Meeting Patient and Professional Needs: Views of Stakeholders on a Training Initiative for DwSIs in Endodontics in London.

BACKGROUND AND AIMS: A pilot scheme was established across London to train NHS primary dental care practitioners to provide endodontic treatment of moderate difficulty. It was co-led by the former London Deanery (Health Education England: North West London) and local NHS commissioners. This research aimed to explore key stakeholders' perceptions about the purpose of the initiative, its advantages, disadvantages and future implications. METHODS: Nineteen semi-structured interviews were conducted with stakeholders (commissioners and providers of the educational initiative; commissioners and providers of care, including trainees, principal dentists and specialists) involved in establishing, running and participating in the initiative and wider endodontic service provision in London. Interviews were based on a topic guide informed by the literature, and a workshop involving the London trainees. Interviews were recorded, transcribed and analysed using framework methodology. RESULTS: The project was perceived as supporting four key areas: addressing services, improving quality/outcomes, delivering education and enhancing professional status. There was evidence that dentists were harnessing health policy in facilitating 'reprofessionalisation' of dentistry with the creation of dentists with enhanced skills (DwSIs). Learning outcomes from the pilot were related to the accreditation of the participants, service tariffs, reimbursement for endodontic treatment on the NHS, and the need for continuity within and between services across the dental system. Uncertainty about funding and the changes within the NHS were among the concerns expressed regarding the future of the initiative. CONCLUSION: The findings of this research suggest that extending the skills of primary care practitioners may contribute to the reprofessionalisation of dentistry, which has much to contribute to patient care and the development of an integrated and accessible dental care system of quality, with improved outcomes for patients. The implications for health policy and further research are discussed.

Short-Term Smoking Cessation in English Resident Adults of Bangladeshi Origin: A Service Review.

INTRODUCTION: Cigarette smoking in English residents of Bangladeshi origin, particularly men, exceeds national estimates. Cessation outcomes and potential predictors of successful cigarette smoking cessation in this group await identification. METHODS: This service review reports cessation outcomes and predictors of success for 324 adult English resident Bangladeshi origin smokers recruited into a project providing a specialist tobacco cessation service. Interview measures included sociodemographics, tobacco use and dependence. Cessation data (self-reported and validated) at 4 weeks was also collected. Cessation rate and predictors of successful cessation, modeled using multiple logistic regressions, are reported. RESULTS: Clients' mean age was 45.59 (SD = 13.83) years. Thirty-three (10%) were females. Mean level of small area deprivation was 56.98 (SD = 5.37). Initial mean expired air carbon monoxide score was 11.66 parts per million (SD = 7.17). Thirty-eight per cent used combination nicotine replacement therapy (NRT) with behavioral support. Sixty-nine percent reported successful smoking cessation after 4 weeks, validated with carbon monoxide (mean =1.23 parts per million, SD = 1.32). Predictors of successful cessation were use of combined NRT with behavioral support (OR = 1.82, 95% CI = 1.07, 3.09), and community recruitment (OR = 1.85, 95% CI = 1.07, 3.22). CONCLUSIONS: English adult smokers of Bangladeshi origin resident in a highly disadvantaged locality, accessing community outreach services to help them quit and using NRT have validated short-term success rates greater than that locality's general population who access National Health Service Stop Smoking Services to quit.

What has been the United Kingdom's experience with retention of third molars?

BACKGROUND: In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom. MATERIALS AND METHODS: Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery. RESULTS: The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines. CONCLUSION: The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.