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Background: Medical students and pediatric residents are not routinely trained in urgent care telemedicine. Increased demand for virtual care following the COVID-19 pandemic is expected to remain, underscoring the need for health care organizations to develop structured training programs that meet the changing educational requirements of future pediatricians. Materials and Methods: The Nemours IRB reviewed this study and designated it a ?Not Research? (#1905675). This mixed-methods study assessed knowledge and comfort levels with telemedicine before and after participants completed a virtual telemedicine training rotation. Seven medical students and pediatric residents completed a brief, pre- and post-rotation survey with multiple-choice, true/false, and open-ended questions. Open-ended questions were thematically analyzed. Results: Improvement in participant knowledge was most notable for understanding the diagnostic limitations of telemedicine. At pretest, only 28.6% of participants believed they could adequately perform a telemedicine examination; after the program, 100% reported comfort with the modality. The most common theme among the participants was the belief that telemedicine played a role in expanding health care access. Discussion: Most participants chose the rotation because of their curiosity about telehealth and came into the training with some general knowledge of its purpose and operation. Exposure to various teaching methods, one-on-one time with attending physicians, and exposure to telemedicine clinical guidelines resulted in positive overall experiences. Conclusion: Our virtual telemedicine rotation curriculum uses an iterative process based on participant feedback to provide a learning experience that is increasingly improved to meet the knowledge level of our participants. Through this quality improvement lens, we aim to maximize participant learning and motivate the development of other remote telemedicine training programs.

Reporting and interpreting effect sizes (ESs) has been recommended by all major bodies within the field of psychology. In this systematic review, we investigated the reporting of ESs in six social-personality psychology journals from 2018, given that this area has been at the center of psychology's replication crisis. Our results highlight that although ES reporting is near perfect (even for follow-up tests), interpreting the magnitude of ESs, including confidence intervals for ESs, and interpreting the precision of the confidence intervals needs development. We also highlight widespread confusion regarding the interpretations of the magnitude of ESs within the context of the research., Author(s): Linda Farmus [sup.1] , Nataly Beribisky [sup.1] , Naomi Martinez Gutierrez [sup.1] , Udi Alter [sup.1] , Emily Panzarella [sup.1] , Robert A. Cribbie [sup.1] Author Affiliations: (1) grid.21100.32, [...]

Adverse drug reactions (ADRs) represent a significant threat to patients’ safety in dentistry, necessitating proactive measures for prevention and treatment. However, identifying ADRs of dental and oral interest can be challenging, and underreporting remains a persistent issue globally. This paper illustrates a smart system to help Italian healthcare personnel, including dentists, in identifying and reporting dental and oral ADRs. This educational program is within a larger multi-regional project financed by the Italian Agency of Drugs (AIFA). The proposed system comprises a free online questionnaire on ADRs of dental interest (including specific items about awareness and attitudes), and after the free consultation of an atlas of clinical images of dental and oral ADRs linked with a digital synopsis of drugs potentially related to ADRs. This section of the project was presented in April 2023 at the 30th National Congress of the Italian College of University Professors of Dental Disciplines, and the system appears to hold tremendous potential to improve the knowledge of healthcare professionals on oral and dental ADRs.

Abstract Background Evidence confirms that the use of Optical Coherence Tomography (OCT) in oral medicine can be a reliable aid for the diagnosis and management of Oral Potentially Malignant Disorders (OPMDs). Several authors described the ability of this system to detect the structural changes of the epithelia involved by the OPMDs. The purpose of this case series is to provide a suggestion for interpretation of OCT images from different OPMDs, compared to OCT images of healthy tissues. Methods A sample of 11 OPMDs patients was recruited and analyzed with OCT. The images obtained were then compared with an OCT repertoire image. In this work the reflectance degree was considered, together with the analysis of the increased/decreased thicknesses of the various layers. Keratin Layer (KL), Epithelial Layer (EP), Lamina Propria (LP), Basal Membrane (BM) assessment, for each lesion, was performed. Results OCT measurements of KL, EP and LP layers, together with BM assessing, should aid the physicians to recognize and describe different oral lesions, relating them to the corresponding oral pathology. Conclusion More studies like this, on larger samples, are needed to validate the results and provide, in the future, a kind of manual that could guide clinicians to correctly interpret the OCT images in relation to the causing pathologies.

