar diferències entre els pacients que van presentar colelitiasi simptomàtica i asimptomàtica; la col·lecistectomia concomitant en conjunt amb el procediment bariàtric només va augmentar de manera significativa el temps quirúrgic en els pacients que se’ls va realitzar gastrectomia vertical sense tenir un impacte significatiu en el temps d’hospitalització ni en les complicacions globals un 15,5% dels pacients amb colelitiasi asimptomàtica preoperatòria als quals no se’ls va realitzar colecistectomia concomitant i un 3,8% dels pacients sense colelitiasi preoperatòria van desenvolupar colelitiasi simptomàtica posterior a la cirurgia bariàtrica, no es van observar diferències significatives en la incidència global de colelitiasi simptomàtica postoperatòria a bypass gàstric oa gastrectomia veetical o en la taxa de pèrdua de pes entre els pacients que van desenvolupar o no van desenvolupar colelitiasi simptomàtica posterior a la cirurgia bariàtrica; Treball 2: La taxa de pèrdua de pes va ser significativament més gran en pacients que van desenvolupar colelitiasi simptomàtica de novo posterior a la cirurgia bariàtrica (SMD 0,36, 95% CI 0,19 – 0,53, p per a l’efecte <0,0001 p per a l’heterogeneïtat = 0,003, I2 = 60%); la pèrdua de pes va ser significativament més gran únicament en els pacients que van ser sotmesos a bypass gàstric (SMD 0,53, 95% CI 0,39 - 0.66, p <0.00001) i va tenir un impacte significatiu tant en els pacients que van desenvolupar colelitiasi simptomàtica durant el primer any de postoperatori com els que la van desenvolupar durant el segon any de postoperatori.INTRODUCCION. La cirugía bariátrica es actualmente el tratamiento más efectivo de la obesidad, logrando a largo plazo una adecuada pérdida de peso, mejoría o resolución de las comorbilidades relacionadas con la obesidad La colelitiasis en los pacientes candidatos a cirugía bariátrica tiene una incidencia que ha sido reportada hasta de un 48% (tasa de enfermedad sintomática de 10-60%) se han publicado tasas de hasta un 53% de desarrollo de colelitiasis posterior a la cirugía bariátrica (colelitiasis sintomática del 2,9-14,7%). OBJETIVOS. 1) Analizar la incidencia de colelitiasis en los pacientes candidatos a cirugía bariátrica en la Unidad de cirugía endocrina, bariátrica y metabólica del Hospital Universitari Vall d’Hebron entre los años 2.009-2.020; 2) Analizar el manejo de la colelitiasis preoperatoria en los pacientes candidatos a cirugía bariátrica en la Unidad de cirugía endocrina, bariátrica y metabólica del Hospital Universitari Vall d’Hebron entre los años 2.009-2.020; 3) Analizar la incidencia de la colelitiasis sintomática postoperatoria en lo pacientes sometidos a cirugía bariátrica en la Unidad de cirugía endocrina, bariátrica y metabólica del Hospital Universitari Vall d’Hebron entre los años 2.009-2.020; 4) Analizar la influencia de la pérdida de peso en el desarrollo de colelitiasis sintomática de novo en los pacientes que han sido sometidos a cirugía bariátrica. DISENO DEL ESTUDIO: La presente tesis fue estructurada en dos trabajos para responder los objeticos planteados para la investigación. Trabajo 1, Análisis de la incidencia y del manejo de la colelitiasis en los pacientes que han sido sometidos a cirugía bariátrica mediante una revisión retrospectiva de la base de datos prospectiva de los pacientes sometidos a cirugía bariátrica en la Unidad de cirugía endocrina, bariátrica y metabólica del Hospital Universitari Vall d’Hebron; Trabajo 2, Análisis de la influencia de la pérdida de peso en la incidencia de colelitiasis sintomática de novo en los pacientes que han sido sometidos a cirugía bariátrica mediante una revisión sistemática de la literatura y metaanálisis. RESULTADOS. Trabajo 1: La incidencia de colelitiasis al momento de la cirugía bariátrica fue 10,5% (44,4% con enfermedad sintomática), no encontraron diferencias entre los pacientes que presentaron colelitiasis sintomática y asintomática; la colecistectomía concomitante en conjunto con el procedimiento bariátrico sólo aumentó de forma significativa el tiempo quirúrgico en los pacientes que se les realizó gastrectomía vertical sin tener un impacto significativo en el tiempo de hospitalización ni en las complicaciones globales un 15,5% de los pacientes con colelitiasis asintomática preoperatoria a los que no se les realizó colecistectomía concomitante y un 3,8% de los pacientes sin colelitiasis preoperatoria desarrollaron colelitiasis sintomática posterior a la cirugía bariátrica, no se observaron diferencias