Social Media Use by Dental Hygiene Educators.

Purpose Social media can be an effective tool in health care education. The purpose of this study was to explore dental hygiene educators' familiarity and use of social media platforms and to examine how social media was implemented in dental hygiene education.Methods A 25-item questionnaire was designed to investigate the use of social media by dental hygiene educators. The instrument included demographic data and items addressing personal, professional, and educational use of twelve common social media sites and the respondents' beliefs about social media using a 4-point Likert scale. The electronic questionnaire was distributed by email to 379 dental hygiene program directors in the United States and Canada. Descriptive statistics were used to analyze the data.Results A total of 120 responses were received. While Facebook was the most utilized site for personal use (78.3%), LinkedIn was the most frequently accessed site for professional use (57.5%), and YouTube for educational use (68.3%). There was strong agreement that the interactive nature of online technologies create better learning environments (84.1%). There was also strong agreement that social media use in the classroom invites student participation (77.5%). More than half of the respondents (64.2%) indicated that social media can be an effective method for content delivery.Conclusion Social media is highly utilized for personal use by dental hygiene educators, but less frequently for engagement purposes in the classroom.

Outcomes of a contemporary credentialing and privileging program in a dental school.

The current credentialing and privileging (C&P) climate has evolved due to a risk reduction/management awareness of increased institutional legal liability. This recognition affects dental colleges and has caused the implementation of C&P processes. Contemporary best practices for methods, processes, and structure are reported here. Data reported from the process show how and what clinicians' red flags were discovered during the process. Conclusions include the following: C&P is a significant process to introduce in terms of institutional resources and commitment. This process includes increased clinician and administrative burden that needs to have a governor. Attention to experiences of other institutions can reduce but not eliminate challenges from the clinician and some administrators. A primary data-based verification process administered by a credentialing specialist can make the process valid and workable.

Prevention and Reduction of Musculoskeletal Pain Through Chair-Side Stretching among Dental Hygiene Students.

Purpose: Musculoskeletal disorders (MSD) are among the most commonly reported injuries in the workforce and there is a particularly high prevalence among dental hygienists. Research has shown that the incidence of MSD may begin during students' academic and clinical training. The purpose of this study was to determine the effectiveness of implementing chair-side stretching exercises on self-reported musculoskeletal (MSK) pain among currently enrolled dental hygiene students.Methods: A total of 31 senior dental hygiene students were divided into treatment and control groups during the fall semester. The treatment group completed a series of chair-side stretching exercises, prior to beginning each clinic session, for approximately 10.5 weeks. Participants completed a modified version of the Standardized Nordic Questionnaire at the beginning (week 0), midpoint (week 5), and end of the study (week 10.5). Descriptive statistics were used to analyze the data.Results: There were significant differences in the total MSK pain scores reported between the treatment and control groups (p=0.03) in addition to the hand and wrist pain severity scores (p=0.04). Hierarchical multiple regression revealed a model explaining the 38.2% variance in MSK pain between the groups (p=0.021). A majority of participants in the treatment group felt that chair-side stretching exercises neither improved nor worsened their MSK pain. However, more than one-half of the participants felt that the exercises helped increase their conscious level regarding ergonomic practices while delivering patient care.Conclusion: Findings from this study suggest that consistent chair-side stretching exercises may be beneficial in reducing and preventing MSK pain, particularly within the hand and wrist region. Future research is needed to determine effective interventions to reduce MSK pain, particularly for the neck, shoulders, and lower back during dental hygiene education.

Population-based estimates of survival among elderly patients with brain metastases.

