Comparison of Treatment Time for Single-Implant Crowns Between Digital and Conventional Workflows for Posterior Implant Restorations: A Randomized Controlled Trial

PURPOSE

To compare the treatment time of digital and conventional workflows for single-implant crowns, as well as prostheses made of polymer-infiltrated ceramic-network (PICN; Vita Enamic, Vita Zahnfabrik) and lithium disilicate (LS2; n!ce, Straumann).

MATERIALS AND METHODS

A total of 40 patients who needed a single-implant crown in posterior regions were considered and randomly divided into digital workflows (n = 20) that used an intraoral scanner (IOS; iTero Element 5D, Align Technologies) and conventional workflows (n = 20) that used polyether impressions (3M ESPE Impregum Penta). Then, each group was again distributed into two subgroups based on the crown material used: PICN (n = 10) and LS2 (n = 10). Treatment time was calculated for both digital and conventional workflows. Analysis was done at a 5% confidence interval (P < .05). An independent two-sample t test was used to compare treatment time between the groups. The Kruskal-Wallis test was used to compare clinical try-in time among subgroups. Any of the implant crowns that had to be remade in each subgroup were evaluated using the Fisher exact test.

RESULTS

The entire process of digital and conventional workflows required 104.31 ± 20.83 and 153.48 ± 16.35 minutes, respectively. Digital workflows saved 39.2% more time than the conventional protocol for the single-implant crown treatment (P < .0001).

CONCLUSIONS

Both digital and conventional workflow protocols can achieve a successful outcome for single-implant monolithic crowns in posterior areas. The digital protocol yielded greater timesaving over the conventional procedure in data acquisition and laboratory steps, while the time for clinical try-in and delivery were similar.

Towards a Regulatory Framework for Electronic Medical Record Data Visualization

Physicians struggle to retrieve data from electronic medical records. We evaluated a digital tool that enhances physician efficiency in retrieving and analyzing patient information for treatment decision-making. Our use case is the care of diabetic patients. Evaluation results showed that healthcare providers who used the i4C (Insights for Care) dashboard experienced greater time efficiency than those who used traditional EMR information retrieval methods. A comprehensive evaluation of the i4C Dashboard confirms its effectiveness in facilitating diabetic care data management, as well as its potential application to a wide range of healthcare scenarios. In order to further maximize its effectiveness on clinical efficiency and patient care, future research should focus on improving its usability and scalability.

Expertise differences in cognitive interpreting: A meta-analysis of eye tracking studies across four decades

This meta-analytic research delves into the influence of expertise on cognitive interpreting, emphasizing time efficiency, accuracy, and cognitive effort, in alignment with prevailing expertise theories that link professional development and cognitive efficiency. The study assimilates empirical data from 18 eye-tracking studies conducted over the past four decades, encompassing a sample of 1581 interpreters. The objective is to elucidate the role of expertise in interpretative performance while tracing the evolution of these dynamics over time. Findings suggest that expert interpreters outperform novices in time efficiency and accuracy and exhibit lower cognitive effort, especially in sight and consecutive interpreting. This effect is particularly pronounced in the English-Chinese language pair and with the use of E-prime and Tobii eye-tracking systems. Further, fixation count and pupil size are essential metrics impacting cognitive effort. These findings have vital implications for interpreter training programs, suggesting a focus on expertise development to enhance efficiency and accuracy, reduce cognitive load, and emphasize the importance of sight interpreting as a foundational skill. The selection of technology and understanding of specific ocular metrics also emerged as essential for future research and practical applications in the interpreting industry. This article is categorized under: Psychology > Theory and Methods Linguistics > Cognitive.

Performance of CT-based deep learning in diagnostic assessment of suspicious lateral lymph nodes in papillary thyroid cancer: a prospective diagnostic study

BACKGROUND

Preoperative evaluation of the metastasis status of lateral lymph nodes (LNs) in papillary thyroid cancer is challenging. Strategies for using deep learning to diagnosis of lateral LN metastasis require additional development and testing. This study aimed to build a deep learning-based model to distinguish benign lateral LNs from metastatic lateral LNs in papillary thyroid cancer and test the model's diagnostic performance in a real-world clinical setting.

METHODS

This was a prospective diagnostic study. An ensemble model integrating a three-dimensional residual network algorithm with clinical risk factors available before surgery was developed based on computed tomography images of lateral LNs in an internal dataset and validated in two external datasets. The diagnostic performance of the ensemble model was tested and compared with the results of fine-needle aspiration (FNA) (used as the standard reference method) and the diagnoses made by two senior radiologists in 113 suspicious lateral LNs in patients enrolled prospectively.

