Using Co-Design to Develop a Collective Leadership Intervention for Healthcare Teams to Improve Safety Culture.

While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed.

The Effect of Irradiation Distance on Light Transmittance and Vickers Hardness Ratio of Two Bulk-fill Resin-based Composites.

The aims of this study were to assess the light energy transmission and Vickers hardness (VH) ratio of two bulk-fill resin-based composites (RBCs) (Tetric EvoCeram and Filtek) cured at different distances between the light curing unit's (LCU) tip and the surface of the restoration (T-S) using either a Bluephase G2, Bluephase® 'turbo tip' or Bluephase Style LCU. Samples were cured from the top at T-S distances of 2mm, 6mm and 10mm for 20 seconds. A MARC-Resin-Calibrator™ recorded the transmitted irradiance reaching the bottom of the sample, in real time. The VH was measured at the top and bottom after 24h of dark storage. Both the total light energy (TLE) transmitted through the samples and their VH ratios were reduced with increasing T-S distance. At 10mm T-S distance, the VH ratio values of samples cured with Bluephase G2 LCU were significantly greater than the samples cured with the other LCUs while the samples cured with Bluephase® 'turbo tip' showed the lowest values. It can be concluded that TLE transmitted through bulk-fill RBCs and their VH ratio reduces with increasing T-S distance but the rate of decline is LCU dependent. Bluephase G2 was associated with the smallest light attenuation.

Hereditary dentine disorders: dentinogenesis imperfecta and dentine dysplasia.

The hereditary dentine disorders, dentinogenesis imperfecta (DGI) and dentine dysplasia (DD), comprise a group of autosomal dominant genetic conditions characterised by abnormal dentine structure affecting either the primary or both the primary and secondary dentitions. DGI is reported to have an incidence of 1 in 6,000 to 1 in 8,000, whereas that of DD type 1 is 1 in 100,000. Clinically, the teeth are discoloured and show structural defects such as bulbous crowns and small pulp chambers radiographically. The underlying defect of mineralisation often results in shearing of the overlying enamel leaving exposed weakened dentine which is prone to wear. Currently, three sub-types of DGI and two sub-types of DD are recognised but this categorisation may change when other causative mutations are found. DGI type I is inherited with osteogenesis imperfecta and recent genetic studies have shown that mutations in the genes encoding collagen type 1, COL1A1 and COL1A2, underlie this condition. All other forms of DGI and DD, except DD-1, appear to result from mutations in the gene encoding dentine sialophosphoprotein (DSPP), suggesting that these conditions are allelic. Diagnosis is based on family history, pedigree construction and detailed clinical examination, while genetic diagnosis may become useful in the future once sufficient disease-causing mutations have been discovered. Differential diagnoses include hypocalcified forms of amelogenesis imperfecta, congenital erythropoietic porphyria, conditions leading to early tooth loss (Kostmann's disease, cyclic neutropenia, Chediak-Hegashi syndrome, histiocytosis X, Papillon-Lefevre syndrome), permanent teeth discolouration due to tetracyclines, Vitamin D-dependent and vitamin D-resistant rickets. Treatment involves removal of sources of infection or pain, improvement of aesthetics and protection of the posterior teeth from wear. Beginning in infancy, treatment usually continues into adulthood with a number of options including the use of crowns, over-dentures and dental implants depending on the age of the patient and the condition of the dentition. Where diagnosis occurs early in life and treatment follows the outlined recommendations, good aesthetics and function can be obtained.