Dental therapists/hygienists working in remote-rural primary care: a structured review of effectiveness, efficiency, sustainability, acceptability and affordability.

AIM: To examine the use of dental therapist/hygienists to provide primary dental treatment in remote-rural areas with regard to their effectiveness, efficiency, sustainability, acceptability and costs (affordability). METHOD: The structured literature review of studies indexed in Medline, Embase and CinAHL was conducted using search terms relevant to 'dental therapists' and 'remote-rural'. Remote-rural was defined as 'those (individuals) with a greater than 30-minute drive time to the nearest settlement with a population of greater than 10,000'. RESULTS: From 1,175 publications screened, 21 studies from 19 publications were initially included. Only seven studies were included that explicitly focused on remote-rural areas. Four were surveys and three were qualitative studies. All of the included studies were reported within the last 7 years. The methodological quality of the surveys varied, particularly with regard to their response rates. All three of the qualitative studies were assessed as potentially weak methodologies. Regarding the research question, none of the studies included provided data relevant to understanding efficiency, cost issues or the acceptability of dental therapists. The available empirical evidence contained only indirect indicators about the sustainability of dental therapy in rural areas. CONCLUSIONS: The available data indicates that dental therapist/hygienists have suitable skills and could constitute a valuable asset to meet the dental demands in remote-rural areas. However, the evidence base is limited and of a poor quality. There is a need to put in place 'well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce'.

What do we know about who does and does not attend general health checks? Findings from a narrative scoping review.

BACKGROUND: General and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease. METHODS: An exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review. RESULTS: Those least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual's marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks. CONCLUSION: Routine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.

Weak evidence supports the use of psychosocial interventions for chronic orofacial pain.

DATA SOURCES: Cochrane Oral Health Group's Trials Register, Central, Medline, Embase, PsycINFO. STUDY SELECTION: Randomised controlled trials of psychosocial interventions for chronic orofacial pain were included. Psychosocial interventions targeted towards changing thoughts, behaviours and/or feelings that may exacerbate pain symptoms through a vicious cycle were eligible. Primary outcomes were pain intensity/severity, satisfaction with pain relief and quality of life. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias. Dichotomous outcomes, were expressed as risk ratios with 95% confidence intervals, continuous outcomes as mean differences with 95% confidence intervals. Heterogeneity was assessed using the Cochrane test for heterogeneity and the I2 test. Meta-analyses were conducted using the random-effect or the fixed-effect models. RESULTS: Fifteen of the 17 eligible studies were on temporomandibular disorders (TMDs), two on burning mouth syndrome. Psychosocial interventions improved long-term pain intensity (standardised mean difference (SMD) -0.34, 95% confidence interval (CI) -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). However, the risk of bias in these studies was high. CONCLUSIONS: There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain.

Validation of a one item screen for problem gambling.

A valid 1 item screen ("In the past 12 months, have you ever had an issue with your gambling?") is potentially important in both a primary care setting and in research applications where an extended screen is not practical or affordable. Prior research by Thomas et al. (A one item screening tool for problem gambling for use in primary care settings, Unpublished Manuscript, Monash University, 2010) and Thomas et al. (MJA 189(3):135-136, 2008) found that the 1 item screen provided acceptable performance when compared to the 9-item Problem Gambling Severity Index (PGSI, Ferris and Wynne in The Canadian problem gambling Index: Final report, Canadian Centre on Substance Abuse, 2001). The current study sought to replicate these findings in a different geographic area. Data were collected from a telephone survey of 1,292 respondents in Queensland. Results from the phone survey showed a very high proportion of false negatives (79%), indicating that approximately 4/5 of positively identified problem gamblers from the PGSI refused to admit to having any "issues with (their) gambling" in the last 12 months. Further investigation using Rasch analysis (Andrich in Medical Care, 42(1):7-16, 2004) revealed that while the internal construct validity of the PGSI was good, the 1 item screen was ineffective as an indicator of those who are presently at risk for problem gambling. One possible explanation for the discrepancy with past results is that the present study employed the qualifier of "In the past 12 months" to match with the questions on the PGSI, whereas the prior research excluded this timeframe limit. Nevertheless, the current study casts doubt on the ability or willingness of people with severe gambling problems to self-diagnose their behavior as problematic.

