The transition from dental school to postgraduate dental foundation training: strengthening the interaction between stakeholders.

This article demonstrates the benefits of collaboration between dental educators in undergraduate and postgraduate settings, to facilitate the transition of dental students into dental foundation training (DFT). The School of Dental Sciences at Newcastle University and Health Education England, working across north-east and north Cumbria, have strengthened links by forming a dental foundation programme undergraduate liaison group (FPUG) involving all stakeholders. The group has shared information between the organisations, enhanced stakeholder engagement, and developed several initiatives including workshops to help prepare final year students for the transition to DFT. A small investment in time has been highly effective, and the formation of a similar group merits consideration in other areas of the UK.

Learning outcomes: Exploring implications of adopting a different level of detail.

INTRODUCTION: Outcome-based programmes provide a framework to support educators and learners in understanding content and end points within taught courses. Management of these outcomes in the Dental Degree at Newcastle University has been a challenge in relation to quality assurance and enhancement, having over 1500 detailed student-level outcomes (SLO). This research aimed to explore the implications of adopting a more superficial "course" level of outcome (CLO), when reviewed against a reference set of external LO requirements. MATERIALS AND METHODS: A purposive sample of five courses within the undergraduate dental programme was selected. The mapping of both SLOs and CLOs was reviewed in relation to their total number and the mapping connections to the reference outcomes. RESULTS: There was a mean reduction of 79% in outcomes when comparing SLOs to CLOs. The number of mapping connections between CLOs and the reference set reduced in three courses and increased in two, when compared to SLOs. DISCUSSION: From a purely numerical perspective, changing the detail of learning outcomes has led to a change in mapping connections. As the delivered curriculum has remained unchanged, this demonstrates a potential impact of differing interpretations of learning outcomes. Further review of learning outcomes in relation to the domains categorised within the reference outcome document suggested more mapping links were obtained in clinically focused courses than academic or theoretical courses. CONCLUSION: A demonstrable impact in mapping connections was observed when the detail within the learning outcomes was changed. This has implications for programme leaders in structuring LOs for a curriculum.

Just One Thing: a novel patient feedback model.

In response to the Educational Standards of the UK's General Dental Council, Newcastle University, School of Dental Sciences introduced a patient feedback card to gather and incorporate patient feedback into their undergraduate assessment framework. The cards ask for patient response to two questions about their experience, and also ask patients to identify 'Just One Thing' (JOT) the student could do to improve this. JOT cards completed during a two week period were collected to evaluate and analyse the nature of patient responses within this model. Over 90% of JOT cards scored the students as 'Excellent' with the remainder scoring the student as 'Good' or giving no response. Many of the free text comments complimented the students and also provided focused suggestions for improvement. While the overwhelming positive responses may suggest that this model for collecting feedback may not be effective at discriminating between students with varying levels of interpersonal/communication skills, the free text comments were seen to be of value in building confidence or identifying areas for improvement.

Virtual courses: enhancing a curriculum.

INTRODUCTION: Providers of education programmes are required to demonstrate to students, staff and external regulators the content of the programme and how this aligns to key outcomes. Whilst many programme themes are straightforward to illustrate, other integral themes prove challenging to demonstrate independently. INNOVATION: A virtual course takes elements within the current programme relating to a specific theme, repackages and maps them to provide clear signposting by highlighting each occasion the theme is taught, experienced and assessed. The individual elements remain within their current course, so there is no disruption to the established curriculum, but there is an enhancement in terms of transparently displaying linkages within a theme. DISCUSSION: Using the concept of virtual courses we have found we can respond to new initiatives and requirements of external regulators, as well as providing improved signposting for staff and students. This can be undertaken without the need to redesign a whole curriculum. CONCLUSION: In well-designed and currently effective curricula, we would like to recommend that virtual course development can enhance programme transparency, demonstrate external regulatory requirements and promote quality assurance without disruption to current content.

Is the onset of influenza in the community age-related?

