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PubMed1992

The search for a profile of aptitudes that characterize dentists.

This article is a reinterpretation of an unsuccessful attempt to develop a standard battery of aptitude measures to distinguish practicing dentists. Of 22 potential predictors used by a firm specializing in aptitude testing and career counseling, the national sample of 116 dentists tested showed few differences from the norm group, and some differences were counterintuitive. For example dentists performed no better than the norm on spatial visualization and worse than the norm on several measures of language skill and on finger dexterity. Based on these findings, this paper argues that a broad conceptualization is required when attempting to characterize the aptitudes necessary to complete dental education and to maintain a dental practice. The apparent inconsistency between these findings and successful prediction of performance in laboratory courses using available admissions instruments is explained.

Aptitude↗

PubMed2005

Toothbrush abrasions and noncarious cervical lesions: evolving concepts.

Toothbrush abrasion at the cervical areas of teeth is generally thought to be a result of frequent or forceful toothbrushing, faulty or vigorous technique, filament stiffness or design, dominant hand dexterity, or abrasive dentifrices. However, a review of the evidence-based literature cannot conclusively establish any one factor as the primary etiology of cervical abrasions because of inherent methodological limitations and conflicting results. Rather, a variety of factors related to toothbrushing may act in concert with dental erosion and, possibly, occlusal loading in the creation of noncarious cervical lesions. Individual variation also may make some individuals more susceptible to development and may modify the progression of those lesions. Individual variations may involve oral and dental anatomy, periodontal status or phenotype, and periodontal disease history and treatment. Further research is needed to clearly assess the interaction of all those factors in the development of cervical lesions. Therefore, awareness of a multifactorial etiology in noncarious cervical lesions may help the clinician to formulate an appropriate treatment plan for the patient.

Acids↗

PubMed2005

[From the Cochrane Library: brushing the teeth with an electric toothbrush with an oscllating rotating movement more effective against plaque and gingivitis than brushing with a conventional toothbrush].

Removing dental plaque plays a key role in maintaining oral health and reducing gingivitis and parodontitis. A systematic Cochrane review ofrandomised controlled trials encompassing participants from the general public with uncompromised manual dexterity showed that when compared to the use of manual toothbrushes, the use of powered toothbrushes with a rotating oscillation action for a period of three months reduced gingivitis and (although not statistically significantly) plaque. The long-term clinical relevance of the differences is unclear. Electric toothbrushes that did not have an oscillating rotating movement were not consistently better than manual toothbrushes.

Automation↗

PubMed1992

Variations of the blood supply of the human conus arteriosus.

The conus arteriosus was divided into right and left halves and each half was subdivided into 3 portions: superior, middle and inferior. The study of the blood supply of the conus was performed in 8O human hearts. The results showed that the sternocostal wall of the conus arteriosus may be supplied by the arteria coni arteriosi but, more frequently by branches of the right and left coronary arteries. The most frequent branches supplying the conus arteriosus were the ramus anterior ventriculi dextri medialis and lateralis (85%), ramus coni arteriosi dexter (51.2%), ramus anterior ventriculi dextri medius I (47.5%), ramus anterior ventriculi dextri intermedius (41.2%), ramus coni arteriosi sinister (40%) and ramus anterior ventriculi dextri superior I (38.7%).

Adolescent↗

PubMedDate not supplied

A training module for laparoscopic urology.

OBJECTIVES: A fellowship training model in laparoscopic urological surgery has been established for interested urologists to help them proceed from the pelvic trainer/animal laboratory environment to safe clinical practice. The objective of the model is to provide trainees with clinical experience under direct mentor supervision before embarking on independent laparoscopic urological surgery at their own base hospitals. METHODS: The fellowship model incorporates 9 fluid phases: Phase 1 to complete basic and advanced training courses. Phase 2 to practice at home or in the office using pelvic trainers. Phase 3 to proceed to an animal laboratory course. Phase 4 to visit centers of international repute to observe high-volume laparoscopic urology. Phase 5 to observe the mentor perform several major renal laparoscopic cases. Phase 6 to perform several hand-assisted renal procedures under direct mentor guidance at the mentor hospital. Phase 7 to perform several laparoscopic or retroperitoneoscopic renal procedures, or both, under direct mentor guidance at the mentor hospital. Phase 8 to mentor assisted trainees to start laparoscopic surgery at their own hospitals. Phase 9 to practice laparoscopic urology independently. RESULTS: So far, 9 trainees have participated in the fellowship. Six have reached phase 9 with independent practice, 2 others are in phase 8, and 1 is in phase 7. Skills development has been steady, with progressive acquisition of surgical dexterity and spatial orientation. CONCLUSION: This fluid fellowship model provides urologists with clinically applicable teaching experience to learn a relatively new surgical concept safely and effectively, thereby promoting clinical governance. It may be possible for other centers to establish similar fluid "mini" fellowships to help disseminate laparoscopic surgical skills.