Ontologies are used to support access to a multitude of databases that cover domains relevant information. Heterogeneity and different semantics can be accessed by using structured texts and descriptions in a hierarchical concept definition. We are interested in Life Sciences (LS) related ontologies including components taken from molecular biology, bioinformatics, physics, chemistry, medicine and other related areas. An Ontology comprises: (i) term connections, (ii) the identification of core concepts, (iii) data management, (iv) knowledge classification and integration to collect key information. An ontology may be very useful in navigating through LS terms. This paper explores some available biomedical ontologies and frameworks. It describes the most common ontology development environments (ODE): Protégé, Topbraid Composer, Ontostudio, Fluent Editor, VocBench, Swoop and Obo-edit, to create ontologies from textual scientific resources for LS plans. It also compares ontology methodologies in terms of Usability, Scalability, Stability, Integration, Documentation and Originality.

ABSTRACT Mechanical liposuction of cervicomental fat is part of the aesthetic procedures of orofacial harmonization. Ultrasonography stands out for illustrating soft tissues with high-resolution images in the diagnostic and postoperative stages. The present study aimed to report the case of a female patient, 54 years old, in good general health, confirmed by all previously requested laboratory tests, whose main complaint was the presence of excess fat in the jowl region. The stages after the liposuction procedure were followed by high-resolution ultrasound examinations in order to assess the healing of the manipulated tissues, and ultrasound evaluations were performed in the postoperative follow-up periods of 30, 60 and 120 days. Through the present study, it was possible to conclude that ultrasonography is an important ally in the postoperative follow-up of neck liposuction, allowing to follow the evolution of the post-surgical repair process.

BackgroundMany consider that cancer has the greatest impact of any disease in the world, and it can drastically limit patients’ quality of life. Combating such a life-threatening disease can pose many challenges to daily life, highlighted by demonstrating the need to discuss one’s health status within a focus group and encourage treatment compliance.Aimthe purposes of this study were to share the authors’ experience of a modified focus group in an Oral Medicine Unit, termed “Improving Cancer Adult Patients Support Network” (iCAN), and to evaluate how effective communication could improve patients’ quality of life and empower them by virtue of enhanced knowledge and an awareness of cancer management.Methodsthe paper adhered to the COREQ checklist regarding its reporting procedures. The iCAN format was precisely reproduced four times with four groups, consisting of 12 adult male and female patients with solid cancers. They discussed several main topics relating to cancer treatment, as chosen by a majority of the participants. Four specialists were involved in the discussion of the selected topics The iCAN format was faithfully reproduced during each meeting, with the participants in the roles of moderator and health specialists. Finally, a satisfaction questionnaire was administered.Resultsthe most reliable results demonstrated a marked change in lifestyle and eating habits in more than 50% of participants. More than 80% were unaware of the side effects of cancer treatments in general and the oral mucosa in particular. Each meeting reported a maximum degree of satisfaction experienced by the participants.ConclusioniCAN focus group meetings appear to have facilitated a process of narrative interviewing, thereby improving the doctor-patient relationship underlying the humanization of the care process.

Oral potentially malignant disorders can be defined as mucosal lesions and conditions with an increased risk of malignant transformation. Oral potentially malignant disorders are a significant health burden, and they are often diagnosed late due to scant attention to routine dental practice and the low number of specialized oral medicine centres. This report summarizes the DoctOral experience, a research initiative, providing a free smartphone-based decision support tool for the general medical/dental practitioner; the tool is based on the clinical appearance of oral lesions. Captured, oral pictures can be immediately examined via interactive decision trees and constructed on the smartphone. Such decision trees are expressed in standard formats, and they are readily accessible for facilitating the completion of a hypothetical diagnostic path. Since October 2017 the DoctOral mobile app has been downloaded by 10K + users, achieving a score of 4.8 out of 5. DoctOral also supports an unfolding joint initiative, called DoctOralAI: this involves selecting reference images, with which to create an open-source model, and perform a Case-Based Reasoning method, both of which are combined with machine learning. The DoctOral mobile app has revolutionized oral pathology by providing dental students and professionals with an interactive platform for recognizing and diagnosing oral lesions.

Oral Mucositis (OM) is the most common side effect due to chemotherapy and radiotherapy, which are the conventional treatment options for head and neck cancers. OM is a severe inflammatory condition characterized by multifactorial etiopathogenesis. It further negatively affects patients’ quality of life by severe impairment of normal oral functions. Consequently, it is mandatory to identify new effective therapeutic approaches to both prevent and treat OM while also avoiding any recurrence. Polyphenols recently attracted the interest of the scientific community due to their low toxicity and wide range of biological activities making them ideal candidates for several applications in the odontostomatological field, particularly against OM. This review collects the in vivo studies and the clinical trials conducted over the past 13 years evaluating the preventive and curative effects of several polyphenolic compounds towards chemo- and radiotherapy-induced OM, both when administered alone or as a plant-extracted phytocomplex. The literature fully confirms the usefulness of these molecules, thus opening the possibility of their clinical application. However, polyphenol limitations (e.g., unfavourable physicochemical properties and susceptibility to degradation) have emerged. Consequently, the interest of the scientific community should be focused on developing innovative delivery systems able to stabilize polyphenols, thus facilitating topical administration and maximizing their efficacy.

