Background
Dentistry is a profession with a high prevalence of work‐related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student ...phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear.
Objectives
To assess the effect of ergonomic interventions for the prevention of work‐related musculoskeletal disorders among dental care practitioners.
Search methods
We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC (OSH‐UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions.
Selection criteria
We included randomised controlled trials (RCTs), quasi‐RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self‐reported pain, or work functioning.
Data collection and analysis
Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full‐text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach.
Main results
We included two RCTs (212 participants), one of which was a cluster‐randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi‐faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.
Physical ergonomic interventions. Based on one study, there is very low‐quality evidence that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six‐month period. Based on one study, there is low‐quality evidence of no clear difference in elbow pain (MD −0.14, 95% CI −0.39 to 0.11; 110 participants), or shoulder pain (MD −0.32, 95% CI −0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16‐week period.
Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.
Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions.
Authors' conclusions
There is very low‐quality evidence from one study showing that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six‐month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low‐quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16‐week period.
We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.
Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well‐designed, conducted, and reported RCTs, with long‐term follow‐up that assess prevention strategies for WMSDs among dental care practitioners.
Objectives
Due to forecasted faculty shortages and increasing student enrollments in dental education, there is a need to attract talented clinicians into academia. To address this growing concern, ...we need to explore dental practitioners’ perspectives on the academic career pathway, including enablers and barriers to entering the academic workforce.
Methods
A mixed‐methods electronic survey was disseminated through professional associations and dental groups on social media in 2018. Qualitative responses were examined using an inductive thematic analysis.
Results
Participants (n = 85) considered an academic career highly regarded (80%) but indicated there was not a clear pathway (79%) and could not recall it being discussed during their dental studies (85%). It was perceived that experience, further study, and networks all played a significant role in forging an academic career. Perceived benefits to an academic career included professional development opportunities, good employment conditions, and making a meaningful contribution. Barriers included the geographical location of universities, losing clinical skills and the lack of a clear career pathway.
Conclusion
Despite being a highly regarded career, clinicians admit the career pathway to academia is not clear. Improving awareness of academic career paths might be achieved by educating dental students and providing accessible resources to the wider profession.
Objectives
This qualitative study explored the enablers and barriers of career satisfaction among Australian oral health therapists (OHTs) and the reasons behind career changes.
Methods
Participants ...were recruited in 2 ways: 1) recruitment posts were made on the Facebook pages of two professional groups; and 2) an email was sent to the Doctor of Dental Medicine students of the University of Sydney School of Dentistry, inviting those with OHT qualifications to participate. Each participant completed a semi‐structured interview which was guided by open‐ended questions. The average interview length was 45 min. All interviews were recorded, transcribed verbatim and manually coded. Thematic analysis of the qualitative data was completed using an inductive approach.
Results
Twenty‐one OHTs participated in this study. The enablers of OHT career satisfaction include clinical practice, job variety, career flexibility, being in a supportive team environment and the opportunity for constant learning and growth. The barriers to career satisfaction include musculoskeletal problems, restrictions on the scope of practice use, psychological stress and lack of recognition from others. OHTs remain in the profession due to stable income and employment opportunities. The main reasons for retirement were burnout and pursuing dentistry. OHTs pursue dentistry to expand their scope of practice.
Conclusion
This study revealed the enablers and barriers of OHT career satisfaction in an Australian context. OHTs are an important component of modern dental workforces, and reasons for attrition within the workforce are essential for maintaining responsiveness to community oral health needs.
Abstract Purpose In mechanically ventilated patients, the endotracheal tube is an essential interface between the patient and ventilator, but inadvertently it also facilitates the development of ...ventilator-associated pneumonia (VAP) by subverting pulmonary host defense. A number of investigations suggest that bacteria colonising the oral cavity may be important in the aetiology of VAP. The present study evaluated microbial changes that occurred in dental plaque and lower airways of 107 critically ill mechanically ventilated patients. Materials and Methods Dental plaque and lower airways fluid was collected during the course of mechanical ventilation, with additional samples of dental plaque obtained during the entirety of patients' hospital stay. Results A ‘microbial shift’ occurred in dental plaque, with colonisation by potential VAP pathogens, namely, Staphylococcus aureus and Pseudomonas aeruginosa in 35 patients. Post-extubation analyses revealed that 70% and 55% of patients whose dental plaque included S. aureus and P. aeruginosa, respectively, reverted back to having a predominantly normal oral microbiota. Respiratory pathogens were also isolates from the lower airways and within the endotracheal tube biofilms. Conclusions To the best of our knowledge, this is the largest study to date exploring oral microbial changes during both mechanical ventilation and following recovery from critical illness. Based on these findings, it was apparent that during mechanical ventilation, dental plaque represents a source of potential VAP pathogens.
