Interprofessional education on complex patients in nursing homes: a focus group study

BACKGROUND

An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients' complex needs. This study describes graduate students' experiences of working practice based in interprofessional teams with complex patients' care needs in nursing homes.

METHOD

Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data.

RESULTS

Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified.

CONCLUSIONS

IPE in nursing homes facilitated the students' scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students' curricula. This could ensure that IPE is experienced more efficient by the students.

Registration of dental erosive wear on study models and intra-oral photographs

BACKGROUND

Clinical photographs and study models may provide permanent records of dental erosion and be useful supplements to clinical registration.

AIM

To assess the reliability and validity of registrations on clinical photographs and study models performed by a group of examiners.

METHODS

Thirty tooth surfaces were selected and assessed clinically, using the visual erosion dental examination system. The chosen surfaces provided the whole range of dental erosions including sound surfaces. The tooth surfaces were photographed and impressions were obtained for preparation of study models. Thirty-three dentists examined and scored the selected surfaces both on photographs and study models.

RESULTS

The quality of diagnosis (AUC, area under curve) was slightly higher using photographs as compared to study models. The difference was statistically significant when the validation criterion was erosion, assuming dentine exposure. The inter-method agreement on photographs and study models versus the clinical evaluation were approximately in the same range with a mean κw of 0.48 and 0.43, respectively. When comparing study models with photographs the mean κw was 0.52. The intra-examiner agreement was strong/substantial for both (photographs mean κw = 0.63 and study models mean κw = 0.60).

STATISTICS

Linear weighted Cohen's kappa (κw) was used to evaluate inter-method and intra-examiner agreement. Receiver operating characteristic and area under the curves were used to express diagnostic quality according to a clinical examination.

CONCLUSION

The results indicated that photographs were as good as study models for recording erosive lesions.

Reliability of two clinical scoring systems for dental erosive wear

The aim of the study was to evaluate and compare two dental erosive wear scoring systems, the Visual Erosion Dental Examination (VEDE) and Basic Erosive Wear Examination (BEWE). Seventy-four tooth surfaces (photographs) and 562 surfaces (in participants) were scored by 5 (photographs) or 3 (in participants) clinicians using both scoring systems. The surfaces in the photographs were scored twice. The level of agreement was measured by weighted kappa (kappa(w)). Inter- and intraexaminer agreement showed small variations between the examiners for both systems when scoring the photographs. Slightly higher mean kappa(w) values were found for VEDE (kappa(w) = 0.77) compared with BEWE (kappa(w) = 0.69). When scoring the surfaces in the clinical examination the mean kappa(w) values for the two systems were equal (kappa(w) = 0.73). Interexaminer agreement using VEDE was calculated to see how differentiation between enamel and dentine lesions influenced the variability. The highest agreement was found for score 0 (sound, 86%) and score 3 (exposure of dentine, 67%), while the smallest agreement was shown for score 1 (initial loss of enamel, 30%) and score 2 (pronounced loss of enamel, 57%). The reliability of the two scoring systems proved acceptable for scoring the severity of dental erosive wear and for recording such lesions in prevalence studies. The greatest difficulties were found when scoring enamel lesions, especially initial lesions, while good agreement was observed when examining sound surfaces (score 0) and dentine lesions (score 3).

An in vitro study on the effect of TiF(4) treatment against erosion by hydrochloric acid on pellicle-covered enamel

The aim of this in vitro study was to examine the effect of fluoride treatment on pellicle-covered enamel exposed to an acidic challenge simulating gastric reflux. Sixteen bovine and 16 human teeth were sectioned into four pieces, divided into four groups: (1) control, (2) 2-hour pellicle, (3) TiF(4), and (4) 2-hour pellicle + TiF(4), and subsequently subjected to 3 ml 0.01 M HCl stepwise for 4 + 4 + 4 min. The acid was analysed for calcium by atomic absorption spectroscopy. TiF(4) reduced Ca release from enamel by 76, 57 and 56% following the 4 + 4 + 4-min acid exposures, respectively, in bovine and 44, 54 and 54% in human enamel. These results suggest that treatment of enamel with a TiF(4) solution, with or without pellicle removal, may provide protection for the enamel against acid attack.