Abstract Background Oral lichen planus (OLP) is an immune-mediated inflammatory chronic disease of the oral mucosa, with different patterns of clinical manifestations which range from keratotic manifestations (K-OLP) to predominantly non-keratotic lesions (nK-OLP). The aim of the study was to analyze the differences in the clinical, psychological profile and symptoms between Italian patients of the North and Central-South with K-OLP and nK-OLP. Methods 270 K-OLP and 270 nK-OLP patients were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were administered. Results The Central-South K-OLP (CS-K-OLP) patients reported a higher frequency of pain/burning compared with the K-OLP patients of the North (N-K-OLP) with higher scores in the NRS and T-PRI (p value

Not available.

Abstract Background Dental age estimation of children may be necessary in the clinical and forensic fields. In the former, it may contribute to the investigation of dental development and biological maturation. In the latter, dental age estimation may support the Court in several circumstances, such as adoption and unidentified bodies of deceased children. This study aimed to apply Willems method for dental age estimation of children from Southeastern Brazil. The second aim of the study was to test the performance of the method modeled with multiple linear regression (MLR) and artificial neural network (ANN). The sample consisted of 1000 panoramic radiographs of female (n = 500) and male (n = 500) Brazilian children. The individuals were evenly distributed through ten age intervals of 1 year from 6 to 15.99 years. Dental development was classified with the 7-teeth technique of Demirjian et al. (1973), followed by age calculation with Willems method (2001). The difference between chronological and estimated ages was quantified for the original Willems model and for the MLR and ANN models. Results For females and males, the overall difference found with Willems original model was 0.27 and 0.28, respectively. With MLR and ANN, the overall differences were 0.54 and 0.35, and 0.26 and 0.24, respectively. The ANN was able to reduce half of the mean error of female age predictions up to 100%. The same phenomenon occurred in 1/3 of the males. Despite the improvements of the ANN model to specific age groups, the original Willems model performed similar or better in 40% of the studied age intervals. All the models showed the worse age predictions in the interval between 15 and 15.99 years (p < 0.001). Conclusions Willems method remains optimal and applicable after 20 years since original development. The ANN model might be an option for future improvements (depending on sex and age interval).

Objective: This paper aims to describe the 2023 update position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF). Methods: This is the second update following the 2013 and 2020 Italian position papers by the Expert panel, which is a representation of the two scientific societies (SIPMO and SICMF). The paper is based on an extensive analysis of the available literature from January 2003 to February 2020, and the subsequent review of literature conducted between March 2020 and December 2022 to include all new relevant published papers to confirm or modify the previous set of recommendations. Results: This position paper highlights the main issues of MRONJ on risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ. Conclusion: The Expert Panel confirmed the MRONJ definition, the diagnostic work‐up, the clinical‐radiological staging system and the prophylactic drug holiday, as recognized by SIPMO‐SICMF; while, it presented novel indications regarding the categories at risk of MRONJ, the prevention strategies, and the treatment strategies associated with the therapeutic drug holiday. [ABSTRACT FROM AUTHOR]

Knowledge of human papillomavirus transmission from the genital tract to the oral mucosa remains unsatisfactory, with poor and often inconsistent literature results. The increase in HPV-associated oral malignancies prompts further analysis of the simultaneous detection of the virus in the two anatomical areas and on the identification of genotypes to be included in future vaccines. Therefore, in this retrospective study, we evaluated orogenital HPV concurrence, hrHPV, lrHPV and type-concordance in 337 samples, as well as the prevalence of the most common genotypes not included in HPV vaccines. Concurrence was found in 12.5% (31/248) of cases, hr-concordance in 61.3% (19/31) and lr-concordance in 12.9% (4/31). Finally, type-concordance was found in 32.3% (10/31) of concurrent infections. Regarding the identification of non-vaccine genotypes, the significantly prevalent genotypes in the anogenital area were HPV66 (12.6%, p < 0.0001), HPV53 (11.1%, p < 0.0001), HPV51 (8.7%, p < 0.0001), HPV42 (8.2%, p < 0.0001) and HPV68 (5.6%, p = 0.0034) in women and HPV66 (14.6%, p = 0.0058), HPV42 (12.2%, p = 0.0428), HPV51 (12.2%, p = 0.0428), HPV53 (12.2%, p = 0.0428), HPV70 (12.2%, p = 0.0428) and HPV73 (12.2%, p = 0.0428) in men. Considering the results of our study, we recommend including the high-risk genotypes HPV51, HPV68, HPV53 and HPV66 in future HPV vaccine formulations.

