The impact of COVID-19 pandemic on orthodontic services and trainees' mental health in India.

Aim: To evaluate the impact of COVID-19 on clinical orthodontic services, orthodontic education, and the emotional well-being of orthodontists and orthodontic trainees in India. Materials and methods: The survey was designed using Survey Monkey™ and distributed to members of the Indian Orthodontic Society via their registered email address and also via social media platforms (WhatsApp and LinkedIn). Results: A total of 610 responses to the survey were received. The majority of respondents agreed on the negative impact of COVID-19 on clinical activity and the associated income of orthodontists. Respondents reported that this was mainly due to national restrictions (70.1%), increased cross infection measures (59.6%), state restrictions (55.9%), and social distancing (39.4%). Ninety one percent of respondents agreed that orthodontic staff should have evidence of vaccination before providing care.COVID-19 was found to have a negative impact on the trainees' perceptions of their clinical dexterity (72.4%), their confidence with respect to academic knowledge (66.5%), their mental health (80.7%), and their stress levels during the pandemic (93.2%). Conclusion: The COVID-19 pandemic has had a negative impact on orthodontic specialists and post-graduate trainees in India. The impact on trainees' mental health was significantly higher compared to trainees from other countries. Decreased clinical activity has reduced the opportunities for learning, and trainers must rise to the challenge of providing additional support to this cohort of trainees who will progress to become the future orthodontic workforce.

A Review of MDMA-Assisted Therapy for Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is a common chronic and disabling psychiatric disorder that may develop after exposure to a traumatic life event. There are existing evidence-based psychotherapies and pharmacotherapies for PTSD; however, these treatments have significant limitations. 3,4-methylenedioxymethamphetamine (MDMA) was granted "breakthrough therapy" status by the U.S. Food and Drug Administration (FDA) in 2017 for the treatment of PTSD in conjunction with psychotherapy after preliminary Phase II results. This treatment is currently being investigated in Phase III trials with anticipated FDA approval of MDMA-assisted psychotherapy for PTSD in late 2023. This article reviews the evidence base for MDMA-assisted psychotherapy for PTSD, pharmacology and the proposed causal mechanisms of MDMA, risks and limitations of the current evidence, and challenges and future directions for the field.

HOPE: A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients With Cancer.

CONTEXT/OBJECTIVES: Psilocybin-assisted psychotherapy shows promise in treating depression and existential distress in people with serious medical illness. However, its individual-based methodology poses challenges for scaling and resource availability. The HOPE trial (A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients with Cancer) is an Institutional Review Boards-approved open-label feasibility and safety pilot study examining psilocybin-assisted group therapy in cancer patients with a DSM-5 depressive disorder (including major depressive disorder as well as adjustment disorder with depressed mood). We report here the safety and clinical outcome measures including six-months follow up data. METHODS: Outcome measures were collected at baseline, two-weeks and 26-weeks postintervention. The study involved three group preparatory sessions, one high-dose (25 mg) group psilocybin session, and three group integration sessions with cohorts of four participants over a three-week intervention. RESULTS: Twelve participants completed the trial. no serious adverse events attributed to psilocybin occurred. The primary clinical outcome measures of change in symptoms of depression on the clinician administered 17-item-HAM-D showed clinically substantial decrease in HAM-D scores from baseline to the two-week timepoint (21.5-10.09, P < 0.001) and the 26-week timepoint (21.5-14.83, P = 0.006). Six out of 12 participants met criteria for remission at two weeks, as defined by HAM-D < 7, three out 12 demonstrated a clinically significant change (4-6 points), and eight out of twelve demonstrated a clinically substantial change (7-12 points). CONCLUSION: This pilot study demonstrated the safety, feasibility, and possible efficacy of psilocybin-assisted group therapy for cancer patients dealing with depressive symptoms. Based on demonstrated efficacy and significant reductions in therapist time, future investigations with the group therapy model are warranted.

The COVID-19 experience of orthodontists in Jordan.

OBJECTIVES: To understand the impact of the COVID-19 pandemic on orthodontic clinical services in Jordan. MATERIALS AND METHODS: Google Forms electronic questionnaires were distributed between March and June 2021 using the WhatsApp platform of the Jordanian Orthodontic Society and via direct WhatsApp messages. The survey was identical and contemporaneous to that used in the United Kingdom. RESULTS: The survey yielded 127 unique responses, giving a response rate of 53.1%. The factors that had the greatest impact on service delivery were government guidance (78%), patients' fear of attending (70.1%), and increased cross-infection measures (65.4%). The survey revealed that there had been a perceived deterioration in oral hygiene (60.3%) and levels of compliance (61.9%) in patients in active treatment even though patients in treatment were prioritized during the pandemic. Also, 56.8% of respondents felt clinical staff should be vaccinated and undergo regular testing for COVID-19. Orthodontists within Jordan were optimistic regarding the speed at which clinical services would return to pre-pandemic levels of activity with 32.5% anticipating this would take less than 6 months. CONCLUSIONS: Patients in active orthodontic treatment, during COVID-19, have been prioritized but at the expense of new and review patients. Respondents in Jordan felt COVID-19 would have ongoing effects on clinical care, professional practice, and society. Most respondents supported the vaccination of orthodontic staff and were optimistic about the effect of a vaccination program on restoring clinical services.

