The awareness and usage of orthodontic apps and social media by orthodontists in the UK: A questionnaire-based study.

OBJECTIVE: To assess the awareness and usage of mobile apps and social media among orthodontic clinicians to support patients with orthodontic treatment, support the professional development of orthodontists, and identify any relevant apps and social media platforms currently recommended to patients. DESIGN: Cross-sectional questionnaire-based study. SETTING: United Kingdom. METHODS: A questionnaire was developed and distributed to members of the British Orthodontic Society (BOS). To increase the response rate, the questionnaire was circulated at three time points between January and March 2020. RESULTS: A total of 149 orthodontists responded to the questionnaire (15% response rate) with 113 orthodontists completing all questions (11.4%). Of those who answered, 81% (n = 111) had been qualified for >10 years, 35% worked in practice (n = 48), 34% worked in a hospital (n = 47) and 26% worked in both hospital and practice (n = 36). The results indicated that 20% of clinicians (n = 22) used apps to support patients and 33% (n = 37) reported using apps for professional purposes. Brush DJ appeared to be the most popular patient focused app (39%, n = 18) whereas the IOTN (17%, n = 8), Invisalign (17%, n = 8) and Dental Monitoring apps (9%, n = 4) were the most popular clinician-focused apps. With regard to social media, 53% (n = 60) of respondents reported that they used social media to communicate generic orthodontic information and promote their practice to patients. The most commonly used social media platforms were Facebook and Instagram. Of respondents, 96% expressed a willingness to recommend an evidence-based mobile app to patients if available, and 88% were willing to recommend an evidence-based social media platform. CONCLUSIONS: Orthodontic clinicians are utilising mobile apps and social media to support both patients and their own professional development. There is a willingness to increase the use of evidence-based platforms and apps to support patients.

Social media and orthodontics: Are our patients scrolling?

OBJECTIVE: To assess patients' awareness of the availability of information related to orthodontics on social media, and to explore patients' willingness to engage with social media to aid with orthodontic treatment. DESIGN: Prospective cross-sectional survey. SETTING: This survey was conducted at Croydon University Hospital orthodontic department. PARTICIPANTS: A total of 125 orthodontic patients, both new and in treatment. There were no exclusion criteria. METHODS: All participants completed a questionnaire designed to explore their awareness, access to and utilisation of social media as well as their willingness to engage with social media to support orthodontic treatment. There were no age restrictions or exclusion criteria. RESULTS: Of the patients, 99% had access to social media. Of these patients, 64% were aware that social media platforms were available to help with orthodontic treatment, 30% had utilised social media related to orthodontics, with the most popular platforms being Instagram (n = 17) and Snapchat (n = 12). Of the patients, 73% stated that they would be willing to use social media in the future to support orthodontic treatment. CONCLUSION: Social media can be engaging, accessible and versatile, and has been shown to be effective at improving patients' knowledge regarding orthodontic treatment. As such, it may be used as a valuable tool for information provision to engage orthodontic patients. Awareness of the availability of orthodontics content on social media is increasing; however, only one-third of participants had previously used it to aid with orthodontic treatment. Given the availability of information on social media targeted at orthodontic patients there is a need to assess the quality of this information and if appropriate navigate patients towards high-quality, effective resources.

Two-hourly vs Three-hourly Feeding in Very Low Birthweight Neonates: A Randomized Controlled Trial.

BACKGROUND: There is no consensus regarding the feeding interval in very low birth weight (VLBW) babies. If 2-hourly feeding schedule is feasible without increasing harm to the neonate, the nursing time consumed in the feeding of VLBW babies can be reduced. OBJECTIVE: To study whether 3-hourly feeding is non-inferior to 2-hourly feeding with respect to time to reach full feeds in VLBW neonates. DESIGN: Open-label, randomized controlled trial. SUBJECTS: 350 Neonates weighing between 1000 to 1500 grams, in whom feed could be started within 96 hours of life randomized to either 2-hourly or 3-hourly feeding schedule. PRIMARY OUTCOME: Time to achieve full enteral feed. RESULTS: The primary outcome of time to achieve full enteral feed was comparable in the two feeding schedule groups (median 5 days IQR 4-6 days in both groups; P=0.665). Among the secondary outcomes, there were no significant differences in incidence of hypoglycemia (RR 0.86; 95% CI: 0.29-2.5) feed intolerance (RR 1.08: 95% CI: 0.5-2.3), and necrotizing enterocolitis (RR 0.8; 95% CI: 0.22-2.3) in both the groups. CONCLUSIONS: Three hourly feeding does not increase the risk of hypoglycemia, necrotizing enterocolitis or feed intolerance.

Availability of orthodontic smartphone apps.

