Summary
Background
Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and ...documentation at each visit.
Objectives
The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter‐ and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA).
Methods
Fifteen patients with mild‐to‐moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h.
Results
In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0·97, MMPDAI activity 0·59 and damage 0·15, ABSIS total 0·84, and PGA 0·72. The intraobserver ICCs (two observers) for ODSS total were 0·97 and 0·93; for MMPDAI activity 0·93 and 0·70 and damage 0·93 and 0·79; for ABSIS total 0·99 and 0·94; and for PGA 0·92 and 0·94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0·88). The mean ± SD time for completion of ODSS was 93 ± 31 s, with MMPDAI 102 ± 24 s and ABSIS involvement 71 ± 18 s. The PGA took < 5 s.
Conclusions
This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform.
What's already known about this topic?
There are no validated scoring methodologies for oral mucous membrane pemphigoid (MMP).
Proposed disease activity scoring tools for MMP include the Mucous Membrane Disease Area Index (MMPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS).
The Oral Disease Severity Score (ODSS) has been validated for use in oral pemphigus vulgaris (PV). It has been shown to be reliable and sensitive in both lichen planus (LP) and MMP.
What does this study add?
The ODSS has been shown to be a thorough, sensitive and reproducible, yet quick scoring tool for the assessment of oral involvement in MMP.
Its versatility for use in oral PV, MMP and LP is an added advantage over other scoring methodologies.
What are the clinical implications of this work?
We propose that the ODSS be used as a clinical scoring tool for monitoring activity in oral MMP in clinical practice as well as for use in multicentre studies.
Respond to this article
Objective
This study explored, and compared, the attitudes of student groups trained at the University of Portsmouth Dental Academy (UPDA) in 2010/2011 towards dental interprofessional education ...(IPE).
Methods
The study population consisted of fifth‐year student dentists (n = 80) from King's College London Dental Institute, second‐ and third‐year dental hygiene and therapy (n = 38) and first‐year dental nursing (n = 14) students from UPDA. A 19‐item, validated and dentally modified questionnaire, ‘Readiness for Inter‐Professional Learning Scale (RIPLS)’, was administered. RIPLS contains three subscales: teamwork and collaboration, professional identity and roles and responsibilities. Mean (x¯) and standard deviation (SD) of the scores were calculated, following reversal of negative items. All the analyses were carried out using SPSS version 20 and STATA version 11.
Results
An overall response rate of 71% (n = 94) was achieved. In reference to teamwork and collaboration, all groups strongly indicated that IPE can contribute to learning teamwork skills (x¯ = 24.98, SD = 3.5) and improving relationships with team members (x¯ = 12.93, SD = 1.63); however, the scores did not differ between the groups (P = 0.09 and P = 0.16, respectively). Concerning professional identity, student dentists had significantly higher preference for a discipline‐based approach (P = 0.002); were more likely to agree that ‘it is not necessary for undergraduate dental and dental care professional students to learn together’ (P = 0.01); and perceived that ‘clinical problem‐solving skills can only be learnt effectively with other students from their own discipline’ (P = 0.02) than dental hygiene and therapy students. In relation to roles and responsibilities, participants demonstrated a strong sense of their own professional role. Student dentists reported that they had ‘to gain more knowledge and skills’ than dental hygiene and therapy (P = 0.01) and dental nursing (P = 0.01) students. Dental hygiene and therapy students were less likely than student dentists to agree that ‘the role of dental nurses and hygienists was to mainly provide support for dentists’ (P = 0.001).
Conclusion
The findings suggest that IPE was perceived as beneficial in relation to teamwork; however, the study raises issues regarding professional identity and roles. Educators should consider differing perceptions of professional roles and identities when planning and delivering interprofessional programmes.
An Oral Disease Severity Score for pemphigus vulgaris Ormond, M.; McParland, H.; Donaldson, A.N.A. ...
British journal of dermatology (1951),
October 2018, 2018-10-00, 20181001, Letnik:
179, Številka:
4
Journal Article
Recenzirano
Summary
Pemphigus vulgaris (PV) is a rare and often serious autoimmune disease that causes painful blistering in a number of sites including the skin, mouth, nose, throat or genitals. It does this by ...producing harmful antibodies that are directed to the skin or mucous membranes. The mouth is a site where the disease often starts and may continue to be affected for many years. Immune suppressant medicines are used to treat PV but in order to use these effectively and safely, clinicians need an accurate and ‘reproducible’ method of assessing and recording the number and site of the lesions. Reproducible means that the test can be repeated by another person and the results will be the same. Scoring tools that have been scientifically validated are therefore used and include the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI). These include an oral (mouth) component but for patients with predominantly oral disease, we have devised a specific Oral Disease Severity Score (ODSS) which looks at 17 sites in the mouth, yet is quick and simple to use. In this UK study, we sought to validate ODSS and to compare its reproducibility with ABSIS, PDAI and the Physicians Global Assessment score. Ten oral medicine specialists, the majority unfamiliar with any of these methodologies, each scored 15 patients with oral PV on one day. Two clinicians rescored all 15 patients. The results have shown that the ODSS was both reliable and reproducible and was at least as good if not better than ABSIS and PDAI for assessing oral disease. By providing a more detailed method for assessing oral PV, we believe that ODSS will be more sensitive (accurate) for long term disease monitoring.
