Clinician perspectives on implementation of digitally fabricated complete dentures: A national survey of prosthodontists.

STATEMENT OF PROBLEM: Research on implementation factors for digitally fabricated complete dentures is sparse. PURPOSE: The purpose of this survey of prosthodontists was to explore the current usage of conventionally and digitally fabricated complete dentures and to identify factors that may impact their use. MATERIAL AND METHODS: A confidential cross-sectional survey consisting of 20 questions was conducted in 2019 using the Qualtrics Research Suite. The survey was distributed via electronic mail to all 1820 members of the American College of Prosthodontics. Frequency distributions, chi-squared tests, and Fisher exact tests were used to analyze the data and compare subgroups (α=.05). RESULTS: The response rate was 16.8% (N=305). A total of 31.5% of respondents were implementing digitally fabricated complete dentures, 36.6% were interested in learning and/or incorporating them, 37.7% reported that they had not tried them, and 12.7% had tried them but were not interested in using them again. When asked which factors were important when considering the implementation of digitally fabricated complete dentures, 55.8% indicated laboratory costs, 72.1% total chair time spent, and 81.9% patient satisfaction. Prosthodontists who graduated from dental school after about 1991 were more interested in learning about and incorporating digitally fabricated complete dentures than earlier graduates (P=.02). CONCLUSIONS: The survey results indicate that prosthodontists are implementing digitally fabricated complete dentures in clinical practice but not at the rate that might be expected of a technology that has been available for nearly a decade. Factors reported to matter in the decision to implement this technology were decreased time, overall cost, and improved patient satisfaction.

Biomechanical comparison of transosseous cortical button and Footprint repair techniques for acute distal biceps tendon ruptures.

BACKGROUND: The biceps brachii is the main forearm supinator, which is a direct consequence of its anatomic arrangement. The primary aim of distal biceps rupture is to restore supination strength and function. Cadaveric studies demonstrate that anatomic repairs significantly improve the supination moment when compared to more anterior repairs; however, this has not been tested in the clinical setting. The aim of this study was to compare biomechanical and clinical outcomes of an anatomic repair (Footprint), with a widely used transosseous technique (Endobutton). METHODS: Twenty-two patients were retrospectively identified from a clinical database (11 Footprint versus 11 Endobutton). Biomechanical performance of strength and endurance for flexion and supination was assessed using a validated isokinetic dynamometry protocol and clinical outcome scores (Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure and the Mayo Elbow Performance Score) were collected for all patients. RESULTS: For supination, the Footprint group demonstrated a superior trend for all biomechanical parameters tested. This was statistically significant for mean peak torque, total work of maximal repetition and work in the last third of repetitive testing (p = 0.031, p = 0.036 and p = 0.048). For flexion, the Footprint group demonstrated a superior trend for all biomechanical parameters tested but this was only statistically significant for work in the last third of repetitive testing (p = 0.039). The clinical outcomes were good or excellent for all patients in both groups. CONCLUSION: This study is the first to demonstrate that an anatomic Footprint repair restores superior biomechanical supination strength and endurance compared to a conventional Endobutton technique in a clinical setting. Both techniques, however, provide good or excellent clinical outcomes.

E-learning for self-management support: introducing blended learning for graduate students - a cohort study.

