The feasibility and acceptability of implementing video reflexive ethnography (VRE) as an improvement tool in acute maternity services.

BACKGROUND: Video-reflexive ethnography (VRE) has been argued to be an alternative approach to collaborative learning in healthcare teams, more able to capture the complexities of the healthcare environment than simulation. This study aims to explore the feasibility and acceptability of employing VRE as an improvement tool in acute maternity services. METHOD: Focused ethnography and semi-structured interviews (n = 17) explored the feasibility of employing VRE from the perspective of the researcher-facilitator, and that of the healthcare staff participants. Reflexive thematic analysis was used to generate key themes. RESULTS: We identified four themes related to feasibility of employing VRE as an improvement approach: laying the groundwork; challenges of capturing in-situ video footage; effective facilitation of reflexive feedback; and, power to change. Of note was the central role of the facilitator in building and maintaining staff trust in the process, particularly in being able to guide collaborative, non-punitive discussion during reflexive feedback sessions. Interestingly, when considering implementation of change, structural hierarchies were evident with more senior staff better able to develop and effect ideas. Two themes related to acceptability of VRE among healthcare staff were identified: staff response to the role of VRE in improvement; and the power of a different perspective. Staff were overwhelmingly positive about their experience of VRE, particularly appreciating the time, space and autonomy it afforded them to navigate and articulate ideas for change and improvement. CONCLUSION: VRE is both feasible and acceptable as an improvement tool with acute, multi-disciplinary maternity staff teams. It is an important healthcare improvement tool that could prompt the development and maintenance of team resilience factors in the face of increasing stress and burn-out of healthcare staff in maternity services.

Patient and Family Involvement in Serious Incident Investigations From the Perspectives of Key Stakeholders: A Review of the Qualitative Evidence.

OBJECTIVES: Investigations of healthcare harm often overlook the valuable insights of patients and families. Our review aimed to explore the perspectives of key stakeholders when patients and families were involved in serious incident investigations. METHODS: The authors searched three databases (Medline, PsycInfo, and CINAHL) and Connected Papers software for qualitative studies in which patients and families were involved in serious incident investigations until no new articles were found. RESULTS: Twenty-seven papers were eligible. The perspectives of patients and families, healthcare professionals, nonclinical staff, and legal staff were sought across acute, mental health and maternity settings. Most patients and families valued being involved; however, it was important that investigations were flexible and sensitive to both clinical and emotional aspects of care to avoid compounding harm. This included the following: early active listening with empathy for trauma, sincere and timely apology, fostering trust and transparency, making realistic timelines clear, and establishing effective nonadversarial communication. Most staff perceived that patient and family involvement could improve investigation quality, promote an open culture, and help ensure future safety. However, it was made difficult when multidisciplinary input was absent, workload and staff turnover were high, training and support needs were unmet, and fears surrounded litigation. Potential solutions included enhancing the clarity of roles and responsibilities, adequately training staff, and providing long and short-term support to stakeholders. CONCLUSIONS: Our review provides insights to ensure patient and family involvement in serious incident investigations considers both clinical and emotional aspects of care, is meaningful for all key stakeholders, and avoids compounding harm. However, significant gaps in the literature remain.

Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis.

BACKGROUND: Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information. OBJECTIVE: To systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles' eligibility was validated by two second reviewers (5%). RESULTS: Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone. CONCLUSION: The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems. TRIAL REGISTRATION NUMBER: CRD42017055602.

A randomised controlled trial of a smoking cessation intervention delivered by dental hygienists: a feasibility study.