Clinical Competence↗

PubMed2005

Gastrointestinal robot-assisted surgery. A current perspective.

Minimally invasive techniques have revolutionized operative surgery. Computer aided surgery and robotic surgical systems strive to improve further on currently available minimally invasive surgery and open new horizons. Only several centers are currently using surgical robots and publishing data. In gastrointestinal surgery, robotic surgery is applied to a wide range of procedures, but is still in its infancy. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed operations. The ZEUS (Computer Motion, Goleta, CA) and the da Vinci (Intuitive Surgical, Mountain View, CA) surgical systems are today the most advanced robotic systems used in gastrointestinal surgery. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery. Its main drawbacks are the absence of force feedback and extremely high costs. At this moment there are no reports to clearly demonstrate the superiority of robotics over conventional laparoscopic surgery. Further research and more prospective randomized trials are needed to better define the optimal application of this new technology in gastrointestinal surgery.

Digestive System Surgical Procedures↗

PubMed2006

Working memory and image guided surgical simulation.

We report on a study that investigates the relationship between visual working memory and verbal working memory and a performance measure in endoscopic instrument navigation in MIST and GI Mentor II (a simulator for gastroendoscopy). Integrated cognitive neuroscience in state-of-the-art simulator training curriculum will take safety science in health care one step ahead. Current simulator validation focuses on how to train. In the light of recent research it is now prime time to ask why in search of mechanisms rather than to repeatedly show that training has effect. This will help tailor training to maximize individual output in procedures that require a high level of dexterity. WM training is a unique learning aid in simulator training and should be used alongside clinical practice in order to improve the quality of complex clinical intervention in the field of image guided surgical simulation.

Computer Simulation↗

PubMed2006

Hybrid analysis of a spherical mechanism for a minimally invasive surgical (MIS) robot--design concepts for multiple optimizations.

Several criteria exist for determining the optimal design for a surgical robot. This paper considers kinematic performance metrics, which reward good kinematic performance, and dynamic performance metrics, which penalize poor dynamic performance. Kinematic and dynamic metrics are considered independently, and then combined to produce hybrid metrics. For each metric, the optimal design is the one that maximizes the performance metric over a specific design space. In the case of a 2-DOF spherical mechanism for a surgical robot, the optimal design determined by kinematic metrics is a robot arm with link angles (alpha(12)=90 degrees , alpha(23)=90 degrees ). The large link angles are the most dextrous, but have the greatest risk of robot-robot or robot-patient collisions and require the largest actuators. The link lengths determined by the dynamic metrics are much shorter, which reduces the risk of collisions, but tend to place the robot in singularities much more frequently. When the hybrid metrics are used, and a restriction that the arm must be able to reach a human's entire abdomen, the optimal design is around (alpha(12)=51 degrees, alpha(23)=54 degrees). The hybrid design provides a compromise between dexterity and compactness.

Equipment Design↗

PubMed2006

Image-guided laser projection for port placement in minimally invasive surgery.

We present an application of an augmented reality laser projection system in which procedure-specific optimal incision sites, computed from pre-operative image acquisition, are superimposed on a patient to guide port placement in minimally invasive surgery. Tests were conducted to evaluate the fidelity of computed and measured port configurations, and to validate the accuracy with which a surgical tool-tip can be placed at an identified virtual target. A high resolution volumetric image of a thorax phantom was acquired using helical computed tomography imaging. Oriented within the thorax, a phantom organ with marked targets was visualized in a virtual environment. A graphical interface enabled marking the locations of target anatomy, and calculation of a grid of potential port locations along the intercostal rib lines. Optimal configurations of port positions and tool orientations were determined by an objective measure reflecting image-based indices of surgical dexterity, hand-eye alignment, and collision detection. Intra-operative registration of the computed virtual model and the phantom anatomy was performed using an optical tracking system. Initial trials demonstrated that computed and projected port placement provided direct access to target anatomy with an accuracy of 2 mm.

