Evaluation of pre-test counselling offered for non-invasive prenatal testing (NIPT) as a primary screening tool

The increasing popularity and expansion of non-invasive prenatal testing (NIPT) to screen for rare conditions beyond common trisomies prompts evaluation of pre-test counselling currently offered. We conducted a prospective survey to assess women's knowledge of NIPT in those who had undergone NIPT (study group) and those who were planning to have NIPT (control group). Out of the 189 questionnaires analysed, the study group did not show a higher knowledge score compared to the control group (P = 0.097). 44% misunderstood that NIPT can identify more conditions than invasive testing, 69.8% were unaware of the recommended need for nuchal translucency measurement and 52.6% were unaware of the possibility of incidental findings. 31% even considered discussing termination of pregnancy as one of the next steps if NIPT shows high risk for Down syndrome. This study shows that current pre-test counselling is inadequate. Service providers should address these knowledge gaps and assist women to make informed choices.Impact StatementWhat is already known on this subject? Pre-test counselling for non-invasive prenatal testing (NIPT) should be conducted to assist women in making an informed consent.What do the results of this study add? Our results show that a significant proportion of women are unaware of the limitations of NIPT.What are the implications of these findings for clinical practice and/or further research? Service providers should improve their pre-test counselling focusing on areas of knowledge deficiencies and misunderstanding on NIPT identified in this study.

Cryptocurrency as a new method for participant compensation in research

Public health research relies heavily on participant involvement. Investigators have examined factors that affect participation and found that altruism enables engagement. At the same time, time commitment, family concerns, multiple follow-up visits, and potential adverse events are barriers to engagement. Thus, investigators may need to find new methods to attract and motivate participants to participate, including new compensation methods. As cryptocurrency is being increasingly used and accepted to pay and reimburse people for work activities, this currency should be similarly explored as an option for research participants to attempt to incentivize them to participate in studies and offer new possibilities for study reimbursement. This paper explores the potential use of cryptocurrency as a form of compensation in public health research studies and discusses the pros and cons of its use. Although few studies have used cryptocurrency to compensate participants, cryptocurrency may be used as a reward for various research tasks, including filling out surveys, participating in in-depth interviews or focus groups, and/or completing interventions. Using cryptocurrencies to compensate participants in health-related studies can provide benefits such as anonymity, security, and convenience. However, it also poses potential challenges, including volatility, legal and regulatory challenges, and the risk of hacking and fraud. Researchers must carefully weigh the benefits against the potential downsides before using them as a compensation method in health-related studies.

Development and preliminary validation of the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC)

Children and adolescents with complex chronic conditions, including those with life-threatening or life-limiting conditions, are a heterogeneous population. Many individuals exhibit sleep abnormalities that are measurable by proxy questionnaires. No suitable instrument to assess the wide range of different complex chronic conditions is currently available. The aim of the present study was to develop a screening tool-the Sleep Screening for Children and Adolescents with Complex Chronic Conditions-to effectively obtain sleep behaviour information in this population. Following a mixed-method design, potential items for the Sleep Screening for Children and Adolescents with Complex Chronic Conditions questionnaire were defined through literature research and expert meetings. In a pre-test with N = 60 family and professional caregivers, the items' relevance and comprehensibility as well as the instrument's overall design were assessed. For the main test, N = 315 participants were recruited in three tertiary paediatric hospitals. A principal components analysis detected the questionnaire's scales. Item analysis focused on mean values, range, difficulty and discriminatory power. Convergent validation of the Sleep Screening for Children and Adolescents with Complex Chronic Conditions was assessed via correlations between scale items. Most patients had neurological or neuromuscular diseases. Four scales ("Falling and staying asleep", "Sleep-associated respiration and arousal", "Daytime sleepiness" and "Sleep-associated movements") emerged. The item analysis showed satisfactory discriminative power. In the preliminary validation, all scales correlated positively with a child's care level and with various sleep circumstances items. Three scales additionally correlated with the number of complex chronic condition diagnoses. This newly developed questionnaire can provide clinicians with first indications of possible sleep problems in a growing paediatric population.

Half a century of the inverse care law: A comparison of general practitioner job satisfaction and patient satisfaction in deprived and affluent areas of Scotland

BACKGROUND AND AIMS

The 'inverse care law', first described in 1971, results from a mismatch of healthcare need and healthcare supply in deprived areas. GPs in such areas struggle to cope with the high levels of demand resulting in shorter consultations and poorer patient outcomes. We compare recent national GP and patient satisfaction data to investigate the ongoing existence of this disparity in Scotland.