Psychosocial health and health-related quality of life in school pupils 11-18 years.

AIM: To establish levels of mental health at a community level and to model the relationship between mental health difficulty, health-related impact and health related quality of life in school pupils aged 11-18 years old. BACKGROUND: The issue of psychosocial and mental health in school pupils is a topic of considerable academic and public interest. The incidence of mental health problems in children 11-18 years shows marked differences between countries and within countries. Much of the epidemiological literature has focused on diagnostic categories rather than population health. DESIGN: The study employed a cross-sectional survey. METHODS: A cross-sectional survey of 1786 school children aged 11-18 years was conducted in Scotland. Participants completed the strengths and difficulties questionnaire and the SF-10 for Children. RESULTS: This group of school pupils had similar levels of mental health needs and psychosocial health status as UK and age-related US norms. They had poorer levels of physical health status. The most important predictors of psychosocial health status were difficulty category, impact, physical health status and chronicity. The most important predictors of impact were difficulty category, chronicity and psychosocial health status. CONCLUSION: There is a need to tackle psychosocial health problems in schools. Problems are often chronic in nature and whilst still having an impact on the life of pupils may not be severe enough for a diagnosis which would trigger treatment in the conventional sense. Psychosocial health is predicted by physical health therefore nursing interventions which are focussed on both physical and psychosocial health may be needed. RELEVANCE TO CLINICAL PRACTICE: This study suggests that in some geographical areas in UK targeting of services to 'high-need' schools is not necessary and universal services are required. Problems need to be detected before they reach current treatment thresholds. Interventions should be school-based with a focus on impact on classroom learning and family difficulties.

Empirical evidence of the relationship between parental and child dental fear: a structured review and meta-analysis.

BACKGROUND: The relationship between parental and child dental fear has been studied for over a century. During this time, the concept of dental fear as well as methodological approaches to studying dental fear in children have evolved considerably. AIM: To provide an overview of the published empirical evidence on the link between parental and child dental fear. DESIGN: A structured literature review and meta-analysis. RESULTS: Forty-three experimental studies from across the six continents were included in the review. The studies ranged widely with respect to research design, methods used, age of children included, and the reported link between parental and child dental fear. The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 and under. A meta-analysis of the available data also confirmed an association between parental and child dental fear. CONCLUSION: The narrative synthesis as well as the meta-analysis demonstrate a significant relationship between parental and child dental fear, particularly in children 8 years and younger.

Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies.

OBJECTIVE: To identify ethical processes and recruitment strategies, participation rates of studies using audio or video recording of primary health care consultations for research purposes, and the effect of recording on the behaviour, attitudes and feelings of participants. METHODS: A structured literature review using Medline, Embase, Cochrane Library, and Psychinfo. This was followed by extensive hand search. RESULTS: Recording consultations were regarded as ethically acceptable with some additional safeguards recommended. A range of sampling and recruitment strategies were identified although specific detail was often lacking. Non-participation rates in audio-recording studies ranged from 3 to 83% for patients and 7 to 84% for GPs; in video-recording studies they ranged from 0 to 83% for patients and 0 to 93% for GPs. There was little evidence to suggest that recording significantly affects patient or practitioner behaviour. CONCLUSIONS: Research involving audio or video recording of consultations is both feasible and acceptable. More detailed reporting of the methodical characteristics of recruitment in the published literature is needed. PRACTICE IMPLICATIONS: Researchers should consider the impact of diverse sampling and recruitment strategies on participation levels. Participants should be informed that there is little evidence that recording consultations negatively affects their content or the decisions made. Researchers should increase reporting of ethical and recruitment processes in order to facilitate future reviews and meta-analyses.

Overcoming health inequalities: a participative evaluation framework fit for the task.