Canada↗

PubMed2006

Urinary incontinence in dementia - a practical approach.

BACKGROUND: Urinary incontinence is a common problem in dementia. Almost invariably, the person with dementia will develop incontinence as the disease progresses. However, the primary reasons for incontinence are often not because of any significant pathology in the urinary system. Rather, it is due to factors outside the urinary system. The term 'functional incontinence' has hence been applied. Maintenance of continence requires mobility, manual dexterity, mental capacit and motivation. Clearly, the person with dementia is vulnerable to developing problems in these domains. OBJECTIVE: This article provides a comprehensive overview of how the stage and type of dementia may account for cognitive and functional deficits, the psycho-emotional world and behaviour of the patient, their care environment, and possible medical factors and pathology in the urinary system. DISCUSSION: Management is directed at turning around reversible factors, preserving independence and dignity of the patient, and providing sensitive and empathetic care even if the problem is not completely remediable. In those with more advanced dementia, timed and prompted voiding have shown the most promise.

Aged↗

PubMed2006

Test-retest reliability of a WRULD functional capacity evaluation in healthy adults.

The aim of this study was to determine test-retest reliability of a Functional Capacity Evaluation for patients with non-specific Work Related Upper Limb Disorders (WRULD FCE). The study sample included 33 healthy adults, consisting of 14 males and 19 females with a mean age of 29.2 years. The WRULD FCE consisted of 8 different tests including 26 items measuring repetitive movements, duration, working in awkward positions, forceful movements and static postures. Two FCE sessions were held with a 10-day interval. Means, 95% confidence intervals, one-way random Intraclass Correlation Coefficients (ICCs), 95% limits of agreement and repeated measures were calculated. An ICC between 0.75 and 0.90 was considered as good and an ICC above 0.90 was considered as an excellent reliability. The results showed that 14 of 26 items (54%) had excellent reliability, 9 of 26 items (35%) had good reliability and 3 of 26 items (11%) had moderate reliability based on ICC values. Significant learning effects were present in the Purdue Pegboard Task and in the Complete Minnesota Dexterity Test. It is concluded that the WRULD FCE is reliable in healthy adults.

Adult↗

PubMed2006

[Upper limb pain and limited mobility in the patients after stroke].

Pain in the paretic upper limb is a common complaint in the post-stroke patients. It usually affects shoulder joint and, less frequently, wrist and hand. Pain is usually accompanied by limited mobility of the shoulder and sometimes by swelling of the hand and wrist. The aetiology of these complaints remains unclear. The objective of the study was to evaluate the incidence of pain, limited mobility, swelling and other signs that appear in the paretic limb within the first year after stroke. Forty-five stroke patients treated in the Department of Neurology in 2000 who answered the questionnaire concerning type, localization and intensity of the complaints from paretic upper limb were included. Twenty-six patients (58%) had a painful shoulder, wrist or hand. These complaints concerned women more frequently than men (71% vs. 46%, consecutively), younger patients aged below 55, and those who initially had more severe paresis. Symptoms and signs appeared within first month after stroke in majority of patients, and 70% of patients considered these symptoms very disturbing, significantly deteriorating the dexterity of the paretic limb. Thirty five percent of patients complained of limited mobility in the shoulder joint, 18% had incomplete mobility of fingers in the paretic limb. Twenty two percent of patients had swollen wrist and hand, and 24% had a discoloration and trophic changes of the skin in the paretic hand. Cold intolerance by means of freezing sensation in the affected limb was experienced by 58% of patients. Three patients had complaints both in shoulder and hand, with accompanied swelling, trophic changes and vasomotor disturbances in the hand, what fulfilled criteria for the diagnosis of shoulder-hand syndrome. The results of the study show that upper limb pain and limited mobility are common complications of the stroke. Usually underestimated by family doctors these symptoms and signs cause a significant discomfort for the patients and delay the recovery of the paretic limb.

