Can Multiple Mini Interviews work in an Irish setting? A feasibility study.

Multiple Mini Interview (MMI) is a new selection tool for medical school applicants. Developed at McMaster University in 2004 it comprises a series of interview stations designed to measure performance across a range of competencies including communication skills, team work, and ethical reasoning. In September 2012, 109 First Year Medical students underwent the MMI. It consisted of 10 stations. The median total score, out of 150, was 100 (min 63, max 129). Cronbach Alphas for the 10 individual stations range from 0.74 to 0.80. Overall Cronbach Alpha of MMI items was 0.78. Staff and student feedback was positive. The outline cost per student was estimated at Euro 145. This study demonstrates that it is feasible to hold a MMI with acceptable levels of reliability and stakeholder approval in an Irish setting. Further work is ongoing to establish the concurrent and predictive validity of MMI in this cohort of medica students.

Assessment of professional behaviour--a comparison of self-assessment by first year dental students and assessment by staff.

OBJECTIVE: A study was set up to assess usefulness and acceptability of a method of assessing professional behaviour of undergraduate dental students. SETTING: The first year preclinical course at the Department of Dentistry and Oral Hygiene, University of Groningen, the Netherlands. MATERIALS AND METHOD: A form was developed with an ordinal scale to assess undergraduate professional behaviour. A standard means of carrying out assessment was then undertaken and subsequently used to give feedback to the students at the end of each of three terms. The students' self-assessment was then compared to that of the staff. RESULTS: Descriptive analysis of the results was carried out per term. The response rate was 80-85%. The significant difference which existed between the scores of students and staff at the start of the study was reduced to reasonable agreement over two of the three criteria. CONCLUSIONS: The study indicated that the initial difference in assessment of their professional behaviour by first year dental students and by staff, was reduced by the forms and procedure used. This indicates the usefulness of the procedure as a teaching aid. The high participation rate confirms this to be an acceptable means of assessment of dental students' professional behaviour.

Assessment of 'borderline' clinical competence using generalisability and decision studies in dental skills training.

INTRODUCTION: Generalisability coefficients are widely used as a measure of reliability in educational sciences. However, coefficients do not inform about how much individual and/or educational variance is needed for borderline competence. Probing depth measurements were used as an example to demonstrate the use of generalisability and decision studies in educational decision-making. METHOD: All six probing depths of seven elements of the first quadrant were assessed in a random crossed four-way 'elements' (7), 'probing depth' (6) 'observers' (7-8) and 'repetitions' design for both students (8) and faculty staff (7). Borderline competence was assessed in four decision study designs. RESULTS: In decision studies the generalisability coefficient varied from 0.31 to 0.88 for the first single and fourth repeated study design, respectively. The standard error of the measurement varied from 1.73 to 0.64 mm with a corresponding 95% confidence interval varying from 3 to 1 mm. CONCLUSION: Repeated measurement is not the most efficient way to improve educational decision-making. What is new to this approach is that we used the 95% confidence interval of the standard error of measurement as a measure for 'borderline competence' expressed in the unity of the measurement instrument. Correctly performing the procedure of probing depth assessment is of clinical and educational importance in deciding whether further treatment is necessary and whether students fail or pass their exams.

The association between generalized joint hypermobility and temporomandibular joint disorders: a systematic review.

To analyze conflicting evidence in the literature for the association between temporomandibular joint disorders (TMD) and generalized joint hypermobility (GJH), we performed a bibliographic search. The methodological quality of the 14 papers found was assessed according to 14 criteria. Papers were included in the analysis if the study population was clinically relevant, if range of motion of 2 or more joints was assessed on the left and right sides, and if cases had a TMD. Four studies fulfilled these selection criteria. Data from 3 studies, 113, cases and 95 controls, were available for analysis. Twenty-six cases and five controls were hypermobile (odds ratio, 5.4). In a sensitivity analysis, the odds ratio changed from significant to non-significant in 2 of 5 scenarios. As a result, it is not clear whether GJH is associated with TMD, and more rigorous studies are needed.

The oblique radiographic technique for bone height measurements on edentulous mandibles: a preclinical study and an introduction to the clinical use.

