Current approaches addressing oral health practitioners' responsiveness to child abuse and neglect: A scoping review protocol.

INTRODUCTION: Child abuse and neglect (CAN) poses significant risks, causing severe and long-lasting effects on a child's well-being, including physical and mental health and learning and socializing capabilities. Oral health practitioners (OHPs) uniquely position themselves to identify signs of maltreatment in the orofacial area, offer appropriate support, and collaborate with a multidisciplinary team. The literature has shown that OHPs under-report child protection concerns to a statutory child protection agency. Responding to CAN is often hindered by various factors, such as the fear of making false accusations and insufficient knowledge to detect and report potential cases. However, the literature lacks a comprehensive understanding of the strategies and interventions that can address the responsiveness of OHPs and other professionals to child protection issues. This scoping review aims to provide a broad overview and map the literature on the existing approaches to enhance the responsiveness of OHPs in child protection. MATERIALS AND METHODS: The proposed scoping review will be conducted following the JBI methodology for scoping reviews guideline and reported using the PRISMA-ScR guideline. The first exploratory search is conducted to refine the search strategy and inclusion and exclusion criteria. The second search will include MEDLINE (EBSCO), CINAHL (EBSCO), Dentistry & Oral Science Source (EBSCO), Cochrane Library, and Scopus, with a date range from January 2000 to March 2023. The third search will involve reference list searching and gray literature searching in Google and Google Scholar. Government and international health organizations' websites will be searched for policies and guidelines. The review will consider studies that report the current approaches to address OHPs' responsiveness to CAN in any setting. Two reviewers will independently select sources and extract data. Any disagreements will be resolved by consensus of the research team. The extracted data will be presented in a tabulated chart with a narrative summary.

Child abuse knowledge and attitudes among dental and oral health therapists in Aotearoa New Zealand: a cross-sectional study.

BACKGROUND: Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect. METHODS: In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey. RESULTS: Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier. CONCLUSIONS: Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.

The effectiveness of interventions and behaviour change techniques to reduce stress in student nurses: A systematic review.

BACKGROUND: Student nurses experience stress leading to poor health and course attrition (Lovegrove, 2018). OBJECTIVES AND DESIGN: This systematic review aimed to evaluate the effectiveness of interventions and 'behaviour change techniques' (BCTs) to reduce student nurse stress. BCTs are active components of interventions that are observable, replicable, irreducible and designed to change behaviour (Michie et al., 2013). DATA SOURCES: Thirteen databases were searched from inception to May 2020. REVIEW METHODS: The interventions were classified according to their target: 'stressors', 'coping', 'cognitive reappraisal' or a combination of these (Lazarus and Folkman, 1984). BCTs were coded using the BCT taxonomy: a hierarchical framework of BCTs (Michie et al., 2013). RESULTS: 28 interventions reported in 23 articles were included in the review. A positive effect was identified in 22 interventions. There were no studies addressing the stressors in isolation and the interventions targeting stressors in combination with coping (n = 1) or cognitive reappraisal (n = 1) found no significant effects. In contrast, 74% of those targeting coping alone (n = 14/19), 100% of those addressing coping and cognitive reappraisal together (n = 4/4) and 66% addressing all three targets together (n = 2/3) were successful. The most common BCTs provided students with information and skills relating to stress management, with 18/21 being successful >50% of the time. CONCLUSIONS: Overall, most interventions aimed to teach students skills to cope with stress, with the majority having a short-term effect. However, as some interventions and BCTs were infrequently used or poorly described and all studies had a medium-high risk of bias, there is a need for longitudinal high-quality studies.

Predictors of children's health system use: cross-sectional study of linked data.

BACKGROUND: Use of health services is increasing in many countries. Most health service research exploring determinants of use has focused on adults and on secondary care. Less is known about factors associated with the use of the emergency department (ED) and general practice (GP) among young children. OBJECTIVE: To explore factors associated with GP consultations and ED attendances among children under 5 in a single UK city. METHODS: Cross-sectional exploratory study using anonymized individual-level health service use data for children aged 0-4 from 21 GPs in Southampton, UK, linked to ED data, over a 1-year period. Univariate and multivariable logistic regression were used to explore the association of socio-demographic factors [using the 2015 Index of Multiple Deprivation (IMD) to define socio-economic status] with high service use (defined as more than eight GP consultations and/or two ED attendances respectively). RESULTS: Among 11 062 children, there were 76 092 GP consultations and 6107 ED attendances. Three thousand two hundred thirty-three (29%) children were high users of GP and 564 (5%) of ED services. Greater socio-economic deprivation was independently associated with high use of GP and ED services separately [odds ratios (OR) for most versus least deprived IMD quintile 1.45 (95% confidence interval, CI 1.20-1.75) and 2.21 (95% CI 1.41-3.46), respectively], and together [OR 2.62 (95% CI 1.48-4.65)]. CONCLUSION: Young children are frequent users of health services, particularly GP. Socio-economic deprivation is an important factor. Parents, carers and health services may benefit from interventions that support families in their management of children's health.

A literature review of interventions to reduce stress in doctors.