RESULTS

The area under the receiver operating characteristic curve of the ensemble model for diagnosing suspicious lateral LNs was 0.829 (95% CI: 0.732-0.927). The sensitivity and specificity of the ensemble model were 0.839 (95% CI: 0.762-0.916) and 0.769 (95% CI: 0.607-0.931), respectively. The diagnostic accuracy of the ensemble model was 82.3%. With FNA results as the criterion standard, the ensemble model had excellent diagnostic performance ( P =0.115), similar to that of the two senior radiologists ( P =1.000 and P =0.392, respectively).

CONCLUSION

A three-dimensional residual network-based ensemble model was successfully developed for the diagnostic assessment of suspicious lateral LNs and achieved diagnostic performance similar to that of FNA and senior radiologists. The model appears promising for clinical application.

Intraoral Scan Accuracy and Time Efficiency in Implant-Supported Fixed Partial Dentures: A Systematic Review

The digital implant impression technique (DIT) and conventional implant impression technique (CIT) workflows in implant-supported fixed partial dentures (FPDs) have not been extensively compared in prior studies. Moreover, there is no agreement on the more accurate method that entails less time in the laboratory and during the clinical phases of fabrication and delivery of the prosthesis, respectively. This review aimed to assess the precision of the imaging procedure and overall fabrication time of the DIT and CIT for the implant-supported FPDs. An electronic search was performed using PubMed, Scopus, EMBASE, Cochrane Oral Health Group, and Dentistry and Oral Science Source databases through EBSCO for relevant studies from January 2014 to April 2023. Following the preliminary screening, the studies that met the inclusion criteria underwent full-text review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Collaboration risk of bias appraisal tool and Newcastle-Ottawa scale were applied to assess the quality of randomized controlled trials (RCTs) and non-randomized prospective clinical studies, respectively. The initial search yielded 332 studies, and after excluding duplicates, 241 papers were available for screening. Titles and abstracts were reviewed, and 97 articles were chosen for full-text review by two authors independently. Furthermore, 89 articles were excluded in compliance with the PICOS question, and eight studies were chosen for qualitative analysis. Hence, the review comprised two RCTs and six prospective clinical studies. The time efficiency of the implant-supported FPDs was examined in four investigations, three of which used the Trios 3 scanner and one used the Intero scanner. The three-dimensional accuracy of DIT and CIT was compared in six clinical comparative studies. One of the RCTs was rated to have a high risk of bias and the other with a moderate quality of evidence. The six prospective studies were rated to have high-quality of evidence. The findings of this review indicate the prospective applicability of future intraoral scanning systems. The DIT was reported to be outstanding in terms of patient preferences and total fabrication time efficiency. Additional in vivo studies are needed to establish the therapeutic usefulness and time efficiency of integrating DIT in more comprehensive settings.

End-to-End Impact of a Cloud-Based Surgical Planning System on Efficiency in Cataract Surgery: A Time-and-Motion Study

Purpose

Inefficiencies from manual data entry and non-integration exist throughout the cataract surgery workflow. The aim of this study was to evaluate the impact of SMARTCataract, an innovative cloud-based digital surgical planning platform (SPS) on efficiency in preoperative (diagnostic workup, surgery planning), intraoperative, and postoperative phases of cataract surgery. The primary objective aimed to assess time and number of manual transcription data points (TPs) required for all pre-, intra-, and postoperative devices that integrate with the SPS and surgery planning time across three patient types (post-refractive, astigmatic, conventional). The secondary objective aimed to assess the overall efficiency impact of the SPS on the surgery workflow for the three patient types by leveraging time-and-motion methods and workflow mapping.

Patients and Methods

This prospective, observational, real-world, pre- and post-cohort time-and-motion study included patients undergoing evaluation for cataract surgery and/or surgery at the study site. Assessed variables included time and TPs required for clinical activities and devices associated with traditional manual methods (pre-cohort) versus the SPS (post-cohort). Statistical analyses (t-test) were performed comparing performance time using the SPS versus traditional methods for each integrated technology and surgery planning activity.

Results

The SPS demonstrated statistically significant time savings over traditional methods in TP data input time taken across all integrated pre-, intra-, and postoperative devices (p<0.0001). The SPS additionally demonstrated statistically significant time savings in preoperative surgery planning across post-refractive (p<0.0001), astigmatic (p=0.0005), and conventional (p=0.0004) cataract patient groups. Overall, the SPS reduced end-to-end patient workflow time and TPs for post-refractive, astigmatic, and conventional cataract patients by averages of 13.2, 12.6, and 4.3 minutes and 184, 166, and 25 TPs per patient, respectively.

Conclusion

Through the SPS' integration and surgery planning capabilities, substantial time efficiencies can be achieved for cataract surgery practices, clinicians, and patients compared to surgery planning with traditional manual methods.