Epistemic injustice and the psychiatrist.

BACKGROUND: Psychiatrists depend on their patients for clinical information and are obligated to regard them as trustworthy, except in special circumstances. Nevertheless, some critics of psychiatry have argued that psychiatrists frequently perpetrate epistemic injustice against patients. Epistemic injustice is a moral wrong that involves unfairly discriminating against a person with respect to their ability to know things because of personal characteristics like gender or psychiatric diagnosis. METHODS: We review the concept of epistemic injustice and several claims that psychiatric practice is epistemically unjust. RESULTS: While acknowledging the risk of epistemic injustice in psychiatry and other medical fields, we argue that most concerns that psychiatric practice is epistemically unjust are unfounded. CONCLUSIONS: The concept of epistemic injustice does not add significantly to existing standards of good clinical practice, and that it could produce changes in practice that would be deleterious. Psychiatrists should resist calls for changes to clinical practice based on this type of criticism.

NHS orthodontic services in Wales: orthodontic workforce distribution and primary care commissioned activity in 2021.

Objectives 1) To ascertain the volume of primary care orthodontic activity commissioned within Wales and compare this to the 12-year-old population; and 2) To ascertain the orthodontic workforce undertaking NHS orthodontic provision within Wales and their distribution.Methods Information was gathered between September and November 2021 from multiple sources within Wales, including: Freedom of Information requests; Welsh Government statistics; orthodontic professional networks; orthodontic provider websites; health boards (HBs); and directors of primary care/contracting/commissioning.Results The HBs had varying levels of orthodontic need and commissioned activity with a significant amount of cross border activity in South Wales. Overall, it indicated that Wales was only commissioning orthodontic activity to meet 76% of the annual orthodontic need. Overall, 97.9% of commissioned primary care orthodontic activity was being used to provide treatment for 9,500 patients per year. Furthermore, 112 GDC-registered clinicians provide NHS orthodontic care within Wales - 52 orthodontic specialists; 32 orthodontic therapists; 24 DwSIs; and 4 orthodontic trainees (StR 1-3). NHS orthodontic care is provided at 47 sites within Wales - 32 sites in the GDS/Specialist Practice, 6 sites within the CDS and 9 secondary care settings.Conclusions NHS commissioned primary care orthodontic activity within Wales is 76% of the potential orthodontic annual need. Primary care orthodontic services are efficient with 97.9% of commissioned activity being used to provide treatment. In total, 112 GDC-registered clinicians provide NHS orthodontic care across 47 sites within Wales, with 29.5% of clinicians working at multiple sites. The distribution of the orthodontic providers is predominately in areas of high population density, resulting in some rural communities being a significant distance from any orthodontic provider.

Engagement with the North Wales Local Dental Committee - part 1: current participation and opinions of its communication methods.

Aims To gather the views of North Wales dentists on the current communication methods of the North Wales Local Dental Committee (LDC) (NWLDC) and how this could be optimised to improve engagement from members.Design Descriptive cross-sectional survey.Setting Online electronic questionnaire.Materials and methods Survey circulated via the NWLDC's current communication channels, local professional groups, the local health board and Health Education and Improvement Wales' Maxcourse distribution list.Results A total of 167 unique responses were received from across North Wales. In total, 79.1% were from dentists, of which most were working in the general dental services (63.6%) on a mixed practice basis (61.9%). Furthermore, 69.5% of respondents felt they received too little information from the LDC, 71.3% never attended LDC meetings and only 15.6% attended more than one meeting a year. The pandemic has had no impact for 82.6% in increasing their engagement with the LDC.Conclusions Communication between the LDC and the dental community within an area is crucial. This survey has shown that, despite the best of intentions, the current communication methods utilised by the NWLDC are not effective at maximising the inclusiveness and participation with the LDC. The survey revealed that there is a lack of clarity over the LDC's role and who is 'allowed' to attend LDC meetings. It showed that although the dental practitioners practising within North Wales want to receive information and updates from the NWLDC, the communication methods which are currently being used are not reaching the majority of them.

Engagement with the North Wales Local Dental Committee - part 2: communication preferences.