The prevalence of musculoskeletal disorders (MSD) in the dental professions has been well established, and can have detrimental effects on the industry, including lower productivity and early ...retirement. There is increasing evidence that these problems commence during undergraduate training; however, there are still very few studies that investigate the prevalence of MSD or postural risk in these student groups. Thus, the aim of this study was to determine the prevalence of MSD and conduct postural assessments of students studying oral health and dentistry. A previously validated self-reporting questionnaire measuring MSD prevalence, derived from the Standardised Nordic Questionnaire, was distributed to students. Posture assessments were also conducted using a validated Posture Assessment Instrument. MSD was highly prevalent in all student groups, with 85% reporting MSD in at least one body region. The neck and lower back were the most commonly reported. The final year dental students had the highest percentage with poor posture (68%), while the majority of students from other cohorts had acceptable posture. This study supports the increasing evidence that MSD could be developing in students, before the beginning of a professional career. The prevalence of poor posture further highlights the need to place further emphasis on ergonomic education.
IMPORTANCE: There is little evidence to support selection of heart rate control therapy in patients with permanent atrial fibrillation, in particular those with coexisting heart failure. OBJECTIVE: ...To compare low-dose digoxin with bisoprolol (a β-blocker). DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label, blinded end-point clinical trial including 160 patients aged 60 years or older with permanent atrial fibrillation (defined as no plan to restore sinus rhythm) and dyspnea classified as New York Heart Association class II or higher. Patients were recruited from 3 hospitals and primary care practices in England from 2016 through 2018; last follow-up occurred in October 2019. INTERVENTIONS: Digoxin (n = 80; dose range, 62.5-250 μg/d; mean dose, 161 μg/d) or bisoprolol (n = 80; dose range, 1.25-15 mg/d; mean dose, 3.2 mg/d). MAIN OUTCOMES AND MEASURES: The primary end point was patient-reported quality of life using the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) at 6 months (higher scores are better; range, 0-100), with a minimal clinically important difference of 0.5 SD. There were 17 secondary end points (including resting heart rate, modified European Heart Rhythm Association EHRA symptom classification, and N-terminal pro-brain natriuretic peptide NT-proBNP level) at 6 months, 20 end points at 12 months, and adverse event (AE) reporting. RESULTS: Among 160 patients (mean age, 76 SD, 8 years; 74 46% women; mean baseline heart rate, 100/min SD, 18/min), 145 (91%) completed the trial and 150 (94%) were included in the analysis for the primary outcome. There was no significant difference in the primary outcome of normalized SF-36 PCS at 6 months (mean, 31.9 SD, 11.7 for digoxin vs 29.7 11.4 for bisoprolol; adjusted mean difference, 1.4 95% CI, −1.1 to 3.8; P = .28). Of the 17 secondary outcomes at 6 months, there were no significant between-group differences for 16 outcomes, including resting heart rate (a mean of 76.9/min SD, 12.1/min with digoxin vs a mean of 74.8/min SD, 11.6/min with bisoprolol; difference, 1.5/min 95% CI, −2.0 to 5.1/min; P = .40). The modified EHRA class was significantly different between groups at 6 months; 53% of patients in the digoxin group reported a 2-class improvement vs 9% of patients in the bisoprolol group (adjusted odds ratio, 10.3 95% CI, 4.0 to 26.6; P < .001). At 12 months, 8 of 20 outcomes were significantly different (all favoring digoxin), with a median NT-proBNP level of 960 pg/mL (interquartile range, 626 to 1531 pg/mL) in the digoxin group vs 1250 pg/mL (interquartile range, 847 to 1890 pg/mL) in the bisoprolol group (ratio of geometric means, 0.77 95% CI, 0.64 to 0.92; P = .005). Adverse events were less common with digoxin; 20 patients (25%) in the digoxin group had at least 1 AE vs 51 patients (64%) in the bisoprolol group (P < .001). There were 29 treatment-related AEs and 16 serious AEs in the digoxin group vs 142 and 37, respectively, in the bisoprolol group. CONCLUSIONS AND RELEVANCE: Among patients with permanent atrial fibrillation and symptoms of heart failure treated with low-dose digoxin or bisoprolol, there was no statistically significant difference in quality of life at 6 months. These findings support potentially basing decisions about treatment on other end points. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02391337 and clinicaltrialsregister.eu Identifier: 2015-005043-13
Improvement of health services and patient outcomes depends on the translation of health research into health policy. Oral health research can inform policies to manage chronic diseases and improve ...quality of life of affected individuals. To determine if translation of this research into policy is occurring, we identify where policymakers obtain evidence to inform the development of Australian health policy. We conducted a citation analysis of oral health, cardiovascular disease, diabetes and cognitive impairment National policies to determine if current oral health research has informed oral health and chronic disease policy. We analysed five National policies with 268 individual references to policy or organizational documents (n = 179), peer-reviewed research (n = 74), grey literature (n = 12), or unidentifiable (n = 3). Although we found oral health references listed in the National policies (92), we did not find this information to have been translated into the oral health and chronic disease policies we analysed.