AIMS: Healthcare providers are confronted with the claim that the distribution of health and healthcare provision is inherently unfair. There is also a growing awareness that the tools and methodologies applied in tackling health inequalities require further development. Evaluations as well as interventions usually focus on population-based indicators, but do not always provide guidance for frontline service evaluation and delivery. That is why the evaluation framework presented here focuses on facilitating local service development, service provider and user involvement, and the adequate representation of different population groups. METHODS: A participative evaluation framework was constructed by drawing on six common success characteristics extrapolated from the published literature and policies on health inequalities. This framework was then applied to an intervention addressing women's psychosocial health needs in order to demonstrate its utility in practice. RESULTS: The framework provides healthcare professionals with an evidence-based tool for evaluating projects or programmes targeting health inequalities in ways that are responsive to local contexts and stakeholders. CONCLUSION: This participative evaluation framework supports the identification of meaningful psychosocial and contextual indicators for assessing the diverse health and social needs of service users. It uses multi-dimensional indicators to assess health and social care needs, to inform local service development, and to facilitate the exchange of knowledge between researchers, service providers, and service users. The inherent responsiveness enables rigorous yet flexible action on local health inequalities.

Decay, Transformation, and Growth: Meaning-Making Processes of Patients With Acute Leukemia Within the First Year After Diagnosis or Relapse.

PURPOSE/OBJECTIVES: To explore the processes through which patients construct their meanings of acute leukemia (AL).
 RESEARCH APPROACH: An exploratory design was employed using serial, in-depth interviews, guided by Smith's Interpretative Phenomenological Analysis approach.
 SETTING: Two inpatient hematology clinics in the United Kingdom.
 PARTICIPANTS: 10 adult patients with AL. 
 METHODOLOGIC APPROACH: Two serial interviews were conducted with each participant, two to four weeks apart, within the first year of diagnosis or post-relapse.
 FINDINGS: AL creates a state of imbalance, which may initiate a search for new equilibrium. Patients' journeys toward making sense of their illness may involve three interchangeable processes. CONCLUSIONS: Findings of this contextually and methodologically novel study highlight the complex nature of sense-making for patients experiencing AL.
 INTERPRETATION: Nurses can take valuable lessons on how to manage the invisibility of AL, enhance trust in healthcare professionals, address the impact of isolation, and facilitate the making-sense processes of patients in ways that favor their short- and long-term psychosocial adjustment.

The experience of acute leukaemia in adult patients: a qualitative thematic synthesis.

PURPOSE: The aim of this review was to systematically identify and synthesise all qualitative evidence on how adult patients diagnosed with acute leukaemia experience living with their illness. METHODS: A systematic search strategy was developed comprising of two search strings: i) acute leukaemia and ii) qualitative methodology. The search strategy was run in seven electronic databases (Medline, CINAHL, PsychINFO, EMBASE, BNI & Archive, SSCI and ASSIA). Nine qualitative studies in adult patients with acute leukaemia, published in peer reviewed journals between 01/1990 and 01/2013 were included in the final sample. RESULTS: The qualitative thematic synthesis resulted in the development of a conceptual model describing a person's path to build a renewed self. Following the initial blow of diagnosis with the range of initial reactions, patients with acute leukaemia are living in a contracting world; they have to deal with the life in hospital, the several losses and the impact of their illness on their emotions and interpersonal relationships. Several factors take up a buffering role at that stage: coping, support, information and hope. Finally, patients accommodate acute leukaemia in their lives through re-evaluating personal values and assigning new meaning to their experience. CONCLUSIONS: Results from this thematic synthesis are indicative of the impact of acute leukaemia on patients' lives and the processes they use to make sense and accommodate the illness in their life. Increasing our understanding of these processes is warranted to improve patient care.

Partnership working and improved service delivery: views of staff providing sexual health services.

OBJECTIVES: Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provision, however, is lacking. Our aim was to assess the views of staff as to the conditions required for partnership working. METHODS: This study was a cross-sectional survey of 687 staff offering sexual health education, information or support to young people in the Healthy Respect intervention area in Scotland. Views of each variable were scored and structural equation modelling was used to assess the theoretical model. RESULTS: Responses were received from 284 (41%) staff. Greater strength of partnership was directly associated with increasing the number of referrals. Establishing professional roles between organizations was also associated with increasing the number of referrals. Strength of partnership was indirectly associated with working more effectively with young people and this relationship depended on clear communication, trust, established professional roles and shared resources. Effective partnership working depends on a number of interdependent relationships between organizations, which act synergistically to improve organizational outcomes. CONCLUSIONS: Effective partnership working leads to improved service delivery though there is a need for better controlled studies which demonstrate the effect on health outcomes.