BACKGROUND: Tobacco use continues to be a global public health problem. Helping patients to quit is part of the preventive role of all health professionals. There is now increasing interest in the role that the dental team can play in helping their patients to quit smoking. The aim of this study was to determine the feasibility of undertaking a randomised controlled smoking cessation intervention, utilising dental hygienists to deliver tobacco cessation advice to a cohort of periodontal patients. METHODS: One hundred and eighteen patients who attended consultant clinics in an outpatient dental hospital department (Periodontology) were recruited into a trial. Data were available for 116 participants, 59 intervention and 57 control, and were analysed on an intention-to-treat basis. The intervention group received smoking cessation advice based on the 5As (ask, advise, assess, assist, arrange follow-up) and were offered nicotine replacement therapy (NRT), whereas the control group received 'usual care'. Outcome measures included self-reported smoking cessation, verified by salivary cotinine measurement and CO measurements. Self-reported measures in those trial participants who did not quit included number and length of quit attempts and reduction in smoking. RESULTS: At 3 months, 9/59 (15%) of the intervention group had quit compared to 5/57 (9%) of the controls. At 6 months, 6/59 (10%) of the intervention group quit compared to 3/57 (5%) of the controls. At one year, there were 4/59 (7%) intervention quitters, compared to 2/59 (4%) control quitters. In participants who described themselves as smokers, at 3 and 6 months, a statistically higher percentage of intervention participants reported that they had had a quit attempt of at least one week in the preceding 3 months (37% and 47%, for the intervention group respectively, compared with 18% and 16% for the control group). CONCLUSION: This study has shown the potential that trained dental hygienists could have in delivering smoking cessation advice. While success may be modest, public health gain would indicate that the dental team should participate in this activity. However, to add to the knowledge-base, a multi-centred randomised controlled trial, utilising biochemical verification would be required to be undertaken.

Infants' blood volume in a controlled trial of placental transfusion at preterm delivery.

OBJECTIVE: To investigate whether it was possible to promote placental blood transfer to infants at preterm delivery by (1) delaying cord clamping, (2) holding the infant below the placenta, and (3) administering an oxytocic agent to the mother, we measured the infants' blood volumes. DESIGN: Randomized study. METHODS: Forty-six preterm infants (gestational age: 24[0/7] to 32[6/7] weeks) were assigned randomly to either placental blood transfer promotion (delayed cord clamping [DCC] group, ie, > or =30 seconds from moment of delivery) or early cord clamping (ECC) with conventional management (ECC group). Eleven of 23 and 9 of 23 infants assigned randomly to DCC and ECC, respectively, were delivered through the vaginal route. The study was conducted at a tertiary perinatal center, the Queen Mother's Hospital (Glasgow, United Kingdom). RESULTS: The infants' mean blood volume in the DCC group (74.4 mL/kg) was significantly greater than that in the ECC group (62.7 mL/kg; 95% confidence interval for advantage: 5.8-17.5). The blood volume was significantly increased by DCC for infants delivered vaginally. The infants in the DCC group delivered through cesarean section had greater blood volumes (mean: 70.4 mL/kg; range: 45-83 mL/kg), compared with the ECC group (mean: 64.0 mL/kg; range: 48-77 mL/kg), but this was not significant. Additional analyses confirmed the effect of DCC (at least 30 seconds) to increase average blood volumes across the full range of gestational ages studied. CONCLUSIONS: The blood volume was, on average, increased in the DCC group after at least a 30-second delay for both vaginal and cesarean deliveries. However, on average, euvolemia was not attained with the third stage management methods outlined above.

Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial.

BACKGROUND: The aim of this study was to establish the efficacy of two different preparation packages, a paper-based cartoon and an interactive computer, at facilitating coping behavior in children undergoing dental general anesthetic (DGA) tooth extraction. METHOD: A total of 198 children were allocated randomly to computer, cartoon or control groups. A Visual Analog Scale (VAS) and Modified Child Dental Anxiety Scale (MCDAS) were used to compare preoperative anxiety levels between the three study groups. Blinded observers then scored behavior at both anesthesia induction and upon recovery using a VAS for each (0 = coped/no distress and 10 = no coping/high distress). RESULTS: The children's median age was 5 (range 3-10) years, 57% were boys, a median of seven teeth were extracted (range 1-20). Preoperative anxiety was similar for all preparation groups; with 24% of all children categorized 'phobic' using MCDAS. The median induction (coping) VAS level for both the computer and the cartoon groups was '1' (range 0-10), compared with the control group level of '3' (range 0-10). The median recovery (coping) VAS levels were: computer group: 0 (range 0-10), cartoon group: 4 (range 0-10) and control group: 2.5 (range 0-10). The Mann-Whitney U-test showed that the computer group coped significantly better than the control group at induction (P = 0.014) and significantly better than the cartoon group upon recovery (P = 0.016). The statistical power for detecting differences between groups (computer/cartoon versus control) was calculated to be 90%, based on pilot study data. CONCLUSIONS: The computer preparation package facilitated coping behavior in children undergoing DGA induction.

