Can Early First Trimester Ultrasounds Correctly Determine Gestational Age Compared to Ultrasounds Performed Between 7 to 14 Weeks Gestational Age?

OBJECTIVES: The Society of Obstetricians and Gynaecologists of Canada (SOGC) recommends the use of an ultrasound performed between 7 and 14 weeks gestation to accurately predict gestational age (GA). This study aimed to assess the accuracy of earlier ultrasounds (5 to 66 weeks gestation) by comparing the estimated delivery dates (EDD) in participants that had undergone both an earlier ultrasound and ultrasound completed during the standard of care timeframe. METHODS: EDD based on crown-rump length were retrospectively reviewed for patients that had undergone an ultrasound between 5-66 weeks GA versus the recommended 7-14 weeks GA at the Montfort Hospital during 2018 and 2019. The charts of 981 patients that had an ultrasound prior to 7 weeks GA and at 7-14 weeks GA were reviewed; 54 were included. RESULTS: There was no significant difference (P = 0.307) between the EDD of the early (5-66 weeks GA) and the second ultrasound (7-14 weeks GA). The first ultrasounds were then separated into very early (5-56 weeks GA) and early (6-66 weeks GA) and compared. No significant differences (P = 0.579) were found. Similarly, no difference was found between the EDD of the early (6-66 weeks GA) and standard of care timing (P = 0.324). CONCLUSION: These results show no significant difference in accurately determining the EDD between ultrasounds completed at the early and standard of care time points. This could result in cost-saving benefits by foregoing a repeat ultrasound; however, further research is required prior to applying these findings in clinical settings.

Using Self-Reported Measures of Confidence and Anxiety to Determine the Efficacy of the Surgical Exploration And Discovery (SEAD) Program in Reducing Anxiety and Increasing Confidence in Performing Procedural Skills.

OBJECTIVE: Clerkship students feel increased anxiety and lack of confidence when it comes to surgery. This study assessed whether participation in Surgical Exploration And Discovery (SEAD), a 2-week intensive surgical program that includes career information, simulation workshops, and operating room observerships, would help decrease anxiety, increase confidence, and foster interest in a surgical career. SETTING: This study took place at The Ottawa Hospital in Ottawa, Ontario, Canada. DESIGN: Thirty first year medical students were randomly selected for the SEAD program and 32 were only given the program's instruction manual during the duration of the program serving as the control. At baseline and after the completion of SEAD, both groups were given a survey containing the State Trait Anxiety Inventory that measures self-reported anxiety levels with an adjunct that gauges confidence and interest in a surgical career. RESULTS: Students who participated in the program showed significant improvements in self-perceived knowledge and confidence for each surgical skill: scrubbing (p-value < 0.001, p-value < 0.001), maintaining sterility (p-value < 0.001, p-value < 0.001), and surgical assisting (p-value < 0.001, p-value < 0.001). However, there was no difference in the average state anxiety with procedural skills (p-value = 0.190) between students who participated in SEAD and those who did not. Students who completed SEAD had a notable increase in their interest in pursuing a career in surgery compared with their pretest (p-value = 0.020) and compared with the control group (p-value = 0.600). CONCLUSIONS: The SEAD program may increase medical students' confidence and interest in pursuing a surgical career. These results encourage offering medical students with similar opportunities that provide exposure to surgery in preclerkship.

Gender disparity within academic Canadian urology.

INTRODUCTION: Increasing female matriculation into medical school has shown an increase in women training in academic urology, but gender disparity still exists within this male-dominated field. This study aims to evaluate publication productivity and rank differences of Canadian female and male academic urologists. METHODS: The Canadian Residency Matching Service (CaRMS) was used to compile a list of 12 Canadian accredited urology programs. Using each institution's website, faculty members' names, genders, academic positions, and leadership ranks were noted. SCOPUS© was consulted to tabulate the number of documents published, citations, and h-index of each faculty member. To account for temporal bias associated with the h-index, the m-quotient was also computed. RESULTS: There was a significantly higher number of men (164, 88.17%) among academic faculty than women (22, 11.83%). As academic rank increased, the proportion of female urologists decreased. Overall, male urologists had higher academic ranks, h-index values, number of publications, and citations (p=0.038, p=0.0038, p=0.0011, and p=0.014, respectively). There was an insignificant difference between men and women with respect to their m-quotient medians (p=0.25). CONCLUSIONS: There is an increasing number of women completing residency in urology, although there are disproportionally fewer female urologists at senior academic positions. Significant differences were found in the h-index, publication count, and citation number between male and female urologists. When using the m-quotient to adjust for temporal bias, no significant differences were found between the gender in terms of academic output.

Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study.

INTRODUCTION: The recently proposed YEARS algorithm was shown to safely exclude pulmonary embolism (PE) and reduce the use of computed tomography pulmonary angiography (CTPA) among pregnant women with suspected PE. Our aim was to externally validate this finding. METHODS: We performed a post hoc analysis of a prospective management outcome study for PE diagnosis in pregnant women. PE was diagnosed with an algorithm that combined the revised Geneva score, D-dimer testing, bilateral lower-limb compression ultrasonography, and CTPA. All women had a 3-month follow-up. All of the items necessary to use the YEARS algorithm were prospectively collected at the time of the study. RESULTS: Of the 395 women included in the original study, 371 were available for the present analysis. The PE prevalence was 6.5%. Ninety-one women had no YEARS items, and 280 had one or more items. When the YEARS items were combined with D-dimer levels (<1000 ng/mL in women with no items, and <500 ng/mL in women with one or more items), 77 women (21%) met the criteria for PE exclusion and would not have undergone CTPA as per the YEARS algorithm. None of these 77 women had PE diagnosed during the initial work-up or 3-month follow-up. Therefore, the failure rate of the YEARS algorithm in our pregnant women population was 0/77 (95% confidence interval 0.0-3.9). CONCLUSION: In our study, application of the YEARS algorithm would have resulted in safe exclusion of PE in one of five pregnant women without the need for radiation exposure, further supporting the use of the algorithm in this population.

Early implant placement for a patient with ectodermal dysplasia: Thirteen years of clinical care.

Patients with ectodermal dysplasia have abnormalities of 2 or more structures that originate from the ectoderm. The oral manifestations often include the congenital absence of teeth and malformed teeth. This clinical report describes the interdisciplinary care from childhood through the definitive dental rehabilitation completed at skeletal maturation to replace the missing teeth in a patient with ectodermal dysplasia. Treatment began at 9 years of age with an implant-assisted mandibular overdenture to improve function and replace the missing mandibular teeth. Orthodontic treatment for the consolidation of space, composite resin restorations, and interim removable dental prostheses were provided to improve esthetics and replace the missing maxillary teeth. Skeletal growth was monitored, and orthognathic surgery was performed at the cessation of growth. The definitive rehabilitation consisted of a mandibular fixed dental prosthesis supported by dental implants and a maxillary removable dental prosthesis to restore the patient to esthetics and function.

The effects of sleep restriction and altered sleep timing on energy intake and energy expenditure.

Experimental evidence suggests that sleep restriction increases energy intake (EI) and may alter energy expenditure (EE). However, it is unknown whether the timing of a sleep restriction period impacts EI and EE the following day. Hence, we examined the effects of sleep restriction with an advanced wake-time or delayed bedtime on next day EI and EE. Twelve men and 6 women (age: 23±4years, body fat: 18.8±10.1%) participated in 3 randomized crossover sessions: control (habitual bed- and wake-times), 50% sleep restriction with an advanced wake-time and 50% sleep restriction with a delayed bedtime. Outcome variables included sleep architecture (polysomnography), EI (food menu), total EE and activity times (accelerometry). Carbohydrate intake was greater on day 2 in the delayed bedtime vs. control session (1386±513 vs. 1579±571kcal; P=0.03). Relative moderate-intensity physical activity (PA) time was greater in the delayed bedtime session vs. control and advanced wake-time sessions on day 1 (26.6±19.9 vs. 16.1±10.6 and 17.5±11.8%; P=0.01), whereas vigorous-intensity PA time was greater following advanced wake-time vs. delayed bedtime on day 1 (2.7±3.0 vs. 1.3±2.4%; P=0.004). Greater stage 1 sleep (ß=110kcal, 95% CI for ß=42 to 177kcal; P=0.004), and a trend for lower REM sleep (ß=-20kcal, 95% CI for ß=-41 to 2kcal; P=0.07), durations were associated with greater EI between sleep restriction sessions. These findings suggest that the timing of a sleep restriction period impacts energy balance parameters. Additional studies are needed to corroborate these findings, given the increasing prevalence of shift workers and incidences of sleep disorders and voluntary sleep restriction.

Effect of long-term steam autoclaving on changes in torque delivery of spring- and friction-type torque wrenches.