BACKGROUND: Prognostic estimates for patients with brain metastases (BM) stem from younger, healthier patients enrolled in clinical trials or databases from academic centers. We characterized population-level prognosis in elderly patients with BM. METHODS: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 9882 patients ≥65 years old with BM secondary to lung, breast, skin, kidney, esophageal, colorectal, and ovarian primaries between 2014 and 2016. Survival was assessed by primary site and evaluated with Cox regression. RESULTS: In total, 2765 versus 7117 patients were diagnosed with BM at primary cancer diagnosis (synchronous BM, median survival = 2.9 mo) versus thereafter (metachronous BM, median survival = 3.4 mo), respectively. Median survival for all primary sites was ≤4 months, except ovarian cancer (7.5 mo). Patients with non-small-cell lung cancer (NSCLC) receiving epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-based therapy for synchronous BM displayed notably better median survival at 12.5 and 20.1 months, respectively, versus 2.8 months exhibited by other patients with NSCLC; survival estimates in melanoma patients based on receipt of BRAF/MEK therapy versus not were 6.7 and 2.8 months, respectively. On multivariable regression, older age, greater comorbidity, and type of managing hospital were associated with poorer survival; female sex, higher median household income, and use of brain-directed stereotactic radiation, neurosurgical resection, or systemic therapy (versus brain-directed non-stereotactic radiation) were associated with improved survival (all P < 0.05). CONCLUSIONS: Elderly patients with BM have a poorer prognosis than suggested by prior algorithms. If prognosis is driven by systemic and not intracranial disease, brain-directed therapy with potential for significant toxicity should be utilized cautiously.

Prescription of memantine during non-stereotactic, brain-directed radiation among patients with brain metastases: a population-based study.

PURPOSE: Whole brain radiation therapy (WBRT) remains an important component of treatment for patients with multiple brain metastases (BrM) but is associated with significant neurotoxicity and memory impairment. Although RTOG 0614 demonstrated that administration of memantine to patients receiving WBRT may reduce radiation-associated cognitive decline, prior literature has suggested that radiation oncologists are hesitant to prescribe memantine. We sought to assess the frequency of memantine prescription in patients managed with non-stereotactic, brain-directed radiation for BrM. METHODS: Patients > 65 years old with newly diagnosed BrM between 2007 and 2016 receiving non-stereotactic, brain-directed radiation (including WBRT) were identified using the SEER-Medicare database. Receipt of memantine with non-stereotactic, brain-directed radiation was defined as any Part D claim for memantine 30 days before or after initiation of non-stereotactic, brain-directed radiation. Clinical and demographic variables among patients who did and did not receive memantine were compared. RESULTS: Between 2007 and 2016, we identified 6220 patients with BrM receiving non-stereotactic, brain-directed radiation. Only 2.20% of patients (n = 137) received memantine with radiation. Rates were 1.10% versus 5.14% in the period preceding (2007-2013) and following (2014-2016) the publication of RTOG 0614, respectively. Overall utilization of memantine remained low across several clinical, demographic, and prognostic variables. CONCLUSION: Despite phase 3 evidence supporting memantine utilization among patients receiving WBRT, our population-based study indicates that rates of memantine prescription are strikingly low, although memantine utilization seems to be increasing since publication of RTOG 0614. Further investigation is needed to identify provider and practice-related barriers preventing incorporation of memantine into management paradigms.

Racial disparities in supportive medication use among older patients with brain metastases: a population-based analysis.