Archwire seating forces produced by different ligation methods and their effect on frictional resistance.

The aims of this study were to determine the mean tensile force of four different elastomeric modules, the archwire seating force of different ligation methods, and its effect on frictional resistance. To determine the mean tensile force, each elastomeric module (purple, grey, Alastik, and SuperSlick) was extended by 5 mm using two hooks attached to a load cell using a Nene M3000 testing machine. To assess the median archwire seating force, a maxillary premolar bracket (3M Unitek) was welded to a sheet of stainless steel (SS) and glued to a Perspex block. The bracket base was removed and the cut continued into the Perspex below. A length of test wire was taken and bent to form a "U" shape, with the middle portion 20 mm in length. The free ends of the wire were secured to the load cell of the Nene testing machine. Two wire sizes were tested, 0.017 x 0.025 and 0.019 x 0.025 inch SS. The load cell was activated and the force with which the wire was displaced into the slot by the ligation method was measured. Four types of elastomeric module were tested together with a pre-formed 0.09 inch SS ligature. The experimental method used to determine the mean frictional force of each module and wire size was carried out using a method described previously. Statistically significant differences existed in the mean tensile forces and median archwire seating forces between the elastomeric modules. Grey modules with either size wire produced the lowest median archwire seating force, whereas SS ligatures produced the highest forces. SS ligatures with either wire produced the lowest mean frictional forces, whereas grey modules produced significantly higher mean frictional force (P < 0.01). The force with which the wire was seated into the bracket did not seem to be related to the subsequent amount of mean frictional force produced.

Effectiveness of health care worker training on the oral health of elderly residents of nursing homes.

OBJECTIVES: The aim of this study was to evaluate the effect of a staff training programme on mouth care on the oral health of elderly residents of long-term care institutions. METHODS: Seventy-eight residents of five long-stay institutions were enrolled and underwent a baseline oral health assessment. Staff caring for residents in three of the sites received intensive training in mouth care. This comprised lecture and video material complemented by clinical demonstrations. The oral health of residents at all five sites was reassessed at periods of 3 and 9 months. Staff caring for residents in the remaining two institutions were then provided with mouth care training and all patients were reassessed at 18 months. Statistical analyses were undertaken to examine for significant changes in selected oral health parameters after training, within each group. RESULTS: Oral mucosal disease and oral dryness were common at baseline. The staff training was well received. Following staff training, there was a significant reduction in the number of residents left to undertake their own oral care. There were significant improvements in denture hygiene and a reduction in the number of residents wearing dentures overnight. The prevalence of oral mucosal disease dropped, with significant reductions in angular cheilitis and denture stomatitis. CONCLUSION: This education programme was effective in changing oral health care procedures within long-stay institutions for the elderly, with measurable improvements in oral health of the residents.

The Effectiveness of Systemp.desensitizer in the treatment of dentine hypersensitivity.