METHODS AND RESULTS

Secondary analysis of cross-sectional national surveys (2017/2018) on upper and lower deprivation quintiles. GP measures; job satisfaction, job stressors, positive and negative job attributes. Patient measures; percentage positive responses per practice on survey questions on access and consultation quality. GPs in high deprivation areas reported lower job satisfaction and positive job attributes, and higher job stressors and negative job attributes compared with GPs in low deprivation areas. Patients living in high deprivation areas reported lower satisfaction with access and consultation quality than patients in low deprivation areas. These differences in GP and patient satisfaction persisted after adjusting for confounding variables.

CONCLUSIONS

Lower GP work satisfaction in deprived areas was mirrored by lower patient satisfaction. These findings add to the evidence that the inverse care law persists in Scotland, over 50 years after it was first described.

A Survey on Methodological Issues of Clinical Research Studies Reviewed by Independent Ethic Committees during the COVID-19 Pandemic in Italy

The struggle for information and the hasty search for answers caused by the COVID-19 pandemic threatened the possibility of lowering study quality, as well as ethical committees' review standards during the outbreak. Our investigation aimed to assess the impact of COVID-19 on the quality of clinical research studies submitted to Italian Ethics Committees in the period between April and July 2020. All 91 Italian ethics committees were contacted via email in order to collect anonymized information on the type and quality of COVID-19-related studies submitted to each committee during the study period. The present study summarizes the characteristics of the 184 study applications collected, pointing out, especially, how the quality of the study population and statistical analysis are crucial variables in determining the study approval. Nevertheless, despite the need for high-quality and open scientific information, especially exacerbated by this particular historical period, only a minority of the ethics committees (20.9%) agreed to share their data; such scarce participation, beyond biasing the representativeness of the results obtained by the present study, more importantly, hinders the broader goal of creating trust between researchers and the general public.

Dental students' observations about teaching of endodontic access cavities in a French dental school

INTRODUCTION

Teaching in French universities has undergone deep changes for several years. Dental studies are no exception to the rule. Endodontics is one of the most difficult fields requiring good knowledge of anatomy before performing clinical procedures. The access cavity is the key step of endodontic therapy. The aim of this study was to collect and understand what students feel and expect from theoretical and practical training on endodontic access cavity.

MATERIALS AND METHODS

A questionnaire survey on the teaching and learning of endodontic access cavities in a French dental school was sent by e-mail to the 4th-year students (n = 66). The questionnaire consisted of 13 questions of different formats. Qualitative variables were analysed using a word cloud according to the words of the participants. Students were also asked how to improve teaching with new educational tools.

RESULTS

60 students answered the questionnaire (response rate of 90.9%). When students were asked which stage of endodontic treatment they feared the most, performing access cavity came in 3rd place. Upper molar (71%) and lower molar (58%) appeared to have the most difficult endodontic access cavities. Within the word cloud gathered after students' answers analysis, the words "fear," "perforation," "cavity" and "axis" were highlighted. Amongst the 3 new educational tools proposed to students, most were in favour of realistic models of teeth with their ideal endodontic access cavity (79%).

DISCUSSION

This study highlighted the feelings of students during their hands-on training on endodontic access cavities. Although they seemed satisfied with practical classes on endodontic access cavities, this step seemed to be stressful for students especially because of the great internal anatomical variabilities of teeth. To help them better understand the root canal anatomy and improve their training, students asked for new educational resources, especially macro-models of teeth with their optimal access cavities.

CONCLUSION

This study showed that students are seeking for innovative resources in addition to traditional resources that would make it easier for them to visualise the root canal system and help them feel more comfortable and facilitate learning when performing endodontic access cavities.

Three-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM): French translation and cultural adaptation

PURPOSE

The routine use of validated diagnostic instruments is key to identifying delirious patients early and expediting care. The 3-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM) instrument is a brief, easy to use, sensitive, and specific delirium assessment tool for hospitalized patients. We aimed to translate the original English version into French, and then adapt it to older high-risk patients.

METHODS

Translation and adaptation of the questionnaire were guided by an expert committee and the 3D-CAM instrument developer. During the translation phase, we achieved semantic and conceptual equivalence of the instrument by conducting forward and backward translations. During the adaptation phase, we assessed the face validity, clarity of wording, and ease of use of the translated questionnaire by administering it to 30 patients and their caregivers in peri-interventional and medical intermediate care units. During both phases, we used qualitative (goal and adequacy of the questionnaire) and quantitative (Sperber score, clarity score) criteria.