Activities of Daily Living↗

PubMed2006

Diabetes mellitus and the elderly: special considerations for foot ulcer prevention and care.

The risk of lower extremity amputation in persons with diabetes mellitus increases with advanced age, necessitating clinical vigilance. Individualized and comprehensive prevention efforts are required to address the complicated and diverse nature of the diabetic foot in the elderly patient, including promotion of lifestyle changes to offset diabetes, attention to cognitive deficits and economic limitations, and provision of foot care education and management (eg, emphasizing the need for appropriate foot wear). If an ulcer develops, physiologic and socioeconomic factors may influence its clinical presentation, assessment, diagnosis, and treatment. To help ulcer-related complications and prevent lower leg amputations, clinicians must address diabetes management; the cost of supplies; the importance of offloading, nutrition, and exercise; and challenges inherent to impaired eyesight, dexterity, and ability to self-care. A multidisciplinary approach is recommended. Additional research to enhance understanding of practice parameters in this population is needed to help clinicians manage the increasing numbers of older adults with diabetes mellitus.

Aged↗

PubMedDate not supplied

Use of SIG device to accurately place permanent miniature dental implants to retain mandibular overdenture. A case report.

A case of mini-dental implant insertion for retention of a mandibular overdenture in a hospitalized patient has been documented. The additional use of the SIG (drill guide) directional device in the implant placement protocol gave the practitioner more confidence and resulted in the proper alignment of the three ball-top, one-piece fixtures. The three implants were inserted exactly 1 cm apart and parallel to each other. The distal fixtures were approximately 1 cm away from the mental foramina, thereby eliminating the risk of lip paresthesia. Keeper caps were placed in the denture's intaglio after one month. The keeper caps allowed for proper retention of the overdenture. The caps also enabled the patient to easily insert and withdraw his denture, even though he displayed limited manual dexterity. The tissue response was excellent, and oral hygiene was made easier with adequate spacing of the exposed ball-tops. The overall experience for both the operator and the patient was very positive. General dentists should be able to readily master this technique and add it to their armamentarium for the benefit of all their patients.

Dental Implantation, Endosseous↗

PubMed1990

[An endodermal sinus tumor (yolk sac tumor) of the anterior mediastinum].

An own case of a primary mediastinal endodermal sinus tumour (yolk sac tumour) is presented that was transformed under therapy into an AFP-negative process and occurred combined with an arcus aortae dexter. This is followed by a description of the clinical and diagnostic patterns of signs and symptoms and of the treatment of this very rare dysontogenetic tumour.

Adult↗

PubMed2006

[Effect of ligustrazine on the expression of bFGF in bone marrow stromal cells of mice after BMT].

This study was purposed to investigate the effect of ligustrazine on the expression of bFGF in bone marrow stromal cells (BMSC) and to explore the mechanism of hematopoietic reconstitution after bone marrow transplantation (BMT). The mice were randomly divided into 3 groups: normal group, saline group and ligustrazine group. BMT mouse models were established. The mice of normal group were not treated, the mice of saline group were given normal saline (0.2 ml/mouse, twice a day) through gastric tube, while the mice of ligustrazine group were given ligustrazine (0.2 ml/mouse, twice a day) through gastric tube. On day 7, 14, 21 and 28 after BMT, the femora were taken and the bone marrow mononuclear cell (BMMNC) suspensions were used for the cultivation of bone marrow stromal cells according to Dexter's culture method. The mRNA and protein expressions of bFGF in BMSC were assayed by RT-PCR and Western blot respectively. The results showed that the expression of bFGF in BMSC on the level of mRNA and protein were all reduced significantly after BMT, and increased slowly with the time. On day 7, 14 and 21 after BMT, the expressions of bFGF mRNA and protein in bone marrow stromal cells of ligustrazine group and saline group were lower than that in bone marrow stromal cells of normal group, but the expressions of bFGF mRNA and protein in ligustrazine group were obviously higher than that in saline group (P < 0.01 or P < 0.05). On day 28 after BMT, the expressions of bFGF mRNA and protein in ligustrazine group returned to normal level, while the expressions of bFGF mRNA and protein in saline group not returned to normal level, there was significant difference between these two groups. It is concluded that ligustrazine can enhance bFGF expression level in bone marrow stromal cells after syngeneic bone marrow transplantation in mice, which confirms that ligustrazine can enhance the repair of bone marrow microvessels, improve bone marrow microenvironment and promote hematopoietic reconstitution.

