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Clinical decision-making in complex endodontic cases between postgraduate students across dental specialties at a UK dental school: A pilot study

Liew J, Zainal Abidin I, Cook N, Kanagasingam S

Eur J Dent Educ, 2021 Dec 22.
PMID: 34936724 DOI: 10.1111/eje.12751

INTRODUCTION: Treatment decisions for a heavily restored endodontically treated tooth vary amongst clinicians owing to multitude of factors. This phenomenon not only often poses dilemmas to clinicians of different clinical backgrounds, but also exerts a degree of treatment difficulty to the treating clinician. Previous studies indicated that specialty training and clinical experience significantly impacted clinical decision-making process.
MATERIALS AND METHODS: Master of Science postgraduate students in endodontics, prosthodontics, periodontics, oral surgery and implantology participated in a questionnaire-based cross-sectional study. The dental specialties were further categorised into restorative and surgical dentistry. A multiple-choice questionnaire with three clinical cases was distributed to the students. Data were analysed for trends using descriptive statistics.
RESULTS: There was a 44% response rate; the majority of respondents were from restorative dentistry specialties. Cases 1 and 2 were rated as moderate to high difficulty, and Case 3 was predominantly rated as high difficulty with procedure predictability being the main factor affecting their clinical decision-making in three cases. Endodontic retreatment was selected as the preferred treatment in Cases 1 and 2 and periradicular surgery in Case 3. The students were fairly confident in managing Cases 1 and 2, but not in Case 3. Referral patterns were consistent in Cases 1 and 2 with endodontists being the first choice of referral except for Case 3 where 48% preferred to refer to oral surgeons and 35% choosing endodontists. Some indication of differences between specialties were noted throughout. Years in practice appeared to be related to the importance of predictability in Case 3 only.
CONCLUSION: Considerable inter-clinician variability was noted whereby specialty postgraduate training impacted on clinical decision-making. Overall, procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most highly ranked factors affecting clinical decision-making. Evidence-based treatment guidelines and dental curricula should be reviewed to enhance inter-clinician agreement in clinical decision-making, ultimately improving patient care.
Fulltext Prevalence of pain and treatment outcomes among cancer patients in a Malaysian palliative care unit

Mejin M, Keowmani T, Rahman SA, Liew J, Lai J, Chua M, et al.

Pharm Pract (Granada), 2019 03 18;17(1):1397.
PMID: 31015879 DOI: 10.18549/PharmPract.2019.1.1397

Background: Pain remains one of the most common and debilitating symptoms of advanced cancer. To date, there is a lack of studies on pain and its treatment among Malaysian palliative care patients.
Objective: This study aimed to explore the prevalence of pain and its treatment outcomes among adult cancer patients admitted to a palliative care unit in Sabah, Malaysia.
Methods: Of 327 patients screened (01/09/15-31/12/17), 151 patients with assessed self-reported pain scores based on the numerical rating scale of 0-10 (current, worst and least pain within the past 24 hours) upon admission (baseline), 24, 48 and 72 hours post-admission and discharge were included. Pain severity and pain score reductions were analysed among those who experienced pain upon admission or in the past 24 hours. Treatment adequacy was measured by the Pain Management Index (PMI) among discharged patients. The PMI was constructed upon worst scores categorised as 0 (no pain), 1 (1-4, mild pain), 2 (5-6, moderate pain), or 3 (7-10, severe pain) which is then subtracted from the most potent level of prescribed analgesic drug scored as 0 (no analgesia), 1 (non-opioid), 2 (weak opioid) or 3 (strong opioid). PMI≥0 indicated adequate treatment.
Results: Upon admission, 61.1% [95%CI 0.54:0.69] of 151 patients presented with pain. Of 123 patients who experienced pain upon admission or in the past 24 hours, 82.1% had moderate to severe worst pain. Throughout patients' ward stay until discharge, there was an increased prescribing of analgesics and adjuvants compared to baseline, excluding weak opioids, with strong opioids as the mainstay treatment. For all pain score types (current, worst and least pain within the past 24 hours), means decreased at each time point (24, 48 and 72 hours post-admission and discharge) from baseline, with a significant decrease at 24 hours post-admission (p<0.001). Upon discharge (n=100), treatment adequacy significantly improved (PMI≥0 100% versus 68% upon admission, p<0.001).
Conclusions: Accounting for pain's dynamic nature, there was a high prevalence of pain among cancer patients in the palliative care unit. Continuous efforts incorporating comprehensive pain assessments, evidence-based treatments and patient education are necessary to provide adequate pain relief and end-of-life comfort care.
Integrating mechanistic models and climate change projections to predict invasion of the mussel, Mytilopsis sallei, along the southern China coast

Tan ALS, Cheng MCF, Giacoletti A, Chung JX, Liew J, Sarà G, et al.