OBJECTIVE: To identify and profile the available orthodontic smartphone apps published on the UK Apple App Store and Google Play Store. DESIGN: A review of available smartphone apps. SETTING: London, UK. METHODS: The Apple App Store and Google Play Store were accessed in October 2018; all orthodontic apps with a title and description available in English were included. Each app was classified according to the following criteria: name; target audience (patient or clinician); focus; platform (Apple App Store and/or Google Play Store); cost; rating and number of ratings; size; creation date; country of development and developer. RESULTS: A total of 305 orthodontic related apps were identified for inclusion. The majority of apps were aimed at patients (n = 241) and the most of these were focussed on gaming (n = 136), many apps were also found to be developed by specialist practices (n = 63) and to provide knowledge for patients (n = 56). Two hundred and ninety-five apps were free, with some of these including the option of paying for in-app purchases. Most apps were developed in the USA (n = 84). CONCLUSIONS: There has been an increase in the availability of orthodontic apps in recent years. The majority of available apps are patient-focused, most commonly games. A number of apps aim to elicit a behaviour change in our patients; therefore, there is a need to assess the quality and educational content of these.

Patient awareness of orthodontic mobile phone apps.

INTRODUCTION: Mobile phone applications (apps) can be engaging, accessible, versatile and have the potential to improve patient care. In 2017, 354 orthodontic apps were reported to be available, many of them targeted at patients; however, the awareness and usage of apps among orthodontic patients was unreported. AIM: The primary aim of this study was to assess patients' current awareness of orthodontic apps. METHODS: One hundred orthodontic patients (50 new and 50 in treatment) completed a questionnaire designed to explore their awareness, access to and utilisation of orthodontic apps and social media to support orthodontic treatment. Furthermore, their willingness to engage with and use an app to aid with orthodontic treatment was explored. There were no age restrictions or exclusion criteria. RESULTS: Ninety percent of patients had access to a smartphone, of which 73% belonged to them (rather than a parent/relative). Apple was the most popular platform (56%) followed by Android (26%). Only 7% of patients were aware that apps were available to help with orthodontic treatment and no patients had previously used an app related to orthodontics. However, 87% of patients stated that they would be willing to use an app to support treatment. Twenty-one percent of patients had previously looked up information on social media, with YouTube being the most popular platform. CONCLUSION: Current awareness of the availability of apps is poor, despite the finding that 87% of patients reported they would be willing to use an app to aid with orthodontic treatment. Given the availability of apps targeted at orthodontic patients, there is a need to assess the quality of these apps and, if appropriate, navigate patients towards high-quality, effective apps.

Hematopoietic stem progenitor cells prevent chronic stress-induced lymphocyte apoptosis.

Physical or psychological chronic stress can suppress the immune system. However, the mechanisms remain to be elucidated. We investigated the effect of hematopoietic stem-progenitor cells (HSPCs) on chronic stress-induced the alterations of immune responses. We demonstrate that HSPCs prevents stress-induced lymphocyte apoptosis. Moreover, we also demonstrate that the protective effect of HSPCs on stress-induced lymphocyte reduction exerts by steroid hormones. Furthermore, we reveal that chronic stress-induced T cell-mediated immune responses contributes to the protective effect of HSPCs. These results indicate that HPSCs might offer a novel therapeutic strategy against the deleterious effects of chronic stress on the immune system.

Secular trends in acute dialysis after elective major surgery--1995 to 2009.

BACKGROUND: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. METHODS: We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function. RESULTS: A total of 552,672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90-day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time. INTERPRETATION: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed.

Statin use associates with a lower incidence of acute kidney injury after major elective surgery.

Statins abrogate ischemic renal injury in animal studies but whether they are renoprotective in humans is unknown. We conducted a population-based retrospective cohort study that included 213,347 older patients who underwent major elective surgery in the province of Ontario, Canada from 1995 to 2008. During the first 14 postoperative days, 1.9% (4020 patients), developed acute kidney injury and 0.5% (1173 patients), required acute dialysis. The 30-day mortality rate was 2.8% (5974 patients). Prior to surgery, 32% of patients were taking a statin. After statistical adjustment for patient and surgical characteristics, statin use associated with 16% lower odds of acute kidney injury (OR, 0.84; 95% CI, 0.79 to 0.90), 17% lower odds of acute dialysis (OR, 0.83; 95% CI, 0.72 to 0.95), and 21% lower odds of mortality (OR, 0.79; 95% CI, 0.74 to 0.85). Propensity score matching produced similar results. These data suggest that statins may protect against renal complications after major elective surgery and reduce perioperative mortality.

Understanding the link between the placenta and future cardiovascular disease.

Inadequate placental development results in a number of untoward pregnancy outcomes, including pre-eclampsia, placental abruption and infarction, and fetal growth restriction and stillbirth. Although it was once assumed that these pregnancy-related complications caused only upfront maternal and fetal morbidity and mortality, poor placental development and function is now a well-recognized female-specific risk factor for future vascular morbidity and mortality. The epidemiological, genetic, and physiological research linking placental development and cardiovascular disease is growing, and this knowledge will undoubtedly not only translate into improved pregnancy outcomes for at-risk women, but also help to identify which women who had a complicated pregnancy could benefit from long-term follow-up and risk modification for cardiovascular disease. This article reviews the literature and provides suggestions for future follow-up of this vulnerable population of women.