Imaging Software Programs for Reliable Mathematical Measurements in Orthodontics

Aim: To evaluate the reliability of linear and angular measurements taken using different software programs in orthodontics. Materials and Methods: A sample of four software programs from different manufacturers, namely MicroDicom viewer, Photoshop® CS3, AutoCAD®, and Image-Pro®, were used for measuring the geometric features of four types of miniscrews from different manufacturers. Each miniscrew type presented a group: Group I, Tomas® (Dentaurum, Ispringen, Germany); Group II, HUBIT® (HUBIT, Gyeonggi-do, Korea); Group III, AbsoAnchor® (Dentos, Daegu, Korea); and Group IV, Creative (Creative, Zhejiang, China). Measurements of apical face angle, thread angle, lead angle, flank, pitch depth, and width were taken on 45 × magnification scanning electron microscope images of the shafts of the miniscrews. One assessor measured the seven geometric features for the four types of miniscrews using the four software programs twice in two sessions separated by a three week interval. Results: Pairwise comparisons, for each of the four miniscrew groups, showed that the only common result observed was the significant difference (p < 0.001) between measurements of flank taken by the four software programs. When measurements of the four types of miniscrews were pooled into one group, a high degree of intra-rater reliability (ICC range from 0.9 to 1.0) for all the seven geometric features was found with all the four software programs. The paired t-test showed insignificant difference (at p ≤ 0.05) between the first and second measurements, except for a few measurements including pitch width measured by Image-Pro® (p = 0.012), MicroDicom (p = 0.023), and Photoshop® (p = 0.001). Conclusions: Results did not give absolute superiority to one software program over the others and suggested an assessor effect. Assessor estimates could have been affected, among other factors, by the design of the miniscrews and the technical features of the software programs

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Imaging Software Programs for Reliable Mathematical Measurements in Orthodontics

Aim: To evaluate the reliability of linear and angular measurements taken using different software programs in orthodontics. Materials and Methods: A sample of four software programs from different manufacturers, namely MicroDicom viewer, Photoshop&reg; CS3, AutoCAD&reg;, and Image-Pro&reg;, were used for measuring the geometric features of four types of miniscrews from different manufacturers. Each miniscrew type presented a group: Group I, Tomas&reg; (Dentaurum, Ispringen, Germany); Group II, HUBIT&reg; (HUBIT, Gyeonggi-do, Korea); Group III, AbsoAnchor&reg; (Dentos, Daegu, Korea); and Group IV, Creative (Creative, Zhejiang, China). Measurements of apical face angle, thread angle, lead angle, flank, pitch depth, and width were taken on 45 &times; magnification scanning electron microscope images of the shafts of the miniscrews. One assessor measured the seven geometric features for the four types of miniscrews using the four software programs twice in two sessions separated by a three week interval. Results: Pairwise comparisons, for each of the four miniscrew groups, showed that the only common result observed was the significant difference (p &lt; 0.001) between measurements of flank taken by the four software programs. When measurements of the four types of miniscrews were pooled into one group, a high degree of intra-rater reliability (ICC range from 0.9 to 1.0) for all the seven geometric features was found with all the four software programs. The paired t-test showed insignificant difference (at p &le; 0.05) between the first and second measurements, except for a few measurements including pitch width measured by Image-Pro&reg; (p = 0.012), MicroDicom (p = 0.023), and Photoshop&reg; (p = 0.001). Conclusions: Results did not give absolute superiority to one software program over the others and suggested an assessor effect. Assessor estimates could have been affected, among other factors, by the design of the miniscrews and the technical features of the software programs

Reliability of Orthodontic Miniscrews: Bending and Maximum Load of Different Ti-6Al-4V Titanium and Stainless Steel Temporary Anchorage Devices (TADs)

Temporary anchorage devices (TADs) have been introduced into orthodontic clinical practice in order to allow tooth movements while avoiding strain on adjacent teeth. Miniscrews are available in the market with different diameters and materials. Accordingly, the purpose of the present report was to measure and compare the forces to bend and fracture different mini implants. Ti-6Al-4V titanium and stainless steel TADs of different manufacturers (Spider ScrewHDC; Mini Implants&ndash;Leone; Benefit&ndash;Orteam; Storm&ndash;Kristal) were evaluated. Two different diameters (1.5 mm and 2.0 mm) were tested. The sample included 10 unused specimens for each group, blocked in an Instron Universal Testing Machine, and a shear load was applied at the neck of the miniscrew. The force to bend the miniscrew was measured at 0.1 mm and 0.2 mm deflections. Also, the maximum force before screw fracture was recorded. Data were submitted for statistical analysis. Results showed significantly higher forces for 2.0 mm than 1.5 mm screws, both at 0.1 mm and 0.2 mm deflections and at maximum load. Moreover, no significant differences were reported between titanium and stainless steel miniscrews of equal diameters