(1) Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potential adverse drug reaction of antiresorptive and/or antiangiogenic treatment. MRONJ is mostly diagnosed by anamnestic data, clinical examination and radiological findings, with signs and symptoms often unspecific. On the other hand, oral squamous cell carcinoma (OSCC) is characteristic for its pleomorphic appearance (e.g., ulcer, mucous dehiscence, non-healing post-extractive socket). We report three cases where OSCC mimicked MRONJ lesions. (2) Patients: Three patients undergoing amino-bisphosphonate treatment for osteoporosis presented with areas of intraorally exposed jawbone and unspecific radiological signs compatible with MRONJ. Due to the clinical suspicious of malignant lesion, incisional biopsy for histological examination was also performed. (3) Results: Histological examination of the tissue specimen revealed the presence of OSCC. All patients underwent cancer treatment. (4) Conclusions: Several signs and symptoms of OSCC may simulate, in patients with a history of anti-resorptive, MRONJ; for these reasons, it is important to perform histologic analysis when clinicians are facing a suspicious malignant lesion.

The mortality rate of patients affected with oral squamous cell carcinoma (OSCC) has been stable in recent decades due to several factors, especially diagnostic delay, which is often associated with a late stage diagnosis and poor prognosis. The aims of this paper were to: analyze diagnostic delay in OSCC and to discuss the various psychological factors of patients with OSCC, with particular attention to the patient’s fear of receiving news regarding their health; and the professional dynamics related to the decision-making processes in cases of suspected OSCC. A preliminary review of literature focusing on OSCC diagnostic delay was performed. Seven articles were included with the diagnostic delay ranging from 45 days to approximately 6 months. Patients’ fears and, to a lesser degree, the concerns of dentists, were found to be still poorly investigated. On the basis of the authors’ professional experience, the development of oral lesions of unknown origin may generate different behaviors in the decision-making processes by patients and clinicians, and fear may play a key role in the distinct steps of this process. It is crucial to increase awareness and inform patients about the onset of OSCC, and contemporaneously encourage experimental studies on patients’ fear and professional behaviors with respect to communication regarding OSCC.

Abstract Background Re-excision due to positive margins following breast-conserving surgery (BCS) negatively affects patient outcomes and healthcare costs. The inability to visualize margin involvement is a significant challenge in BCS. 5-Aminolevulinic acid hydrochloride (5-ALA HCl), a non-fluorescent oral prodrug, causes intracellular accumulation of fluorescent porphyrins in cancer cells. This single-center Phase II randomized controlled trial evaluated the safety, feasibility, and diagnostic accuracy of a prototype handheld fluorescence imaging device plus 5-ALA for intraoperative visualization of invasive breast carcinomas during BCS. Methods Fifty-four patients were enrolled and randomized to receive no 5-ALA or oral 5-ALA HCl (15 or 30 mg/kg). Forty-five patients (n = 15/group) were included in the analysis. Fluorescence imaging of the excised surgical specimen was performed, and biopsies were collected from within and outside the clinically demarcated tumor border of the gross specimen for blinded histopathology. Results In the absence of 5-ALA, tissue autofluorescence imaging lacked tumor-specific fluorescent contrast. Both 5-ALA doses caused bright red tumor fluorescence, with improved visualization of tumor contrasted against normal tissue autofluorescence. In the 15 mg/kg 5-ALA group, the positive predictive value (PPV) for detecting breast cancer inside and outside the grossly demarcated tumor border was 100.0% and 55.6%, respectively. In the 30 mg/kg 5-ALA group, the PPV was 100.0% and 50.0% inside and outside the demarcated tumor border, respectively. No adverse events were observed, and clinical feasibility of this imaging device-5-ALA combination approach was confirmed. Conclusions This is the first known clinical report of visualization of 5-ALA-induced fluorescence in invasive breast carcinoma using a real-time handheld intraoperative fluorescence imaging device. Trial registration Clinicaltrials.gov identifier NCT01837225 . Registered 23 April 2013.

