Methods of reducing and eliminating prosthetic iatrogenic factors

Rezumat Metoda elementului finit are o aplicabilitate în creştere în domeniul medical stomatologic şi reprezintă o tehnică modernă de investigaţie, furnizând informaţii importante pentru determinarea formei optime a preparaţiilor dentare. Deoarece rezultatul tratamentului protetic depinde în mare măsură de relaţia pe care piesa protetică o stabileşte cu parodonţiul marginal, am urmărit să facem aprecieri obiective şi motivări legate de atitudinea profilactică şi terapeutică în restaurarea protetică fixă.Summary Finite element method has a growing application in medicine and dentistry and is a modern technique for investigation, providing important information for determining the optimum shape of dental preparations. Because the result of prosthetic treatment depends mainly on the relationship that a prosthetic piece sets with marginal periodontal, we watched to make objective assessments and reasons related to prophylactic and therapeutic attitude in fixed prosthetic restoration

Методы оценки и контроля факторов риска в развитии кариеса зубов

Universitatea „Lucian Blaga”, Sibiu, România, Universitatea „Titu Maiorescu”, Bucureşti, România, Catedra Stomatologie terapeutică, USMF „Nicolae Testemiţanu”, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaThe study included 207 students aged 16-18 years studying in a college town with an industrial profile (Sibiu). They were examined clinically in the dental office with dental mirror and probe, the teeth were dried of saliva with an air stream. It was established that dietary modification and improvement of oral hygiene are key factors in decreasing the risk of dental caries.В исследование были включены 207 студентов, в возрасте 16-18 лет городского лицея промышленного профиля г. Сибиу, которые были обследованы клинически в стоматологическом кабинете с помощью соответствующего стоматологического оборудования. Было установлено, что рациональное питание и улучшение гигиены полости рта являются ключевыми факторами в уменьшении риска развития кариеса

Intra-operative spectroscopic assessment of surgical margins during breast conserving surgery

Background: In over 20% of breast conserving operations, postoperative pathological assessment of the excised tissue reveals positive margins, requiring additional surgery. Current techniques for intra-operative assessment of tumor margins are insufficient in accuracy or resolution to reliably detect small tumors. There is a distinct need for a fast technique to accurately identify tumors smaller than 1 mm2 in large tissue surfaces within 30 min. Methods: Multi-modal spectral histopathology (MSH), a multimodal imaging technique combining tissue auto-fluorescence and Raman spectroscopy was used to detect microscopic residual tumor at the surface of the excised breast tissue. New algorithms were developed to optimally utilize auto-fluorescence images to guide Raman measurements and achieve the required detection accuracy over large tissue surfaces (up to 4 × 6.5 cm2). Algorithms were trained on 91 breast tissue samples from 65 patients. Results: Independent tests on 121 samples from 107 patients - including 51 fresh, whole excision specimens - detected breast carcinoma on the tissue surface with 95% sensitivity and 82% specificity. One surface of each uncut excision specimen was measured in 12–24 min. The combination of high spatial-resolution auto-fluorescence with specific diagnosis by Raman spectroscopy allows reliable detection even for invasive carcinoma or ductal carcinoma in situ smaller than 1 mm2. Conclusions: This study provides evidence that this multimodal approach could provide an objective tool for intra-operative assessment of breast conserving surgery margins, reducing the risk for unnecessary second operations

A new tool for the evaluation of CO2 emissions from road traffic: A case study in Cluj-Napoca, Romania

In the past years, there has been great interest in developing tools for an effective management including the evaluation of the impact of different policies on decreasing greenhouse gas emissions (CO2) and other transport pollutant-related emissions, especially in the urban areas. This paper represents a first attempt to study a new approach to identify criticalities of pollutant emissions associated with road traffic in urban areas. The tool we propose concerns the development of an emission indicator, a proxy measure, which is useful for the assessment of emission problems, based on the use of GPS (Global Positioning System) instantaneous vehicle speed data. It can be considered an innovative and adequate solution in many cases in which the development of a valid and robust traffic simulation model, especially DTA (dynamic traffic assignment), is not available in the medium- and short-term horizon. The methodological process concerns the monitoring of road traffic conditions using GPS data from probe vehicles in combination with the use of GIS (Geographic Information System) for the estimation of an emission indicator. The tool was tested in a real case study in Romania for CO2 emissions. The results show the utility of the tool in policy and decision making, due to its ease of application and consistency, especially in defining critical areas and that it can be used in any other urban contexts with GPS data availability. Further developments will deal with the computation of the emission indicator for other pollutants and validation of the approach by applying other methods and comparing the results. The analysis of the results could be focused not on the capacity to evaluate emissions but on the development of a proxy measure useful in the planning process

The Effect of Music on Pain in the Adult Intensive Care Unit: A Systematic Review of Randomized Controlled Trials

