The Crossroads of Wellness and Second Victim Syndrome: Identifying Factors that Alter the Pathway of Caregiver Recovery Following an Unanticipated Adverse Patient Outcome

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery. Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The Impact of Event Scale-Revised (IES-R) was used as a measure of the stress a provider senses following a traumatic event. The Second Victim Experience and Support Tool (SVEST) was used to assess the medical provider’s emotional response and level of institutional support in response to an adverse clinical event. Results: Analysis of SVEST vs. IES-R demonstrated that respondents with greater self-perception of personal distress reported increased psychological (p=0.0008) and physical (p=0.0015) distress. Respondents who reported higher HRLSI scores had a greater perception that non-work-related support (p=0.04) such as family support was inadequate; however, these respondents were less likely to perceive institutional support (p=0.04) as inadequate. The results indicate that caregivers with more perceived life stresses believe that they do not have strong non-work-related support services, which is a known protective factor; thus, they may perceive any institutional support as more adequate. Conclusion: This study suggests that personal life risk factors, institutional support, and non-work related support may play an important role in the development of SVS and the perception of stress and wellness in the setting of SVS

"THE STUDY OF DOSE-RESPONSE MITOGENIC EFFECT OF L-DOPA ON THE HUMAN PERIODONTAL LIGAMENT FIBROBLAST CELLS"

Avulsion is one of the most serious emergencies in dental office. In the event of any problem, the tooth should be stored in a medium that supports the periodontal ligament cell viability. In other clinical situations, preserving media, growth factors and mitogenic products may be useful in repairing the traumatized tissues. It has been previously reported that levodopa (L-dopa) accelerates healing by increasing the growth hormone level. In this study, the local effect of L-dopa, as a mitogen, on human periodontal ligament fibroblast (HPLF) cells was evaluated. Samples from impacted or semiimpacted wisdom or canine teeth, which were devoid of inflammation, were taken. The cells obtained from this tissue were cultured in an appropriate medium. The passage numbers between 3-6 were taken for further experiments. The viability of HPLF cells, which were treated by L-dopa, was evaluated by trypan blue dye exclusion and neutral red assay. Results indicated that low concentration of L-dopa produces significant increase of these cells compared to control group. These results confirmed previous studies about direct action of L- dopa on the viability of HPLF cells. On the basis of this study and previous reports, presence of L-dopa in preserving media may be useful in increasing the self-life transferring HPLF cells

A comparative investigation on the accuracy of Neosono Ultima EZ instrument, radiography and anexperimental apex locator in root canal working length measurement

Various methods have already been suggested to measure the working length in root"ncanal therapy among which the use of paper point, tactile sense, radiography and electronic apex finder"ninstruments can be named. Investigations on EAL (Electronic Apex Locator) indicate that these instruments"ncan reduce the number of required radiography to a great extent. Moreover, in special cases such as patients"nwith high risk reflex, pregnant women, the mental disabled and handicapped and also in cases with special"nanatomical structures these instruments are proper substitutes for radiography."nPurpose: The aim of this study was to compare the accuracy of an Iranian made apex finder instrument with"nNeosono Ultima EZ and radiography."nMaterials and Methods: This study was conducted on 51 mandibular molars, devoid of calcification, internal"nand external resorption, severe root curve or fracture, which were extracted due to periodontal disease or"nsevere caries. All the specimens were washed in 2.5% hypochlorite sodium and washing with water, kept in"n10% formalin solution, under room temperature."nResults: The accuracy of the Iranian instrument was measured (81.8%) similar to that of radiography"n(81.2%). But the accuracy of Neosono Wtima EZ was (92.9%) which was higher than the two other methods."nConclusion: No statistically significant difference was found between Neosono Ultima EZ instrument and"ntwo other groups, using SPSS 10 statistical soft ware

Efficacy of pharmacotherapy and cognitive therapy, alone and in combination in major depressive disorder

