Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review.

OBJECTIVE: This systematic review aims to examine whether cone-beam CT (CBCT) assessment influences the incidence of nerve injury following high-risk mandibular third molar (MTM) surgery. STUDY DESIGN: Randomised controlled trials comparing two and three-dimensional imaging for assessing high-risk MTMs were included. MEDLINE, EMBASE, CENTRAL and the Dentistry and Oral Science Source (DOSS) were systematically searched along with extensive grey literature searches, hand searching of web sites, and detailed citation searching up to 3 September 2022. Risk of bias was assessed against the Cochrane Risk of Bias Tool (RoB 2.0). Certainty of the evidence was assessed using GRADE. RESULTS: Two authors independently screened 402 abstracts prior to full text screening of 27 articles, which culminated in seven RCTs for inclusion. Two studies were assessed as high risk of bias overall. The other five raised some concerns largely due to unblinded patients and lack of prior trial registration. Just one study reported significantly less nerve injuries following CBCT. The remaining six articles found no significant difference. CONCLUSION: The seven RCTs included in this systematic review offered moderate quality evidence that CBCT does not routinely translate to reduced incidence of nerve injury in MTM removal. A single study provided low quality evidence for a consequent change in the surgical approach. Low quality evidence from 3 studies suggested CBCT does not influence the duration of third molar surgery.

Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study.

BACKGROUND: Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. OBJECTIVE: This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. METHODS: A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. RESULTS: A total of 1083 participants replied to the survey (186% of the estimated minimum target sample). The proportion of users was 61.58% (667/1083). Among these, most (385/667, 57.7%) used the portal at least once a month. To characterize the system's users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8% women; 551/650, 84.8% >40 years). Most participants were White (498/650, 76.6%) and resided in London (420/650, 64.6%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95% CI 1.04-2.39 and OR 2.38, 95% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (≥30) were associated with higher odds of being a user (adjusted OR 2.96, 95% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95% CI 0.37-0.91). CONCLUSIONS: This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care.

Characteristics of Preapproval and Postapproval Studies for Drugs Granted Accelerated Approval by the US Food and Drug Administration.

IMPORTANCE: Drugs treating serious or life-threatening conditions can receive US Food and Drug Administration (FDA) accelerated approval based on showing an effect in surrogate measures that are only reasonably likely to predict clinical benefit. Confirmatory trials are then required to determine whether these effects translate to clinical improvements. OBJECTIVE: To characterize preapproval and confirmatory clinical trials of drugs granted accelerated approval. DESIGN AND SETTING: Publicly available FDA documents were reviewed to identify the preapproval trials leading to accelerated approval between 2009 and 2013. Information on the status and findings of required confirmatory studies was extracted from the FDA's database of postmarketing requirements and commitments, ClinicalTrials.gov, and matched peer-reviewed publications. Follow-up ended on April 7, 2017. EXPOSURES: Granting of accelerated approval. MAIN OUTCOMES AND MEASURES: Characteristics of preapproval and confirmatory studies were compared in terms of study design features (randomization, blinding, comparator, primary end point). Subsequent regulatory decisions and estimated time between accelerated approval and fulfillment of regulatory requirements were summarized. RESULTS: The FDA granted accelerated approval to 22 drugs for 24 indications (19 for indications involving cancer treatment) between 2009 and 2013. A total of 30 preapproval studies supported the 24 indications. The median number of participants enrolled in the preapproval studies was 132 (interquartile range, 89-224). Eight studies (27%) included fewer than 100 participants and 20 (67%) included fewer than 200. At a minimum 3 years of follow-up, 19 of 38 (50%) required confirmatory studies were completed, including 18 published reports. Twenty-five of the 38 (66%) examined clinical efficacy, 7 (18%) evaluated longer follow-up, and 6 (16%) focused on safety The proportion of studies with randomized designs did not differ before and after accelerated approval (12/30 [40%] vs 10/18 [56%]; difference, 16%; 95% CI, -15% to 46%; P = .31). Postapproval requirements were completed and demonstrated efficacy in 10 of 24 indications (42%) on the basis of trials that evaluated surrogate measures. Among the 14 of 24 indications (58%) that had not yet completed all requirements, at least 1 of the confirmatory studies failed to demonstrate clinical benefit in 2 (8%), were terminated in 2 (8%), and were delayed by more than 1 year in 3 (13%). Studies were progressing according to target timelines for the remaining 7 indications (29%). Clinical benefit had not yet been confirmed for 8 indications that had been initially approved 5 or more years prior. CONCLUSIONS AND RELEVANCE: Among 22 drugs with 24 indications granted accelerated approval by the FDA in 2009-2013, efficacy was often confirmed in postapproval trials a minimum of 3 years after approval, although confirmatory trials and preapproval trials had similar design elements, including reliance on surrogate measures as outcomes.

'It seems like a luxury to be able to offer that': Factors influencing the implementation of annual health checks for autistic people in England.