RESULTS

Translation: four items were judged inadequate and were revised until all reached a Sperber score of < 3/7. Face validity: 91% of patients thought the questionnaire was designed to assess memory, thoughts, or reasoning. Clarity: eight items required adjustments until all scored ≥ 9/10 for clarity. Ease of use: all bedside caregivers reported that the questionnaire was easy to complete after receiving brief instructions.

CONCLUSIONS

We produced a culturally adapted French version of the 3D-CAM instrument that is well understood and well-received by older high-risk patients and their caregivers.

Prevalence of breastfeeding in the public health sector of Argentina according to the National Survey on Breastfeeding of 2017

INTRODUCTION

Breastfeeding reduces the risk for morbidity and mortality in children and also provides environmental and financial advantages. Breastfeeding monitoring is critical for public policies.

OBJECTIVES

The objectives of this study were to estimate the prevalence of breastfeeding in the population seeking care in the public sector, compare this prevalence to data from 2015, and assess associated outcome measures.

POPULATION AND METHODS

Cross-sectional, observational study. A structured questionnaire was used to collect intake and sociodemographic data from infants aged < 6 months (n = 15 322) and 12-15 months (n = 3243) who sought care from public sector health care providers spontaneously between August and September 2017.

RESULTS

The prevalence of exclusive breastfeeding among infants < 6 months was 53.5% (95% confidence interval [CI]: 52.7-54.3); and at 4 and 6 months, 51.5% (95% CI: 49.7-53.4) and 41.7% (95% CI: 39.8-43.5), respectively. The prevalence of exclusive breastfeeding at 4 and 6 months increased compared to 2015 (p < 0.001). The prevalence of breastfeeding among infants aged 12-15 months was 77.8% (95% CI: 76.4-79.3). The following variables were independently associated with a lower frequency of exclusive breastfeeding (< 6 months old) and breastfeeding: older age, lower level of maternal education, delivery via C-section, low birth weight, initial breastfeeding after the first hour, and separation of the mother-child dyad ≥ 4 hours a day.

CONCLUSIONS

Exclusive breastfeeding at 6 months and continued breastfeeding showed certain improvement, but the rate of breastfed infants is still below desirable levels.

The influence of age and gender on perception of orofacial esthetics among laypersons in Switzerland

OBJECTIVE

The purpose of this study was to evaluate the perception and role of orofacial esthetics by laypersons, and how attitudes may be correlated with age and gender in Switzerland.

MATERIAL AND METHODS

Self-administrated questionnaires (SAQ) were distributed both conventionally and digitally to Swiss residents over 16 years of age (range 16-99 years). The participants were identified in the medical practice, at an open house of the ZMK Bern, in elderly care centers, and via the internet (Facebook and Instagram). To verify that the participants were Swiss residents and laypersons, they were checked by an operator (conventional) or were provided an exact description of eligible participants at the beginning of the SAQ (digital). The SAQ included 30 questions with multiple-choice responses and visual analogue scales (0-100) divided into four sections regarding dental appearance with respect to body esthetics, partner selection, employment and career opportunities, and overall health/quality-of-life. For statistical analysis, respondents were segregated into two age groups (<25 years and ≥25 years) and into two gender groups (male and female). Descriptive analyses, the Fisher exact test, and Welch's t-test were applied (α = 0.05).

RESULTS

Five hundred and two laypersons completed the SAQ. The study's hypothesis-that various age groups and genders have different perceptions of dental esthetics-was supported. The willingness to correct one's own dentition was lower among older participants (OR: 0.54; p = 0.001); charisma and dental esthetics were considered equally important with a trend toward charisma in both age groups (p = 0.003). The belief that excellent dentition improves employment chances at a job interview (OR: 0.47; p = 0.0003) was significantly lower among older participants, and the belief that dental correction would improve quality-of-life was significantly higher among older participants (OR: 1.81; p = 0.001). The assumption that individuals with attractive teeth appear happier was significantly lower among older respondents (OR: 0.67; p = 0.03). Women were less satisfied with their dental appearance and, proportionally, their willingness to receive correction was significantly higher (OR: 1.79; p = 0.01 and OR: 1.77; p = 0.002 relative to men, respectively). Moreover, male participants had a lower desire to have brighter teeth and undergo bleaching treatments (OR: 0.54; p = 0.002; OR: 0.53; p = 0.002). The proportion of men believing that having beautiful teeth improves attractiveness and employment chances was significantly lower (OR: 0.33; p = 0.02 and OR: 0.66; p = 0.04; respectively).

CONCLUSIONS

Within the limitations of this observational study, it was concluded that age and gender of laypersons in Switzerland have a significant impact on the perception of dental esthetics.

