Treatment of the Prominent Mandibular Angle by Using a Custom Made Surgical Splint

In this case report, we would like to present an alternative surgical technique for the treatment of the bilateral prominent mandibular angles by using a custom-made resin splint (template). The prefabricated template provided a precise outline for the osteotomy, which alleviated the uncertainty of the osseous cut. Furthermore, masseter muscle myomectomy was not necessary in this case which decreased morbidity, and procedure and recovery time, while assuring a more symmetric outcome

Giant Mandibular Condyle Osteoma

Osteomas are benign tumors composed of mature compact or cancellous bone. They represent an uncommon lesion that occurs mainly in craniofacial complex bones. In jaws, they can appear on the bone surface as a polypoid or sessile mass, characterizing a peripheral osteoma (PO), or can be a lesion in the medullar space, then it is called central osteoma. In view of the scarcely reported cases about POs, this article presents a case of PO of the maxillofacial area that was surgically resected using hemicoronal approach

Perfil da população atendida em uma unidade de emergência referenciada

Acquiring knowledge concerning the characteristics of the population that seeks an emergency department can support the planning of health actions. This study identifies the socio-demographic profile and the main complaints of the adult population cared for in a Referral Emergency Unit (RECU). This descriptive and retrospective study was conducted in the RECU of a university hospital in the State of Sao Paulo, Brazil. The sample was composed of the services care forms generated for the period between January and December 2008. The instrument was based on data contained in the care forms. Young women (14 to 54 years old), residents of neighborhoods near the RECU, spontaneously sought the service during the week from 7am to 7pm. The most frequent complaints were headache, back pain, abdominal and chest pain. The conclusion is that most of the sample was young adults, of productive age, female, who spontaneously sought the service on weekdays during the day. Most complaints were of low complexity.El objetivo del estudio fue identificar el perfil sociodemográfico y las principales quejas de la población adulta atendida en la Unidad de Emergencia de Referencia (UER). El conocimiento de las características de la población que frecuenta un servicio de emergencia constituye una herramienta de planificación de las acciones en salud. Se trata de un estudio descriptivo/retrospectivo desarrollado en la UER de un hospital de enseñanza en el interior del estado de Sao Paulo. La muestra fue constituida por los boletines de atención(BAU) del período de enero a diciembre de 2.008. El instrumento utilizado fue estructurado con base en los datos del BAU. La búsqueda espontánea fue hecha por mujeres jóvenes (14 a 54 años) de los barrios próximos a la UER durante la semana y en el horario de las siete a las diecinueve horas. Las quejas más frecuentes fueron: cefalea, lumbago, dolores (abdominal, torácica). Se concluye que el perfil de la muestra fue en su mayoría adulto y joven, en edad productiva, de sexo femenino, con demanda espontánea y en el período diurno en días útiles. Las atenciones apuntaron para quejas de baja complejidad.O conhecimento das características da população que frequenta um serviço de emergência constitui ferramenta de planejamento de ações em saúde. O objetivo deste estudo foi identificar o perfil sociodemográfico e as principais queixas da população adulta, atendida na unidade de emergência referenciada (UER). O método usado foi o descritivo/retrospectivo, desenvolvido na UER de um hospital de ensino no interior do Estado de São Paulo. A amostra ficou constituída pelos boletins de atendimento (BAU), referentes ao período de janeiro a dezembro/2008. O instrumento utilizado foi estruturado com base nos dados do BAU.. Os resultados mostraram que a procura espontânea foi feita por mulheres jovens (14 aos 54 anos) dos bairros próximos à UER, durante a semana e no horário das sete às dezenove horas. As queixas mais frequentes foram: cefaleia, lombalgia, dores (abdominal, torácica). Conclui-se que o perfil da amostra foi, na maioria, composta por adulto jovem, idade produtiva, sexo feminino, demanda espontânea e no período diurno em dias úteis. Os atendimentos apontaram para queixas de baixa complexidade

Histologic and Histomorphometric Analysis of Posterior Region of the Human Temporomandibular Disc

Objective The aim of this study was to analyze histologic and histomorphometric features of the articular disc in groups with and without disc displacement. Study design A sample of 39 temporomandibular joints TMJs (31 case specimens, 8 control specimens) from 28 patients (mean age 31.2 years) were recruited for this study. The patients were considered to be affected and treated surgically with disc repositioning when presenting painful clinical signs of disc displacement after unsuccessful nonsurgical treatment for at least 6 months. Of the control patients, 4 presented condyle fracture which required opening to be reduced for treatment, and 4 displayed active condyle hyperplasia. The posterior region of the disc was removed and sent for histologic and histomorphometric analysis. Histologic (hematoxylin-eosin) and histomorphometric (picro-Sirius red) analyses were performed. Statistically significant differences between the analyzed groups were accessed through the chi-squared test (P ≤ .05). The Mann-Whitney U test was used to observe the differences between mean values when variables did not present normal distribution [Kolmogorov-Smirnov(a) test]. Results There were no significant differences between the groups in relation to the parameters studied by histologic and histomorphometric analysis (using or not using polarization). Conclusions To the limits of this study, there were no significant histologic and histomorphometric differences in the articular disc between groups with and without TMJ dysfunction

Strategic Management in Public Administration: A Balanced Scorecard Applicability Framework in School Management