We studied the spread of influenza in the community between 1993 and 2009 using primary-care surveillance data to investigate if the onset of influenza was age-related. Virus detections [A(H3N2), B, A(H1N1)] and clinical incidence of influenza-like illness (ILI) in 12·3 million person-years in the long-running Royal College of General Practitioners-linked clinical-virological surveillance programme in England & Wales were examined. The number of days between symptom onset and the all-age peak ILI incidence were compared by age group for each influenza type/subtype. We found that virus detection and ILI incidence increase, peak and decrease were in unison. The mean interval between symptom onset to peak ILI incidence in virus detections (all ages) was: A(H3N2) 20·5 [95% confidence interval (CI) 19·7-21·6] days; B, 18·8 (95% CI 15·8·0-21·7) days; and A(H1N1) 17·0 (95% CI 15·6-18·4) days. Differences by age group were examined using the Kruskal-Wallis test. For A(H3N2) and A(H1N1) viruses the interval was similar in each age group. For influenza B there were highly significant differences by age group (P = 0·0001). Clinical incidence rates of ILI reported in the 8 weeks preceding the period of influenza virus activity were used to estimate a baseline incidence and threshold value (upper 95% CI of estimate) which was used as a marker of epidemic progress. Differences between the age groups in the week in which the threshold was reached were small and not localized to any age group. In conclusion we found no evidence to suggest that influenza A(H3N2) and A(H1N1) occurs in the community in one age group before another. For influenza B, virus detection was earlier in children aged 5-14 years than in persons aged ⩾25 years.

Patients' experiences of dental implant treatment: A literature review of key qualitative studies.

OBJECTIVES: To identify and summarise the findings of previous qualitative studies relating to patients' experience of dental implant treatment (DIT) at various stages of their implant treatment, by means of textual narrative synthesis. DATA/SOURCES: Original articles reporting patients' experience with dental implant were included. A two-stage search of the literature, electronic and hand search identified relevant qualitative studies up to July 2014. An extensive electronic search was conducted of databases including PubMed, Embase, Scopus, Web of Knowledge, Cochrane Database and Google Scholar. STUDY SELECTION: Included primary studies (n=10) used qualitative research methods and qualitative analysis to investigate patients' experiences with dental implants treatment. CONCLUSIONS: While the growing interest in implant treatment for the replacement of missing dentition is evident, it is essential to investigate patients' perceptions of different aspects of implant treatment. This textual narrative synthesis conducted to review qualitative studies which provided insight into patients' experience of two types of implant prostheses namely ISOD (implant-supported overdenture) and FISP (fixed implant supported prostheses). Primary reviewed studies tended to include samples of older patients with more extensive tooth loss, and to focus on experiences prior to and post-treatment rather than on the treatment period itself. Findings across reviewed studies (n=10) suggested that patients with FISP thought of implant treatment as a process of 'normalisation'(1) and believed that such implant restorations could be similar to natural teeth, whereas patients with ISOD focused more on the functional and social advantages of their implant treatment. CLINICAL SIGNIFICANCE: The growing interest in qualitative research is evident in several branches of clinical dentistry and dental implantology is not an exception. Qualitative studies concerning the patients account of their experience of dental implants is however limited. The aim of this review is to firstly identify recent work within this field and to subsequently categorise it more consistently by means of textural narrative synthesis, thus highlighting similarities and differences and enabling identification of gaps in research knowledge thereby setting the direction of further research.

Patterns of selection and polymorphism of innate immunity genes in bumblebees (Hymenoptera: Apidae).

In response to on-going biodiversity loss, conservation genetics has established itself as an important branch of biology. Historically concentrating on assessing stochastic processes using neutral loci, there has been a recent surge of interest in understanding and quantifying variation at loci underlying ecologically important traits. To this end, patterns of selection and polymorphism at these loci must be characterized. Loci underlying immunity make good candidates in this context: they are expected to be important for population persistence and may exhibit diversifying or divergent selection. Predictions regarding the pattern of selection expected at immune system loci have been based on their interactions with pathogens, however, published studies report mixed results as to whether these are borne out or not. Here, polymorphism and selection is examined for three innate immune system loci in bumblebees: a peptidoglycan recognition protein, a putative alpha-macroglobulin, and scavenger receptor. Both intra- and inter-specific sequence variation is quantified. Very little polymorphism was encountered, precluding robust tests of selection. However, the lack of inter-specific polymorphisms suggests a lack of positive selection for the regions sequenced. Results are discussed with respect to population genetic predictions and generation of a specific immune response in insects. Alternative loci and methods for studying adaptive genetic variation in a conservation context are considered.

Do implant-supported dentures facilitate efficacy of eating more healthily?

