The Effects of Various Teaching Methods on Chest X-ray Interpretation Skills Among Medical Students and Interns: A Systematic Review

Chest X-ray (CXR) is a common tool used in medical practice. Medical students and interns should acquire knowledge of CXR interpretation, as it is an essential diagnostic tool for a large spectrum of diseases. This systematic review aimed to compare the effect of different intervention techniques on the competency of medical students and interns to demonstrate the level of confidence and competence in interpreting common presentations of CXRs. The population, intervention, comparison, and outcomes (PICO) framework was used to formulate the review question. All related articles in five databases (PubMed, Web of Science, Scopus, Medline, and Embase) were retrieved and the search was completed in March 2023 with no limiters on date and time. The number of relevant studies was 469. A multi-level approach through the Rayyan platform was used for the screening and exclusion processes. Eleven articles were included in the systematic review consisting of eight randomized controlled trials, one quasi-experimental study, one cross-sectional study, and one interventional cohort. Results showed significant effects of teaching methods utilizing deductive or inductive approach, clinical history, patient care comfort survey, and SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled). Contrarily, no significant effect was shown by flipped classroom models and mixed and blocked practice, peer-assisted learning vs. expert-assisted learning, and Chester, an artificial intelligence tool. This review identified beneficial approaches that may enhance the learning outcomes of interpreting CXRs for medical students and interns, highlighting the remarkable impact of SAFMEDS on medical students' ability to identify CXR findings as well as the availability and practicality of online and e-learning resources for students.

Can malocclusion among children impact their oral health-related quality of life? parents' perspective

Background and Aim

Malocclusion can negatively impact the quality of life of children. Therefore, this study assesses the impact of proxy-reported malocclusion and oral health-related quality of life among children in Riyadh, Saudi Arabia, from the parents or guardians' perspectives.

Materials and Methods

A self-administered electronic questionnaire was used to assess the correlation between proxy-reported malocclusion conditions during the early mixed dentition stage (children age 6-12 years) and oral health-related quality of life using the OHIP-14 measure. All collected data were analyzed using SPSS.

Results

Among the 353 participants in the study, anterior open-bite was the most common proxy-reported malocclusion with a prevalence of 19%, followed by unilateral posterior cross bite (13.3%). Furthermore, 31% reported that their children sometimes experienced negative impacts on quality of life from malocclusions. The results also show that OHIP-14 scores were significantly associated with all proxy-reported malocclusion (p < 0.05). The highest OHIP-14 score was found to be significantly associated with the presence of deep-bite from parents' or guardians' perspective.

Conclusion

The presence of some proxy-assessed malocclusion was associated with negative impacts on children's oral health-related quality of life. This is very important to consider when assessing the need for orthodontic intervention, especially at this stage as this age is critical in building a child's confidence and self-esteem.

Effect of pressure support level, patient's effort, and lung mechanics on phase synchrony during pressure support ventilation

BACKGROUND

Pressure support ventilation (PSV) is used to encourage spontaneous breathing and facilitate weaning. During PSV, duration of the breath is not set, but controlled by the patient, and influenced by some ventilator settings. There is no guarantee that the PS breathe will match start and end of patient's breathe. Indeed, patient-ventilator breath mismatching during PSV is the rule, not the exception.

OBJECTIVE

This bench study was conducted to investigate effects of varying PSV, patient's effort, and lung mechanics on trigger response time (TRT), and expiratory delay time (EDT).

METHODS

We used an electromechanical lung simulator (ASL 5000) to create different clinical scenarios. The simulator was set at 15 b/min and inspiratory time of 1 sec. In experiment I, we used 5, 10, 15, and 20 cmH2O of PS at each level of patient effort (Pmus) of 3, 6, and 10 cm H2O. In the second experiment, we set airway resistance (R) at 5, 10, and 20 cm H2O/L/s at each compliance (C) level of 30, 60, and 90 ml/cm H2O. For each combination of setting, we analyzed 5 consecutive breaths and calculated TRT and EDT. Mean values of TRT and EDT for each scenario were reported and compared for trends and statistical significance.

RESULTS

At each given Pmus, increasing PS produced shorter TRT. This effect seems to plateau at higher PS levels. Significant change (p < 0.01) in EDT was noticed with increase in PS setting. Pmus alone did not affect trigger or cycle delay times. Increasing airway resistance caused an increase in TRT, expect when R5 was increased to R10 at compliance levels of 30 and 60 ml/ cm H2O. Similarly, increasing compliance significantly lengthened TRT. Higher R and C produced extended EDT, casing major expiratory asynchrony.

CONCLUSION

This study delineates direction of effect for certain individual variables on patient-ventilator synchrony. Results of this study should help clinicians understand the complexity of synchrony issue.