When did “teaching” become a taboo word for clinician educators?

Abstract

In our recent work with clinician educators leading UME small groups, we noticed a phenomenon – many clinician educators are saying they don’t teach, they just facilitate. Medical schools have moved to a new model of curriculum that integrates basic, clinical, and social science concepts. As curriculum shifts, so too must the definition and role of a teacher in medical education. The purpose of this article is to explore the work of current clinician educators and to encourage clinician educators to embrace their teaching role and seek educator development opportunities. In this article, we explore the history of how and why the word “teaching” became taboo for clinician educators. Then we explain the current state of the complex work of teaching for today’s clinician educators and its implications for educator development.     

Lisdexamfetamine: chemistry,pharmacodynamics, pharmacokinetics,and clinical efficacy,safety, and tolerability in the treatment of binge eating disorder

Introduction: The indications for lisdexamfetamine (LDX), a central nervous system stimulant, were recently expanded to include treatment of moderate to severe binge eating disorder (BED).

Areas covered: This review aims to describe the chemistry and pharmacology of LDX, as well as the clinical trials investigating the efficacy and safety of this medication for the management of BED.

Expert opinion: LDX is the first medication with United States Food and Drug Administration approval for the treatment of BED. It is an inactive prodrug of d-amphetamine that extends the half-life of d-amphetamine to allow for once daily dosing. D-amphetamine acts primarily to increase the concentrations of synaptic dopamine and norepinephrine. Metabolism of LDX to d-amphetamine occurs when peptidases in red blood cells cleave the covalent bond between d-amphetamine and l-lysine. D-amphetamine is then further metabolized by CYP2D6. Excretion is primarily through renal mechanisms. In clinical trials, LDX demonstrated statistical and clinical superiority over placebo in reducing binge eating days per week at doses of 50 and 70 mg daily. Commonly reported side effects of LDX include dry mouth, insomnia, weight loss, and headache, and its use should be avoided in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia or coronary artery disease. As with all CNS stimulants, risk of abuse needs to be assessed prior to prescribing.     

The effect of calcium fluoride (CaF(2)) on the chemical solubility of an apatite-mullite glass-ceramic material.

OBJECTIVE: To assess the effect of varying CaF(2) on the chemical solubility of apatite-mullite glass-ceramic (G-C) materials in both the glassy and crystallized states. METHODS: Apatite-mullite forming glasses used in this study are ionomer cement derivatives based on the general formula (4.5SiO(2)-3Al(2)O(3)-1.5P(2)O(5)-3CaO-XCaF(2)). Six glass formulations were produced where X=0.5, 1, 1.5, 2, 2.5 and 3, and called HG1-6, respectively. Batches were melted in covered silliminite crucibles in a furnace overnight at 1050 degrees C, then at 1450 degrees C for 2h, before quenching in water. The six glass compositions were analyzed using differential thermal analysis (DTA), X-ray diffraction (XRD) and X-ray fluorescence spectrometry (XRF). Thirty discs (2mm thick and 12 mm diameter) were produced per glass using the lost wax casting technique. Ten were left as cast and 10 heat treated to either apatite or apatite-mullite. Solubility testing was carried out according to International Standard BS EN ISO 6872 1999 and the mass difference in solubility calculated as mug/cm(2). A lithium disilicate G-C system was used as a control material. RESULTS: All compositions formed glasses and on heat treatment could form apatite and apatite-mullite. The as-cast glass samples were the most soluble followed by the apatite samples. The apatite-mullite G-C was significantly less soluble than the other two phases (p<0.05) for all six compositions. The control material was significantly less soluble than all the HG glass-ceramic compositions for every phase (p<0.05). Decreasing the CaF(2) content (3-0.5 mol%) led to a decrease in solubility, without affecting the ability of the material to form apatite and apatite-mullite phases. SIGNIFICANCE: Increasing the CaF(2) content increases the chemical solubility for the glass, apatite G-C and apatite-mullite G-C phases. The solubility values obtained show that all the compositions, as cast and heat treated would be suitable for use as core ceramics.     

Light-cured or chemically cured orthodontic adhesive resins? A selection based on the degree of cure,monomer leaching,and cytotoxicity

PURPOSE: The purpose of this study was to estimate the degree of cure and monomer leaching of a light-cured and a chemically cured (no-mix) adhesive and to assess their biologic properties. MATERIAL: The degree of cure of adhesive specimens prepared with a procedure identical to the clinical bonding process was assessed by infrared spectroscopy. The adhesives were then immersed in normal saline solution for 2 months, and the residual monomer leached from the adhesives was quantitatively and qualitatively analyzed by liquid chromatography. The effect of the immersion media on human gingival fibroblasts' viability and proliferation was also evaluated with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and deoxyribonucleic acid (DNA) synthesis assays, respectively. The results were analyzed by analysis of variance and Tukey test (alpha = .05). RESULTS: No difference was found between the 2 adhesives with respect to their degree of cure and the amount of triethylene glycol dimethacrylate released; no diglycidyl dimethacrylate monomer was detected in the eluent. However, significant qualitative changes in the composition of the substances eluted from the 2 adhesives were observed. CONCLUSIONS: Whereas no cytotoxic effect was shown for either immersion media, a moderate reduction in the DNA synthesis was obtained by both adhesives, implying a minor cytostatic effect. Further research is required to assess the long-term biologic properties of adhesives, including potential estrogenic action.     

Clinical evaluation of a novel dental whitening lamp and light-catalyzed peroxide gel

OBJECTIVE: This study examined whether an ultraviolet light enhanced the whitening efficacy of a peroxide gel containing a photo-Fenton activator. METHODOLOGY: Fifty subjects were enrolled into the trial at two geographically separate sites. As directed by the randomization keys, teeth of half of the study subjects were concurrently exposed to the whitening lamp, while the gel was on their teeth, for a total light exposure of 45 minutes. The other half of the subjects received no light treatment. At each examination, clinical data were collected on the gingival index, shade score, and self-assessed dentinal hypersensitivity. RESULTS: Changes in tooth shade were significantly better (approximately 26% improvement; p < 0.05) for subjects exposed to the gel and dental whitening lamp (average = 7.7 shade changes) compared to subjects exposed to the gel only (average 6.1 shades) immediately after treatment. No reports of erythema, desquamation, ulceration of soft tissues, gross changes in teeth, gingiva, or restorations were documented. The relative changes in mean sensitivity scores were similar for both groups, with no significant differences between the Light and No-light groups at any interval. CONCLUSION: The whitening effect was improved by approximately 26% when the Zoom2 dental whitening lamp was used. It was demonstrated that the a photo-Fenton activator used with a bleaching light and 20% hydrogen peroxide gel is safe and effective for whitening teeth rapidly.     

In-vivo incorporation of [3H]-proline into rabbit dental pulp collagen.

Collagen metabolism of rabbit dental pulp was studied by following the incorporation of [³H]-proline into pulp collagen. The specific activity of hydroxyproline was studied in various collagen fractions in rabbit incisor and molar teeth of different ages. The specific activity of the collagen fractions was consistently higher in incisor than in molar pulps at all ages, except for the pepsin-resistant fraction. In the molar at most ages, the pepsin-resistant fraction had a specific activity equal to, or greater than, that in the fractions solubilized by either acid or pepsin. The results demonstrate the high metabolic activity of dental pulp, and rapid incorporation of new collagen into the insoluble fibre network.     

Replacing a broken facing on a removable partial denture.

A technique for using a denture tooth to replace a broken facing on an RPD is described. The technique is simple, inexpensive, and easily accomplished in the dental office with minimum time.