BACKGROUND: Brain metastases (BM) cause symptoms that supportive medications can alleviate. We assessed whether racial disparities exist in supportive medication utilization after BM diagnosis. METHODS: Medicare-enrolled patients linked with the Surveillance, Epidemiology, and End Results program (SEER) who had diagnoses of BM between 2007 and 2016 were identified. Fourteen supportive medication classes were studied: non-opioid analgesics, opioids, anti-emetics, anti-epileptics, headache-targeting medications, steroids, cognitive aids, antidepressants, anxiolytics, antidelirium/antipsychotic agents, muscle relaxants, psychostimulants, sleep aids, and appetite stimulants. Drug administration ≤30 days following BM diagnosis was compared by race using multivariable logistic regression. RESULTS: Among 17,957 patients, headache aids, antidepressants, and anxiolytics were prescribed less frequently to African Americans (odds ratio [95% CI] = 0.81 [0.73-0.90], P < 0.001; OR = 0.68 [0.57-0.80], P < 0.001; and OR = 0.68 [0.56-0.82], P < 0.001, respectively), Hispanics (OR = 0.83 [0.73-0.94], P = 0.004 OR = 0.78 [0.64-0.97], P = 0.02; and OR = 0.63 [0.49-0.81], P < 0.001, respectively), and Asians (OR = 0.81 [0.72-0.92], P = 0.001, OR = 0.67 [0.53-0.85], P = 0.001, and OR = 0.62 [0.48-0.80], P < 0.001, respectively) compared with non-Hispanic Whites. African Americans also received fewer anti-emetics (OR = 0.75 [0.68-0.83], P < 0.001), steroids (OR = 0.84 [0.76-0.93], P < 0.001), psychostimulants (OR = 0.14 [0.03-0.59], P = 0.007), sleep aids (OR = 0.71 [0.61-0.83], P < 0.001), and appetite stimulants (OR = 0.85 [0.77-0.94], P = 0.002) than Whites. Hispanic patients less frequently received antidelirium/antipsychotic drugs (OR = 0.57 [0.38-0.86], P = 0.008), sleep aids (OR = 0.78 [0.64-0.94, P = 0.01), and appetite stimulants (OR = 0.87 [0.76-0.99], P = 0.04). Asian patients received fewer opioids (OR = 0.86 [0.75-0.99], P = 0.04), anti-emetics (OR = 0.83 [0.73-0.94], P = 0.004), anti-epileptics (OR = 0.83 [0.71-0.97], P = 0.02), steroids (OR = 0.81 [0.72-0.92], P = 0.001), muscle relaxants (OR = 0.60 [0.41-0.89], P = 0.01), and appetite stimulants (OR = 0.87 [0.76-0.99], P = 0.03). No medication class was prescribed significantly less frequently to Whites. CONCLUSIONS: Disparities in supportive medication prescription for non-White/Hispanic groups with BM exist; improved provider communication and engagement with at-risk patients is needed. KEY POINTS: 1. Patients with BM commonly experience neurologic symptoms.2. Supportive medications improve quality of life among patients with BM.3. Non-White patients with BM receive fewer supportive medications than White patients.

Social Media Use Behaviors and State Dental Licensing Boards.

Purpose: The importance of upholding and maintaining professionalism is even greater in a digital world particularly for health care providers entrusted to care for patients and maintain privacy laws. Studies suggest that specific consequences of violation of professionalism and other ethical standards have not been well established. The purpose of this study is to identify how online social media behaviors influence the licensure and enforcement practices of dental professionals.Methods: A non-experimental descriptive electronic survey research design was utilized for this study. A total of 52 surveys consisting of questions relating to social media and the licensure of and practice act enforcement of dental professionals were sent to the executive directors of the dental boards in the United States.Results: Of the surveys that were sent (n=52), 18 responses were received for a 35% response rate. Overall, respondents indicated a lack of social media usage surveillance initiated by state dental boards. Incidents of online unprofessional behavior came to the attention of the board a variety of ways and with a range of consequences. Overall, there was a level of concern reagarding online activities by licensees that may be in violation of laws, rules and regulations of the state or the dental board exists. However, no state dental licensing boards are currently in the process of creating a social media policy.Conclusion: Dental boards are aware of potential online unprofessional behaviors and have implemented various consequences. Dental boards should consider developing policies to address potential online unprofessional behavior to protect the public that they serve.

Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process.

Dental care in the U.S. is based on a general practice model of care delivery that can be enhanced by the integration of the dentists and allied dental professionals. There are 25 U.S. dental schools with associated dental hygiene programs, presenting distinctive opportunities for educating the dental health care team. Integrated educational clinical experiences are believed to positively influence teamwork and quality of care that parallels the authentic general practice environment. Lean management, developed by Toyota and used in a variety of types of organizations including health care, provides a distinctive blend of engineering principles and operations management to enhance business and operations processes. A fundamental principle of Lean management is the elimination of waste and preservation of only those value-added components of a process. The faculty and staff of The Ohio State University College of Dentistry, trained in Lean process improvement, applied techniques to enhance and integrate an inefficient patient intake (admissions) process. The aim of this initiative was to improve patient throughput in the patient intake process and to provide dental and dental hygiene students with enhanced educational experiences from improved clinical integration. These goals were achieved through streamlining patient flow and relocating major phases of the process. Although new patient retention and cancellation/no-show rates remained mostly unchanged, this enhancement project resulted in improved access to care, improved continuity of care, expanded scope of dental services offered, improved patient satisfaction, and enhanced dental and dental hygiene student collaboration and teamwork. These outcomes suggest that process improvement initiatives can serve as valuable opportunities for integration of the dental health care team.