OBJECTIVE: The aim of this study was to quantify the effect of mandibular angulation, position, and shape of the edentulous mandible on the distortion of its image on lateral oblique radiographs in a preclinical study. Suggestions for the clinical use of this technique are made. STUDY DESIGN: Five edentulous dry mandibles were used, varying in size from small to wide and equipped with metal bars in and on top of the mandible. The mandibles were radiographed at 9 different positions by tilting the mandible around the intercondylar axis and by using the oblique projection technique in a cephalostat. RESULTS: The length of the images of the metal bars varied significantly when we tilted the mandibles from 20 degrees to -20 degrees. As a result of the effects of magnification and distortion, the image size varied from between 0.96% and 1.06% of the real size. Neither the size of the mandible nor the position of the bars was related to the degree of magnification. CONCLUSION: The oblique projection technique has limited geometric errors in depicting the edentulous mandible. For evaluative bone height measurements in patients with extremely resorbed mandibles treated with dental implants, it is a promising technique if the patient (specifically the mandible) can be positioned reproducibly in the apparatus.

Smallest detectable difference of maximal mouth opening in patients with painfully restricted temporomandibular joint function.

Changes in maximal mouth opening reflect the impact of temporomandibular disorders and the effect of a therapeutic intervention. No information about the amount of change in maximal mouth opening with regard to reasoned decision-making is available. The smallest detectable difference, as a measure of reliability assessment, provides this information and is expressed in the unit of the measurement instrument. Twenty-five consecutive patients (5 males, 20 females) with a painfully restricted temporomandibular joint participated in this study. Measurements of maximal mouth opening were performed by two well-trained observers on two separate measurement days, one week apart. The maximal mouth opening measurements were repeated three times. Inter-observer, intra-observer, and test-retest reliability varied between 0.90 and 0.96. Inconsistency in measurement results analyzed in terms of absolute error variance, i.e. the measurement facets plus all the interactions, represented 11% of total variance. The smallest detectable difference of maximal mouth opening varied from 9 to 6 mm. For being successful in painfully restricted temporomandibular joint patients, statistically as well as clinically, the clinician has to measure at least 9 mm of improvement in maximal mouth opening. To reduce the smallest detectable difference from 9 to 6 mm, repeated measurement is necessary.

The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint.

Mandibular functions such as speech, laughing, yawning, mastication, and taking a large bite may be impaired if temporomandibular disorders exist. The Mandibular Function Impairement Questionnaire is a validated instrument that scores perceived difficulty of representative mandibular functions in relation to jaw complaints. However, the reliability of the Mandibular Function Impairment Questionnaire has never been adequately tested. Generalizability and decision studies are currently proposed to assess the reliability of a measurement device. The smallest detectable difference is the smallest statistically significant amount of change to be detected with a measurement device. The purpose of this study was to assess the reliability of the Mandibular Function Impairement Questionnaire in terms of the smallest detectable difference. Twenty-five consecutive patients with painfully restricted temporomandibular joints completed the Mandibular Function Impairement Questionnaire on two separate measurement days, one week apart, using two consecutive sessions per day. Spearman's r was calculated for test-retest reliability. Variance components such as patients, measurement days, repetitions, and all their interactions were analyzed in the generalizability study. In the decision study, the smallest detectable difference was calculated for different days and repetitions. Spearman's r varied from 0.69 to 0.96. The between-patient variance and the error variance contributed 81% and 19% to total variance, respectively. The Mandibular Function Impairment Questionnaire is a reliable instrument for the assessment of mandibular function impairment. The minimal amount of change to be detected is 14 units on a scale of 0 to 68. Reliability in terms of the smallest detectable difference increases if the measurement is repeated twice on two separate days: The smallest detectable difference improves to 10 units.

Therapeutic outcome assessment in permanent temporomandibular joint disc displacement.

In permanent temporomandibular disc displacement (TMJ-DD) outcome studies many authors claim positive effects of arthroscopic surgery, arthrocentesis and physical therapy. This literature review was undertaken to analyse whether the claimed effects are based on acceptable methodology. The recorded papers were analysed by two independent observers according to (1) method of investigation, (2) therapeutic intervention studied, (3) therapeutic outcome variables used, and (4) claimed effectiveness of the intervention. Agreement between observers was calculated. Twenty-four papers were found in which therapeutic outcome of interventions on temporomandibular disorders were studied. Six studies applied a true experimental design. Each of these six studies compared a different set of interventions. Twenty-two papers used maximal mouth opening (MMO) as an outcome variable, nine studied pain intensity on a visual analogue scale, one paper assessed the mandibular function impairment questionnaire. Kappa for overall agreement concerning the reviewing criteria was 0.82 (P < or = 0.001). No distinguishing effects on MMO, pain or function impairment were reported between arthroscopic surgery, arthrocentesis and physical therapy. Results of methodological sound outcome studies evaluating the effects of arthroscopic surgery, arthrocentesis and physical therapy are needed.

Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint.