UNLABELLED: Edentulous persons have poor diet quality demonstrating a need for dietary intervention. Implant-supported mandibular overdentures (IODs) have functional advantages over conventional dentures (CD), but whether they enhance the ability to eat more healthily following dietary advice is unknown. OBJECTIVES: This study aimed to compare the effectiveness of dietary intervention between IODs and CD patients. METHODS: Edentulous adults (28 IOD and 26 CD) received customised dietary advice. The percentage contribution of dietary fats, carbohydrate and protein to energy (kcal) intake, dietary intakes of fibre, fruits, vegetables and antioxidants, and plasma antioxidants were assessed pre- and at 3 and 6 months post-dietary intervention. RESULTS: Both groups increased fruit and vegetable intake at 3 and 6 months following dietary intervention but intakes between groups did not differ. The IOD group had reduced % energy from total fat at 3 and 6 months and from saturated fat at 3 months. The CD group had reduced % energy from saturated by 6 months. The IOD group had a significantly lower % energy intake from saturated fat at 3 months and higher intake of non-starch polysaccharide (NSP) compared with the CD group. Both groups showed improvements in serum antioxidant status but the IOD group had significantly higher plasma antioxidant capacity post intervention compared with the CD group. CONCLUSIONS: Dietary intervention benefits denture patients. IOD patients showed moderately greater dietary improvements compared with conventional denture patients.

Development of a patient-based questionnaire about emotional and social issues related to eating with dentures.

OBJECTIVES: In order to fully assess the impact of prosthetic rehabilitation and to formulate appropriate dietary advice, in-depth information about patients' experiences of eating with dentures is needed. The objective of this study was to develop and validate a questionnaire that accurately reflected the real concerns of patients with dental prostheses about the aspects of their life related to eating, using detailed information derived from qualitative interviews with patients. METHODS: Themes around factors related to eating with dentures were derived from interviews with patients (n=66) with either implant-supported mandibular over-dentures or conventional dentures. The themes were used to design a self-completed questionnaire with questions scored on a visual analogue scale and additionally questions answered using free text. The content and face validity of the questionnaire was tested on a different group of patients (n=10) with implant-supported mandibular over-dentures ('implant-supported') or conventional dentures. Test-retest reliability analysis was conducted on a further group of 30 patients (n=15 implant-supported; n=15 conventional dentures). RESULTS: A questionnaire has been developed with 33 questions scored on a visual analogue scale and 31 open questions designed to collect further information as free text. Themes identified were around social, emotional and practical issues about eating. The instrument has good internal reliability with a Cronbach alpha values of 0.86-0.95 and good test-retest reliability with intra-class correlation coefficients 0.87-0.92 across the domains. CONCLUSIONS: A patient-based instrument has been developed to measure emotional and social issues related to eating with dentures (ESIRE questionnaire). The questionnaire will be a useful tool in future trials of prosthetic rehabilitation.

Are implant supported overdentures too complex to be included in the undergraduate curriculum?

To widen the availability of implant supported mandibular overdentures, their inclusion in the undergraduate clinical training curriculum has been encouraged. The aim was to determine whether implant supported mandibular overdentures provided by undergraduates could achieve similar levels of improvement in patient satisfaction and quality of life as previously demonstrated by experienced prosthodontists. Nineteen patients were treated by Stage 3 undergraduate students at Newcastle University, School of Dental Sciences. Changes between pre-treatment and 3 month post-treatment satisfaction and oral health related quality of life suggest dental undergraduates achieve similar levels of improvement as experienced prosthodontists.

Two implant retained overdentures--a review of the literature supporting the McGill and York consensus statements.

The McGill consensus statement on overdentures (14) was published following a symposium held at McGill University in Montreal, Canada in 2002. A panel of relevant experts in the field stated that: The evidence currently available suggests that the restoration of the edentulous mandible with a conventional denture is no longer the most appropriate first choice prosthodontic treatment. There is now overwhelming evidence that a two-implant overdenture should become the first choice of treatment for the edentulous mandible (14). In 2009, a further consensus statement was released as a support and follow-up to the McGill consensus statement. This report was jointly created by members of the BSSPD (British Society for the Study of Prosthetic Dentistry) Council and the panel of presenters at the BSSPD conference in York, UK in April 2009 (15). This report also highlighted that since the McGill statement in 2002, uptake by dentists of implant technology for complete denture wearers has been slow. The York statement concluded that 'a substantial body of evidence is now available demonstrating that patients' satisfaction and quality of life with ISOD mandibular overdentures is significantly greater than for conventional dentures. Much of this data comes from randomised controlled trials (15). Whilst it is accepted that the two-implant overdenture is not the gold standard of implant therapy it is the minimum standard that should be sufficient for most people, taking into account performance, patient satisfaction, cost and clinical time.

Microsatellite standardization and evaluation of genotyping error in a large multi-partner research programme for conservation of Atlantic salmon (Salmo salar L.).