Aims To gather the views of dentists practising within North Wales on their preferences as to how they would prefer to interact with the North Wales Local Dental Committee (LDC) (NWLDC).Design Descriptive cross-sectional survey.Setting Online electronic questionnaire.Materials and methods Survey circulated via the NWLDC's current communication channels, local professional groups, the local health board and Health Education and Improvement Wales' MaxCourse email distribution.Results A total of 167 unique responses were received from across North Wales, which included 132 responses from primary care dentists, yielding a response rate of 40.6%. Respondents would prefer to interact with the NWLDC via email notifications (88%), virtual meetings (52.1%) and via the LDC website (41.9%). Furthermore, 31.1% wanted a combination of both physical and virtual attendance at an LDC meeting to be an option and 43.7% of respondents did not want to attend LDC meetings as a preferred method of engaging with the LDC. The survey indicated that holding an educational event just before the LDC meeting will not have a positive impact on subsequent participation in the LDC meeting for 91.6% of respondents. The survey revealed that 70% had never visited the NWLDC's website, with only 20.4% of people visiting it more than once a year. Also, 83.8% stated that the pandemic had made no difference on them accessing the NWLDC website. The results allowed the identification of the top five 'core elements' for an ideal LDC website and which elements should have their access restricted only to LDC members.Conclusions The survey revealed that the respondents want greater communication from the NWLDC and that this is best achieved over a variety of different communication platforms, using the NWLDC website as a primary information resource to which the other communication methods are tethered. It is recognised that only a minority will want to, or be able to, attend the quarterly LDC meetings and so it is imperative that the NWLDC's communication strategy accommodates these individuals, both proactively and passively, by effective use of digital media and to continuously monitor its effectiveness so that it can adapt its strategy to maximise engagement and information delivery. There is a need to expand the representation of the LDC committee to encompass those who have newly entered the profession or are new to the area. The NWLDC recognises the need to reach out to dentists across North Wales who many feel isolated and disenfranchised to establish a constructive, mutually beneficial relationship.

Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care.

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions - about what we should do in any given situation - are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.

The orthodontic-restorative interface: 2. Compensating for variations in tooth number and shape.

UNLABELLED: The aim of this second article in this series of two is to outline a variety of methods which may be used to compensate for variations in tooth shape and number using a combination of orthodontic and restorative approaches. It will also provide an overview of other areas of patient care which necessitate a multi-disciplinary orthodontic/restorative approach. The article will highlight the importance of combined planning from the outset and the close relationship between the different specialties, which must be maintained throughout treatment. The methods of compensating for variations in tooth number and shape will often require contributions from both orthodontist and restorative dentist. It is important that both disciplines are involved in the assessment and treatment planning process so that they know what will be expected of them during the patient's care. Treatment planning in isolation may lead to care being delivered which is below the optimum standard which can be achieved. The orthodontist and restorative dentist are likely to liaise with the patient's general dental practitioner so that he/she can provide the restorative treatment in some cases. CLINICAL RELEVANCE: Great improvements in aesthetics and function may be obtained using an interdisciplinary approach for patients who have variations in tooth number and shape.

The orthodontic-restorative interface: 1. Patient assessment.

UNLABELLED: The first article in this series of two aims to outline the assessment of patients for whom a combined orthodontic-restorative approach would be beneficial. In particular, it will concentrate on the assessment of patients who have hypodontia and tooth size discrepancies. The importance of the aesthetic assessment for these cases will be highlighted. Variations in tooth number and tooth size discrepancy often require a combined treatment planning approach from the orthodontist and restorative dentist. The referring general dental practitioner has a key role in recognizing that this approach may be required and highlighting this in the initial patient referral. It is likely in the more straightforward cases that the GDP will be providing the restorative treatment and so an increased understanding of these cases would be beneficial. In the second paper, treatment options will be presented. CLINICAL RELEVANCE: For patients who require a combined orthodontic/restorative approach, it is important that orthodontic and restorative disciplines liaise closely in the assessment and treatment planning process so that optimal care may be planned.

Decision-making for children with traumatized permanent incisors: a holistic approach.

UNLABELLED: Traumatic injury to permanent central incisors is a common occurrence in childhood and adolescence. It is of paramount importance that expedient and appropriate care is provided to ensure an optimum short- and long-term outcome for injured teeth and, importantly, the patients themselves. Treatment planning should thus adopt a holistic approach, taking into account a number of patient- and dental-related factors. Multidisciplinary care, involving paediatric dentistry, orthodontics or oral and maxillofacial surgery may be indicated. Decisions should also be informed by a sound understanding of the exact nature and prognosis of the presenting dental injury. CLINICAL RELEVANCE: Poor primary management of dental trauma may have lifelong consequences for the young patient.

Maxillary anterior tooth size and arch dimensions in unilateral cleft lip and palate.

OBJECTIVE: To investigate differences in size of the maxillary permanent anterior teeth and arch dimensions between individuals with repaired unilateral cleft lip and palate (UCLP) and a matched control group representing the general population. DESIGN: Retrospective study cast review. PARTICIPANTS: Study casts of 30 subjects due to commence orthodontic treatment following an alveolar bone graft (ABG) were collected from the Cleft Lip and Palate Units in South Yorkshire. Thirty control subjects were collected from a previously validated control group of white individuals in South Yorkshire. MAIN OUTCOME MEASURES: Casts were analyzed with an image analysis system to measure the dimensions of the maxillary permanent anterior teeth, incisor chord lengths, and the intercanine and intermolar widths. The results were analyzed statistically using paired t-tests and two-way univariate analysis of variance (ANOVA). RESULTS: The mesiodistal widths of maxillary anterior teeth in the study group were smaller than the noncleft control group (p