Introduction& Objective: Patients with Major depressive are difficult to treat, and the relative efficacy of medications and cognitive therapy in the treatment of depression is still a matter of deabath. The purpose of this study was to compare the efficacies of antidepressant medication, cognitive therapy and combination of cognitive therapy and antidepressant medication. Materials & Methods: In an experimental study, 120 depressive patients were randomly selected and divided in three groups as well. Group A, were treated with cognitive therapy; Group B, were treated with antidepressant medication and Group C, were treated with combined therapy (medication and cognitive therapy). Outcomes were assessed with the Beck Depression Inventory. Results: Outcome showed cognitive therapy, medication and combination Cognitive therapy intervention and medication had positive effect on depression therapy. There was no significant difference between medication and cognitive therapy, But significant differences between cognitive therapy and medication with combination method. Conclusion: Depression can be treated with medications, cognitive therapy, or both. Outcomes have showed that the combination of medications and cognitive therapy was more effective in our cases

Review The Impact of E-learning Program on Dictation Skills of Primary School Students Based on Design Principles

The aim of this study is to review the impact of e-learning program on the dictation skills of third grade primary school students based on educational design principles. This study is full field in the form of quasi – experiment. Statistical society included 62 female students of shahid mahdavi third base elementary school of region one of Tehran city education. Sampling in this study is done using random sampling method. Samples divided to two equal control and experimental groups and the experimental group learned dictation lesson in three months using web based e-Learning program that was designed by the researcher and approved by the 16 relevant specialists in the ministry of education and universities. Control group were instructed using Traditional classroom method. Analysis of obtained data using statistical T test of independent groups showed that there is a significant relationship between the use of E-learning program of dictation and academic progress of third grade students of primary school in dictation lesson. Similarly, there is a significant difference between academic progress of students who learned dictation using web based program and students who learned dictation using traditional method. In addition, the findings showed that there is a significant difference between pre-requisite capabilities in dictation lesson including visual, Auditory and movement skills in the end test of experimental and control group showed significant differences between dictation and pre-requisite elements

An Investigation on the Histologic Responses of Periapical Tissues Following Retrofilling with Root MTA and Portland Cement Type I Versus Pro Root MTA in the Canine Teeth of Cats

Statement of the Problem: Endodontic surgery if required is considered as an additive therapy after classic endodontic treatments. The most prevalent type of endodontic surgeries are apicoectomy and corrective surgeries. Type of material applied inapicoectomies is of high importance. Root end filling material should not only be biocompatible but also provide appropriate seal. Considering these findings, the subject of this paper was to compare the histologic responses of the periradicular tissues after usingRoot MTA and Portland cement, as Root end fillings, with Pro Root MTA.Purpose: The aim of the present study was to introduce a suitable material for root end filling.Materials and Methods: The canals of sixty maxillary canines of cats, after cutting the crowns and exposing the pulps, were instrumented 1 mm beyond the apex until 25 # file to develop periapical lesion after 28 days. They were then randomly divided into five groups.After apicoectomy, Pro Root MTA, Root MTA and Portland cement were placed, as root end filling materials in three experimental groups whereas the two remaining groups were considered as positive and negative controls.After 3, 6 and 12 weeks the animals were sacrificed and the specimens were stained forhistologic evaluation under light microscope. The data were submitted to statistical analyses (Fisher exact test, k2 test and one- way variance analysis).Results: No statistically significant difference was found between these three materials in cementum apposition on roots and implanted materials, fibrous capsule formation and the severity of inflammation, however, bone formation in Root MTA group was significantly less than pro Root MTA and Portland cement groups. The extent of inflammation thickness in Portland cement group was significantly less than Pro Root MTA group.Conclusion: According to these findings if long term investigations with larger sample size confirm the obtained results of the present study, Root MTA and Portland cement which are cost- effective and readily available, can replace Pro Root MTA in endodontic surgeries

Difference in developmental stage of homologous mandibular second and third molars in seven to 11 year olds using panoramic radiography and Demirjian’s method