PURPOSE: This study reports the effectiveness of Systemp.desensitizer (Ivoclar Vivadent, Schaan, Liechtenstein), when used both with and without an acid-etch step, in the treatment of patients with dentine hypersensitivity in UK dental practices. MATERIALS AND METHODS: Ten general dental practitioners (GDPs) were selected from two practice-based research groups. The GDPs were each requested to use Systemp.desensitizer in the treatment of at least ten patients who presented with pain due to dentine hypersensitivity. Systemp.desensitizer was applied to the sensitive dentine area in strict accordance with the manufacturer's handling instructions, except that the patients were divided into two groups. For the first, group NE, the procedure was to isolate the tooth, gently blot it dry with cotton wool pellets, rub Systemp.desensitizer into the tooth for 20 seconds, then gently air-dry it. For the second, group E, the procedure was identical except that after isolation, the treatment area was etched for 15 seconds with 35% phosphoric acid. Patients were asked to complete a pro forma using a 10 cm visual analogue scale designed to provide details of the extent of their pain before treatment, 24 hours post-treatment, one week post-treatment, one month post-treatment, and three months post-treatment. The zero end of the scale was marked 'no pain' and the 10 cm end was marked 'extreme pain'. The percentage change in the patients' perception of their pain, relative to pretreatment, was calculated using repeated measures analysis and suitable follow-up confidence intervals for the mean changes in perceived pain. Comparisons were then made between the treatment groups NE and E. RESULTS: Ninety-one patients completed the first pro forma and 77 completed all the pro formas. Overall, there was a significant reduction in pain at each of the time points after treatment but the pattern of pain reduction across the two groups was different. In general, the non-etched group (group NE) saw an 'immediate' reduction in pain which was then fairly consistent across the longer term, whilst, in general, the etched group (group E) saw less reduction in pain 24 hours after treatment, and then further reduction in pain at both one week and one month after treatment. Thus the non-etched group experienced an early reduction whilst the etched group took longer to perceive a reduction in pain; however, there were no statistically significant differences between the reductions in pain scores between the two groups at any of the time points after treatment. CONCLUSION: It is concluded that Systemp.desensitizer was effective in reducing pain from dentine hypersensitivity in the patients treated, and this finding was unaffected by whether or not the tooth was acid-etched prior to application of the reagent.

Evaluation of methods of archwire ligation on frictional resistance.

The aim of the study was to investigate the effect of elastomeric type and stainless steel (SS) ligation on frictional resistance using a validated method. To assess the validity of the new test system to measure mean frictional forces, SS and TMA wires, each with dimensions of 0.017 x 0.025 and 0.019 x 0.025 inches, were used in combination with a self-ligating Damon II bracket or a conventional preadjusted edgewise premolar SS bracket without ligation. Four types of elastomeric module, purple, grey, Alastik or SuperSlick, and a pre-formed 0.09 inch SS ligature were then assessed as methods of ligation using preadjusted edgewise premolar SS brackets. The specimens were tested on a Nene M3000 testing machine, with a crosshead speed of 5 mm/minute and each test run lasted for 4 minutes. Each bracket/wire combination with each method of ligation was tested 10 times in the presence of human saliva and the mean frictional force was recorded. The mean frictional forces were compared using three-way analysis of variance. The Damon II self-ligating bracket and unligated conventional SS bracket produced negligible mean frictional forces with any of the wires tested. For the 0.017 x 0.025 SS, 0.019 x 0.025 SS or 0.019 x 0.025 inch TMA wires, SS ligatures produced the lowest mean frictional forces. With the 0.017 x 0.025 TMA wire, purple modules produced the lowest mean frictional force. There was no consistent pattern in the mean frictional forces across the various combinations of wire type, size and ligation method. Under the conditions of this experiment, the use of passive self-ligating brackets is the only method of almost eliminating friction.

A pilot study of patients' views of an oral health scoring system.

