Infant Death Rates between Different Medical Attendants

The function of midwives in the context of maternal health is important, especially when understanding the role of midwives in a global context compared to in the United States. Globally, midwives have served as historically important members in the process of childbirth, but their role has experienced changes in response to increased medicalization over the years, especially in the United States.1 Based of their use and effectiveness in a global context, literature suggests that it may be beneficial for both the healthcare system, mothers, and infants to expand the role of midwives in the United States.2 The purpose of this research was to compare infant death rates within the United States between births supervised by physicians (both MD and DO) versus midwives to understand if differences exist between the groups. Furthermore, in order to assess the role of potentially moderating social determinants of health, the impact of the mother’s race and use of prenatal care was assessed in relation to which type of medical attendant supervised the birth. Data from between 2007 and 2017 was collected on infant birth and death records from the Centers for Disease Control and Prevention website (https://wonder.cdc.gov) for births that occurred in the United States to United States residents. Data was then categorized according to which type of medical attendant supervised the birth, mother’s race, and mother’s prenatal care. Data analysis showed that infant death rates were significantly higher when births were supervised by MD/DO physicians compared to midwives, and these differences persisted regardless of maternal race or prenatal care. These findings are relevant to helping understand the role of midwives within the United States healthcare system

Integrating an Evidence Based Medicine Module Presentation into the Ob-Gyn Clerkship

Introduction: During the preclinical curriculum, students are introduced to EBM principles, however structured application to clinical medicine varies throughout clinical experiences. Application of EBM in a clinical educational environment affords students opportunities to practice required skills. Methods: Students selected a patient case and formulated a question related to diagnosis ortreatment using the PICO framework. Students selected research publications related to the patient case, critically appraised their validity and generalization, and developed a comprehensive presentation involving a case summary and related EBM topics, which were evaluated by a faculty member using a rubric developed for the project. To assess the effectiveness of the curriculum addition, students were administered a survey to rate their knowledge of EBM before and after completing the EBM project. Results: One full academic year of clerkship cohorts (n=103) were surveyed. Regardless of EBM knowledge before the project, comparison of self-reported knowledge increased to above-average level of understanding as a result of the project (mean=4.0, SD=1.07, CI=3.75-4.19). Furthermore, student presentation percentage scores using the rubric showed an above average understanding of EBM (mean=96, SD=4.40). Conclusion: It is important for students to integrate EBM into their practice early in their training. This curriculum addition was effective and could be utilized in other clerkships

Determination of Shear Bond Strength of Nanocomposite to Porcelain and Metal Alloy

Objective: To compare porcelain and metal repair done with both nanocomposite and conventional composite. Material and Methods: A total of 30 cylinders were fabricated from Porcelain (I), Porcelain fused to metal (II), and metal (III) substrate each. Control group (A) was bonded with conventional micro-hybrid composite and experimental group (B) was bonded with nanocomposite in a 2 mm thickness. All specimens were thermocycled and stored in distilled water at 37 °C for 7 days. A universal testing machine was used to measure the Shear bond strength (SBS). The difference between bond strengths of the groups was compared using an independent t-test. Results: In all three groups, the SBS was higher in the experimental group as compared to the control group. The use of nanocomposite of metal alloy presented maximum shear bond strength, followed by samples of porcelain fused to metal and finally porcelain, showing the lowest values of SBS. Conclusion: Porcelain and alloys bonded with nanocomposite exhibit enhanced adhesiveness as well as aesthetic and mechanical properties. This subsequently would translate into providing higher clinical serviceability and durability and hence a cost-effective and accessible repair option for human welfare

Determination of Shear Bond Strength of Nanocomposite to Porcelain and Metal Alloy

Objective: To compare porcelain and metal repair done with both nanocomposite and conventional composite. Material and Methods: A total of 30 cylinders were fabricated from Porcelain (I), Porcelain fused to metal (II), and metal (III) substrate each. Control group (A) was bonded with conventional micro-hybrid composite and experimental group (B) was bonded with nanocomposite in a 2 mm thickness. All specimens were thermocycled and stored in distilled water at 37 °C for 7 days. A universal testing machine was used to measure the Shear bond strength (SBS). The difference between bond strengths of the groups was compared using an independent t-test. Results: In all three groups, the SBS was higher in the experimental group as compared to the control group. The use of nanocomposite of metal alloy presented maximum shear bond strength, followed by samples of porcelain fused to metal and finally porcelain, showing the lowest values of SBS. Conclusion: Porcelain and alloys bonded with nanocomposite exhibit enhanced adhesiveness as well as aesthetic and mechanical properties. This subsequently would translate into providing higher clinical serviceability and durability and hence a cost-effective and accessible repair option for human welfare

Integrating an Evidence Based Medicine Module Presentation into the Ob-Gyn Clerkship