Do Personal Nurse-Initiated Medication Boxes Work in Prison? A Cross-Sectional Study Involving Incarcerated Persons and Prison Officers in a Swiss Prison

INTRODUCTION

Daily in-hand medication dispensing in prisons and jails is resource intensive, disempowering, and nonconfidential. This research aimed to assess a nurse-initiated, low-frequency medication dispensing system using personal lockable boxes.

METHODS

A cross-sectional study was carried out in a Swiss prison involving 47 box users and 19 custodial officers.

FINDINGS

Box users agreed or strongly agreed about the perceived advantages of the box system, including user-friendliness, lower theft risk, and increased dignity, confidentiality, compliance, and autonomy to self-manage medication. Officers, who must accompany nurses during dispensing rounds, concurred that medication boxes were more time-efficient and improved role differentiation between custodial and clinical staff. Patients and officers were overall satisfied with the system and would recommend scaling it up in other facilities.

DISCUSSION

This study suggests that medication boxes are feasible, acceptable, easy to use, and secure. Boxes could promote patients' autonomy, protect confidentiality, and allow nurses to dedicate more time to individual visits and health promotion and prevention activities.

Time-efficient implantable catheters for draining malignant ascites in terminal cancer patients

BACKGROUND

There is a need for an improved version of the implantable catheter for malignant ascites in the abdominal cavity.

OBJECTIVE

New implantable catheters have been developed that drain ascites from the abdominal cavity to the bladder by applying pressure. Based on pigtail catheters, these newly designed catheters have silicone membranes and apertures.

METHODS

Experimental instruments controlled flow rates and water level to observe changes of the activation pressure and its cycle time along flow rates and turns of catheters. Furthermore, various normality tests, difference tests and non-parametric tests were investigated to observe statistical validity.

RESULTS

Cycle times were significantly affected by flow rate (3/4 cases of p< 0.05). The effects of flow rate on activation pressure, however, were not significant (1/4 case of p< 0.05). Cycle times were not significantly affected by the number of turns of the catheter (3/8 cases of p< 0.05). In contrast, the effects of the turns on activation pressure were significant (5/8 cases of p< 0.05).

CONCLUSION

Overall, there was no significant difference between cycle times for 1.5 turns and 2.0 turns of catheters. In addition, catheters with 1.5 turns have a lower activation pressure than catheters with 2.0 turns. It is possible to customize catheters based on the ascites excretion and urination rates of various terminal patients.

Impact of Artificial Intelligence Assistance on Chest CT Interpretation Times: A Prospective Randomized Study

BACKGROUND. Deep learning-based convolutional neural networks have enabled major advances in development of artificial intelligence (AI) software applications. Modern AI applications offer comprehensive multiorgan evaluation. OBJECTIVE. The purpose of this article was to evaluate the impact of an automated AI platform integrated into clinical workflow for chest CT interpretation on radiologists' interpretation times when evaluated in a real-world clinical setting. METHODS. In this prospective single-center study, a commercial AI software solution was integrated into clinical workflow for chest CT interpretation. The software provided automated analysis of cardiac, pulmonary, and musculoskeletal findings, including labeling, segmenting, and measuring normal structures as well as detecting, labeling, and measuring abnormalities. AI-annotated images and autogenerated summary results were stored in the PACS and available to interpreting radiologists. A total of 390 patients (204 women, 186 men; mean age, 62.8 ± 13.3 [SD] years) who underwent out-patient chest CT between January 19, 2021, and January 28, 2021, were included. Scans were randomized using 1:1 allocation between AI-assisted and non-AI-assisted arms and were clinically interpreted by one of three cardiothoracic radiologists (65 scans per arm per radiologist; total of 195 scans per arm) who recorded interpretation times using a stopwatch. Findings were categorized according to review of report impressions. Interpretation times were compared between arms. RESULTS. Mean interpretation times were significantly shorter in the AI-assisted than in the non-AI-assisted arm for all three readers (289 ± 89 vs 344 ± 129 seconds, p < .001; 449 ± 110 vs 649 ± 82 seconds, p < .001; 281 ± 114 vs 348 ± 93 seconds, p = .01) and for readers combined (328 ± 122 vs 421 ± 175 seconds, p < .001). For readers combined, the mean difference was 93 seconds (95% CI, 63-123 seconds), corresponding with a 22.1% reduction in the AI-assisted arm. Mean interpretation time was also shorter in the AI-assisted arm compared with the non-AI-assisted arm for contrast-enhanced scans (83 seconds), noncontrast scans (104 seconds), negative scans (84 seconds), positive scans without significant new findings (117 seconds), and positive scans with significant new findings (92 seconds). CONCLUSION. Cardiothoracic radiologists exhibited a 22.1% reduction in chest CT interpretations times when they had access to results from an automated AI support platform during real-world clinical practice. CLINICAL IMPACT. Integration of the AI support platform into clinical workflow improved radiologist efficiency.