Animals↗

PubMed2006

Contributions of Muhadhdhab Al-Deen Al-Baghdadi to the progress of medicine and urology. A study and translations from his book Al-Mukhtar.

This study of the Arabic 4-volume book of Al-Mukhtar Fi Al-Tibb (Choice Book on Medicine) written by the Muslim physician Muhadhdhab Al-Deen Al-Baghdadi (515-610 H, 1117-1213 AD) aimed at evaluating his contributions to the progress of medicine and urology along with providing English translations of relevant excerpts. Al-Baghdadi laid emphasis on the morals of medical practice and the principles of medical education describing how to select medical students and how to evaluate graduates. He stressed on the need for a long training program directly supervised by skilled expert doctors both in hospitals (Al-Bimaristanat) and during home visits. A good part of volume 1 was allocated to preventive medicine and the whole of volume 2 was devoted to the pharmacy section, which he restricted to what was proven by the experience of his teacher and by his own experiments. Same as all his predecessors in the Islamic era, Al-Baghdadi stressed the importance of clinical medicine and gave more details related to history taking, physical examination, differential diagnosis and prognosis. Similar to them, he also, emphasized that a doctor should be quite knowledgeable in anatomy. Furthermore, the presence of anatomical drawings in Kitab Al-Mukhtar Fi Al-Tibb is a further step forward in illustrating medical text books; a trend that flourished in the Islamic era reflecting the role of direct observations and experience. The detailed description of the functional anatomy of the uretero-vesical junction and the antireflux and micturition mechanisms given by Al-Baghdadi is contrary to that of Galen (130-200 AD) but conforms well to our contemporary understanding. In the conservative management of urinary stones, he described 70 simple and 13 compound drugs while those described by Pulus of Aegina (625-690 AD) were only 20 simple and 3 compound drugs. Furthermore, Al-Baghdadi's description of the instruments and techniques of urethral catheterization, perineal cystolithotomy and perineal cystolithotripsy using Al-Zahrawi's lithotrite is meticulous and reveals originality, dexterity and experience.

Anatomy↗

PubMed2006

[Experimental study of platelet-rich plasma optimizing mesenchymal stem cells culture].

OBJECTIVE: To explore a new method for in vitro expansion of human mesenchymal stem cells (MSC) by using platelet-rich plasma (PRP) in place of fetal calf serum (FCS). METHODS: Bone marrow(BM) samples were obtained from the proximal femurs of patients with normal haematopoietic function undergoing total hip arthroplasty. 2 x 10(5)/cm2 BM nucleated cells were seeded in 25 cm2 flasks for MSC cultivation containing one of the 3 mediums: complete Dexter medium with 12.5% FBS and 12.5% horse serum (medium1), alpha-MEM with 10% FCS (medium2) and alpha-MEM with 5% PRP(medium3). At the same time, 1 x 10(6) nucleated BM cells and same amount of nucleated cells from iliac aspirate were seeded in 25 cm2 tissue flasks, colony forming unit-fibroblast (CFU-F) assay. RESULTS: Culture-expanded cells from proximal femurs presented a typical fibroblast-like morphology. Cells were positive for SH2 (CD 105), SH3 (CD73), Thy-1 (CD90), while negative for CD34 and CD45. On induction, these cells could differentiate into osteoblasts. A significantly higher proliferative capacity of MSCs expanded in medium3 was observed in comparison to those in mediuml or 2 without alteration of the phenotype and the differentiation property. CFU-F assays indicated that bone marrow from the proximal femoral contained significantly more CFU-F than that from iliac aspirate. CONCLUSION: Platelet-rich plasma can be used in place of FCS to provide a safer and more effective culture condition to expand MSCs for clinical purpose. The proximal femur BM cells can be obtained in hip surgeries.

Blood Platelets↗