Introduction: During the preclinical curriculum, students are introduced to EBM principles, however structured application to clinical medicine varies throughout clinical experiences. Application of EBM in a clinical educational environment affords students opportunities to practice required skills. Methods: Students selected a patient case and formulated a question related to diagnosis ortreatment using the PICO framework. Students selected research publications related to the patient case, critically appraised their validity and generalization, and developed a comprehensive presentation involving a case summary and related EBM topics, which were evaluated by a faculty member using a rubric developed for the project. To assess the effectiveness of the curriculum addition, students were administered a survey to rate their knowledge of EBM before and after completing the EBM project. Results: One full academic year of clerkship cohorts (n=103) were surveyed. Regardless of EBM knowledge before the project, comparison of self-reported knowledge increased to above-average level of understanding as a result of the project (mean=4.0, SD=1.07, CI=3.75-4.19). Furthermore, student presentation percentage scores using the rubric showed an above average understanding of EBM (mean=96, SD=4.40). Conclusion: It is important for students to integrate EBM into their practice early in their training. This curriculum addition was effective and could be utilized in other clerkships

Integrating an Evidence Based Medicine Module Presentation into the Ob-Gyn Clerkship

Introduction: During the preclinical curriculum, students are introduced to EBM principles, however structured application to clinical medicine varies throughout clinical experiences. Application of EBM in a clinical educational environment affords students opportunities to practice required skills. Methods: Students selected a patient case and formulated a question related to diagnosis ortreatment using the PICO framework. Students selected research publications related to the patient case, critically appraised their validity and generalization, and developed a comprehensive presentation involving a case summary and related EBM topics, which were evaluated by a faculty member using a rubric developed for the project. To assess the effectiveness of the curriculum addition, students were administered a survey to rate their knowledge of EBM before and after completing the EBM project. Results: One full academic year of clerkship cohorts (n=103) were surveyed. Regardless of EBM knowledge before the project, comparison of self-reported knowledge increased to above-average level of understanding as a result of the project (mean=4.0, SD=1.07, CI=3.75-4.19). Furthermore, student presentation percentage scores using the rubric showed an above average understanding of EBM (mean=96, SD=4.40). Conclusion: It is important for students to integrate EBM into their practice early in their training. This curriculum addition was effective and could be utilized in other clerkships

Integrating an Evidence Based Medicine Module Presentation into the Ob-Gyn Clerkship

Introduction: During the preclinical curriculum, students are introduced to EBM principles, however structured application to clinical medicine varies throughout clinical experiences. Application of EBM in a clinical educational environment affords students opportunities to practice required skills. Methods: Students selected a patient case and formulated a question related to diagnosis ortreatment using the PICO framework. Students selected research publications related to the patient case, critically appraised their validity and generalization, and developed a comprehensive presentation involving a case summary and related EBM topics, which were evaluated by a faculty member using a rubric developed for the project. To assess the effectiveness of the curriculum addition, students were administered a survey to rate their knowledge of EBM before and after completing the EBM project. Results: One full academic year of clerkship cohorts (n=103) were surveyed. Regardless of EBM knowledge before the project, comparison of self-reported knowledge increased to above-average level of understanding as a result of the project (mean=4.0, SD=1.07, CI=3.75-4.19). Furthermore, student presentation percentage scores using the rubric showed an above average understanding of EBM (mean=96, SD=4.40). Conclusion: It is important for students to integrate EBM into their practice early in their training. This curriculum addition was effective and could be utilized in other clerkships

External validation and recalibration of an incidental meningioma prognostic model - IMPACT: protocol for an international multicentre retrospective cohort study

Introduction: Due to the increased use of CT and MRI, the prevalence of incidental findings on brain scans is increasing. Meningioma, the most common primary brain tumour, is a frequently encountered incidental finding, with an estimated prevalence of 3/1000. The management of incidental meningioma varies widely with active clinical-radiological monitoring being the most accepted method by clinicians. Duration of monitoring and time intervals for assessment, however, are not well defined. To this end, we have recently developed a statistical model of progression risk based on single-centre retrospective data. The model Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and MRI Tests (IMPACT) employs baseline clinical and imaging features to categorise the patient with an incidental meningioma into one of three risk groups: low, medium and high risk with a proposed active monitoring strategy based on the risk and temporal trajectory of progression, accounting for actuarial life expectancy. The primary aim of this study is to assess the external validity of this model. Methods and analysis: IMPACT is a retrospective multicentre study which will aim to include 1500 patients with an incidental intracranial meningioma, powered to detect a 10% progression risk. Adult patients ≥16 years diagnosed with an incidental meningioma between 1 January 2009 and 31 December 2010 will be included. Clinical and radiological data will be collected longitudinally until the patient reaches one of the study endpoints: intervention (surgery, stereotactic radiosurgery or fractionated radiotherapy), mortality or last date of follow-up. Data will be uploaded to an online Research Electronic Data Capture database with no unique identifiers. External validity of IMPACT will be tested using established statistical methods. Ethics and dissemination: Local institutional approval at each participating centre will be required. Results of the study will be reported through peer-reviewed articles and conferences and disseminated to participating centres, patients and the public using social media