Accuracy of the electronic apex locator, tactile, and radiographic methods in working length determination.

Background: Determination of working length (WL) is necessary for the successful outcome of root canal treatment (RCT). Common methods in WL determination include tactile, radiographic, and electronic apex locators (EAL). Aim: The aim of this study was to compare three methods of WL determination to the actual visualization of the apical constriction (AC). Materials and Methods: Consecutive patients with indications for extraction of single-rooted single canal teeth at the University of Ghana Dental School clinic were randomly assigned to three groups. In-vivo root canal WL was determined by tactile sensation, digital radiography, and a 5th generation EAL (Sendoline S5). Files were cemented in the canals after the in-vivo measurements. The apical 4-5 mm of the roots was trimmed to expose the inserted files and the AC. Actual WL, as determined by visualization of the AC, was done using a digital microscope. Different WLs were then compared for the various groups, and the mean actual canal lengths were reported. Results: EAL accurately predicted the AC in 31 (96.9%) teeth, while the digital radiographic and tactile sensation methods accurately predicted the constriction in 19 (59.4%) and 8 (25%) teeth, respectively, in the study population. The mean working canal lengths for single-rooted teeth showed no observable difference among sexes, age categories, and side of the jaw. Conclusion: The EAL provided more reliable and accurate WL measurements for single-rooted teeth among Ghanaians, compared to digital radiography and tactile methods.

Residency training in Ghana: the residents' perspective.

BACKGROUND: Prior to 1973, West African citizens completed postgraduate medical and surgical training abroad, particularly in the United Kingdom. In 2003, the Ghana College of Physicians and Surgeons were established respectively and began to offer specialized training locally. The aim of this study was to obtain and evaluate the views of Medical and Surgical Residents of the GCPS on their training in Ghana. METHOD: A descriptive cross-sectional study was undertaken whereby a 25 item, self-administered questionnaire, was distributed to 170 residents of Korle Bu and Komfo Anokye Teaching Hospitals in Ghana. Information regarding the residents' sociodemographic characteristics, level of residency, and satisfaction with the programs in terms of clinical supervision, didactic teaching, program duration and research training was collected. RESULTS: 117 residents completed the survey, yielding a response rate of 68.8%. 59.8% were males and 40.2% females. The age of the residents ranged from 25 to 40 years with a mean age of 32.7+1.4 years. Majority of residents (92.3%) were satisfied with the duration of the programs . Slightly more than half of the residents (50.4%) were satisfied with the clinical supervision, however only a third of the respondents (33.3%) were satisfied with the didactic teaching and an even smaller percentage (17.1%) with research training. CONCLUSION: Whilst majority of residents were satisfied with the duration of the residency program, the perspective of the respondents was that trainees would benefit from additional didactic teaching and increased research exposure. FUNDING: None.

HIV, Sexually Transmitted Infection, and Substance Use Continuum of Care Interventions Among Criminal Justice-Involved Black Men Who Have Sex With Men: A Systematic Review.

BACKGROUND: Because Black men who have sex with men (BMSM) experience high rates of both HIV and incarceration relative to other groups, the various stages of criminal justice involvement may serve as important intervention points for addressing HIV and related conditions in this group. Although systematic reviews of HIV interventions targeting MSM in general and BMSM in particular exist, no review has explored the range and impact of HIV, sexually transmitted infection (STI), and substance use prevention and care continuum interventions focused on criminal justice-involved (CJI) populations. OBJECTIVES: To describe the range and impact of published HIV, STI, and related substance use interventions for US-based CJI populations and to understand their relevance for BMSM. SEARCH METHODS: We conducted systematic searches in the following databases: PubMed, MEDLINE, Cochrane, CINAHL, and PsycINFO, covering the period preceding December 1, 2016. SELECTION CRITERIA: We selected articles in scientific publications involving quantitative findings for studies of US-based interventions that focused on CJI individuals, with outcomes related to sexual or substance use risk behaviors, HIV, or STIs. We excluded studies if they provided no demographic information, had minimal representation of the population of interest (< 30 African American or Black male or transgender participants), had study populations limited to those aged younger than 18 years, or were limited to evaluations of preexisting programs. DATA COLLECTION AND ANALYSIS: We abstracted data from these articles on study design; years covered; study location; participant number, demographics, and sexual orientation (if available); criminal justice setting or type; health condition; targeted outcomes; and key findings. We scored studies by using the Downs and Black quality and bias assessment. We conducted linear regression to examine changes in study quality by publication year. MAIN RESULTS: Fifty-eight articles met inclusion criteria, including 8 (13.8%) modeling or cost-effectiveness studies and 13 (22.4%) randomized controlled trials. Just 3 studies (5.2%) focused on sexual or gender minorities, with only 1 focused on BMSM. In most studies (n = 36; 62.1%), however, more than 50% of participants were Black. The most common intervention addressed screening, including 20 empirical studies and 7 modeling studies. Education-focused interventions were also common (n = 15) and usually employed didactic rather than skill-building approaches. They were more likely to demonstrate increases in HIV testing, knowledge, and condom-use intentions than reductions in sex- and drug-risk behaviors. Screening programs consistently indicated cost-effectiveness, including with BMSM. Care continuum interventions for people living with HIV showed mixed results; just 3 involved randomized controlled trials, and these interventions did not show significant differences compared with control conditions. A minority of programs targeted non-custody-based CJI populations, despite their constituting a majority of the CJI population at any given time. AUTHORS' CONCLUSIONS: Screening CJI populations for HIV and other STIs is effective and cost-efficient and holds promise for reducing HIV in BMSM. Education-based and care provision interventions also hold promise for addressing HIV, STIs, mental health, and substance use in CJI populations. Additional empirical and modeling studies and results specific to sexual minorities are needed; their paucity represents a disparity in how HIV is addressed. Public Health Implications. HIV and STI screening programs focused on CJI populations should be a priority for reducing HIV risk and numbers of undiagnosed infections among BMSM. Funding agencies and public health leaders should prioritize research to improve the knowledge base regarding which care continuum intervention approaches are most effective for BMSM with criminal justice involvement. Developments in modeling approaches could allow researchers to simulate the impacts and costs of criminal justice involvement-related interventions that might otherwise be cost, time, or ethically prohibitive to study empirically.

Patient experience and anxiety during and after treatment for an HPV-related oropharyngeal cancer.

OBJECTIVES: Diagnosis with an HPV-related oropharyngeal cancer includes unique social issues. However, it is unknown how common these psychosocial issues are for patients and whether they continue after treatment. MATERIALS AND METHODS: Patients with pathologically confirmed HPV-positive oropharyngeal cancer (HPV-OPC, n=48) were recruited from two medical centers. Participants completed a computer assisted self interview that explored their psychosocial experiences during and after treatment. We examined responses overall and by age. RESULTS: The majority of participants with confirmed HPV-OPC, reported being told that HPV could have (90%) or did cause (77%) their malignancy, but only 52% believed that HPV was the main cause of their OPC. Participants over 65years were less likely than younger participants to report that their doctors told them their tumor was HPV-positive (50% vs 84%, p=0.03). Anxiety that their tumor was HPV-related was a major issue among participants when first diagnosed (93%). However, only 17% still reported anxiety after treatment was complete. While many patients reported that providers discussed the emotional effects of diagnosis and treatment adequately (58%), almost half reported discussing these emotional effects inadequately (24%), or not at all (18%). Further, 18% reported that their families still wondered about some questions that they had never asked. CONCLUSION: After treatment, some HPV-OPC patients remain concerned about HPV and have unanswered questions about HPV. Older patients had lower awareness of the role of HPV in their cancer.