Purpose/objective
The objective of this project was to evaluate the perceptions of predental students’ shadowing experiences during a pandemic and further, explore innovative solutions that can be ...implemented to ensure that shadowing opportunities are equitable and accessible.
Methods
Data was collected via the Web 2.0 social media platform, Instagram (owned by Meta Platforms, Inc.) from 122 participants attending college in North America and are on the predental track: freshman (N = 11), sophomores (N = 25), juniors (N = 30), seniors (N = 34) and recent college graduates (N = 22). Participants completed a survey consisting of 20 questions.
Results
Results showed that the pandemic disrupted traditional shadowing methods; students turned to various virtual platforms, such as YouTube and Zoom, to obtain shadowing experiences. There was an increase in the number of students who shadowed virtually during the pandemic versus pre‐COVID‐19. The majority of the respondents (80%) agreed that dental schools have not provided sufficient guidance on how to approach shadowing during a pandemic.
Conclusion
Innovative shadowing platforms should be implemented in order to help college students explore careers within dentistry and beyond. The development of a standardized virtual shadowing program with clear guidelines can increase equity and accessibility.
Health-related quality of life (QOL) has not been well-studied in survivors of muscle-invasive bladder cancer (MIBC). The present study compared long-term QOL in MIBC patients treated with radical ...cystectomy (RC) versus bladder-sparing trimodality therapy (TMT).
This cross-sectional bi-institutional study identified 226 patients with nonmetastatic cT2-cT4 MIBC, diagnosed in 1990 to 2011, who were eligible for RC and were disease free for ≥2 years. Six validated QOL instruments were administered: EuroQOL EQ-5D, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire and EORTC MIBC module, Expanded Prostate Cancer Index Composite bowel scale, Cancer Treatment and Perception Scale, and Impact of Cancer, version 2. Multivariable analyses of the mean QOL scores were conducted using propensity score matching.
The response rate was 77% (n=173). The median follow-up period was 5.6 years. Of the 173 patients, 64 received TMT and 109, RC. The median interval from diagnosis to questionnaire completion was 9 years after TMT and 7 years after RC (P=.009). No significant differences were found in age, gender, comorbidities, tobacco history, performance status, or tumor stage. On multivariable analysis, patients who received TMT had better general QOL by 9.7 points of 100 compared with those who had received RC (P=.001) and higher physical, role, social, emotional, and cognitive functioning by 6.6 to 9.9 points (P≤.04). TMT was associated with better bowel function by 4.5 points (P=.02) and fewer bowel symptoms by 2.7 to 7.1 points (P≤.05). The urinary symptom scores were similar. TMT was associated with better sexual function by 8.7 to 32.1 points (P≤.02) and body image by 14.8 points (P<.001). The patients who underwent TMT reported greater informed decision-making scores by 13.6 points (P=.01) and less concern about the negative effect of cancer by 6.8 points (P=.006). The study limitations included missing baseline QOL data and different follow-up times.
Both TMT and RC result in good long-term QOL outcomes in MIBC survivors, supporting TMT as a good alternative to RC for selected patients. Whether TMT leads to superior QOL requires prospective validation.
In 2012, when the National Board Dental Examination (NBDE) was changed from a numerical scoring system to pass/fail, advanced dental education programs lost a metric widely used for differentiating ...applicants to those programs. The American Dental Association (ADA) has developed the Advanced Dental Admission Test (ADAT) to address this issue. Implementation of the ADAT began in 2016 with a pilot program, which has not yet been widely accepted in the overall admissions process. This Point/Counterpoint explores the benefits and challenges of using the ADAT for postgraduate admissions. Viewpoint 1 supports use of the ADAT, arguing that the test provides a viable, long-term solution to this immediate need. In contrast, Viewpoint 2 questions the need for and appropriateness of this additional academic measure for postgraduate admissions.
Purpose/objectives
Reflection is one of four components of the experiential learning cycle and is often the one overlooked. This practice can be used in graduate‐level health care education, such as ...medicine and dentistry. This metacognitive practice allows students to conceptualize learning in a clinical setting and apply this knowledge to new scenarios. Reflective practice can be taught using different modalities of narrative medicine, and several studies have studied its effectiveness in areas such as professional development, collaboration, communication among others. Most of these studies, however, have been conducted solely in the medical setting, and narrative medicine may have useful application in the practice and teaching of dentistry.
Methods
This literature review examined the outcomes of narrative medicine in medical studies concerning reflection and hypothesized their benefits to dental education. The studies reviewed were chosen by utilizing key term searches of the National Center for Biotechnology Information PubMed library and qualitative factor analysis by study team investigators. Elective‐based, prospective enrollment and whole cohort participation programs were analyzed for potential effectiveness in dental education.
Results
The most feasible programs for potential integration into dental curricula are elective‐based, small‐group, graduate‐level courses with a level of evaluation such as residency competencies, as demonstrated by Arntfield et al.
Conclusion(s)
These programs should be investigated further to evaluate their potential in improving reflective skills of students, and ultimately in improving their experiential learning experience.
•This is the first report HMGB1 and HSP60 are expressed in a Myd88 dependent manner.•The manuscript shows mammary carcinoma overexpress HMGB1 and HSP60.•The manuscript shows HMGB1 and HSP60 ...expression influences tumor cell growth.•Results contribute to a better understanding of DAMPs and PAMPs in a tumor setting.