UNLABELLED: An oral health scoring system (Oral Health Score: OHS) has been designed to provide a numerical measure of the overall state of a patients oral health by means of a series of simple clinical examinations. OBJECTIVE: To assess, by means of a questionnaire, patients opinions of the value of the OHS. METHODS: Eight general dental practitioners who used the OHS were asked to participate in the project. The participating dentists were requested to explain the aims of the project to 50 patients. Patients who agreed to participate were asked to complete a questionnaire after a visit during which the OHS was used. These patients were provided with a reply-paid envelope for the return of the questionnaire. RESULTS: Completed usable questionnaires were received from 315 patients. Of respondents, 97% considered that the OHS gave them a better understanding of the condition of their mouth and 98% considered that the OHS was a good method for communication between dentist and patient. CONCLUSION: The results of the present study indicate that, within the study group, the OHS is considered by a large majority of patients to be a good method for communication of the patient's oral health between dentist and patient.

In vitro fracture resistance of teeth with dentin-bonded ceramic crowns and core build-ups.

PURPOSE: To assess the fracture strength of dentin-bonded crowns placed on cores of amalgam, resin composite and viscous glass-ionomer. METHODS: 40 sound maxillary premolar teeth were selected. These were mounted in acrylic resin in stainless steel molds. The palatal cusp of each tooth was removed in a standardized manner to simulate a core build-up preparation. Teeth were randomly divided into four groups, and each group was allocated a core material. For Group A, the core was pin-retained amalgam, for Group B the core was bonded amalgam, for Group C the core material was resin composite and for Group D the core material was high-viscosity glass-ionomer material. Cores were then constructed to the original tooth dimensions. A standardized crown preparation was made, impressions taken and an all-ceramic crown constructed in feldspathic porcelain. The crowns were luted in position using a dentin-bonding agent/dual cure resin-composite cement and the completed specimens subjected to compressive loading in a Universal Testing machine at 1 mm/minute. RESULTS: The mean forces to produce fracture of the crowns were 1.58 kN (+/- 0.41), 1.35 kN (+/- 0.44), 1.25 kN (+/- 0.24), and 1.12 kN (+/- 0.25) respectively for groups A, B, C and D. Statistical analysis by ANOVA indicated that the pinned amalgam group performed significantly better than the glass-ionomer group (P > 0.05).

Occupational exposures occurring among dental assistants in a UK dental school.

PURPOSE: The cross-infection risks for dentists have been well recognised, and much has been published regarding the incidence of occupational exposures to patient body fluids. Less has been reported regarding the risks to dental assistants. The purpose of this study was to evaluate the incidence of occupational exposures to patient body fluids among dental assistants, to assess the rate of reporting of such incidents, and to evaluate the association of various factors with these exposures. METHOD: All 84 dental assistants working at Birmingham Dental Hospital were asked to complete a confidential questionnaire to provide retrospective information regarding the nature and incidence of any occupational exposures they had experienced. RESULTS: An overall response rate of 94% was achieved. Dental nurses experienced fewer occupational exposures than dental students at the same institution, and reported incidents more frequently. More injuries occurred after the treatment session. Handling local anaesthetic syringes was associated with more injuries, and percutaneous injuries predominated. Trainee nurses had experienced more occupational injuries in the preceding six months than their qualified colleagues. There was no significant association with any of the other factors evaluated. CONCLUSIONS: The general incidence of occupational exposures among the dental assistants in this survey was low in comparison to dental students at the same institution. A further reduction may be possible by increasing the training of unqualified nurses with particular regard to post-treatment handling of sharp dental instruments and equipment.

The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study.

The purpose of this study was to compare in vitro the suitability of four disinfectants as intracanal medications: calcium hydroxide, chlorhexidine gel, chlorhexidine in the form of a controlled-release delivery system (PerioChip), and the combination of chlorhexidine gel with calcium hydroxide. Saline was used as the control. The disinfectants were tested at three different time periods (3, 8, and 14 days) by using human tooth specimens that had been previously contaminated with Enterococcus faecalis. Calcium hydroxide worked very efficiently in killing E. faecalis in the 3-day group and 8-day group. It was not as effective in the 14-day group. The different chlorhexidine formulations were also found to be effective for all time periods. More specifically, the combination of chlorhexidine gel with calcium hydroxide and the chlorhexidine gel worked slightly better than the PerioChip, but there was no significant difference among the medications.