AIM: Stress is prevalent among doctors, and interventions are offered, often as part of their continuing professional development, to help doctors learn in the workplace about the recognition, prevention and management of the harmful effects of stress. The aim of this review was to examine existing research to ascertain the features of successful educational interventions with practising doctors and any factors that may affect outcomes. METHODS: We searched key databases for papers published between 1990 and 2017 on the themes of stress that included an education-based intervention and practising doctors. Using an inclusive approach to the review, a broad evaluation was made of the primary research using both quantitative and/or qualitative evidence where the study reported a positive outcome in terms of stress management. RESULTS: Review criteria were met in 31 studies of 1,356 originally retrieved. Three broad categories of interventions emerged from the coding process: mindfulness-type (n = 12), coping and solutions focused (CSF) (n = 12) and reflective groups (n = 7). There is evidence that these interventions can be successful to help doctors deal with stress. Based on the results from this review, an original guide is advanced to help educators choose an educational intervention. CONCLUSION: Although evidence for some interventions may be 'hierarchically stronger', it is misleading to assume that interventions can be imported as successfully into any context. Factors such as medical specialty and health care systems may affect which intervention can be used. The guide offers an evidence base on which further research can be built.

Values exchange: using online technology to raise awareness of values and ethics in radiography education.

INTRODUCTION: Ethics and values are increasingly significant aspects of patient-centred healthcare. While it is widely agreed that ethics and values are essential for healthcare delivery, there is also an acknowledgement that these are areas that are challenging to teach. The purpose of this study is to report a small-scale evaluative research project of a web-based technology with the educational potential to facilitate learning in relation to ethics, values, self-reflection and peer-based learning. METHODS: Five diagnostic radiography students took part in a semi-structured focus group with the aim of exploring their experiences of using Values Exchange, an online ethical decision-making framework, to examine practice-based ethical issues. Transcripts were interrogated for key themes. RESULTS: From the thematic analysis three major themes emerged, understanding and appreciating others, addressing the theory-practice gap and delivering a safe and effective learning environment. Perceived limitations of the platform included students' fear of misinterpreted responses and possibility of poor group dynamics. CONCLUSIONS: There are varied approaches to how ethics and values are taught and assessed within health-related environments. Values Exchange is one such teaching tool and has been investigated and described positively by radiography students in this study. Online teaching tools can have a positive effect in helping students identify their own values but require skilled implementation to reap positive rewards.

Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study.

BACKGROUND: There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children. OBJECTIVE: To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA. DESIGN: (1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families' views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting. SETTING: Forty-four UK secondary and tertiary UK centres (service evaluation). PARTICIPANTS: Children with OM/SA. INTERVENTIONS: PCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study. RESULTS: Data were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement. LIMITATIONS: Data were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited. CONCLUSIONS: A future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based. FUTURE WORK: A RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Positioning Children's Voice in Clinical Trials Research: A New Model for Planning, Collaboration, and Reflection.

Following the United Nations Convention on the Rights of the Child, there has been considerable growth in research with children about health and services that affect them. Creative methods to engage with children have also been developed. One area where progress has been slower is the inclusion of children's perspectives in qualitative research in the context of clinical trials or feasibility studies. Addressing this gap, this article discusses experiences of, and reflections on, the process of researching children's views as part of a clinical feasibility study. The article considers what worked well and highlights remaining dilemmas. A new continuum of children's engagement in research is presented, designed to assist researchers to make explicit the contingent demands on their research, and to suggest a range of techniques from within the broader fields of health, childhood studies, and education research that could be used to forward qualitative research in clinical contexts.

Community governance in primary health care: towards an international Ideal Type.

Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non-governmental status. Future policy and research priorities are outlined. Copyright © 2016 John Wiley & Sons, Ltd.

Facilitating values awareness through the education of health professionals: Can web based decision making technology help?

Recent events in the health care landscape have focused nursing's collective mind on the role of values in health care delivery. For example, in England, the government has issued a mandate to health educators that places primacy on developing a workforce who prioritise and implement the core values of the National Health Service. In the current environment in which 'values' have become common currency, this paper begins by asking what values are, arguing for greater understanding and recognition of their intrinsic role in driving decisions. It then reports on research carried out in New Zealand exploring the potential of the Values Exchange web based educational technology to promote and facilitate a values aware health workforce. Qualitative thematic analysis from a cohort of pre-registration health professionals revealed new understandings about values through the facilitation of deeper, multi-layered thinking. The unique online space provided a safe pre-registration environment for deliberating complex cases, with students readily identifying advantages for future practice and patients. For lasting and meaningful change to occur, a fundamental shift is required in our understanding of values and how they ultimately impact on the way we individually and collectively deliver care to our patients. The Values Exchange may offer a contemporary and timely vehicle for achieving these goals.

Ethics education for health professionals: a values based approach.