CONTEXT: Multimodal analgesic approaches are recommended for intensive care unit (ICU) pain management. Although music is known to reduce pain in acute and chronic care settings, less is known about its effectiveness in the adult ICU. OBJECTIVES: Determine the effects of music interventions on pain in the adult ICU, compared with standard care or noise reduction. METHODS: This review was registered on PROSPERO (CRD42018106889). Databases were searched for randomized controlled trials of music interventions in the adult ICU, with the search terms [ music* and ( critical care or intensive care )]. Pain scores (i.e., self-report rating scales or behavioral scores) were the main outcomes of this review. Data were analyzed using a DerSimonian-Laird random-effects method with standardized mean difference (SMD) of pain scores. Statistical heterogeneity was determined as I(2) \u3e 50% and explored via subgroup analyses and meta-regression. RESULTS: Eighteen randomized controlled trials with a total of 1173 participants (60% males; mean age 60 years) were identified. Ten of these studies were included in the meta-analysis based on risk of bias assessment (n = 706). Music was efficacious in reducing pain (SMD -0.63 [95% CI -1.02, -0.24; n = 10]; I(2) = 87%). Music interventions of 20-30 minutes were associated with a larger decrease in pain scores (SMD -0.66 [95% CI -0.94, -0.37; n = 5]; I(2) = 30%) compared with interventions of less than 20 minutes (SMD 0.10 [95% CI -0.10, 0.29; n = 4]; I(2) = 0%). On a 0-10 scale, 20-30 minutes of music resulted in an average decrease in pain scores of 1.06 points (95% CI -1.56, -0.56). CONCLUSION: Music interventions of 20-30 minutes are efficacious to reduce pain in adult ICU patients able to self-report

Content validation of behaviours and autonomic responses for the assessment of pain in critically ill adults with a brain injury.

The evidence shows that brain-injured patients express behaviours that are related to their level of consciousness (LOC), and different from other patients in the intensive care unit (ICU). Therefore, existing behavioural scales should be revised to enhance their content and validity for use in these patients. The aim was to evaluate the content relevance of behaviours and autonomic responses for pain assessment of brain-injured ICU patients from the perspective of critical care clinicians. A total of 77 clinicians from four adult neuroscience ICUs (three from Canada and one from the United States) participated in this descriptive study. A physician/nurse ratio of 21% (13/61) was reached in this quota sample, and three physiotherapists also participated. They completed a content validation questionnaire of 19 items rated on clarity and relevance based on the patient's LOC. Item Content Validity Index (I-CVI), and modified kappa (κ*) were calculated. Values higher than 0.78 and 0.75 respectively were considered excellent. Regardless of the patient's LOC, brow lowering, grimacing, and trying to reach the pain site were rated as the most relevant behaviours by clinicians, with excellent values of I-CVI>0.78 and κ*>0.75. Eyes tightly closed, moaning and verbal complaints of pain also obtained excellent values in altered LOC and conscious patients. Eye weeping obtained excellent values only in conscious patients. Other items showed fair (0.40-0.59) to good (0.60-0.74) values, while blinking and coughing showed poor values (<0.40) at various LOC. Facial expressions, movements towards the pain site, and vocalisation of pain were the most relevant pain-related behaviours rated by critical care clinicians. The relevance of some behaviours (e.g., moaning and verbal complaints of pain) varied across LOCs, thereby calling forth adaptations of behavioural pain scales to allow for interpretation in the context of a patient's LOC and ability to express specific behaviours

Additional file 1: of The effect of tailored Web-based interventions on pain in adults: a systematic review protocol

PRISMA-P 2015 checklist. The PRISMA framework will be used to ensure the transparent reporting of this systematic review including the flow diagram. (DOCX 35.5 kb

Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit:a prospective cohort study

Abstract Background Pain assessment in brain-injured patients in the intensive care unit (ICU) is challenging and existing scales may not be representative of behavioral reactions expressed by this specific group. This study aimed to validate the French-Canadian and English revised versions of the Critical-Care Pain Observation Tool (CPOT-Neuro) for brain-injured ICU patients. Methods A prospective cohort study was conducted in three Canadian and one American sites. Patients with a traumatic or a non-traumatic brain injury were assessed with the CPOT-Neuro by trained raters (i.e., research staff and ICU nurses) before, during, and after nociceptive procedures (i.e., turning and other) and non-nociceptive procedures (i.e., non-invasive blood pressure, soft touch). Patients who were conscious and delirium-free were asked to provide their self-report of pain intensity (0–10). A first data set was completed for all participants (n = 226), and a second data set (n = 87) was obtained when a change in the level of consciousness (LOC) was observed after study enrollment. Three LOC groups were included: (a) unconscious (Glasgow Coma Scale or GCS 4–8); (b) altered LOC (GCS 9–12); and (c) conscious (GCS 13–15). Results Higher CPOT-Neuro scores were found during nociceptive procedures compared to rest and non-nociceptive procedures in both data sets (p  0.40 and > 0.60, respectively). CPOT-Neuro cut-off scores ≥ 2 and ≥ 3 were found to adequately classify mild to severe self-reported pain ≥ 1 and moderate to severe self-reported pain ≥ 5, respectively. Interrater reliability of raters’ CPOT-Neuro scores was supported with intraclass correlation coefficients > 0.69. Conclusions The CPOT-Neuro was found to be valid in this multi-site sample of brain-injured ICU patients at various LOC. Implementation studies are necessary to evaluate the tool’s performance in clinical practice