The smallest detectable difference is the smallest statistically significant change in measurement results. In the field of temporomandibular disorders, the smallest detectable difference is not a commonly used concept. Most outcome studies are based on comparisons of group means, although this does not provide information about individual changes or about the clinical relevance thereof. The smallest detectable difference for maximal mouth opening was calculated from previously published reliability coefficients and the standard deviations of different samples of healthy subjects and patients with complaints of the temporomandibular joint. The smallest detectable difference of pain intensity measured with different visual analogue scales was calculated from the reliability coefficients and standard deviations of a heterogeneous group of pain patients. The smallest detectable difference of function impairment was calculated for a group of patients with complaints of the temporomandibular joint. For maximal mouth opening in healthy subjects, the smallest detectable difference was 5 mm. Repeated measurements improved it to 3 mm. The smallest detectable difference on a visual analogue scale was 28 mm for actual pain intensity and 22 mm for minimal pain as well as for maximal pain intensity. For total function impairment of patients with complaints of the temporomandibular joint, the smallest detectable difference was 8 units on a 0 to 68 scale.

The effects of spinal cord stimulation on quality of life in patients with therapeutically chronic refractory angina pectoris.

Objective. For patients with refractory angina pectoris, spinal cord stimulation (SCS) is a beneficial and safe adjuvant therapy. However, it has not yet been established whether SCS alters the quality of life (QoL) in these patients. Methods. In this study, 26 consecutive patients (age 61.3 ± 7.0 years, 13 females, angina duration 12.7 ± 6.0 years) were recruited. Social, mental, and physical aspects of QoL were determined by Nottingham Health Profile (NHP I), depression scale (CES-D), scoring of angina pectoris attacks and short-acting nitroglycerine intake, pain score on the Visual Analog Scale (VAS), perceived health percentage, Satisfaction With Life scale (SWLS), and one-aspect Linear Analog Self Assessment scale (LASA). QoL outcomes at baseline were compared with reference values from healthy subjects. Within-group changes and magnitude of changes (effect size, ES) were assessed after 3 months and 1 year of SCS. Results. Compared to healthy subjects, the patients had significantly worse scores at baseline on NHP, SWLS, and LASA. After 3 months of SCS, NHP I aspect pain (ES = 1.39), AP-score (ES = 0.85), perceived health percentage (ES =- 0.80), NTG-use (ES = 1.08) and VAS-score (ES = 1.13) were all significantly improved (p < 0.05). After 3 months, moderate changes were observed; however, they were not statistically significant on the NHP-aspects "emotion" (ES = 0.57) and "sleep" (ES = 0.56). At the 1-year follow-up, significant and substantial improvements were found on NHP-I aspects: pain, energy, emotional reactions, social isolation, sleep, and physical mobility (p < 0.05) with changes that can be interpreted as large (ES > 0.80). Conclusion. QoL in patients with refractory angina pectoris is poor. Both pain and health aspects of QoL improved significantly after 3 months of SCS. Social, mental, and physical aspects of QoL were found improved after 1 year of SCS.

Ratio between vertical and horizontal mandibular range of motion.

Mandibular range of motion (ROM), vertical and horizontal, is often measured as a part of a diagnostic assessment of temporomandibular joint disorders. In the literature, a fixed ratio between the vertical and the horizontal ROM has been suggested, i.e. 4:1. The ratio is frequently used to predict the vertical ROM on the basis of the horizontal ROM and vice versa. However, no scientific data are available to substantiate the ratio suggested. The aim of this study was to determine whether the fixed ratio of 4:1 exists and, if so, whether this ratio has a predictive value. Vertical and horizontal mandibular ROM was measured in 91 healthy subjects, 59 women, and 32 men (mean age 27.2 years, s.d. 7.4 years) using vernier callipers. We found a mean ratio between vertical and horizontal ROM ranging from 6.0:1-6.6:1. On an individual basis the ratio ranged from 3.6-15.5. Correlations between vertical and horizontal ROM were weak. On the basis of the results on this study it is concluded that the ratio between vertical and horizontal ROM is approximately 6:1 rather than 4:1, and that the ratio has poor predictive value.

Modified use of a dynamic bite opener--treatment and prevention of trismus in a child with head and neck cancer: a case report.

Trismus may be a complication arising during or after treatment of patients with head and neck cancer. Treatment of trismus is difficult, making prevention very important. To prevent and treat trismus in a patient with a nasopharyngeal tumor, the Contract-Relax-Antagonist-Contract (CRAC) technique was applied, with the aid of a custom-made dynamic bite opener (DBO). The CRAC technique in combination with the DBO, as a therapy/prevention program for trismus, is not referred to in the literature. The combination of CRAC and DBO appeared to be a gentle and effective method well tolerated by the patient.