Overview Obstructive sleep apnoea (OSA) is a medical condition characterised by multiple episodes of reduced or absent breathing during sleep. OSA can reduce quality of life and raise the risk of ...significant medical conditions, such as strokes, hypertension, type II diabetes mellitus and sudden cardiac death. This article aims to summarise the key features of OSA and the role the dental team can play in its management.Clinical relevance OSA can have life-threatening consequences if left untreated and the dental team have a role in recognition, referral and treatment.Objectives The reader should have better knowledge of OSA and their potential role in diagnosis and management.
Introduction
Shared decision‐making (SDM) is a partnership between healthcare professionals and patients when choosing care.
Aim
To measure knowledge of, and attitudes to, SDM amongst undergraduate ...dental students and dentists in the UK.
Design and setting
Cross‐sectional online questionnaire for 4th and 5th year dental students and dentists in the UK.
Materials and methods
The questionnaire included attitudinal questions, knowledge of SDM relative to the evidence base and preferred approach to decision‐making. The questionnaire identified perceived learning needs and preferred method for SDM teaching for dentists and dental students. Respondents were invited to participate via social media, mailing lists and CPD courses.
Results
Respondents included 266 undergraduates and 130 dentists. SDM was defined by the people involved, components of the discussion, approach to decision‐making and expected outcome. Attitudes to SDM were generally positive although concerns were expressed about patients wanting professionals to make the decision, straying from the professionals’ preferred option and compatibility with clinical guidelines. Respondents reported a preference for decision‐making to involve patients, but this tended to be an informative rather than deliberative approach. Respondents were least sure of the evidence about the impact of SDM on adherence, choices and health outcomes, and the best approach to risk communication. Respondents from both groups reported an interest in learning more about SDM and its integration into clinical practice.
Conclusion
Knowledge of, and attitude to, SDM in UK dentists and dental undergraduates is generally positive; however, a demand for further SDM training was identified.
The Covid-19 pandemic had a profound effect on the delivery of healthcare research. Covid-19 research was prioritised and many non-essential trials were paused. This study explores the engagement ...experiences of trial participants', PPIE contributors' and trial staff during the Covid-19 pandemic and towards recovery and restoring a diverse and balanced UK clinical trials portfolio.
Interviews and focus groups were undertaken with PPIE contributors, trial participants and trial staff members from NIHR research trials across the UK (November 2020-June 2021) across portfolio specialities: Cancer, Oral and Dental Health, Musculoskeletal Disorders, Cardiovascular Disease, Neurological Disorders, Primary Care, and Conditions associated with susceptibility to Covid-19 (Diabetes, Stroke, Respiratory Disorders). Topic guides were developed for each participant group and interviews were conducted over Zoom. The transcripts were analysed using codebook thematic analysis in NVivo (V.12).
106 participants comprising, 45 PPIE contributors, 27 trial participants and 34 trial staff members were recruited. Three themes to engagement with trials during Covid-19 were developed. 1) Ensuring continued contact. Continued and tailored communication, having a trial point of contact and regular updates all enhanced trial engagement and retention. Patients' unfamiliarity with materials being sent electronically reduced engagement and trust. 2) A balanced move to remote consultations. Remote follow-up and monitoring were convenient and allowed for wider recruitment across the UK. Participants were more likely to discuss personal subjects in their own homes. Remote visits lacked a personal touch, some concerns over missed diagnoses or being unable to appreciate the situation, technical abilities or equipment failures were seen as barriers, especially for disadvantaged or older people. 3) The importance of feeling fully informed. Factors that supported attendance were knowledge about trial conduct adherence to Covid-19 regulations, social distancing, clear signage at the site and opportunities to ask questions. Barriers included not knowing what to expect and not feeling safe with rules and regulations.
Our findings highlight a number of ways to future proof trial delivery against future pandemics or disruptions such as offering online options to participate in research, ensuring consistent communication between participants and the research team, making sure participants feel fully informed and the continued reassurance of safety in the clinical setting.
Background/Aim
Variability in the outcome measures used to assess the success of tooth autotransplantation presents challenges for combining data to examine the success of the technique. Reaching ...agreement on the most important outcomes will enable routine procedural and follow‐up data to be collected in a standardised way. In turn this will promote greater data synthesis to evaluate outcomes and examine which procedural techniques influence outcome. The aim of this study was to identify which prognostic factors and outcomes are most important to clinicians with experience in autotransplantation of developing teeth.
Methods
The Delphi method was used to build consensus on the most important prognostic factors and outcomes. Item identification involved a systematic literature review and review of current clinical datasets in use. A two‐round Delphi questionnaire was undertaken with clinicians providing tooth autotransplantation, followed by a consensus meeting to finalise the most important items.
Results
Outcomes and prognostic factors were identified from the systematic review (82 studies and eight reviews), one guideline and three existing clinical datasets. Patient interviews and a clinician survey added a number of items that would not have been identified from the literature only. A total of 56 outcomes and 93 prognostic factors were included for rating in the Delphi questionnaire. The Delphi questionnaire was completed by 15 respondents in round one and 13 respondents in round two. The consensus meeting was attended by nine participants. The final items that were judged to be most important included 29 outcomes (25 clinical, three patient‐reported and one service delivery) and 49 prognostic factors (18 patient characteristics, four presurgical, 17 surgical and 10 postsurgical). Clinical outcomes were consistently rated higher than patient‐reported outcomes.