STATEMENT OF PROBLEM: Two types of mechanical torque-limiting devices (MTLD) are available: friction-style and spring-style. Limited information is available regarding the accuracy of different types of MTLDs after sterilization. PURPOSE: The purpose of this in vitro study was to determine the accuracy of MTLDs after sterilization. MATERIAL AND METHODS: Three new friction-style and 3 new spring-style MTLDs (Astra Tech/Dentsply, Zimmer Dental, Biohorizons, Biomet 3i, Straumann [ITI] and Nobel Biocare; n=5 per manufacturer; 30 total) were selected to evaluate their accuracy in delivering the target torque values preset by their manufacturers before and after sterilization. Target torque measurements were made with a digital torque gauge (model DFS2-R-ND; Chatillon) 10 times for each device. All MTLDs were sterilized following the manufacturers' recommendations. The sterilization procedure was repeated 100 times, and the accuracy of all MTLDs was retested. Absolute torque differences were analyzed using a repeated measures analysis of variance with instrument as the repeated factor. MTLD type (friction or spring) and MTLD status (new or autoclaved) were the independent variables. Post hoc testing was done using the Tukey method for balanced data. RESULTS: No significant difference was found between the spring-style and friction-style MTLDs or within the spring-style and friction-style MTLDs before and after sterilization (P>.05). CONCLUSIONS: After 100 cycles of steam autoclaving, the accuracy of spring-style and friction-style MTLDs was similar. All MTLDs fell within ±10% of the target torque value before and after sterilization.

Accuracy of mechanical torque-limiting devices for dental implants.

STATEMENT OF PROBLEM: A common complication in implant dentistry is unintentional implant screw loosening. The critical factor in the prevention of screw loosening is the delivery of the appropriate target torque value. Mechanical torque-limiting devices (MTLDs) are the most frequently recommended devices by the implant manufacturers to deliver the target torque value to the screw. Two types of MTLDs are available: friction-style and spring-style. Limited information is available regarding the influence of device type on the accuracy of MTLDs. PURPOSE: The purpose of this study was to determine and compare the accuracy of spring-style and friction-style MTLDs. MATERIAL AND METHODS: Five MTLDs from 6 different dental implant manufacturers (Astra Tech/Dentsply, Zimmer Dental, Biohorizons, Biomet 3i, Straumann [ITI], and Nobel Biocare) (n=5 per manufacturer) were selected to determine their accuracy in delivering target torque values preset by their manufacturers. All torque-limiting devices were new and there were 3 manufacturers for the friction-style and 3 manufacturers for the spring-style. The procedure of target torque measurement was performed 10 times for each device and a digital torque gauge (Chatillon Model DFS2-R-ND; Ametek) was used to record the measurements. Statistical analysis used nonparametric tests to determine the accuracy of the MTLDs in delivering target torque values and Bonferroni post hoc tests were used to assess pairwise comparisons. RESULTS: Median absolute difference between delivered torque values and target torque values of friction-style and spring-style MTLDs were not significantly different (P>.05). Accuracy of Astra Tech and Zimmer Dental friction-style torque-limiting devices were significantly different than Biohorizons torque-limiting devices (P<.05). CONCLUSIONS: There is no difference between the accuracy of new friction-style MTLDs and new spring-style MTLDs. All MTLDs fell within ±10% of the target torque value. Astra Tech and Zimmer Dental friction-style torque-limiting devices were significantly more accurate than Biohorizons (C) torque-limiting devices (P<.05); however, all the torque-limiting devices fell within ±10% of the target torque value preset by the manufacturers.

Accuracy of mechanical torque-limiting devices for dental implants after clinical service.

STATEMENT OF PROBLEM: Limited information is available regarding the accuracy of mechanical torque-limiting devices (MTLDs) after their clinical use. PURPOSE: The purpose of this study was to determine the accuracy of 2 types of MTLDs (friction-style and spring-style) after clinical use. MATERIAL AND METHODS: Twenty-seven MTLDs in clinical service at The Ohio State University College of Dentistry were collected. Thirteen were friction-style and 14 were spring-style. A total of 6 different dental implant companies were represented (Astra Tech, Zimmer Dental, Biomet 3i, Straumann, Nobel Biocare, and Thommen Medical). All MTLDs had been in use for at least 6 months without being recalibrated, and all were tested to determine their accuracy in delivering target torque values. Statistical analysis used nonparametric tests to determine the accuracy of the MTLDs in delivering target torque values, and Bonferroni post hoc tests were used to assess pairwise comparisons. RESULTS: After clinical service, spring-style MTLDs were significantly more accurate than friction-style MTLDs (P<.05). CONCLUSIONS: Within the limitations of this study, it was concluded that after clinical service, spring-style MTLDs were more accurate than friction-style MTLDs. All MTLDs delivered torque values within 10% of the target torque value.