A systematic review and meta-analysis of face-to-face communication of tailored health messages: implications for practice.

OBJECTIVE: To conduct a systematic review of the effect of face-to-face delivered tailored health messages on patient behavior and applications for practice. DESIGN: A systematic literature review and meta-analysis. METHODS: Systematic searches of a number of electronic databases were conducted and criteria for selection of studies were specified. RESULTS: 6 experimental studies published between 2003 and 2009 were included. The studies were all randomized controlled trials to evaluate the effectiveness of a face-to-face tailored messaging intervention. There were variation in their research design and methods used to randomize. All participants were aged at least 18 years. All of the studies reported positive changes in participants' health behavior with varying degrees of effect size and duration. A meta-analysis of the available data also confirmed an overall positive effect of tailored messaging on participants' health behaviors. CONCLUSION: The systematic review and the meta-analysis demonstrate a significant and positive effective of face-to-face tailored messaging upon participants' health behaviors. PRACTICE IMPLICATIONS: Health practitioners should be encouraged to allot time in their work routines to discover their patients' psycho-social characteristics and felt needs in order that they can provide a tailored health message to enable the patient to adopt health-promoting regimes into their lifestyle.

Developing a longitudinal database of routinely recorded primary care consultations linked to service use and outcome data.

The primary care consultation provides access to the majority of health care services and is central to obtaining diagnoses, treatment and ongoing management of long-term conditions. This paper reports the findings of an interdisciplinary feasibility study to explore the benefits and practical, technical and ethical challenges (and solutions) of creating a longitudinal database of recorded GP consultations in Tayside, Scotland which could be linked to existing routine data on intermediate and long-term health outcomes. After consultation we attempted to recruit and audio-record the consultations of all patients attending three general practices over a two week period. Background patient data, and patient and staff experiences of participation were also collected. Eventually, two practices participated with 77% of patients approached agreeing to participate. The findings suggest that the perceived integrity of the consultation was preserved. The overwhelming majority of patients believed that recording was worthwhile and did not feel it impacted on communication or the treatment they received; 93% indicated they would be willing to have subsequent consultations recorded and 81% would recommend participation to a friend. Staff had similar beliefs but raised concerns about potential increases in workload, confidentiality issues and ease of software use. We conclude that practice participation could be increased by providing safeguards on data use, financial reward, integrated recording software, and procedures to lessen the impact on workload. The resulting Scottish Clinical Interactions Project (SCIP) would provide the largest and most detailed longitudinal insight into real world medical consultations in the world, permitting the linking of consultation events and practices to subsequent outcomes and behaviours.

Frail older people's experiences and use of health and social care services.

AIMS: To highlight older people's experiences and expectations of services and the consequences for service provision, service development and research. RATIONALE: A large amount of resources have been invested in providing services for frail older people who experienced multiple hospital admissions. However, their own views are under-reported. METHOD: Semi-structured interviews with frail older people were conducted in four Scottish Health Board areas to explore the context of emergency admissions and the use of extramural services. OUTCOMES: Frail older people are high users of services but claim that services are not responsive to their main concerns: meeting individual needs, maximizing independence and helping to live fulfilled lives. Services not catering for these needs are often cancelled or left in abeyance. CONCLUSION: The same people who are targeted by care services are reluctant to engage with them. Care providers need to adopt older people's priorities to provide them with responsive patient-centred care.

Professional perceptions of joint working in primary care and social care services for older people in Scotland.

The purpose of this paper is to report health and social care professionals' perceptions on joint working for the care of older people in Scotland. Semi-structured interviews were conducted with 34 primary care and social care professionals. These professionals emphasised that joint working requires a fundamental change in thinking and a scrutiny of professional roles and identities and is influenced by the given geographical and organisational infrastructure. In order to facilitate sustained joint working knowledge and models of care bespoke to joint working need to be developed. This requires health and social care organisations to focus on the co-creation and generation of new knowledge by health and social care professionals as well as the communication and exchange of existing knowledge between services. However, joint working also needs to be based on patient views to guarantee a whole systems perspective.