A Comparison of Cognitive Presence in Asynchronous and Synchronous Discussions in an Online Dental Hygiene Course.

Purpose: Many dental hygiene degree completion (34) and graduate (14) programs offer the majority or all of their course offerings online. While the concept of real-time video web-conferencing has been realized through advances in technology, only 5% of dental hygiene programs report utilizing real-time technologies. The purpose of this study was to use the Community of Inquiry Framework to observe and compare the development of cognitive presence and critical thinking between two different methods of online discussion; asynchronous discussion boards and synchronous video web-conferences.Methods: Students in one online course were divided into two groups. Each week one group completed the course discussion questions through an asynchronous discussion board while the other group completed the same discussion questions via a synchronous video web-conference. Data were recorded and analyzed to compare total indicators of cognitive presence during the two discussion sessions, as well as comparing the various levels of cognitive presence.Results: A total of 117 messages were recorded in the asynchronous discussion sessions and 260 messages in the synchronous discussion sessions. The synchronous video web-conferences achieved significantly more total cognitive presence than the asynchronous discussions (p=0.005). Furthermore, the synchronous discussions reached the highest phase of cognitive presence, the resolution phase, in 10.19% of the messages, while the asynchronous discussions reached the resolution phase significantly less often at 0.85% (p=0.005).Conclusions: This study suggests that synchronous video web-conference in online discussions may create higher levels of cognitive presence in an online course. Higher levels of cognitive presence found in synchronous video web-conferencing may foster critical thinking skills in degree completion and graduate dental hygiene online courses.

Measuring the Impact of Cultural Competence Training for Dental Hygiene Students.

Purpose: The purpose of this study was to measure the change in levels of knowledge of providing culturally competent care and self-assessed cultural competence of senior level dental hygiene students after the implementation of an online cultural competence training module.Methods: Twenty-eight members of the senior class of 31 dental hygiene students (N=28) volunteered to participate in this IRB approved study at the Ohio State University School of Dentistry. The students took the online Inventory for Assessing the Process of Cultural Competence- Student Version (IAPCC-SV), to assess their self-perceived cultural competence. Upon completion of the pre-test, students then completed the United States Department of Health and Human Services (HHS) Office of Minority Health (OMH) Cultural Competency Program for Oral Health Professionals; a three-module online training program designed to measure increased knowledge of cultural competence. Three weeks following the initial pre-test and upon completion of the Cultural Competency Program for Oral Health Professionals online learning modules, students re-took the IAPCC-SV.Results: Twenty-eight senior dental hygiene students completed the IAPCC-SV pre-test, the OMH e-learning modules and the IAPCC-SV post-test. The average score on the pre-test was 55.14±7.54 and the average score on the post-test was 61.33±7.86. There was a significant difference in pre-test and post-test scores (p<0.001). There were also significant differences in the constructs of knowledge of cultural competence (p<0.001) and skill (p<0.001).Conclusion: The HHS OMH Cultural Competency Program for Oral Health Professionals was effective for increasing dental hygiene students' levels of knowledge of cultural competence.

Evaluating Student Self-Assessment through Video-Recorded Patient Simulations.