Systemic administration of opioids has been associated with aspiration and swallow dysfunction in humans. We speculated that systemic administration of codeine would induce dysfunctional swallowing ...and that this effect would have a peripheral component. Experiments were conducted in spontaneously breathing, anesthetized cats. The animals were tracheotomized and electromyogram (EMG) electrodes were placed in upper airway and chest wall respiratory muscles for recording swallow related motor activity. The animals were allocated into three groups: vagal intact (VI), cervical vagotomy (CVx), and supra-nodose ganglion vagotomy (SNGx). A dose response to intravenous codeine was performed in each animal. Swallowing was elicited by injection of 3 mL of water into the oropharynx. The number of swallows after vehicle was significantly higher in the VI group than in SNGx. Codeine had no significant effect on the number of swallows induced by water in any of the groups. However, the magnitudes of water swallow-related EMGs of the thyropharyngeus muscle were significantly increased in the VI and CVx groups by 2–4 fold in a dose-related manner. In the CVx group, the geniohyoid muscle EMG during water swallows was significantly increased. There was a significant dose-related increase in spontaneous swallowing in each group from codeine. The spontaneous swallow number at the 10 mg/kg dose of codeine was significantly larger in the CVx group than that in the SNGx group. During water-evoked swallows, intravenous codeine increased upper airway motor drive in a dose-related manner, consistent with dysregulation. The data support the existence of both central and peripheral actions of codeine on spontaneous swallowing. At the highest dose of codeine, the reduced spontaneous swallow number in the SNGx group relative to CVx is consistent with a peripheral excitatory action of codeine either on pharyngeal/laryngeal receptors or in the nodose ganglion itself. The higher number of swallows in the CVx group than the VI group supports disinhibition of this behavior by elimination of inhibitory vagal sensory afferents.
Introduction
There is very little evidence of dental schools offering leadership or career development training for students. Given that tertiary students come from diverse backgrounds with differing ...experiences, it is important that all students learn skills that improve their employability by preparing them for a range of career paths and equipping them with the confidence to lead their profession into the future. This study mapped current leadership and career development training in dental education programmes throughout Australia, focusing on the capacity, barriers and enablers.
Methods
In 2018, an electronic survey was sent to the Program Convenors of all nineteen dental programmes in Australia. Survey questions were sourced from existing literature and the current regulatory competencies.
Results
Whilst the majority of respondents (n = 17, 89% response rate) indicated that their programmes included both leadership training (72%) and career development activities (88%), it is clear that the content focus, hours allocated and assessment items vary widely across the country. Further, curriculum appeared to focus almost exclusively on clinical work, which does not provide an avenue for students to explore alternative, non‐clinical career options or pathways or develop their skills beyond treating individual patients. Time constraints and ideological differences were reported as the biggest barriers to implementing leadership and career development curricula.
Conclusion
Despite an inconsistent approach nationally, it appears there is an opportunity for faculty across institutions to collaborate, potentially to develop a set of leadership and career development competencies and best practice teaching and learning activities.
Historically, simulation‐based dental education was taught using practical skills and the action of doing. An increased awareness of the importance of patient safety in healthcare education and ...delivery has seen considerable advances in the application of simulation‐based education across several healthcare disciplines including medicine, nursing and anaesthetics. Dental simulation–based education requires improved standards of best‐practice, and evidence‐based, curriculum design that is based on theoretical frameworks, conceptual frameworks and educational theories. In this commentary, we explore the educational theory and the development of healthcare simulation, including internationally recognised standards of best practice and the simulation‐based activity cycle. Given simulation‐based education should be fit‐for purpose, the components of these standards are examined within the specific context of dental education. We propose an evidence‐based, best‐practice framework that can be applied in the design and delivery of contemporary simulation‐based dental curriculum.
PDF