Linked Article: Ormond et al. Br J Dermatol 2018; 179:872–881
Cognitive-behavioural self-care is advocated as a first step in the treatment of bulimia nervosa.
To examine the effectiveness of a CD-ROM-based cognitive-behavioural intervention in bulimia nervosa ...and eating disorder not otherwise specified (NOS) (bulimic type) in a routine setting.
Ninety-seven people with bulimia nervosa or eating disorder NOS were randomised to either CD-ROM without support for 3 months followed by a flexible number of therapist sessions or to a 3-month waiting list followed by 15 sessions of therapist cognitive-behavioural therapy (CBT) (ISRCTN51564819). Clinical symptoms were assessed at pre-treatment, 3 months and 7 months.
Only two-thirds of participants started treatment. Although there were significant group x time interactions for bingeing and vomiting, favouring the CD-ROM group at 3 months and the waiting-list group at 7 months, post hoc group comparisons at 3 and 7 months found no significant differences for bingeing or vomiting. CD-ROM-based delivery of this intervention, without support from a clinician, may not be the best way of exploiting its benefits.
Introduction
Peer assessment is increasingly used in health education. The aims of this study were to evaluate the reliability, accuracy, educational impact and student's perceptions of undergraduate ...pre‐clinical and clinical dental students' structured and prospective Peer assessment and peer feedback protocol.
Materials and methods
Two Direct Observation of Procedural Skills (DOPS) forms were modified for use in pre‐clinical and clinical peer assessment. Ten year two dental students working in a phantom‐heads skills laboratory and 16‐year five dental students attending a comprehensive care clinic piloted both peer DOPS forms. After training, pairs of students observed, assessed and provided immediate feedback to each other using their respective peer DOPS forms as frameworks. At the end of the 3‐month study period, students anonymously provided their perceptions of the protocol.
Results
Year 2 and year 5 students completed 57 and 104 peer DOPS forms, respectively. The generalizability coefficient was 0.62 for year 2 (six encounters) and 0.67 for year 5 (seven encounters). Both groups were able to differentiate amongst peer‐assessed domains and so detect improvement in peers' performance over time. Peer DOPS scores of both groups showed a positive correlation with their mean end‐of‐year examination marks (r ≥ 0.505, P ≥ 0.051) although this was not statistically significant. There was no difference (P ≥ 0.094) between the end‐of‐year examination marks of the participating students and the rest of their respective classes. The vast majority of both groups expressed positive perceptions of the piloted protocol.
Discussion
There are no data in the literature on the prospective use of peer assessment in the dental undergraduate setting. In the current study, both pre‐clinical and clinical students demonstrated the ability to identify those domains where peers performed better, as well as those which needed improvement. Despite no observable educational impact, most students reported positive perceptions of the peer DOPS protocol.
Conclusions
The results of this pilot study support the need for and the potential benefit of a larger‐ and longer‐term follow‐up study utilising the protocol.
In people with bulimic eating disorders, exposure to high-calorie foods can result in increases in food craving, raised subjective stress and salivary cortisol concentrations. This cue-induced food ...craving can be reduced by repetitive transcranial magnetic stimulation (rTMS). We investigated whether rTMS has a similar effect on salivary cortisol concentrations, a measure of hypothalamic-pituitary-adrenal axis (HPAA) activity.
We enrolled twenty-two female participants who took part in a double-blind randomized sham-controlled trial on the effects of rTMS on food craving. Per group, eleven participants were randomized to the real or sham rTMS condition. The intervention consisted of one session of high-frequency rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC). Salivary cortisol concentrations were assessed at four time points throughout the 90-min trial. To investigate differences in post-rTMS concentrations between the real and sham rTMS groups, a random-effects model including the pre-rTMS cortisol concentrations as covariates was used.
Salivary cortisol concentrations following real rTMS were significantly lower compared with those following sham rTMS. In this sample, there was also a trend for real rTMS to reduce food craving more than sham rTMS.
These results suggest that rTMS applied to the left DLPFC alters HPAA activity in people with a bulimic disorder.
Introduction
A national follow‐up survey was undertaken to determine whether dental graduates from 2009 perceived that their undergraduate oral surgery education had equipped them for general dental ...practice 4 years after graduating.
Materials and Methods
Graduates from the same 13 United Kingdom dental schools who had taken part in the original survey were invited to take part in this follow‐up online survey. Their contact details were identified via the general dental council register, social media and alumni groups.
Results
In total, 161 responded (2009b) which represents 16% of the graduates of the original survey in 2009a. A similar percentage of these respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practice (83% and 79% in 2009a and 2009b, respectively). Most respondents (99% in both years) reported confidence in undertaking simple forceps exodontia. Confidence in surgical exodontia was poor in both surveys, but one area that appeared improved in the follow‐up related to the sectioning of teeth (84% in 2009b compared with 49% in 2009a). Areas of weakness identified in 2009 were reported to be improved in the follow‐up.
Conclusion
This follow‐up survey supports the findings of the original survey. Future longitudinal studies would allow institutions to identify possible weaknesses in their curriculum and to track the career development of their graduates and facilitate robust data collection.
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