It is now widely accepted that ethics is an essential part of educating health professionals. Despite a clear mandate to educators, there are differing approaches, in particular, how and where ethics is positioned in training programmes, underpinning philosophies and optimal modes of assessment. This paper explores varying practices and argues for a values based approach to ethics education. It then explores the possibility of using a web-based technology, the Values Exchange, to facilitate a values based approach. It uses the findings of a small scale study to signal the potential of the Values Exchange for engaging, meaningful and applied ethics education.

Theoretically speaking: use of a communities of practice framework to describe and evaluate interprofessional education.

This article uses Wenger's (1998) theory of communities of practice, and in particular his learning design framework, to describe and evaluate the pedagogy of one interprofessional continuing professional development (CPD) programme for health, education and social care professionals. The article presents findings from 27 post-intervention interviews conducted 12 months after the CPD. Key pedagogic features of small group working, action planning, facilitation, continued independent learning and 'safe' learning environment were found to provide facilities for 'engagement', 'imagination' and 'alignment' (Wenger, 1998), with the use of task-focused small group work particularly appreciated by participants. Problems of falling attendance and marginalisation are discussed using Wenger's concept of 'identification/negotiability'. It is suggested that careful selection of delegates and provision of sufficient organisational support may mitigate such problems.

Children's participation in vaccine research: parents' views.

AIM: Vaccine studies that evaluate the persistence of protection following immunisation require subjects to continue participation in a research protocol over many years. As parents' attitudes and opinions may change over time, and with experience of research, it is important to consider the factors influencing parents' decision-making about their child's continued participation in such prolonged vaccine studies. METHOD: Parental views about participation of their child in a one-year follow-up vaccine study were explored by means of a self-administered questionnaire. Of the 254 eligible parents, 187 took part (74 per cent). RESULTS: Parents who provided consent were more likely to agree that having a home visit to take blood was very helpful (p=0.005) and that information obtained during the earlier part of the study influenced their decision to take part in a follow-up study (p<0.0001). Parents who did not consent to their child's participation were more likely to report the presence of personal reasons as a variable influencing their decision (p<0.0001). CONCLUSIONS: The relationship between study staff and parents is the cornerstone for success in performing studies involving vaccines and children. Provision of clear study information (oral and written) and offering the convenience of home visits are important in retaining participants in paediatric vaccine trials.

Opportunities and barriers to successful learning transfer: impact of critical care skills training.

AIM: This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward-based nurses. BACKGROUND: Following a government review in the UK of adult critical care provision, new ways of working were advocated to ensure that critical care services depended on the needs of the patient, not their location in the hospital. A re-conceptualization beyond service provision in high dependency units and intensive care units was required in order to deliver an integrated service. This has ramifications for training requirements. METHODS: Semi-structured interviews were used to explore perceived learning and learning transfer from a range of courses. The data were collected from course attendees (n = 47) and line-managers (n = 19) across two sites between 2005 and 2006. FINDINGS: Learning was closely associated with the clinical application of new skills and knowledge. Commonly, course attendees and line-managers quoted increased knowledge and confidence, better assessment skills and improved interprofessional working. Time with competency assessors, availability of expanding roles, and supernumerary time were key factors for successful learning transfer. Barriers were financial pressures on hospitals, lack of perceived relevance of the course to staff or nursing practice, and lack of time to practice skills or work with clinical skills facilitators. CONCLUSION: Course design should be a collaborative activity between education providers and commissioners to ensure the impact of training on practice. Relevance of material, time to practise skills and new learning, and organizational, rather than merely individual, support are essential for successful training interventions.

The role familiarity with science and medicine plays in parents' decision making about enrolling a child in vaccine research.

Parental consent to children's participation in vaccine research has resulted in the licensure of essential vaccines. Recruitment to this type of research is typically difficult, however, and many parents decline. In this study, the authors interviewed parents about their decision for or against enrolling their child in a vaccine study. The data analysis suggests that parents' ability to evaluate a vaccine study depends on how attuned they are with science and medicine, either professionally or as consumers of health services. Familiarity does not predispose parents to enrolling their child in research; rather, it is a predictor of parents' confidence in their decision making. Many parents were motivated by altruism and trust, which, if uninformed, can leave the parents prone to exploitation. It is vital to ensure that parents are confident in their judgment of a study and its potential benefit to their child and society.

Parental views on the introduction of an infant pneumococcal vaccine.

Streptococcus pneumoniae is a major cause of early childhood morbidity and mortality. A heptavalent pneumococcal conjugate vaccine (PnC7) is licensed for use and could prevent the majority of infant invasive pneumococcal infections. A recent announcement confirmed its inclusion into the U.K. childhood immunisation programme. In anticipation of PnC7 being recommended for use, this study explored parental understanding of pneumococcal disease and their views on the possible introduction of this vaccine. Twenty three interviews and two focus groups were held with parents of children under two years of age. Four main themes emerged from the data analysis: 'Confidence and belief in immunisation'; 'Anxiety about immunisation'; 'Trust and understanding of immunisation information' and 'Response to a new immunisation'. Overall parental confidence in immunisation has been affected by the MMR controversy. With little knowledge of pneumococcal disease, parents want information about the safety and effectiveness of PnC7. Information needs to be conveyed in a way that restores parents' trust in immunisation.