Internet Use and Job Satisfaction: Evidence from China

We explore the causal effects of Internet use on job satisfaction using a sample of 83,012 Chinese labor force members aged 16-64 years from the China Family Panel Studies (CFPS) from 2010 to 2018. We use ordered logistic estimation and find that Internet use significantly increases job satisfaction by 3.2%. Heterogeneity analysis shows that the Internet has a more positive impact on those who are in urban areas and have higher incomes and higher education. Our results are robust after eliminating endogeneity using instrumental variables and solving the self-selection problem using the PSM method. Our mechanistic analysis leads to similar conclusions to mainstream research, where Internet use induces job satisfaction by increasing time efficiency and enhancing job autonomy. Specifically, shorter working hours boosted job satisfaction by approximately 0.3%, while working in informal places boosted job satisfaction by 5.4%. Thus, employers may consider encouraging employees to access the Internet.

Effect of training on time efficiency and marginal adaptation of computer-aided design/computer-aided manufacturing crowns among dental students

INTRODUCTION

The computer-aided design/computer-aided manufacturing (CAD/CAM) technology has revolutionised dentistry at present. An operator's skills can affect the overall clinical duration and marginal accuracy of the prosthesis fabricated through this workflow. The aim of this study was to assess the effect of CAD/CAM hands-on training compared with that of a self-instructional video on the performance of dental students in digital impression and fabrication of a CAD/CAM crown.

METHODS

In this cross-sectional study, 30 undergraduate dental students were shown a CEREC demonstration video. Each operator then captured a digital impression using the intra-oral scanner, and a crown was subsequently milled. All participants underwent a training course before repeating the process. Marginal discrepancy for each crown on its abutment tooth was measured before and after training using a stereomicroscope and was evaluated using Wilcoxon signed rank test. The duration taken for the process was recorded before and after training and evaluated using paired t-test.

RESULTS

The overall mean ±standard deviation marginal adaptation for the CEREC crowns was 78.15 ± 42.83 μm before training and 52.41 ± 17.12 μm after training. The Wilcoxon signed rank test found significant difference (p < .05) in terms of marginal adaptation of crowns fabricated before and after training. Paired t-tests showed that the time efficiency after training significantly improved compared with that before training.

CONCLUSIONS

Training with guided feedback is crucial to improve the time efficiency of making a digital impression and marginal adaptation of fixed prosthesis using the CAD/CAM technology.

The time complexity of self-assembly

Time efficiency of self-assembly is crucial for many biological processes. Moreover, with the advances of nanotechnology, time efficiency in artificial self-assembly becomes ever more important. While structural determinants and the final assembly yield are increasingly well understood, kinetic aspects concerning the time efficiency, however, remain much more elusive. In computer science, the concept of time complexity is used to characterize the efficiency of an algorithm and describes how the algorithm's runtime depends on the size of the input data. Here we characterize the time complexity of nonequilibrium self-assembly processes by exploring how the time required to realize a certain, substantial yield of a given target structure scales with its size. We identify distinct classes of assembly scenarios, i.e., "algorithms" to accomplish this task, and show that they exhibit drastically different degrees of complexity. Our analysis enables us to identify optimal control strategies for nonequilibrium self-assembly processes. Furthermore, we suggest an efficient irreversible scheme for the artificial self-assembly of nanostructures, which complements the state-of-the-art approach using reversible binding reactions and requires no fine-tuning of binding energies.

Time Efficiency of Immediate Loading of Full-arch Implant Reconstructions Using Prefabricated Prostheses Located by an Anchor Pin: a Pilot Study

OBJECTIVE

To investigate the time efficiency of prefabricated prostheses located by an anchor pin stereolithographic attachment system for immediate loading implant reconstruction of completely edentulous jaws and compare it with the conventional protocol.

METHODS

Edentulous patients were recruited and randomly assigned into two groups: the full digital workflow group (digital group) and the conventional workflow group (conventional group). In the digital group, a provisional prosthesis was fabricated before surgery using a fully digital workflow and delivered immediately after implant placement. The positioning of the provisional prosthesis was guided precisely by the anchor pin attachment system. In the conventional group, the provisional prosthesis was fabricated after implant placement using a conventional procedure. Clinical and laboratory time efficiency were recorded, and clinician and patient satisfaction were evaluated.

RESULTS

Six patients were enrolled in this pilot study and 57 implants were placed following the guided surgery protocol. Of these, 54 were immediately loaded. The total clinical chair time in the digital workflow group was significantly less than that in the conventional workflow group (digital 60.0 ± 13.2 minutes; conventional 106.7 ± 24.7 minutes) (P = 0.045). The total post-surgery procedure took significantly less time in the digital group than the conventional group (digital 202.5 ± 22.5 minutes; conventional 403.7 ± 55.4 minutes) (P = 0.004). The patients' and clinicians' satisfaction with the provisional prostheses was similar in both groups.