Background: Assessment of dental developmental stage is more valuable than tooth eruption because the duration of tooth eruption is short and is determined by the appearance of tooth in the oral cavity. Also, tooth eruption can be changed by local factors such as space shortage and systemic factors such as nutritional status. Several methods are used to determine the developmental stage of teeth. The Demirjian’s method is extensively used for this purpose. This study aimed to assess the developmental stage of homologous mandibular second and third molars in 7 to 11 year olds using the Demirjian’s method. Materials and methods: This cross-sectional study was conducted on 187 panoramic radiographs of 7 to 11-year-old Iranians (91 females and 96 males) presenting to Pardis Dental School clinic. Two observers evaluated the developmental stage of homologous mandibular second and third molars using the Demirjian’s method. The observers were first calibrated for use of the Demirjian’s method and then the inter- and intra-examiner reliability and the respective kappa values were calculated after observing 187 panoramic radiographs. The Demirjian’s method for tooth development includes eight developmental stages. Assessments were made twice with a one-month interval. Data were analyzed using SPSS version 22. Results: No significant difference was noted in terms of developmental stage of the second molars in the right and left sides. However, in 44 cases, third molars in the right side were one stage ahead of those in the left side and this difference was statistically significant (P0.05). Conclusion: No significant difference was noted in mandibular second molars in higher developmental stages but the difference in mandibular third molars in earlier stages of development was statistically significant. Molar teeth in the right and left sides are significantly different in early stages of development but over time, this difference is minimized and no significant difference is seen between them in later stages of development

Correlation Between Migraine Headaches and Obsessive-Compulsive Disorder: A Two Year Study

Background: Migraine is the most common cause of headache which affects 15% of female and 6% of male populations. Patients with migraine may have psychological problems, thus, association of migraine with depression, anxiety and other psychological disorders should be considered for choosing the best management approach. Methods: In this case-control analytical study, one hundred and twenty patients with migraine were recruited among patients who attended the Psychiatry Clinic of Farshchian Hospital in Hamedan, Iran during 2008- 2009. The patients met the IHS criteria for migraine and none had disorders, such as Huntington disease, that are associated with obsessive-compulsive disorder (OCD). The people who accompanied patients attending the Internal Medicine Clinic of the Hospital and had no history of migraine headaches were recruited as the controls. Maudsleys inventory was used for the diagnosis of OCD. Finally, the data were analyzed by SPSS software. Results: In the control group, 3 (2.5%) and in the case group 11 (9.17%) people had OCD (P=0.024). All of those with OCD in the control group and 9 out of 11 in the case group were female. There were no cases of OCD among patients with mild migraine. Among 36 patients with moderate headache 5 (13.89%) people had OCD and among 62 people with severe migraine 6 (9.68%) had OCD (P=0.510). Conclusion: The prevalence of OCD in patients with migraine was significantly higher than the normal population. Special attention to comorbid conditions such as OCD is necessary in the management of migraine headaches

Stephanoascus ciferrii Complex: The Current State of Infections and Drug Resistance in Humans

In recent years, the incidence of fungal infections in humans has increased dramatically, accompanied by an expansion in the number of species implicated as etiological agents, especially environmental fungi never involved before in human infection. Among fungal pathogens, Candida species are the most common opportunistic fungi that can cause local and systemic infections, especially in immunocompromised individuals. Candida albicans (C. albicans) is the most common causative agent of mucosal and healthcare-associated systemic infections. However, during recent decades, there has been a worrying increase in the number of emerging multi-drug-resistant non-albicans Candida (NAC) species, i.e., C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, C. auris, and C. ciferrii. In particular, Candida ciferrii, also known as Stephanoascus ciferrii or Trichomonascus ciferrii, is a heterothallic ascomycete yeast-like fungus that has received attention in recent decades as a cause of local and systemic fungal diseases. Today, the new definition of the S. ciferrii complex, which consists of S. ciferrii, Candida allociferrii, and Candida mucifera, was proposed after sequencing the 18S rRNA gene. Currently, the S. ciferrii complex is mostly associated with non-severe ear and eye infections, although a few cases of severe candidemia have been reported in immunocompromised individuals. Low susceptibility to currently available antifungal drugs is a rising concern, especially in NAC species. In this regard, a high rate of resistance to azoles and more recently also to echinocandins has emerged in the S. ciferrii complex. This review focuses on epidemiological, biological, and clinical aspects of the S. ciferrii complex, including its pathogenicity and drug resistance