Microsatellite genotyping is a common DNA characterization technique in population, ecological and evolutionary genetics research. Since different alleles are sized relative to internal size-standards, different laboratories must calibrate and standardize allelic designations when exchanging data. This interchange of microsatellite data can often prove problematic. Here, 16 microsatellite loci were calibrated and standardized for the Atlantic salmon, Salmo salar, across 12 laboratories. Although inconsistencies were observed, particularly due to differences between migration of DNA fragments and actual allelic size ('size shifts'), inter-laboratory calibration was successful. Standardization also allowed an assessment of the degree and partitioning of genotyping error. Notably, the global allelic error rate was reduced from 0.05 ± 0.01 prior to calibration to 0.01 ± 0.002 post-calibration. Most errors were found to occur during analysis (i.e. when size-calling alleles; the mean proportion of all errors that were analytical errors across loci was 0.58 after calibration). No evidence was found of an association between the degree of error and allelic size range of a locus, number of alleles, nor repeat type, nor was there evidence that genotyping errors were more prevalent when a laboratory analyzed samples outside of the usual geographic area they encounter. The microsatellite calibration between laboratories presented here will be especially important for genetic assignment of marine-caught Atlantic salmon, enabling analysis of marine mortality, a major factor in the observed declines of this highly valued species.

Embedding implant dentistry into the undergraduate dental curriculum.

This article represents the consensus from a meeting of the British Society of Prosthetic Dentistry's Education Group which met to discuss implant dentistry at the undergraduate student level. The consensus recognises the need to embed the teaching of implant supported prostheses if such a treatment modality is to be widely practised after graduation. This short article makes some recommendations as well as detailing some challenges and barriers that need to be overcome if implant dentistry is to be successfully embedded in an undergraduate dental curriculum.

Interaction of cationic surfactants with DNA detected by spectroscopic and acoustic wave techniques.

Interaction of the cationic surfactants benzalkonium chloride and 1-hexadecylpyridinium chloride, in the concentration range 0.1 microM to 1 mM with calf thymus DNA and with short 19-mer double-stranded DNA has been examined in solution using UV absorption and fluorescent spectroscopies and at the liquid-solution interface by thickness-shear mode acoustic wave sensor. Higher concentrations of surfactant resulted in an increase of UV absorption, and decrease of melting temperature and van't Hoff enthalpy of calf thymus DNA. Both surfactants induce fluorescence quenching of ethidium bromide which is also associated with intercalation of the molecules into the nucleic acid strand. The effect of the pyridinium compound is greater than for the other surfactant likely because of the lower size of polar head group in this molecule. With respect to acoustic wave detection at the device surface, for relatively low surfactant concentrations (below 100 microM), decreases of both series resonant frequency and motional resistance were observed. At higher surfactant concentration both parameters increased. These effects are attributed to acoustic coupling processes that occur at the device-film/liquid boundary.

Estimating influenza vaccine effectiveness using routinely collected laboratory data.

BACKGROUND: Estimation of influenza vaccine effectiveness (V/E) is needed early during influenza outbreaks in order to optimise management of influenza--a need which will be even greater in a pandemic situation. OBJECTIVE: Examine the potential of routinely collected virological surveillance data to generate estimates of V/E in real-time during winter seasons. METHODS: Integrated clinical and virological community influenza surveillance data collected over three winters 2004/5-2006/7 were used. We calculated the odds of vaccination in persons that were influenza-virus-positive and the odds in those that were negative and provided a crude estimate of V/E. Logistic regression was used to obtain V/E estimates adjusted for confounding variables such as age. RESULTS: Multivariable analysis suggested that adjustments to the crude V/E estimate were necessary for patient age and month of sampling. The annual adjusted V/E was 2005/6, 67% (95% CI 41% to 82%); 2006/7 55% (26% to 73%) and 2007/8 67% (41% to 82%). The adjusted V/E in persons <65 years was 70% (57% to 78%) and 65 years and over 46% (-17% to 75%). Estimates differed by small insignificant amounts when calculated separately for influenza A and B; by interval between illness onset and swab sample; by analysis for the period November to January in each year compared with February to April and according to viral load. CONCLUSION: We have demonstrated the potential of using routine virological and clinical surveillance data to provide estimates of V/E early in season and conclude that it is feasible to introduce this approach to V/E measurement into evaluation of national influenza vaccination programs.

Facilitation of implant provision in primary care.