CONCLUSION

Time efficiency in immediate loading of implant-supported full-arch fixed restorations was improved with prefabricated prostheses located by the anchor-pin-attachment system. Less postoperative chair time was required in the digital group than in the conventional group.

Accuracy Evaluation of Additively and Subtractively Fabricated Palatal Plate Orthodontic Appliances for Newborns and Infants-An In Vitro Study

Different approaches for digital workflows have already been presented for their use in palatal plates for newborns and infants. However, there is no evidence on the accuracy of CAD/CAM manufactured orthodontic appliances for this kind of application. This study evaluates trueness and precision provided by different CAM technologies and materials for these appliances. Samples of a standard palatal stimulation plate were manufactured using stereolithography (SLA), direct light processing (DLP) and subtractive manufacturing (SM). The effect of material (for SM) and layer thickness (for DLP) were also investigated. Specimens were digitized with a laboratory scanner (D2000, 3Shape) and analyzed with a 3D inspection software (Geomagic Control X, 3D systems). For quantitative analysis, differences between 3D datasets were measured using root mean square (RMS) error values for trueness and precision. For qualitative analysis, color maps were generated to detect locations of deviations within each sample. SM showed higher trueness and precision than AM technologies. Reducing layer thickness in DLP did not significantly increase accuracy, but prolonged manufacturing time. All materials and technologies met the clinically acceptable range and are appropriate for their use. DLP with 100 µm layer thickness showed the highest efficiency, obtaining high trueness and precision within the lowest manufacturing time.

The dentist will scan you now: The next generation of digital-savvy graduates

INTRODUCTION

Undergraduate dental curriculum consisting of digital tools is essential in today's era of modern dentistry. The aim of this study was to evaluate final-year undergraduate dental students' perception of using intraoral scanners and the feasibility of increasing exposure to intraoral scanners in their undergraduate programme.

MATERIALS AND METHODS

Forty students volunteered to complete one maxillary conventional and optical impression (TRIOS 3, 3Shape A/S). Questionnaires were used to assess their familiarity, perceived confidence levels, difficulties and user-friendliness of each technique using a visual analogue scale prior to and after experiencing each impression technique.

RESULTS

Students felt more familiar with conventional (C) than digital (D) impressions (P = .00). Their pre-confidence level was also higher with the conventional method (C: 80.9 ± 15.5; D: 39.6 ± 25.5); however, the post-confidence level significantly increased for the digital impression technique (P = .00). Participants perceived conventional technique to be easier (P = .02) and faster than optical impressions (P = .03). User-friendliness of the intraoral scanner scored moderate (67.7 ± 22.9). The difference in the mean total working time was not significant (P = .05). Forty per cent of participants indicated that they preferred using the digital impression technique.

CONCLUSIONS

Although final-year undergraduate students still perceived the conventional impression technique to be easier and faster than digital scanning, there was a significant increase in the level of confidence by this cohort after only one occasion of clinical optical impressions. Undergraduate dental students are ready to uptake new technology, and it should be strongly considered to incorporate more digital scanning during their training.

Influence of Scanning-Aid Materials on the Accuracy and Time Efficiency of Intraoral Scanners for Full-Arch Digital Scanning: An In Vitro Study

This study was performed to verify the influence of scanning-aid materials on the accuracy and time efficiency of full-arch scanning with intraoral scanners. The full-arch reference model was constructed by a 3D printer and scanned with a model scanner to obtain the reference dataset. Four experimental groups (application of ScanCure (SC-80, ODS Co, Incheon, Korea), IP Scan Spray (IP-Division, Haimhausen, Germany) and Vita Powder Scan Spray (Vita Zahnfabrik, Stuttgart, Germany), and no treatment) were designed, and the scans were executed (trueness, n = 5) using two intraoral scanners: I500 (Medit Co., Seoul, Korea) and TRIOS (3shape, Copenhagen, Denmark). All acquired scan data were compared with the reference datasets using the 3D superimposition method and 2D linear measurements. In the 3D analysis, intragroup data were compared with each other (precision, n = 10). Time efficiency was also verified by comparing the scan times of the four experimental groups. In the 3D analysis, the root mean square (RMS) value of the precision of the scanned image was statistically significantly more accurate in the scanning-aid agent-treated groups than in the no-treatment group (p < 0.05). However, the RMS values of trueness and the types of scanning-aid materials were not significantly different. In the 2D measurements, the increased scan distance generated a greater distance deviation. The working time was significantly shorter in the scanning-aid agent groups than in the no-treatment group, with statistical significance (p < 0.05). Therefore, in clinical situations, the application of scanning-aid materials is recommended to reduce scanning time and more efficiently obtain the full-arch scanned image.