LAY ABSTRACT: Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.

The self-management abilities test (SMAT): a tool to identify the self-management abilities of adults with bronchiectasis.

Bronchiectasis is an increasingly common chronic respiratory disease which requires a high level of patient engagement in self-management. Whilst the need for self-management has been recognised, the knowledge and skills needed to do so- and the extent to which patients possess these-has not been well-specified. On one hand, understanding the gaps in people's knowledge and skills can enable better targeting of self-management supports. On the other, clarity about what they do know can increase patients' confidence to self-manage. This study aims to develop an assessment of patients' ability to self-manage effectively, through a consensus-building process with patients, clinicians and policymakers. The study employs a modified, online three-round Delphi to solicit the opinions of patients, clinicians, and policymakers (N = 30) with experience of bronchiectasis. The first round seeks consensus on the content domains for an assessment of bronchiectasis self-management ability. Subsequent rounds propose and refine multiple-choice assessment items to address the agreed domains. A group of ten clinicians, ten patients and ten policymakers provide both qualitative and quantitative feedback. Consensus is determined using content validity ratios. Qualitative feedback is analysed using the summative content analysis method. Overarching domains are General Health Knowledge, Bronchiectasis-Specific Knowledge, Symptom Management, Communication, and Addressing Deterioration, each with two sub-domains. A final assessment tool of 20 items contains two items addressing each sub-domain. This study establishes that there is broad consensus about the knowledge and skills required to self-manage bronchiectasis effectively, across stakeholder groups. The output of the study is an assessment tool that can be used by patients and their healthcare providers to guide the provision of self-management education, opportunities, and support.

Getting the whole story: Integrating patient complaints and staff reports of unsafe care.

OBJECTIVE: It is increasingly recognized that patient safety requires heterogeneous insights from a range of stakeholders, yet incident reporting systems in health care still primarily rely on staff perspectives. This paper examines the potential of combining insights from patient complaints and staff incident reports for a more comprehensive understanding of the causes and severity of harm. METHODS: Using five years of patient complaints and staff incident reporting data at a large multi-site hospital in London (in the United Kingdom), this study conducted retrospective patient-level data linkage to identify overlapping reports. Using a combination of quantitative coding and in-depth qualitative analysis, we then compared level of harm reported, identified descriptions of adjacent events missed by the other party and examined combined narratives of mutually identified events. RESULTS: Incidents where complaints and incident reports overlapped (n = 446, reported in 7.6%' of all complaints and 0.6% of all incident reports) represented a small but critical area of investigation, with significantly higher rates of Serious Incidents and severe harm. Linked complaints described greater harm from safety incidents in 60% of cases, reported many surrounding safety events missed by staff (n = 582), and provided contesting stories of why problems occurred in 46% cases, and complementary accounts in 26% cases. CONCLUSIONS: This study demonstrates the value of using patient complaints to supplement, test, and challenge staff reports, including to provide greater insight on the many potential factors that may give rise to unsafe care. Accordingly, we propose that a more holistic analysis of critical safety incidents can be achieved through combining heterogeneous data from different viewpoints, such as through the integration of patient complaints and staff incident reporting data.

Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis.

OBJECTIVE: The study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes. METHODS: A systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF). RESULTS: A total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor. CONCLUSION: This review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future. PRACTICE IMPLICATIONS: Practices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.

Which behaviour change techniques are most effective in improving healthcare utilisation in COPD self-management programmes? A protocol for a systematic review.

Introduction: Self-management interventions are often presented as a way to improve the quality of care for patients with chronic illness. However, self-management is quite broadly defined and it remains unclear which types of interventions are most successful. This review will use the Theoretical Domains Framework (TDF) as a lens through which to categorise self-management interventions regarding which programmes are most likely to be effective and under which circumstances.The aim of this study is to (1) describe the types of self-management programmes that have been developed in chronic obstructive pulmonary disease (COPD) and identify the common elements between these to better classify self-management, and (2) evaluate the effect that self-management programmes have on the healthcare behaviour of patients with COPD by classifying those programmes by the behaviour change techniques used. Methods and analysis: A systematic search of the literature will be performed in MEDLINE, EMBASE, HMIC and PsycINFO. This review will be limited to randomised controlled trials and quasi-experimental studies. The review will follow PRISMA-P guidelines, and will provide a PRISMA checklist and flowchart. Risk of bias in individual studies will be assessed using the Cochrane Risk of Bias criteria, and the quality of included studies will be evaluated using the GRADE criteria, and will be reported in a Summary of Findings table.The primary analysis will be a catalogue of the interventions based on the components of the TDF that were used in the intervention. A matrix comparing included behaviour change techniques to improvements in utilisation will summarise the primary outcomes. Ethics and dissemination: Not applicable, as this is a secondary review of the literature. Prospero registration number: CRD42018104753.