OBJECTIVE: To investigate primary care practitioner participation in implant-supported mandibular overdenture (ISOD) provision. DESIGN: Postal questionnaire. SETTING: Primary dental care, North East England 2007. SUBJECTS AND METHODS: Two hundred and ninety-five practitioners in North East England were sent questionnaires presenting a case-based scenario of a patient unable to manage a lower denture on an atrophic ridge. The questionnaire led them through the facilitation stages of ISOD provision, asking them to state their anticipated level of participation at each stage. Demographic details were also collected. RESULTS: Two hundred and seventeen responses were received (74%). Most practitioners would consider the option of provision of ISODs (89%) in this case and all who considered would discuss the option with the patient. Of those offering to facilitate treatment, 66% (122/184) would never deliver themselves, with the majority (60%, 111/184) referring within primary care. Statistical analysis showed associations between demographics and behaviour. CONCLUSIONS: The majority of practitioners in this study area would facilitate ISOD provision in this case. Practitioners who are male and working in a practice where a framework for the provision of implants already exists are most likely to facilitate provision and/or provide an ISOD within primary care.

Detection of DNA damage: effect of thymidine glycol residues on the thermodynamic, substrate and interfacial acoustic properties of oligonucleotide duplexes.

Thymidine glycol residues in DNA are biologically active oxidative molecular damage sites caused by ionizing radiation and other factors. One or two thymidine glycol residues were incorporated in 19- to 31-mer DNA fragments during automatic oligonucleotide synthesis. These oligonucleotide models were used to estimate the effect of oxidized thymidines on the thermodynamic, substrate and interfacial acoustic properties of DNA. UV-monitoring melting data revealed that modified residues in place of thymidines destabilize the DNA double helix by 8-22 degrees C, depending on the number of lesions, the length of oligonucleotide duplexes and their GC-content. The diminished hybridizing capacity of modified oligonucleotides is presumably due to the loss of aromaticity and elevated hydrophilicity of thymine glycol in comparison to the thymine base. According to circular dichroism (CD) data, the modified DNA duplexes retain B-form geometry, and the thymidine glycol residue introduces only local perturbations limited to the lesion site. The rate of DNA hydrolysis by restriction endonucleases R.MvaI, R.Bst2UI, R.MspR9I and R.Bme1390I is significantly decreased as the thymidine glycol is located in the central position of the double-stranded recognition sequences 5'-CC / WGG-3' (W = A, T) or 5'-CC / NGG-3' (N = A, T, G, C) adjacent to the cleavage site. On the other hand, the catalytic properties of enzymes R.Psp6I and R.BstSCI recognizing the similar sequence are not changed dramatically, since their cleavage site is separated from the point of modification by several base-pairs. Data obtained by gel-electrophoretic analysis of radioactive DNA substrates were confirmed by direct spectrophotometric assay developed by the authors. The effect of thymidine glycol was also observed on DNA hybridization at the surface of a thickness-shear mode acoustic wave device. A 1.9-fold decrease in the rate of duplex formation was noted for oligonucleotides carrying one or two thymidine glycol residues in relation to the unmodified analog.

A randomized-controlled trial of food choices made by edentulous adults.

AIM: The aim of this study was to conduct a randomized-controlled trial to compare food choices of edentulous adults provided with implant-supported mandibular overdentures and conventional dentures. METHODS: Edentulous patients were randomly allocated to an implant group (IG) or a denture group (DG). IG subjects (n=49) were provided with conventional maxillary dentures and implant-retained mandibular overdentures. Subjects in this group refusing implants were retained using the 'intention-to-treat principle' and provided with conventional dentures. DG subjects (n=48) were provided with conventional dentures. Subjects indicated whether they consumed any of seven test foods and the level of chewing difficulty experienced. Data were collected pre-treatment and 3 months post treatment. RESULTS: IG subjects reported increased consumption of carrots, apples and nuts post-treatment (P<0.05) and decreased post-treatment difficulty in chewing apples and nuts. DG subjects reported decreased post-treatment difficulty in chewing carrots, bacon and nuts (P<0.05). Between group differences for chewing difficulty were detected for nuts that DG subjects found easier to chew than IG subjects (P=0.002). CONCLUSION: Food selection and perceived chewing difficulty improved in both groups, with no significant differences between groups. Successful rehabilitation may not result in different food selection, which may require concurrent tailored dietary interventions, but may increase available food choices.

Change in cardiovascular risk status after dental clearance.

There is considerable debate over the relationship between periodontal and cardiovascular disease. It has been postulated that inflammatory mediators prevalent in periodontal disease may impact on atheroma formation and the thrombotic process. In cross-sectional, observational studies, periodontitis is associated with elevated C-reactive protein (CRP), hyperfibrinogenaemia and moderate leukocytosis. CRP levels have also been shown to decrease following periodontal therapy. CRP is a reliable marker of the acute phase reaction to infections and/or inflammation and is a powerful predictor of future coronary events.