Conclusions
The clinical outcomes rated as the most important were transplant survival and reason for failure, outcomes relating to pulp health, different types of resorption and evidence of infection (suppuration). Important patient‐reported outcomes were satisfaction with overall treatment experience, and outcome and quality of life related to function of the transplanted tooth. Procedural information rated as being the most important related to the donor tooth: stage of root development, method for surgical removal and storage and condition of the donor tooth root surface following removal.
Objective:
To establish UK orthodontic treatment providers’ knowledge of, and attitudes to, shared decision-making (SDM). SDM involves patients as equal partners in decisions about treatment.
Design:
...Cross-sectional survey.
Setting:
Online survey across the UK.
Population:
Dentists and orthodontists providing orthodontic treatment in the UK.
Methods:
Potential participants were contacted through the British Orthodontic Society mailing lists. An online survey was developed to examine knowledge of, and attitudes to, SDM using a combination of evidence-based statements and free text boxes. Questions regarding previous training in SDM and preferences for further training were also included.
Results:
The survey was completed by 210 respondents, yielding an approximate response rate of 15%. Respondents were mainly consultants (34%) and specialist orthodontists (42%). SDM was well described in terms of the people involved in this process, how it is approached, the components and topics of discussion, and the overall purpose of SDM. Generally, there was consistency in attitudinal responses, with the largest variance in responses to questions about the professional–patient partnership, the interface between SDM and clinical guidelines, and accepting a decision that is discordant with the professional’s opinion. Fifty-one respondents reported having some previous teaching/training in SDM, with the majority (87%) indicating that they would like more training.
Conclusion:
Clinicians providing orthodontic treatment in the UK have a good understanding of the meaning of shared decision-making. Concerns raised about using SDM and knowledge gaps suggest there is value in providing SDM training for the orthodontic team and that orthodontic providers would welcome it.
Introduction:
Patient and public involvement and engagement (PPIE) in research is an essential component of high-quality research. Patients and the public can identify which research topics are most ...relevant to them, contribute to study design, and interpretation and dissemination of findings. While inclusion of PPIE is widely adopted in medical research, awareness within the dental research community is more limited.
Aim:
To examine patient and public involvement and engagement in orthodontic research activity.
Design:
Identification and appraisal of use of PPIE in orthodontic research reporting and funding applications using a systematic approach.
Methods:
Three sources of information were examined: (1) research articles published between September 2018 and September 2019 in four major orthodontic journals. Articles were examined for reported PPIE; (2) common funding bodies for orthodontic research were assessed to establish whether PPIE was mandated (National Institute for Health Research, Medical Research Council, Wellcome Trust, Chief Scientist Office (Scotland), Health and Care Research Wales, British Orthodontic Society Foundation, Royal College of Surgeons and CLEFT); and (3) publication guidance for authors in these journals was examined to identify whether reporting of PPIE was included.
Results:
Of the 363 research articles, 2 (0.6%) mention patient/public involvement. None of the 363 research articles mention patient/public engagement. Of nine funding bodies, 2 (22%) request evidence of patient/public involvement as a condition of receiving funding with one (11%) expecting evidence of public engagement to be provided as a condition of receiving funding. None of the four major orthodontic journals include patient/public involvement and/or engagement in their guidance for authors.
Conclusion:
There is currently: (1) a notable lack of reporting of PPIE in orthodontic research; (2) variability in the requirements of funding bodies for researchers to include PPIE in funding applications and throughout the research process; and (3) no stipulation in journals’ instructions for authors.
Introduction
The aim was to assess the ability and confidence of UK undergraduate dental students in applying the Index of Orthodontic Treatment Need (IOTN) and determining appropriate orthodontic ...referral.
Materials and Methods
This was a cross‐sectional survey using a case‐based online questionnaire. Fourth and fifth year undergraduate dental students were recruited from UK dental schools through their university and social media. Six cases were presented and participants were asked to provide an IOTN score and judgement about referral. Participants were asked about their confidence, experience and orthodontic teaching.
Results
Sixty‐nine responses were returned. A quarter of participants reported having used IOTN before in a clinical setting. Clinical experience with IOTN influenced confidence. Familiarity with making orthodontic referrals was low and only one participant reported having made an orthodontic referral. Correct IOTN scores were given by 68% of participants for a large 14 mm overjet (5a) case, 43% of participants for an impacted canine (5i) case and 26% of participants for an impacted premolar (5i) case. Incorrect IOTN was most common in hypodontia cases with only 19% correctly identifying mild hypodontia (4h) and 28% identifying severe hypodontia (5h). For the majority of cases, incorrect answers about referral were due to confusion between specialist practitioner and orthodontic consultant pathways.
Conclusions
Dental students' ability and confidence in correctly applying the IOTN Dental Health Component and selecting the appropriate referral pathway was inadequate. Responses suggest a lack of clinical experience in assessing patients, applying the IOTN and making referrals. The low response rate is disappointing and limits the scope for making recommendations.
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