significativas en la incidencia global de colelitiasis sintomática postoperatoria entre los pacientes sometidos a bypass gástrico o a gastrectomía veetical o en la tasa de pérdida de peso entre los pacientes que desarrollaron o no desarrollaron colelitiasis sintomática posterior a la cirugía bariátrica; Trabajo 2: La tasa de pérdida de peso fue significativamente mayor en pacientes que desarrollaron colelitiasis sintomática de novo posterior a la cirugía bariátrica (SMD 0,36, 95% CI 0,19 – 0,53, p para el efecto <0,0001; p para la heterogeneidad= 0,003, I2=60%); la pérdida de peso fue significativamente mayor únicamente en los pacientes que fueron sometidos a bypass gástrico (SMD 0,53, 95% CI 0,39 - 0.66, p <0.00001) y tuvo un impacto significativo tanto en los pacientes que desarrollaron colelitiasis sintomática durante el primer año de postoperatorio como en los que la desarrollaron durante el segundo año de postoperatorio.INTRODUCTION. Bariatric surgery is currently the most effective treatment for obesity, achieving long-term adequate weight loss, improvement or resolution of obesity-related comorbidities Cholelithiasis in patients who are candidates for bariatric surgery has an incidence that has been reported up to of 48% (symptomatic disease rate of 10-60%), rates of up to 53% have been published for the development of cholelithiasis after bariatric surgery (symptomatic cholelithiasis of 2.9-14.7%). OBJECTIVES. 1) To analyze the incidence of cholelithiasis in patients who are candidates for bariatric surgery in the Endocrine, Bariatric and Metabolic Surgery Unit of the Vall d’Hebron University Hospital between the years 2009-2020; 2) To analyze the management of preoperative cholelithiasis in patients who are candidates for bariatric surgery in the Endocrine, Bariatric and Metabolic Surgery Unit of the Vall d’Hebron University Hospital between the years 2009-2020; 3) To analyze the incidence of postoperative symptomatic cholelithiasis in patients undergoing bariatric surgery in the Endocrine, Bariatric and Metabolic Surgery Unit of the Vall d’Hebron University Hospital between the years 2009-2020; 4) Analyze the influence of weight loss on the development of de novo symptomatic cholelithiasis in patients who have undergone bariatric surgery. STUDY DESIGN: This thesis was structured into two papers to respond to the objectives set for the research. Work 1, Analysis of the incidence and management of cholelithiasis in patients who have undergone bariatric surgery through a retrospective review of the prospective database of patients undergoing bariatric surgery in the Endocrine, Bariatric and Metabolic Surgery Unit the Vall d’Hebron University Hospital; Work 2, Analysis of the influence of weight loss on the incidence of de novo symptomatic cholelithiasis in patients who have undergone bariatric surgery through a systematic review of the literature and meta-analysis. RESULTS. Work 1: The incidence of cholelithiasis at the time of bariatric surgery was 10.5% (44.4% with symptomatic disease), no differences were found between patients who presented symptomatic and asymptomatic cholelithiasis; Concomitant cholecystectomy in conjunction with the bariatric procedure only significantly increased surgical time in patients who underwent sleeve gastrectomy without having a significant impact on hospitalization time or overall complications in 15.5% of patients with Asymptomatic cholelithiasis who did not undergo concomitant cholecystectomy and 3.8% of patients without preoperative cholelithiasis developed symptomatic cholelithiasis after bariatric surgery, no significant differences were observed in the overall incidence of symptomatic postoperative cholelithiasis among patients who underwent to gastric bypass or veetical gastrectomy or in the rate of weight loss among patients who did or did not develop symptomatic cholelithiasis after bariatric surgery; Work 2: The rate of weight loss was significantly higher in patients who developed de novo symptomatic cholelithiasis after bariatric surgery (SMD 0.36, 95% CI 0.19 – 0.53, p for effect < 0.0001 ;p for heterogeneity=0.003, I2=60%); weight loss was significantly greater only in patients who underwent gastric bypass (SMD 0.53, 95% CI 0.39 - 0.66, p < 0.00001) and had a significant impact both in patients who developed symptomatic cholelithiasis during the first postoperative year as in those who developed it during the second postoperative year.Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique