The Francis Report--implications for the regulator.

The professional regulators were identified in the Francis Report as having a central role in maintaining fundamental standards of care. This paper describes the key themes in the Report and the importance of regulatory powers to ensure that the serious failings in patient care highlighted by the Mid-Staffs Inquiry cannot be repeated. The central role of the GDC Standards in the profession's response to the Francis Report is stressed. Clinical Relevance: The importance of our professional regulator in ensuring adherence to fundamental standards of care is a central tenet of clinical dentistry.

The Francis Report--implications for oral care of the elderly.

Oral health is an essential, yet often neglected, aspect of care in the elderly population. A mouth free of pain and disease which is functional, comfortable and aesthetic improves quality of life. Following the shocking reports of patient neglect and abuse published in the Francis Report, the dental profession must acknowledge that there are longstanding deficiencies in the provision of oral healthcare for the elderly, whether residing in care homes, hospitals or at home with support. It must be a universal goal to improve the care provision for this population through developing a greater understanding and overcoming the multi-factorial barriers to care. This article will highlight the key features of the Francis Report and its significance in the context of oral healthcare provision for the elderly. Clinical Relevance: To provide insight into the oral healthcare needs of the growing elderly population and the necessity of dealing with the current limitations in service provision.

The Francis Report--dento-legal implications.

This article explores the potential implications of the Francis Report for members of the dental team from a dento-legal perspective. It looks at the broad recommendations in light of the existing ethical environment in which dental registrants work and asks what is new and what the recommendations will actually mean for dental professionals in practical terms. Clinical Relevance: The fundamental recommendations of the Francis Report, namely, that those who provide care should put patients' interests first and be open about outcomes and performance, are not new concepts. A breach of these ethically based expectations may, however, create grounds for legal proceedings, which is clearly a significant point for all members of the dental team. It is therefore important to be aware of what is expected of those providing clinical care.

Quality assurance tests for digital radiography in general dental practice.

UNLABELLED: Quality assurance (QA) is essential in dental radiography. Digital radiography is becoming more common in dentistry, so it is important that appropriate QA tests are carried out on the digital equipment, including the viewing monitor. The aim of this article is to outline the tests that can be carried out in dental practice. CLINICAL RELEVANCE: Quality assurance for digital equipment is important to ensure consistently high quality images are produced.

Capturing patient benefits of treatment.

Findings from the Academy of Osseointegration State of the Science on Implant Dentistry Conference clearly demonstrate that data are lacking regarding both quality of design and adequate outcome measures (standardization, validity, and relevance to patient) to support an evidence-based systematic evaluation of implant efficacy. Despite the dearth of controlled trials and the variability in defining implant survival/success, the preponderance of evidence is viewed as lending support for consideration of dental implant therapy as a safe and predictable alternative to conventional restorations for many applications. However, this minimal conclusion undermines the best intentions of the dental profession, which is striving to substantiate to the patient, third-party providers, and the government the relative benefits and risks of various prosthetic treatment alternatives. The conclusions of multiple consensus conferences have repeatedly stressed that additional research with good strength of evidence following a broad spectrum of outcomes is vital to extend the breadth of conclusions regarding dental implant treatment efficacy. However, without a set of consensus-based core outcome measures addressing pertinent clinical and patient-centered factors, future expensive, time-consuming, and technically complex clinical studies may suffer the same critical flaws seen in the current body of research. It may be possible and useful to establish a core set of well-defined, discriminatory, and feasible outcome measures for common utilization and a hierarchy of additional recommended outcome measures for specific benefit categories. Such a standardized group of outcome measures would be likely to significantly enhance the potential for future research. In addition, with the formation of consensus guidelines, there would be an opportunity for scientific journals to promote the quality of implant dentistry research by suggesting the inclusion of these core outcome measures in studies submitted for publication.

Diabetes Risk Assessment, A1C Measurement, and Goal Achievement of Standards of Care in Adults Experiencing Homelessness.

PURPOSE: The purpose of this study was to explore diabetes in adults experiencing homelessness by evaluating diabetes risk, A1C measurement, and achievement of the goals of the American Diabetes Association (ADA) Standards of Medical Care in Diabetes. METHODS: Project Homeless Connect Omaha is a 1-day health and social services event for adults who are homeless. The event seeks to meet immediate needs, identify potential future needs, and provide a connection with community resources for further follow-up for these adults. Health professions students and faculty from the university where the event is held volunteer their time to provide these services. Risk assessment for type 2 diabetes, A1C measurement, and evaluation of the ADA Standards of Medical Care were available for participants of this event. RESULTS: Of the 478 participants who completed a risk assessment for diabetes, 91 underwent rapid A1C testing. Four participants at the diabetes station (4%) were newly identified as having diabetes with elevated A1C, and 32% of the participants had elevated A1C levels demonstrating prediabetes. Twelve individuals reported being previously diagnosed with diabetes, and of those, 50% had A1C levels between 7.3% and >13% (56 to 119 mmol/mol). Participants whose A1Cs classified them as having prediabetes or diabetes (n = 40) completed an evaluation of standards of medical care goals. Participants identified eye, foot, and dental examinations; lipid management; and urine protein screening as some of the areas in which the standards were not yet achieved. CONCLUSION: Adults experiencing homelessness have a significant need for diabetes screening and management. Diabetes educators can provide education to equip adults with the ability to effectively manage their illness and prevent complications.

Quality indicators: the rationale behind their use in NHS dentistry.

This paper explores the concept of quality as applied to healthcare and its subsequent application to dentistry. The assessment of quality arose from the manufacturing industry and is viewed as a cornerstone of current Government thinking. The difficulties in defining and therefore in measuring are examined and, in particular, the tensions between quantifying quality at a population level and at an individual level. The findings of the application of quality measures to primary medical care are reviewed, especially those that are linked to financial reimbursement of care providers and the implications for any future dental agenda discussed.