Impact of a geriatric assessment and optimisation-based preoperative clinic on the management of older patients receiving dental treatment under general anaesthetic or conscious sedation: A service evaluation.

OBJECTIVES: The main objectives of the study were to review patient characteristics, recommendations made and treatment outcomes of frail/older patients referred to a specialist multidisciplinary geriatric assessment and optimisation-based preoperative clinic (PROKARE), prior to patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). BACKGROUND: Although the use of preoperative comprehensive geriatric assessment to improve pre/peri and postoperative mortality has been reported for many surgical domains, its use prior to dental surgery has not been reported previously. METHODS: The data were collected retrospectively from the dental notes of 52 patients referred from the Special Care Dental (SCD) Department to the PROKARE service for optimisation prior to dental treatment under GA/CS using a case note study approach. The data extracted included patient demographic characteristics, medical history, clinical management and the treatment outcomes for each patient. The data extracted was analysed with descriptive statistics. RESULTS: Key reasons for referral were caries management, retained roots and poor co-operation. Multiple co-morbidities were noted among the patients referred, with 14 (27%) having four or more co-morbidities. The PROKARE assessment identified issues such as treatment could be carried out under CS instead of GA; consent; and the need for medication change and/or further medical investigations. As per recommendations from PROKARE, 39 patients (75%) received dental treatment while five (10%) did not receive treatment, and a further eight (15%) died prior to treatment. CONCLUSION: Geriatric assessment and optimisation-based preoperative clinics in the dental management of frail, elderly patients having treatment under GA or CS techniques is valuable, but further research and assessment of current service provision are needed to increase the evidence base.

Triboelectric Nanogenerator (TENG) Mass Spectrometry of Falsified Antimalarials.

RATIONALE: An epidemic of low quality medicines continues to endanger patients worldwide. Detection of such "medicines" requires low cost, ambient ionization sources coupled to fieldable mass spectrometers for optimum sensitivity and specificity. With the use of triboelectric nanogenerators (TENGs), the charge required to produce gas-phase ions for mass analysis can be obtained without the need for high voltage electrical circuitry, simplifying and lowering the cost of next-generation mass spectrometry instruments. METHODS: A sliding freestanding (SF) TENG was coupled to a toothpick electrospray setup for the purposes of testing if falsified medicines could be fingerprinted by this approach. Extracts from both genuine and falsified medicines were deposited on the toothpick and the SF TENG actuated to generate electrical charges, resulting in gas-phase ions for both active pharmaceutical ingredients and excipients. RESULTS: Our previous work had shown that direct analysis in real-time (DART) ambient mass spectrometry can identify the components of multiple classes of falsified antimalarial medicines. Experiments performed in this study show that a simple extraction into methanol along with the use of a SF TENG-powered toothpick electrospray can provide similar detection capabilities, but with much simpler and rugged instrumentation, and without the need for compressed gases or high voltage ion source power supplies. CONCLUSIONS: TENG toothpick MS allows for rapid analyte ion detection in a safe and low-cost manner, providing robust sampling and ionization capabilities.

The graduate entry generation: a qualitative study exploring the factors influencing the career expectations and aspirations of a graduating cohort of graduate entry dental students in one London institution.

BACKGROUND: Dentistry in the UK has a number of new graduate-entry programmes. The aim of the study was to explore the motivation, career expectations and experiences of final year students who chose to pursue a dental career through the graduate entry programme route in one institution; and to explore if, and how, their intended career expectations and aspirations were informed by this choice. METHOD: In-depth interviews of 14 graduate entry students in their final year of study. Data were transcribed verbatim and analysed using framework analysis. RESULTS: There were three categories of factors influencing students' choice to study dentistry through graduate entry: 'push', 'pull' and 'mediating'. Mediating factors related to students' personal concerns and circumstances, whereas push and pull factors related to features of their previous and future careers and wider social factors. Routes to Graduate Entry study comprised: 'early career changers', 'established career changers' and those pursuing 'routes to specialisation'. These routes also influenced the students' practice of dentistry, as students integrated skills in their dental studies, and encountered new challenges.Factors which students believed would influence their future careers included: vocational training; opportunities for specialisation or developing special interests and policy-related issues, together with wider professional and social concerns.The graduate entry programme was considered 'hard work' but a quick route to a professional career which had much to offer. Students' felt more could have been made of their pre-dental studies and/or experience during the programme. Factors perceived as influencing students' future contribution to dentistry included personal and social influences. Overall there was strong support for the values of the NHS and 'giving back' to the system in their future career. CONCLUSION: Graduate entry students appear to be motivated to enter dentistry by a range of factors which suit their preferences and circumstances. They generally embrace the programme enthusiastically and seek to serve within healthcare, largely in the public sector. These students, who carry wider responsibilities, bring knowledge, skills and experience to dentistry which could be harnessed further during the programme. The findings suggest that graduate entry students, facilitated by varied career options, will contribute to an engaged workforce.

A Qualitative Exploratory Study of Informal Carers' Experiences of Identifying and Managing Oral Pain and Discomfort in Community-Dwelling Older People Living with Dementia.

Increased prevalence of dementia and poor oral health in older people is associated with more people living with dementia who experience oral pain and discomfort. However, little is known about how informal carers manage oral pain for people living with dementia in the community. This study aimed to explore informal carers' experiences of identifying and managing oral pain and discomfort in people living with dementia, and barriers and enablers they encountered. Focus groups with informal carers of people living with dementia were conducted, transcribed verbatim, and analysed using thematic analysis. Carers' accounts suggested that day-to-day contact was required to identify oral pain and discomfort, and a symptomology of the signs and symptoms was developed. Carers' accounts also highlighted issues in maintaining oral health, difficulties in accessing the mouth, managing dentures, competing demands, and difficulties in accessing treatment due to health service-, behavioural- and treatment- related barriers. Enablers included informal carers' pivotal role in the identifying and managing oral pain and discomfort in people living with dementia. The study concludes that carers want more partnership work with dental professionals, and clearer care pathways are required to meet the oral health needs of people living with dementia who experience oral pain.

A simple and inexpensive container for the transport of biological specimens in limited resource situations.

We describe a diagnostic specimen transport container that is appropriate for limited resource or emergency settings. The transport container is constructed from polyvinyl chloride (PVC) plumbing pipe, which is readily available and inexpensive (US$1-2, depending on size) and has wide flexibility of size due to the range of PVC pipe dimensions available. The PVC transporters are durable, water-resistant and may be easily decontaminated. They have been adapted for the transport of blood culture bottles from provincial hospitals in Laos, where, during a 2-year period, 380 PVC tubes containing blood culture bottles were transported without any leakage or breakage. We have found the PVC transporter to be a useful and cost-efficient durable alternative that meets IATA Packing Instruction 650 biological transport container requirements.

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.

Recruitment and retention of dental nurses and dental hygienists in general practice.

PURPOSE OF STUDY: To explore the recruitment and retention of dental nurses and dental hygienists working in general dental practice in West Kent, and to identify training needs. BASIC PROCEDURE: Questionnaire survey of 195 general dental practices in West Kent. MAIN FINDINGS: Problems with turnover of staff were reported by 19% of practices. Some 49% of practices reported difficulties in recruiting dental nurses, 6% had experienced difficulties recruiting dental hygienists, and 15% had difficulties recruiting both nurses and hygienists. The median length of service for both dental nurses and dental hygienists was five years. Approximately 39% of practices had advertised single posts three or more times. Difficulties in recruiting were related more strongly to ensuring the right person for the job, than to a shortage of applicants. PRINCIPAL CONCLUSIONS: Difficulties in the recruitment and retention of dental nurses and dental hygienists were reported by dental practices in West Kent. These are likely to be exacerbated by the requirement that all dental nurses be registered with the General Dental Council.

SYBR green real-time PCR for the detection of all enterovirus-A71 genogroups.

Enterovirus A71 (EV-A71) has recently become an important public health threat, especially in South-East Asia, where it has caused massive outbreaks of Hand, Foot and Mouth disease every year, resulting in significant mortality. Rapid detection of EV-A71 early in outbreaks would facilitate implementation of prevention and control measures to limit spread. Real-time RT-PCR is the technique of choice for the rapid diagnosis of EV-A71 infection and several systems have been developed to detect circulating strains. Although eight genogroups have been described globally, none of these PCR techniques detect all eight. We describe, for the first time, a SYBR Green real-time RT-PCR system validated to detect all 8 EV-A71 genogroups. This tool could permit the early detection and shift in genogroup circulation and the standardization of HFMD virological diagnosis, facilitating networking of laboratories working on EV-A71 in different regions.

The safety and tolerability evaluation of DepoFoam bupivacaine (bupivacaine extended-release liposome injection) administered by incision wound infiltration in rabbits and dogs.

OBJECTIVE: DepoFoam bupivacaine (DB) is in development for prolonged postoperative analgesia. Studies were conducted to evaluate the potential local and systemic toxicity and any effect on wound healing after wound infiltration. METHODS: The model simulates an inguinal hernia (skin incision ∼2.5 and 5.5 cm). Animals (four/sex/group of each species) received DB 9, 18 or either 25 or 30 mg/kg, bupivacaine solution (B(sol); 7.5 mg/ml, 9 mg/kg) or saline. DB was given at 0.6, 1.2 and 1.0 or 1.2 ml/kg, respectively, and B(sol) or saline at 1.2 ml/kg. Each dose was infiltrated in small fractions on Day 1. End points included histology on Days 3 and 15. Wound healing was recorded on Day 2 through Day 15. RESULTS: There was no adverse effect in either species. Notably, granulomatous inflammation was noted in surgical sites from 8 of 24 rabbits in the DB groups only. Based on the minimal to mild severity on Day 15, this was considered a normal reaction against the liposomes. Except for granulomatous inflammation, there were no differences in overall incidence or severity of histologic changes in the sites dosed to DB, saline or B(sol). CONCLUSIONS: The data reported here are the first demonstration of the safety of DB in toxicology species.

Noma in Laos: stigma of severe poverty in rural Asia.

Noma, or cancrum oris, is a debilitating necrotizing ulcerative stomatitis that destroys the mouth and face. It usually starts in early childhood and is associated with severe poverty, malnutrition, and infections. It is most frequently described from sub-Saharan Africa but is under-reported. There have been very few reports from Asia. We describe the clinical and social features of a series of 12 patients with noma from remote poor villages in rural Lao People's Democratic Republic (Laos). Noma is an ominous stigma of severe poverty and the description of this disease emphasizes the importance of poverty reduction and nutritional improvement in Lao development. In the meantime, more awareness of the problem and the importance of early therapy in acute noma by primary health care workers may reduce mortality and prevent progression to severe disfigurement.