Purpose - This study aims at developing a framework of the Balanced Scorecard (BSC) in public educational organizations.Theoretical framework – There are 3-sections: Strategic planning in public sector, Balanced Scorecard and BSC in the public sector. Strategic management in public administration is an important issue, with the BSC as one of the most widely used tools. Although, the application of this technique in public schools is still unexplored and uncommon, it does possess the potential to improve their effectiveness.Methodology - A 3-stage qualitative approach: (i) 8 semi-structured interviews with the principals of participating schools; (ii) 4 stages of focus groups with 3 of the principals from different schools; and (iii) non-participant observation using a field diary. Also, the data were analyzed through content analysis and cross-referencing the different forms of data collected.Findings - The results do not indicate a vast knowledge concerning the BSC’s techniques and tools, or an alignment between management planning posture, principles nor objectives of BSC application. Also, school planning is realized through the expertise of the Principal, without instruments of strategic management. Finally, adapted BSC models and strategic maps were proposed in public schools to collaborate and facilitate the strategic management process.Research, Practical & Social implications - The paper contributes towards developing new research agendas for strategic management in Brazil, with the possibility of improving public results and to appoint new practices in public schools.Originality/value - We have collaborated with the creation of a tool to use in the strategic planning of primary schools and pushing BSC studies into public sectors

CARACTERIZAÇÃO HIDROGEOQUÍMICA DOS SISTEMAS AQUÍFEROS BARREIRAS E PIRABAS DA REGIÃO METROPOLITANA DE BELÉM (RMB) E INVESTIGAÇÃO DE POSSÍVEIS MISTURAS ENTRE AS ÁGUAS

A região metropolitana de Belém (RMB) é palco de intensa explotação de recursos hídricos subterrâneos, quer seja pelas companhias públicas que captam água do sistema aquífero Pirabas ou de poços residenciais que em geral captam água do sistema aquífero Barreiras. O estudo visou à caracterização hidroquímica das águas da RMB, para identificar misturas entre os dois principais sistemas aquíferos e suas vulnerabilidades. No sistema Barreiras os íons Cl- e Na+ são os principais elementos presentes. No sistema Pirabas, os íons predominantes são o HCO3- e Ca2+. Estudos estatísticos mostraram correlações entre os sistemas aquíferos (≥ 0,8) e no modelamento geoquímico há evidência de certo grau de mistura entre os aquíferos (10%), conforme demonstra o diagrama de Schoeller, sugerindo misturas entre os aquíferos estudados, de forma mais evidente no período chuvoso

A (DES)CONSTRUÇÃO DA GESTÃO ESTRATÉGICA EM ESCOLAS PÚBLICAS MUNICIPAIS: UM ESTUDO DA UTILIZAÇÃO DO BALANCED SCORECARD E MAPA ESTRATÉGICO

The purpose of this article was to identify how strategic planning occurs in the public sector, specifically in municipal public school. A qualitative approach was used, with the technical procedure of the multiple case study with unique presentation. We characterized as applied and descriptive. Interviews, focus group, non-participant observation and field diary were the forms of data collection. Already the form of data analysis was the analysis of content. We discussed that formal and informal factors coexist in strategic school management, that the specifics of the public sector affect directly in the creation and implementation of the strategy, the role of the manager is primordial for the elaboration and implementation of the strategy in the public sector. The possible application of the balanced scorecard (BSC) and strategic map as an administrative plan and strategic tool in the public sector and that the strategy mixes political factors and presents intuitive aspects of the manager.El propósito de este artículo fue identificar cómo se lleva a cabo la planificación estratégica en el sector público, en específico en la escuela pública municipal. Se utilizó un enfoque cualitativo, siendo el procedimiento técnico el caso de estudio múltiplo con presentación única. Se caracteriza por ser aplicada y descriptiva. Las entrevistas, el grupo focal, la observación no participante y el diario de campo fueron las formas de recopilación de datos. La forma de análisis de datos fue el análisis de contenido. Los resultados muestran que los factores formales e informales coexisten en la gestión estratégica de la escuela, que las especificidades del sector público afectan directamente la creación y la implementación de la estrategia, el papel del gerente es primordial para la elaboración e implementación de la estrategia en el sector público. La discusión de la posible aplicación del Balanced Scorecard (BSC) y mapa estratégico como plan administrativo y herramienta estratégica en el sector público e que la estrategia se mezcla con factores políticos y aspectos intuitivos del gerente.O objetivo desse artigo foi caracterizar o processo de gestão estratégica em escolas públicas municipais. Utilizou-se uma abordagem aplicada, descritiva e qualitativa, com o procedimento técnico de estudos de caso múltiplos com apresentação única. Como ferramentas de coleta de dados foram utilizadas as seguintes técnicas: entrevistas, grupo focal, observação não participante e diário de campo. Os resultados mostram que coexistem fatores formais e informais na gestão estratégica escolar, que as especificidades do setor público afetam diretamente na criação e implantação da estratégia e o gestor executa um papel primordial no processo. Apresenta-se a discussão da possível aplicação do balanced scorecard e do mapa estratégico como plano administrativo e ferramenta estratégica no setor público. Os dados indicam que há uma carência de mecanismos para o planejamento estratégico no setor público e que o processo estratégico nas escolas públicas coaduna fatores políticos e aspectos centralizadores e intuitivos do gestor.DOI: 10.53706/gep.v.23.761

Investigating the relation between self-assessment and patients' assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil

This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. Objectives This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. Design A multicentric, observational, cross-sectional study. Setting This study was conducted in three public teaching hospitals in Brazil. Participants From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females. Primary and secondary outcome measures Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE). Results This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments. Conclusions Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP' (grant number: 2016/11908-1) and by the ’Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq' (grant number: 202319/2017-2

One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants

There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. Objective: To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. Material and Methods:Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). Results: Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p&lt;0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p&lt;0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p&lt;0.05). Conclusion: MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant. &nbsp