Situational Awareness in the Context of Clinical Practice.

In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) facilitates clinical reasoning, diagnostic accuracy, and appropriate goal-directed performance, and it enables clinicians to immediately adapt treatment strategies in response to changes in clinical situational actualities and to modify the course of goal-directed activities accordingly. It also helps clinicians prepare future operational plans and procedures based on the projection of situational developments. SA, therefore, is an important prerequisite for safe clinical procedures. The purpose of this narrative review is to highlight certain cognitive and external (environmental) situational factors that influence the development of situational awareness. Understanding the dynamic, adaptive, and complex interactions between these factors may assist clinicians and managers of healthcare systems in developing methods aimed at facilitating the acquisition of accurate clinical situational awareness and, in turn, may bring about a reduction in the incidence of SA, diagnostic, and operational errors.

Errors in clinical diagnosis: a narrative review.

Diagnostic errors are often caused by cognitive biases and sometimes by other cognitive errors, which are driven by factors specific to clinicians, patients, diseases, and health care systems. An experienced clinician diagnoses routine cases intuitively, effortlessly, and automatically through non-analytic reasoning and uses deliberate, cognitively effortful analytic reasoning to diagnose atypical or complicated clinical cases. However, diagnostic errors can never be completely avoided. To minimize the frequency of diagnostic errors, it is advisable to rely on multiple sources of information including the clinician's personal experience, expert opinion, principals of statistics, evidence-based data, and well-designed algorithms and guidelines, if available. It is also important to frequently engage in thoughtful, reflective, and metacognitive practices that can serve to strengthen the clinician's diagnostic skills, with a consequent reduction in the risk of diagnostic error. The purpose of this narrative review was to highlight certain factors that influence the genesis of diagnostic errors. Understanding the dynamic, adaptive, and complex interactions among these factors may assist clinicians, managers of health care systems, and public health policy makers in formulating strategies and guidelines aimed at reducing the incidence and prevalence of the phenomenon of clinical diagnostic error, which poses a public health hazard.

Comparison of apical debris extrusion using clockwise and counter-clockwise single-file reciprocation of rotary and reciprocating systems.

The aim was to evaluate apical debris extrusion produced by a single-file system used in counter-clockwise reciprocation and compare it to rotary single-file systems used in clockwise rotation and clockwise reciprocation. A total of 100 first mandibular molars were divided into five groups (n = 20): (i) WaveOne Gold Glider and Primary instrument in counter-clockwise reciprocation; (ii) One G and One Curve file in clockwise rotation; (iii) One G and One Curve file in clockwise reciprocation; (iv) TruNatomy Glider and Prime instrument in clockwise rotation; and (v) TruNatomy Glider and Prime instrument in clockwise reciprocation. Apical debris extruded was measured after glide path preparation and canal preparation. WaveOne Gold displayed significantly higher amounts of apical debris extrusion in all the groups (P < 0.05). The lowest mean values were recorded by clockwise reciprocation groups: TruNatomy Glider, One Curve and TruNatomy Glider and Prime combined value, for glide path, canal preparation and combined mean values, respectively.