Fracture Load of an Orthodontic Appliance for Robin Sequence Treatment in a Digital Workflow

CAD/CAM technologies and materials have the potential to improve the treatment of Robin Sequence with orthodontic appliances (Tübingen palatal plate, TPP). However, studies on the provided suitability and safety are lacking. The present study evaluates CAD/CAM technologies and materials for implementation into the workflow for producing these orthodontic appliances (TPPs), manufactured by different techniques and materials: additive manufacturing (AM) and subtractive manufacturing (SM) technologies vs. conventional manufacturing. The fracture load was obtained in a universal testing machine, and the breaking behavior of each bunch, as well as the necessity of adding a safety wire, was evaluated. The minimum fracture load was used to calculate the safety factor (SF) provided by each material. Secondary factors included manufacturing time, material cost and reproducibility. Dental LT clear showed the highest fracture load and best breaking behavior among AM materials. The highest fracture load and safety factor were obtained with Smile polyether ether ketone (PEEK). For the prototyping stage, the use of a Freeprint tray (SF = 114.145) is recommended. For final manufacturing, either the cost-effective approach, Dental LT clear (SF = 232.13%), or the safest but most expensive approach, Smile PEEK (SF = 491.48%), can be recommended.

Clinical Evaluation of Time Efficiency and Fit Accuracy of Lithium Disilicate Single Crowns between Conventional and Digital Impression

The purpose of this study was to demonstrate the time-efficiency and the clinical effectiveness of chairside-fabricated lithium disilicate single crowns by digital impressions compared to the conventional method. Thirteen patients requiring a single crown on the maxillary or mandibular premolar or first molar were assigned as study subjects. The impressions were obtained using the conventional method and two digital methods with intraoral scanners: AEGIS.PO (Digital Dentistry Solution, Seoul, Korea) and CEREC Omnicam (Sirona, Bensheim, Germany). Two types of lithium disilicate single crowns were obtained; a reference crown (by conventional workflow) and a chairside crown (by digital workflow). The total time taken for fabricating the chairside crown was recorded. The replica technique was performed to compare the marginal and internal fit of the two types of crowns. In addition, accuracy of the intraoral scanners was evaluated by the best-fit alignment method. The difference between the groups was analyzed using the two-tailed paired t-test or one-way ANOVA, followed by the Student–Newman–Keuls test for multiple comparisons. Statistical significance was accepted at p < 0.05 for all statistical tests. The time required to obtain the impressions by the AEGIS (7:16 ± 1:50 min:s) and CEREC (7:29 ± 2:03 min:s) intraoral scans was significantly lower than the conventional method (12:41 ± 1:16 min:s; p < 0.001). There was no significant difference between the intraoral scanners. The total working time to fabricate the chairside crown averaged 30:58 ± 4:40 min:s. The average marginal gap was not significantly different between the reference (107.86 ± 42.45 µm) and chairside (115.52 ± 38.22 µm) crowns (p > 0.05), based on results of replica measurement. The average internal gaps were not significantly different. The average value of the root mean square between the AEGIS (31.7 ± 12.3 µm) and CEREC (32.4 ± 9.7 µm) scans was not significantly different (p > 0.05). Intraoral scans required a significantly shorter impression time than the conventional method, and it was possible to fabricate a lithium disilicate crown in a single visit. There were no statistically significant differences in the fit of the restorations and accuracy of the intraoral scanners compared to the conventional workflow.

Frequent Mobile Electronic Medical Records Users Respond More Quickly to Emergency Department Consultation Requests: Retrospective Quantitative Study

Background

Specialty consultation is a critical aspect of emergency department (ED) practice, and a delay in providing consultation might have a significant clinical effect and worsen ED overcrowding. Although mobile electronic medical records (EMR) are being increasingly used and are known to improve the workflow of health care providers, limited studies have evaluated their effectiveness in real-life clinical scenarios.

Objective

For this study, we aimed to determine the association between response duration to an ED specialty consultation request and the frequency of mobile EMR use.

Methods

This retrospective study was conducted in an academic ED in Seoul, South Korea. We analyzed EMR and mobile EMR data from May 2018 to December 2018. Timestamps of ED consultation requests were retrieved from a PC-based EMR, and the response interval was calculated. Doctors’ log frequencies were obtained from the mobile EMR, and we merged data using doctors’ deidentification numbers. Pearson’s product-moment correlation was performed to identify this association. The primary outcome was the relationship between the frequency of mobile EMR usage and the time interval from ED request to consultation completion by specialty doctors. The secondary outcome was the relationship between the frequency of specialty doctors’ mobile EMR usage and the response time to consultation requests.