(1) Background: Gingival cancer has a significant incidence and is often diagnosed at advanced stages. The aim of this paper is to highlight its clinical aspects on the basis of a case series analysis in order to promote awareness and improve the diagnosis process. (2) Methods: Oral cancers diagnosed and treated at three Italian University Hospitals over ten years were retrospectively investigated. Cancer location on the gingiva, edentulous ridge, and retromolar pad was addressed. Data regarding clinical features, stage at the diagnosis, and time from presenting symptoms to first medical consultation were retrieved. (3) Results: Thirty-three cancers located on the gingiva, edentulous ridge, and retromolar pad were retrieved from 276 total oral cancer cases (11.9%). A median of 50 days (range 2–300) passed for the patient to seek for a medical evaluation. At the time of diagnosis, 63.3% were advanced stage cancers, mainly located at the mandible (91%), especially in the retromolar pad (48.5%) and the edentulous alveolar ridge (24.2%). Lesions were red (45.5%), red and white (45.4%), or white (9.1%), appearing as an ulcer (69.7%), exophytic mass (12.1%) or flat lesion (12.1%). Sixty-six percent of cancers were completely asymptomatic, regardless their clinical appearance. A statistically significant association between the time from the presentation of symptoms to the first medical consultation and the cancers stage was found. (4) Conclusions: The clinical appearance of gingival cancer is very polymorphous; its understanding may be significant to improve patient education and early medical consultation.

Abstract Background Although continuous positive airway pressure (CPAP) is the first line treatment for obstructive sleep apnea (OSA) patients, the perioperative adherence rate is unclear. The objective of this study was to determine the perioperative adherence rate of patients with OSA with a CPAP prescription and the effect of adherence on nocturnal oxygen saturation. Methods This prospective cohort study included adult surgical patients with a diagnosis of OSA with CPAP prescription undergoing elective non-cardiac surgery. Patients were divided into CPAP adherent and non-adherent groups based on duration of usage (≥ 4 h/night). Overnight oximetry was performed preoperatively and on postoperative night 1 and 2 (N1, N2). The primary outcome was adherence rate and the secondary outcome was nocturnal oxygen saturation. Results One hundred and thirty-two patients completed the study. CPAP adherence was 61% preoperatively, 58% on postoperative N1, and 59% on N2. Forty-nine percent were consistently CPAP adherent pre- and postoperatively. Using a linear fixed effects regression, oxygen desaturation index (ODI) was significantly improved by CPAP adherence (p = 0.0011). The interaction term CPAP x N1 was significant (p = 0.0015), suggesting that the effect of CPAP adherence varied on N1 vs preoperatively. There was no benefit of CPAP adherence on postoperative mean SpO2, minimum SpO2, and percentage of sleep duration with SpO2

A human papillomavirus (HPV) infection is globally one of the most common causes of sexually transmitted infections of the mucous membranes (genital, anal and oral). Over the last decade, an increasing number of young patients have been infected due to the changes in sexual habits in the general population. The majority of the lesions are benign; however, substantial scientific evidence has suggested a role for the HPV family in the carcinogenesis of squamous cell carcinoma (SCC). It is proposed that dentists, in addition to ENT specialists, should apply standardized management protocols in order to construct a well-defined pathway in terms of diagnosis, which is based on a PCR diagnostic technique and the management of those lesions.

Background: Recent efforts supporting children's dietary behaviors suggest the importance of food literacy (FL), which is a multidimensional concept that encompasses food-related knowledge, skills, and behaviors. To date, FL has been largely informed by adult and adolescent research. Aims: To assess the FL experiences, perceived skills, and knowledge of school-age children to inform FL educational opportunities. Method: Six focus groups were conducted with children (age 9-12 years) from three Massachusetts elementary schools. Two team members independently reviewed and coded a portion of the transcripts to assess interrater reliability. Predominant themes connected to children's perceived FL skills and knowledge were identified using an inductive and deductive content analysis approach. Results: There were five central FL themes identified during the focus groups (n = 31 children), including (1) food systems concepts; (2) food safety and food freshness; (3) gardening environment, perceived skills, and knowledge; (4) cooking environment, perceived skills, and safety; and (5) autonomy of meal preparation. Discussion: The themes that emerged in these focus groups with children provided new information surrounding children's perceived FL skills and knowledge as well as important context regarding the food environment (school vs. home). These findings captured important concepts across the "farm to plate" spectrum and highlight potential school-based opportunities where FL topics could be expanded upon most successfully. Conclusion: This formative research informed educational opportunities for a FL curriculum, which holds promise for improving food-based education and programs, designing more effective interventions, and developing measurement tools.