Previously we reported that Myd88 contributed to tumor progression. To begin to decipher what may be inducing Myd88 dependent signaling we focused on proteins that could function as damage associated molecular pattern molecules (DAMPs) since DAMPs have been reported to be secreted by tumors, and certain DAMPs mediate effects through toll-like receptors. A screen of mammary carcinoma for DAMP expression showed HMGB1 and HSP60 were significantly elevated relative to normal mammary epithelium, and targeting these DAMPs, or receptors for these DAMPs influenced growth of tumor cells. Moreover, analysis using a Myd88 inhibitory peptide suggested that HMGB1 mediated its effects in a Myd88 dependent manner, and inhibiting Myd88 function decreased HMGB1 and HSP60 gene expression. Collectively, these data suggest that HMGB1 and HSP60 contribute to growth of mammary carcinoma cells, HMGB1 accomplishes this, at least in part, through Myd88 dependent signaling, and these DAMPs are expressed in a Myd88 dependent manner.
Previous data obtained in our laboratory suggested that there may be constitutive signaling through the myeloid differentiation primary response gene 88 (Myd88)-dependent signaling cascade in murine ...mammary carcinoma. Here, we extended these findings by showing that, in the absence of an added Toll-like receptor (TLR) agonist, the myddosome complex was preformed in 4T1 tumor cells, and that Myd88 influenced cytoplasmic extracellular signal–regulated kinase (Erk)1/Erk2 levels, nuclear levels of nuclear factor-kappaB (NFκB) and signal transducer and activator of transcription 5 (STAT5), tumor-derived chemokine (C–C motif) ligand 2 (CCL2) expression, and in vitro and in vivo tumor growth. In addition, RNA-sequencing revealed that Myd88-dependent signaling enhanced the expression of genes that could contribute to breast cancer progression and genes previously associated with poor outcome for patients with breast cancer, in addition to suppressing the expression of genes capable of inhibiting breast cancer progression. Yet, Myd88-dependent signaling in tumor cells also suppressed expression of genes that could contribute to tumor progression. Collectively, these data revealed a multifaceted role for Myd88-dependent signaling in murine mammary carcinoma.
In 2012, when the National Board Dental Examination (NBDE) was changed from a numerical scoring system to pass/fail, advanced dental education programs lost a metric widely used for differentiating ...applicants to those programs. The American Dental Association (ADA) has developed the Advanced Dental Admission Test (ADAT) to address this issue. Implementation of the ADAT began in 2016 with a pilot program, which has not yet been widely accepted in the overall admissions process. This Point/Counterpoint explores the benefits and challenges of using the ADAT for postgraduate admissions. Viewpoint 1 supports use of the ADAT, arguing that the test provides a viable, long‐term solution to this immediate need. In contrast, Viewpoint 2 questions the need for and appropriateness of this additional academic measure for postgraduate admissions.
Biomarkers and mechanisms of poly (ADP-ribose) polymerase (PARP) inhibitor-mediated cytotoxicity in tumor cells lacking a BRCA-mutant or BRCA-like phenotype are poorly defined. We sought to explore ...the utility of PARP-1 inhibitor (PARPi) treatment with/without ionizing radiation in muscle-invasive bladder cancer (MIBC), which has poor therapeutic outcomes. We assessed the DNA damaging and cytotoxic effects of the PARPi olaparib in nine bladder cancer cell lines. Olaparib radiosensitized all cell lines with dose enhancement factors from 1.22 to 2.27. Radiosensitization was correlated with the induction of potentially lethal DNA double-strand breaks (DSB) but not with RAD51 foci formation. The ability of olaparib to radiosensitize MIBC cells was linked to the extent of cell kill achieved with the drug alone. Unexpectedly, increased levels of reactive oxygen species (ROS) resulting from PARPi treatment were the cause of DSB throughout the cell cycle in vitro and in vivo. ROS originated from mitochondria and were required for the radiosensitizing effects of olaparib. Consistent with the role of TP53 in ROS regulation, loss of p53 function enhanced radiosensitization by olaparib in non-isogenic and isogenic cell line models and was associated with increased PARP-1 expression in bladder cancer cell lines and tumors. Impairment of ATM in addition to p53 loss resulted in an even more pronounced radiosensitization. In conclusion, ROS suppression by PARP-1 in MIBC is a potential therapeutic target either for PARPi combined with radiation or drug alone treatment. The TP53 and ATM genes, commonly mutated in MIBC and other cancers, are candidate biomarkers of PARPi-mediated radiosensitization.
The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. ...By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes.
A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations.
On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients.
The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.
Abstract
Previously we reported that Myd88 contributed to growth, metastasis, and expression of CCL2 and CCL5 by mammary carcinoma implying that constitutive signaling through Myd88 contributes to ...tumor progression. To begin to decipher downstream effects of Myd88 signaling in the tumor cells we used RNA interference and a Myd88 inhibitory peptide and then screened for expression of genes involved in signaling and the cell cycle. Some of the alterations that were found included TLR signaling components such as Tirap, Tollip, Irak1 and Irak2 suggesting a potential feedback mechanism for Myd88 in TLR signaling in the tumor cells. Many of the genes that were modulated upon Myd88 inhibition may contribute to multiple downstream effects such as inflammation, migration and growth. For instance, genes utilized for the NFKb and MAPK pathways including NF-KB1, IKB-beta, MEK, JNK and p38 exhibited reduced expression upon Myd88 inhibition. Genes encoding proteins that could regulate the cell cycle such as p53, cyclins B, D, and F were also modulated, and a role for Myd88 in cell cycle progression was confirmed by cell cycle analysis which showed that Myd88 was important for progression to the G2 phase of the cell cycle. Collectively, these data imply that Myd88 may contribute to tumor progression by regulating several pathways (apoptosis, proliferation, migration and/or inflammation), and underscores the importance of delineating the role of Myd88 in murine mammary carcinoma.
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