Results

A total of 25,454 consultations requests were made for 15,555 patients, and 252 specialty doctors provided ED specialty consultations. Of the 742 doctors who used the mobile EMR, 208 doctors used it for the specialty consultation process. After excluding the cases lacking essential information, 21,885 consultations with 208 doctors were included for analysis. According to the mobile EMR usage pattern, the average usage frequency of all users was 13.3 logs/day, and the average duration of the completion of the specialty consultation was 51.7 minutes. There was a significant inverse relationship between the frequency of mobile EMR usage and time interval from ED request to consultation completion by specialty doctors (coefficient=–0.19; 95% CI –0.32 to –0.06; P=.005). Secondary analysis with the response time was done. There was also a significant inverse relationship between the frequency of specialty doctors’ mobile EMR usage and the response time to consultation requests (coefficient=–0.18; 95% CI –0.30 to –0.04; P=.009).

Conclusions

Our findings suggest that frequent mobile EMR usage is associated with quicker response time to ED consultation requests.

Clinical quality and efficiency of monolithic glass ceramic crowns in the posterior area: digital compared with conventional workflows

PURPOSE

The aim of this clinical study was to test whether or not digital workflows for the fabrication of crowns render different clinical outcomes from the conventional pathway with respect to (1) crown quality, and (2) time efficiency.

MATERIAL AND METHODS

For each of the 10 patients in need of one tooth-supported crown, five monolithic crowns were produced out of lithium disilicate reinforced glass ceramic. Four different optical impression and associated computer-aided design/computer-aided manufacturing (CAD/CAM) systems were used for crown fabrication (digital workflows): (1) Lava C.O.S. scanner and Lava C.O.S. and CARES CAD software, centralized CAM (group L); (2) Cadent iTero scanner, CARES CAD software and centralized CAM (group iT); (3) Cerec Bluecam, Cerec Connect CAD software, followed by laboratory-based CAM (group CiL); and (4) centralized CAM (group CiD). The conventional crown (group K) was fabricated based on a conventional silicone impression followed by a conventional wax-up and heat press technique. The examiners were blinded and evaluated the crowns clinically at the bisque-bake stage (initial try-in), and subsequently after finalization by a dental technician (final try-in). For the assessment of crown quality, modified United States Public Health Service (USPHS) criteria were used. Treatment times were recorded for clinical evaluation and adjustment. The quality ratings were analyzed descriptively. For both the continuous and ordinal outcomes, the non-parametric paired Wilcoxon test was applied, together with an appropriate Bonferroni correction to evaluate the differences between treatment groups. The results of the statistical analysis were interpreted globally at the significance level P = 0.05.

RESULTS

The clinical evaluation during the initial and final try-ins demonstrated similar clinical outcome measures for crowns generated with the four digital workflows and the conventional workflow. No statistically significant differences of crown quality in any state were found between groups (P > 0.005). The total clinical treatment times measured were: 456 ± 240 s for L; 655 ± 374 s for iT; 783 ± 403 s for CiL; 556 ± 285 s for CiD; and 833 ± 451 s for K. No statistically significant differences in treatment times were found between the groups (P > 0.05).

CONCLUSIONS

Within the limitations of the present study, the monolithic ceramic crowns resulting from the four different CAD/CAM systems did not differ from the conventionally produced crowns with respect to the clinical quality rating and the treatment time efficiency.

Time efficiency, difficulty, and operator's preference comparing digital and conventional implant impressions: a randomized controlled trial

OBJECTIVES

The aim of this randomized controlled trial was to analyze implant impression techniques applying intraoral scanning (IOS) and the conventional method according to time efficiency, difficulty, and operator's preference.

MATERIAL AND METHODS

One hundred participants (n = 100) with diverse levels of dental experience were included and randomly assigned to Group A performing digital scanning (TRIOS Pod) first or Group B conducting conventional impression (open tray with elastomer) first, while the second method was performed consecutively. A customized maxillary model with a bone-level-type implant in the right canine position (FDI-position 13) was mounted on a phantom training unit realizing a standardized situation for all participants. Outcome parameter was time efficiency, and potential influence of clinical experience, operator's perception of level of difficulty, applicability of each method, and subjective preferences were analyzed with Wilcoxon -Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Mean total work time varied between 5.01 ± 1.56 min (students) and 4.53 ± 1.34 min (dentists) for IOS, and between 12.03 ± 2.00 min (students) and 10.09 ± 1.15 min (dentists) for conventional impressions with significant differences between the two methods. Neither assignment to Group A or B, nor gender nor number of impression-taking procedures did influence working time. Difficulty and applicability of IOS was perceived more favorable compared to conventional impressions, and effectiveness of IOS was rated better by the majority of students (88%) and dentists (64%). While 76% of the students preferred IOS, 48% of the dentists were favoring conventional impressions, and 26% each IOS and either technique.

CONCLUSIONS

For single-implant sites, the quadrant-like intraoral scanning (IOS) was more time efficient than the conventional full-arch impression technique in a phantom head simulating standardized optimal conditions. A high level of acceptance for IOS was observed among students and dentists.