PURPOSE: The purpose of this pilot study was to determine if the use of a video-recorded clinical session affects the accuracy of dental hygiene student self-assessment and dental hygiene instructor feedback. METHODS: A repeated measures experiment was conducted. The use of the ODU 11/12 explorer was taught to students and participating faculty through video and demonstration. Students then demonstrated activation of the explorer on a student partner using the same technique. While faculty completed the student assessment in real time, the sessions were video recorded. After completing the activation of the explorer, students and faculty completed an assessment of the student's performance using a rubric. A week later, both students and faculty viewed the video of the clinical skill performance and reassessed the student's performance using the same rubric. The student videos were randomly assigned a number, so faculty reassessed the performance without access to the student's identity or the score that was initially given. RESULTS: Twenty-eight students and 4 pre-clinical faculty completed the study. Students' average score was 4.68±1.16 on the first assessment and slightly higher 4.89±1.45 when reviewed by video. Faculty average scores were 5.07±2.13 at the first assessment and 4.79±2.54 on the second assessment with the video. No significant differences were found between the differences in overall scores, there was a significant difference in the scores of the grading criteria compared to the expert assessment scores (p=0.0001). CONCLUSION: This pilot study shows that calibration and assessment without bias in education is a challenge. Analyzing and incorporating new techniques can result in more exact assessment of student performance and self-assessment.

Massive Open Online Courses in Dental Education: Two Viewpoints: Viewpoint 1: Massive Open Online Courses Offer Transformative Technology for Dental Education and Viewpoint 2: Massive Open Online Courses Are Not Ready for Primetime.

This point/counterpoint article discusses the strengths and weaknesses of incorporating Massive Open Online Courses (MOOCs) into dental education, focusing on whether this relatively new educational modality could impact traditional dental curricula. Viewpoint 1 asserts that MOOCs can be useful in dental education because they offer an opportunity for students to learn through content and assessment that is delivered online. While specific research on MOOCs is limited, some evidence shows that online courses may produce similar learning outcomes to those in face-to-face courses. Given that MOOCs are intended to be open source, there could be opportunities for dental schools with faculty shortages and financial constraints to incorporate these courses into their curricula. In addition to saving money, dental schools could use MOOCs as revenue sources in areas such as continuing education. Viewpoint 2 argues that the hype over MOOCs is subsiding due in part to weaker than expected evidence about their value. Because direct contact between students, instructors, and patients is essential to the dental curriculum, MOOCs have yet to demonstrate their usefulness in replacing more than a subset of didactic courses. Additionally, learning professionalism, a key component of health professions education, is best supported by mentorship that provides significant interpersonal interaction. In spite of the potential of early MOOC ideology, MOOCs in their current form require either further development or altered expectations to significantly impact dental education.

Outcomes of an Oral Care Protocol in Postmechanically Ventilated Patients.

BACKGROUND: Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients. AIMS: To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients. METHODS: In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures. RESULTS: Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group. LINKING EVIDENCE TO ACTION: This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.

A Comparison of Attrition Rates in Dental Hygiene Programs Using Selective and Nonselective Admissions.

Purpose: The purpose of this study was to determine if there is a difference between attrition rates for dental hygiene programs that use selective admissions and nonselective admissions. Admissions to dental hygiene programs is based on a predetermined class size; therefore, applicants must meet the criteria to be considered for selection. Dental hygiene programs want to retain their enrolled students and maximize their student successes; therefore, it is imperative to validate current admissions practices that help reduce attrition rates.Methods: An online survey consisting of forced choice and open-ended questions was sent to the directors of accredited dental hygiene programs in the United States. Surveys were analyzed using descriptive statistics and frequency distributions. Open-ended questions were analyzed using the constant comparative method to identify recurring themes.Results: Ninety-nine surveys were returned for a 30% response rate. There was no statistical difference in attrition rates when selective or nonselective admissions criteria was used in dental hygiene programs (year 2011 p=.435 and year 2012 p=.784). Results of this study also showed baccalaureate degree dental hygiene programs have significantly higher completion rates than associate degree dental hygiene programs (2011 p=.002 and 2012 p=.005).Conclusion: Evidence from this study suggests there is no difference between attrition rates for dental hygiene programs that use selective admissions versus nonselective admissions. Additionally, this study determined that baccalaureate degree dental hygiene programs have less attrition compared to associate degree dental hygiene programs.