Sci Total Environ, 2021 Mar 25;762:143097.
PMID: 33139009 DOI: 10.1016/j.scitotenv.2020.143097

Species invasion is an important cause of global biodiversity decline and is often mediated by shifts in environmental conditions such as climate change. To investigate this relationship, a mechanistic Dynamic Energy Budget model (DEB) approach was used to predict how climate change may affect spread of the invasive mussel Mytilopsis sallei, by predicting variation in the total reproductive output of the mussel under different scenarios. To achieve this, the DEB model was forced with present-day satellite data of sea surface temperature (SST) and chlorophyll-a concentration (Chl-a), and SST under two warming RCP scenarios and decreasing current Chl-a levels, to predict future responses. Under both warming scenarios, the DEB model predicted the reproductive output of M. sallei would enhance range extension of the mussel, especially in regions south of the Yangtze River when future declines in Chl-a were reduced by less than 10%, whereas egg production was inhibited when Chl-a decreased by 20-30%. The decrease in SST in the Yangtze River may, however, be a natural barrier to the northward expansion of M. sallei, with colder temperatures resulting in a strong decrease in egg production. Although the invasion path of M. sallei may be inhibited northwards by the Yangtze River, larger geographic regions south of the Yangtze River run the risk of invasion, with subsequent negative impacts on aquaculture through competition for food with farmed bivalves and damaging aquaculture facilities. Using a DEB model approach to characterise the life history traits of M. sallei, therefore, revealed the importance of food availability and temperature on the reproductive output of this mussel and allowed evaluation of the invasion risk for specific regions. DEB is, therefore, a powerful predictive tool for risk management of already established invasive populations and to identify regions with a high potential invasion risk.
Autoantibody profile of patients infected with knowlesi malaria

Liew J, Amir A, Chen Y, Fong MY, Razali R, Lau YL

Clin Chim Acta, 2015 Aug 25;448:33-8.
PMID: 26086445 DOI: 10.1016/j.cca.2015.06.006

Autoantibodies or antibodies against self-antigens are produced either during physiological processes to maintain homeostasis or pathological process such as trauma and infection. Infection with parasites including Plasmodium has been shown to generally induce elevated self-antibody (autoantibody) levels. Plasmodium knowlesi is increasingly recognized as one of the most important emerging human malaria in Southeast Asia that can cause severe infection leading to mortality. Autoimmune-like phenomena have been hypothesized to play a role in the protective immune responses in malaria infection.
Enhanced Sodium Ion Batteries' Performance: Optimal Strategies on Electrolytes for Different Carbon-based Anodes

Liu L, Bashir S, Ling GZ, Hoe LK, Liew J, Kasi R, et al.

ChemSusChem, 2024 Jan 22;17(2):e202300876.
PMID: 37695539 DOI: 10.1002/cssc.202300876

Carbon-based materials have emerged as promising anodes for sodium-ion batteries (SIBs) due to the merits of cost-effectiveness and renewability. However, the unsatisfactory performance has hindered the commercialization of SIBs. During the past decades, tremendous attention has been put into enhancing the electrochemical performance of carbon-based anodes from the perspective of improving the compatibility of electrolytes and electrodes. Hence, a systematic summary of strategies for optimizing electrolytes between hard carbon, graphite, and other structural carbon anodes of SIBs is provided. The formulations and properties of electrolytes with solvents, salts, and additives added are comprehensively presented, which are closely related to the formation of solid electrolyte interface (SEI) and crucial to the sodium ion storage performance. Cost analysis of commonly used electrolytes has been provided as well. This review is anticipated to provide guidance in future rational tailoring of electrolytes with carbon-based anodes for sodium-ion batteries.
Assessment of solar geoengineering impact on precipitation and temperature extremes in the Muda River Basin, Malaysia using CMIP6 SSP and GeoMIP6 G6 simulations

Tan ML, Tew YL, Liew J, Bala G, Tye MR, Chang CK, et al.

Sci Total Environ, 2024 Jul 15.
PMID: 39019269 DOI: 10.1016/j.scitotenv.2024.174817

The concept of solar geoengineering remains a topic of debate, yet it may be an effective way for cooling the Earth's temperature. Nevertheless, the impact of solar geoengineering on regional or local climate patterns is an active area of research. This study aims to evaluate the impact of solar geoengineering on precipitation and temperature extremes of the Muda River Basin (MRB), a very important agricultural basin situated in the northern Peninsular Malaysia. The analysis utilized the multi-model ensemble mean generated by four models that contributed to the Geoengineering Model Intercomparison Project (GeoMIP6). These models were configured to simulate the solar irradiance reduction (G6solar) and stratospheric sulfate aerosols (G6sulfur) strategies as well as the moderate (SSP245) and high emission (SSP585) experiments. Prior to the computation of extreme indices, a linear scaling approach was employed to bias correct the daily precipitation, maximum and minimum temperatures. The findings show that the G6solar and G6sulfur experiments, particularly the latter, could be effective in holding the increases in both annual and monthly mean precipitation totals and temperature extremes close to the increases projected under SSP245. For example, both G6solar and G6sulfur experiments project increases of temperature over the basin of 2 °C at the end of the 21st century as compared to 3.5 °C under SSP585. The G6solar and G6sulfur experiments also demonstrate some reliability in modulating the increases in precipitation extreme indices associated with flooding to match those under SSP245. However, the G6sulfur experiment may exacerbate dry conditions in the basin, as monthly precipitation is projected to decrease during the dry months from January to May and consecutives dry days are expected to increase, particularly during the 2045-2064 and 2065-2084 periods. Increases dry spells could indirectly affect agricultural and freshwater supplies, and pose considerable challenges to farmers.
Fulltext SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry

Liew J, Gianfrancesco M, Harrison C, Izadi Z, Rush S, Lawson-Tovey S, et al.

RMD Open, 2022 Apr;8(1).
PMID: 35387864 DOI: 10.1136/rmdopen-2021-002187

OBJECTIVE: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2.
METHODS: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes.
RESULTS: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died.
CONCLUSION: More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.