The time efficiency of intraoral scanners: an in vitro comparative study

BACKGROUND

Although intraoral scanners are known to have good accuracy in computer-aided impression making (CAIM), their effect on time efficiency is not. Little is known about the time required to make a digital impression. The purpose of the authors' in vitro investigation was to evaluate the time efficiency of intraoral scanners.

METHODS

The authors used three different intraoral scanners to digitize a single abutment (scenario 1), a short-span fixed dental prosthesis (scenario 2) and a full-arch prosthesis preparation (scenario 3). They measured the procedure durations for the several scenarios and compiled and contrasted the procedure durations for three conventional impression materials.

RESULTS

The mean total procedure durations for making digital impressions of scenarios 1, 2 and 3 were as much as 5 minutes 57 seconds, 6 minutes 57 seconds, and 20 minutes 55 seconds, respectively. Results showed statistically significant differences between all scanners (P < .05), except Lava (3M ESPE, St. Paul, Minn.) and iTero with foot pedal (Align Technology, San Jose, Calif.) for scenario 1, CEREC (Sirona, Bensheim, Germany) and CEREC with foot pedal for scenario 2, and iTero and iTero with foot pedal for scenarios 2 and 3. The compiled procedure durations for making conventional impressions in scenarios 1 and 2 ranged between 18 minutes 15 seconds and 27 minutes 25 seconds; for scenario 3, they ranged between 21 minutes 25 seconds and 30 minutes 25 seconds.

CONCLUSIONS

The authors found that CAIM was significantly faster for all tested scenarios. This suggests that CAIM might be beneficial in establishing a more time-efficient work flow.

PRACTICAL IMPLICATIONS

On the basis of the results of this in vitro study, the authors found CAIM to be superior regarding time efficiency in comparison with conventional approaches and might accelerate the work flow of making impressions.

Time-Efficient High-Rate Data Flooding in One-Dimensional Acoustic Underwater Sensor Networks

Because underwater communication environments have poor characteristics, such as severe attenuation, large propagation delays and narrow bandwidths, data is normally transmitted at low rates through acoustic waves. On the other hand, as high traffic has recently been required in diverse areas, high rate transmission has become necessary. In this paper, transmission/reception timing schemes that maximize the time axis use efficiency to improve the resource efficiency for high rate transmission are proposed. The excellence of the proposed scheme is identified by examining the power distributions by node, rate bounds, power levels depending on the rates and number of nodes, and network split gains through mathematical analysis and numerical results. In addition, the simulation results show that the proposed scheme outperforms the existing packet train method.

CD95 system counter attack and prognostic impact

Hintergrund

Die verfügbare ärztliche Arbeitszeit nimmt ab. Zugleich gehen gut ausgebildete Ärztinnen für den Beruf verloren. Angesichts der Zunahme onkologischer Erkrankungen besteht Handlungsbedarf.

Ziel der Arbeit

Die Identifizierung karriereförderlicher und karrierehinderlicher Faktoren, um insbesondere Karrieren von Ärztinnen besser fördern zu können.

Material und Methoden

Online-Befragung der Mitglieder der DGHO mittels eines Fragebogens mit 42 Items. Im Zuge der Auswertung wurden χ²- und t‑Tests für unabhängige Stichproben berechnet.

Ergebnisse

Ärztinnen und Ärzte organisieren ihr berufliches und familiäres Leben entlang traditioneller Geschlechterrollen. Sind Kinder im Haushalt, reduzieren Ärztinnen ihre Berufsarbeitszeit, Ärzte arbeiten mehr Stunden im Beruf. Ärzte profitieren stark von der Unterstützung der Partnerin. Ärztinnen werden durch Familienarbeit in der Karriereentwicklung behindert. Für Ärztinnen und Ärzte bringen die Inanspruchnahme von Elternzeit und Teilzeit Karrierenachteile. Ärztinnen und Ärzte bringen in ihren Wünschen ein modernes, paritätisches Geschlechterrollenverständnis zum Ausdruck. Sie streben ein ausgeglichenes Verhältnis zwischen Beruf und Familie/Freizeit an. Sie wünschen sich mehr Betreuungsmöglichkeiten für Kinder und für zu pflegende Angehörige sowie Flexibilität in der Arbeitszeitorganisation. Vor allem Ärztinnen wünschen Teilzeitoptionen für Facharztweiterbildung und Führungspositionen.

Diskussion

Arbeitgeber können die Karriereentwicklung von Ärztinnen und Ärzten aktiv unterstützen, indem sie flexible Arbeitszeitmodelle und Teilzeitoptionen auch für Facharztweiterbildung und Führungspositionen anbieten und mehr Betreuungsmöglichkeiten für Kinder und zu pflegende Angehörige schaffen.