Development of the objective, structured communication assessment of residents (OSCAR) tool for measuring communication skills with patients.

BACKGROUND: Although interpersonal and communication skills are essential to physician practice, there is a dearth of effective tools to meaningfully teach and assess communication skills. OBJECTIVE: The purpose of our study was to create a standardized tool for evaluation of communication skills for residents across specialties. METHODS: We designed an Objective, Structured Communication Assessment of Residents (OSCAR) tool, consisting of 4 clinical stations, to assess intern communication skills with relationship development, their establishment of case goals, and their organization and time management skills. Interns from 11 training programs completed the stations, with senior residents trained to function as standardized patients. The 4 stations' scenarios were a disruptive patient, handling a phone call for a narcotics refill, disclosing a medical mistake, and delivering bad news. RESULTS: Eighty-three interns completed OSCAR during orientation. The assessment took interns about 40 minutes to complete, and participants were given immediate feedback by the standardized patients. The total possible score for each station was 50. Resident performance was highest for disclosing a medical error (94%, 47 of 50), followed by handling a disruptive patient (90%, 45 of 50), disclosing bad news (86%, 43 of 50), and handling the phone call for the narcotics refill (62%, 31 of 50). Multivariate analysis of variance results indicated differences between residents from US and international medical schools, but there were no significant differences across specialties. Interrater reliability was excellent for each station (> 0.80). CONCLUSIONS: OSCAR is a practical tool for assessing interns' communication skills to provide timely results to program directors.

Mandibular incisive canal: cone beam computed tomography.

PURPOSE: Panoramic radiography is often used to analyze the anatomical structure of the teeth, jaws, and temporomandibular joints. Cone beam computed tomography (CBCT) imaging allows multiple axial slices of the image to be obtained through these anatomical structures. The aim of this study was to assess CBCT compared with panoramic radiography to verify the presence, location, and dimensions of the mandibular incisive canal. MATERIALS AND METHODS: CBCT scan images and panoramic radiographs of 89 subjects were compared for the presence of the mandibular incisive canal, its location, size, and anterior-posterior length. The distance between the incisive canal and the buccal and lingual plate of the alveolar bone, and the distance from the canal to the inferior border of the mandible and the tooth apex were also measured. A paired t-test was used to calculate any significant difference between the two imaging techniques. RESULTS: Eighty-three percent of the CBCT scans showed the presence of the incisive canal, as did 11% of the panoramic radiographs. The range of the incisive canal diameter, as seen in the CBCT scans, was from 0.4 × 0.4 mm to 4.6 × 3.2 mm. The mean length of the canal was 7 ± 3.8 mm. The distance from the inferior border of the mandible to the canal was 10.2 ± 2.4 mm, and the mean distance to the buccal plate was 2.4 mm. The apex-canal distance (in dentate subjects) was 5.3 mm. CONCLUSION: The presence, location, and dimensions of the mandibular incisive canal are better determined by CBCT imaging than by panoramic radiography.

Synthesis of a-factor peptide from Saccharomyces cerevisiae and photoactive analogues via Fmoc solid phase methodology.

a-Factor from Saccharomyces cerevisiae is a farnesylated dodecapeptide involved in mating. The molecule binds to a G-protein coupled receptor and hence serves as a simple system for studying the interactions between prenylated molecules and their cognate receptors. Here, we describe the preparation of a-factor and two photoactive analogues via Fmoc solid-phase peptide synthesis using hydrazinobenzoyl AM NovaGel™ resin; the structure of the synthetic a-factor was confirmed by MS-MS analysis and NMR; the structures of the analogues were confirmed by MS-MS analysis. Using a yeast growth arrest assay, the analogues were found to have activity comparable to a-factor itself.

Measurement of clinicians' ability to hand torque dental implant components.

There is a varying degree of hand torque abilities using finger drivers among clinicians. Calibrating one's own abilities requires complicated instruments not readily available. This study evaluated a simple-to-use method that allows dental practitioners to have a quantifiable clinical assessment of relative torque ability using finger drivers to torque down dental implant components. A typodont that includes dental implants was mounted in a mannequin placed in a patient-reclined position. The subjects were asked to torque as tightly as they could a new healing abutment to an implant secured firmly in resin within the typodont. All participants wore moistened gloves when using a finger driver. The healing abutment was countertorqued using a certified precalibrated precision torque measurement device. The reading on the torque driver was recorded when the healing abutment disengaged. An average of torque values of dentists and dental students was calculated. Fifty subjects had an average maximum torque ability of 24 Ncm (male dentists: 28 Ncm; students: 22 Ncm; male students: 24 Ncm; female students: 19 Ncm). Maximum torque values for all participants ranged from 11 Ncm to 38 Ncm. There was no significant difference between groups. This study showed a varying degree of hand torquing abilities using a finger driver. Clinicians should regularly calibrate their ability to torque implant components to more predictably perform implant dentistry. Dental implant manufacturers should more precisely instruct clinicians as to maximum torque, as opposed to "finger tighten only".

Autogenous bone grafting in a patient on long-term oral bisphosphonate therapy: case report.

A 66-year-old patient was referred to the Periodontal Clinic at Case Western Reserve University for implant placement in the mandibular left first molar area. The patient reported a history of oral bisphosphonate intake for the last 7 years for the treatment of osteoporosis. Autogenous bone block grafting was planned to augment the ridge before implant placement. The surgery was performed under local anesthesia, and the implant was successfully placed 8 months after ridge augmentation. Healing was uneventful postoperatively, and the buccolingual width of the ridge increased significantly, allowing placement of a 5-mm-diameter dental implant. The patient showed proper healing of both the donor site and the recipient site, in spite of the long-term oral bisphosphonate therapy, with no resulting osteonecrosis of the jawbone.