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All Journal Crown: Journal of Dentistry and Health Research Enigma in Education
Danniel Hilman Maulana
Department of Anesthesiology and Intensive Care, CMHC Research Center, Palembang, Indonesia
Humanities Dentistry Education Health Professions Languange, Linguistic, Communication & Media Mathematics Medicine & Pharmacology Neuroscience Public Health Other

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Effectiveness of High-Fidelity Simulation on Creative Clinical Reasoning Among Nursing Students: A Quasi-Experimental Study Danniel Hilman Maulana; Karina Chandra; Maria Rodriguez
Enigma in Education Vol. 3 No. 2 (2025): Enigma in Education
Publisher : Enigma Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61996/edu.v3i2.118

Abstract

High-fidelity simulation has become a key pedagogical strategy in nursing education, yet its specific effect on creative clinical reasoning remains underexplored, particularly in Southeast Asian higher-education contexts. The aim of this study was to evaluate the effectiveness of high-fidelity simulation on creative clinical reasoning, clinical judgment, and self-efficacy among nursing students. This quasi-experimental pre-test/post-test control group study, conducted at a private university in Palembang, Indonesia, evaluated its effectiveness among ninety final-year nursing students allocated to a simulation group (n=46) receiving four structured high-fidelity simulation sessions over eight weeks or a control group (n=44) receiving conventional case-based learning. Outcomes were measured using the Health Sciences Reasoning Test, a Creative Clinical Problem-Solving Scale, the Lasater Clinical Judgment Rubric, and the General Self-Efficacy Scale, with all scores standardized to a 0–100 metric, and analyzed using paired t-tests, independent t-tests, and ANCOVA with pre-test covariates. The simulation group demonstrated significantly greater improvements than controls in clinical reasoning (mean difference 16.2, 95% CI 13.8–18.6, p<0.001, Cohen’s d=1.98), creative problem-solving (15.5, p<0.001, d=2.10), self-efficacy (14.5, p<0.001, d=1.73), and clinical judgment (16.3, p<0.001, d=2.12); ANCOVA confirmed significant group effects (partial η²=0.322–0.375), and a positive dose-response correlation was observed (r=0.72, p<0.001). High-fidelity simulation was highly effective in enhancing creative clinical reasoning and related competencies, with large effect sizes supporting its systematic integration into nursing education curricula.
CRISPRi-Mediated Repression of gtfB Attenuates Streptococcus mutans Virulence and Promotes Ecological Homeostasis in a Preclinical Cariogenic Biofilm Model Khairiel Anwar; Maria Rodriguez; Sony Sanjaya; Danniel Hilman Maulana; Karina Chandra; Isadora Selestine
Crown: Journal of Dentistry and Health Research Vol. 3 No. 1 (2025): Crown: Journal of Dentistry and Health Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/crown.v3i1.234

Abstract

Introduction: Streptococcus mutans is a primary etiological agent of dental caries, largely due to its capacity to form robust, acidogenic biofilms. This virulence is critically dependent on glucosyltransferases, particularly GtfB, which synthesizes the adhesive extracellular glucan matrix. Conventional antimicrobial strategies often lack specificity, leading to oral dysbiosis. This study aimed to develop and evaluate a highly targeted CRISPR interference (CRISPRi) system to silence the gtfB gene in S. mutans, thereby inhibiting its cariogenic potential without adversely affecting the viability of key oral commensal species. Methods: A CRISPRi system, comprising a nuclease-deactivated Cas9 (dCas9) and a single guide RNA (sgRNA) targeting the gtfB promoter, was engineered into S. mutans UA159. The efficacy of gtfB silencing was quantified via qRT-PCR. The consequential effects on bacterial growth kinetics, insoluble glucan synthesis, and single-species biofilm formation were assessed using spectrophotometry, anthrone assays, crystal violet staining, and confocal laser scanning microscopy (CLSM). The ecological impact was investigated in a multi-species biofilm model containing S. mutans and the commensal bacteria Streptococcus gordonii, Streptococcus oralis, and Actinomyces naeslundii, with microbial composition analyzed by species-specific qPCR. All research activities were conducted in Indonesia. Results: The CRISPRi system induced a profound and specific downregulation of gtfB mRNA expression by over 98% (p<0.001) in the engineered S. mutans strain compared to the wild-type. This silencing did not impair bacterial planktonic growth. However, it led to a significant reduction in insoluble glucan production by 85% (p<0.001) and a corresponding 79% decrease in total biofilm biomass (p<0.001). CLSM imaging confirmed the formation of structurally deficient biofilms with minimal extracellular matrix. In the multi-species model, repression of S. mutans virulence significantly altered the biofilm ecology, resulting in a 65% reduction in the proportional abundance of S. mutans and a concomitant increase in the representation of commensal species, thereby fostering a community structure more aligned with oral health. Conclusion: Targeted repression of the gtfB gene using a CRISPRi-based approach effectively 'disarms' S. mutans, neutralizing its primary cariogenic mechanism without being bactericidal. This strategy not only attenuates its virulence but also shifts the ecological balance in favor of beneficial commensal bacteria. These findings underscore the therapeutic potential of gene-targeted virulence modulation as a precise, ecologically-sound strategy for the prevention and treatment of dental caries.
Co-Authors Isadora Selestine Karina Chandra Khairiel Anwar Maria Rodriguez Sony Sanjaya