BACKGROUND: E-learning allows delivery of education in many diverse settings and researchers have demonstrated it can be as effective as learning conducted in traditional face-to-face settings. However, there are particular practices and skills needed in the area of providing patient self-management support (SMS), that may not be achievable online. The aim of this study was to compare three approaches in the training of university students regarding the preparation of a Chronic Condition Self-Management Care Plan: 1) traditional face-to-face delivery of SMS training, 2) an e-learning approach and 3) a blended approach (combining e-learning and face-to-face teaching). METHODS: Graduate entry physiotherapy students and medical students at Flinders University were recruited. Depending on the cohort, students were either exposed to traditional face-to-face training, e-learning or a blended model. Outcomes were compared between the three groups. We measured adherence to care plan processes in the preparation of an assessment piece using the Flinders Program Chronic Care Self Management tools. A total of 183 care plans were included (102 traditional, 52 blended, 29 e-learning,). All students submitted the Flinders Program Chronic Care Plan for university assessment and these were later assessed for quality by researchers. The submission was also assigned a consumer engagement score and a global competence score as these are integral to successful delivery of SMS and represent the patient perspective. RESULTS: The blended group performed significantly better than the traditional group in quality use of the Flinders Program tools: Problem and Goals (P < 0.0001). They also performed significantly better in the total care plan score (P < 0.0001) and engagement score (P < 0.0001). There was no significant difference between the groups for the Partners in Health tool. CONCLUSIONS: In this pilot study, the blended learning model was a more effective method for teaching self-management skills than the traditional group, as assessed in the development of a chronic condition self-management care plan. We anticipate that future research with identical groups of students would yield similar results but in the meantime, academics can have confidence that blended learning is at least as effective as traditional learning methods.

FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES.

OBJECTIVES: To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. BACKGROUND/PURPOSE: While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. METHODS: A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. RESULTS: At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque (p = 0.47) or total work (p = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue (p = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F(1,22)=5.67, p = 0.03. CONCLUSION: The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. STUDY DESIGN: Retrospective case series. LEVEL OF EVIDENCE: Level 4.

Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: a two-year observational study.

AIMS: To observe the natural history of hand function during a two-year period in participants with hand syndromes associated with diabetes and to determine factors related to changing function. METHODS: Hand function was measured over three annual visits using Disability of the Arm, Shoulder and Hand (DASH) and SF-36v2 questionnaires, grip strength, light touch and 9-hole peg tests. Light touch was tested with WEST monofilaments at 7 sites on the hand (score 35 to 0). Data were analyzed using repeated-measures ANOVA, Spearman's correlation, and Wilcoxon signed-rank tests. RESULTS: Participants (n=60) were aged 61 ± 10.5 years, 57% female, diagnosed with diabetes and at least one of four associated hand disorders. Presentations of carpal tunnel syndrome, or past release (n=27, 45%) and trigger finger (n=24, 40%) were common. Tactile sensation was reduced during the two-year period (median, range; 30 months, 25-40 months). Initial median (inter-quartile range) scores for the dominant hand of 25.5 (22-28.5) were reduced to 23 (21.5-27). This sensory loss was weakly associated with HbA1c (r=0.30, p=0.05) and occurred predominantly in participants with trigger finger (p=0.05). CONCLUSIONS: Light touch perception was reduced in longstanding diabetic hand syndromes. Tactile abnormalities that were detected by clinical examination progressed during a two year period and were related to metabolic control and musculoskeletal diagnosis.

Hand syndromes associated with diabetes: impairments and obesity predict disability.

OBJECTIVE: We determined patterns of disability in diabetic hand conditions and identified factors that contributed to functional limitations. METHODS: Hand assessments were performed on 60 adults with DM1 or DM2 and carpal tunnel syndrome, trigger finger, Dupuytren's disease, or the syndrome of limited joint mobility. The examination included measurement of grip strength, light touch perception, and dexterity, as well as self-reported function using the Disabilities of the Arm, Shoulder and Hand (DASH) instrument and the Medical Outcomes Study Short Form-36 questionnaire. Associations with hand disability were analyzed using correlation and regression. RESULTS: The most frequent presentation was carpal tunnel syndrome (45%) but it was common for patients to present with clinical features associated with more than one hand syndrome (47%). Overall, women had greater difficulties, with significantly higher DASH scores than men [mean 30.3 (95% CI 23.2, 37.5) vs 18.0 (95% CI 12.1, 23.9), respectively; p = 0.01]. Grip strength, dexterity, and obesity were associated with hand disability (p < 0.05). CONCLUSION: In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome. Obesity and overall physical functioning influenced hand disability, particularly in women.