CLINICAL SIGNIFICANCE

Evaluating and quantifying perceptions of dental esthetics for daily life across various age groups and genders can improve clinicians' understanding of individual needs in order to offer patient-oriented dental care.

General practitioners' evaluations of optimal timing to initiate advance care planning for patients with cancer, organ failure, or multimorbidity: A health records survey study

BACKGROUND

Appropriate timing to initiate advance care planning is difficult, especially for individuals with non-malignant disease in community settings.

AIM

To identify the optimal moment for, and reasons to initiate advance care planning in different illness trajectories.

DESIGN AND METHODS

A health records survey study; health records were presented to 83 GPs with request to indicate and substantiate what they considered optimal advance care planning timing within the 2 years before death. We used quantitative and qualitative analyses.

SETTING AND PATIENTS

We selected and anonymized 90 health records of patients who died with cancer, organ failure or multimorbidity, from a regional primary care registration database in the Netherlands.

RESULTS

The median optimal advance care planning timing according to the GPs was 228 days before death (interquartile range 392). This moment was closer to death for cancer (87.5 days before death, IQR 302) than for organ failure (266 days before death, IQR 401) and multimorbidity (290 days before death, IQR 389) (p < 0.001). The most frequently mentioned reason for cancer was "receiving a diagnosis" (21.5%), for organ failure it was "after a period of illness" (14.7%), and for multimorbidity it was "age" and "patients" expressed wishes or reflections' (both 12.0%).

CONCLUSION

The optimal advance care planning timing and reasons to initiate advance care planning indicated by GPs differ between patients with cancer and other illnesses, and they also differ between GPs. This suggests that "the" optimal timing for ACP should be seen as a "window of opportunity" for the different disease trajectories.

Skincare practices in extremely premature infants: A survey of tertiary neonatal intensive care units from Australia and New Zealand

AIM

To investigate skincare practices in the first 2 weeks of life in extremely premature infants across tertiary neonatal intensive care units (NICUs).

METHODS

A web-based secure survey invite was emailed to the medical directors of tertiary NICUs. The survey included questions on various aspects of skincare practices in the first 2 weeks of life in extremely premature infants (born before 28 weeks gestation). The person most familiar with local skincare practices was asked to complete the survey and only one response per unit was requested. We performed a descriptive analysis.

RESULTS

We received responses from 30 out of 32 NICUs (response rate 93%). Twenty-five NICUs (89%) reported offering resuscitation and intensive care to infants born at ≥23 weeks gestation. All NICUs reported occurrences of skin breakdown, including medical adhesive-related skin injury (30%), abrasion/friction-associated skin injury (46%), perineal skin breakdown (55%), pressure site injury (47%) and diaper dermatitis (60%). A high level of consensus (≥75%) was observed for certain practices, such as the use of polyethylene occlusive plastic wraps at birth and aqueous chlorhexidine solution for sterile procedures, but a low level of consensus (<25%) was observed for many other practices, including the skin risk assessment tool used.

CONCLUSIONS

Skin injuries in extremely premature infants are common and skincare practices vary considerably amongst NICUs. Clinical practice improvement projects and further clinical research will help improve consistency amongst NICUs. Further research is needed to assist the development of evidence-based guidelines and benchmarking for skincare practices in these vulnerable infants.

Test-retest reliability of the Epworth Sleepiness Scale in clinical trial settings

The present analysis examined the test–retest reliability of the Epworth Sleepiness Scale in participants with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea in three clinical trials. Intraclass correlation coefficient estimates for Epworth Sleepiness Scale scores from two solriamfetol 12‐week placebo‐controlled trials (one narcolepsy, one obstructive sleep apnea) and one long‐term open‐label extension trial (narcolepsy or obstructive sleep apnea) were calculated using postbaseline time‐point pairs for the overall population in each trial, by treatment, and by primary obstructive sleep apnea therapy adherence. In the 12‐week narcolepsy trial, intraclass correlation coefficients (95% confidence intervals) were 0.83 (0.79, 0.87) for weeks 4 and 8 (n = 199), 0.87 (0.83, 0.90) for weeks 8 and 12 (n = 196), and 0.81 (0.76, 0.85) for weeks 4 and 12 (n = 196). In the 12‐week obstructive sleep apnea trial, intraclass correlation coefficients (95% confidence intervals) were 0.74 (0.69, 0.78) (n = 416), 0.80 (0.76, 0.83) (n = 405), and 0.74 (0.69, 0.78) (n = 405), respectively. In the open‐label extension trial, intraclass correlation coefficients (95% confidence intervals) were 0.82 (0.79, 0.85) for weeks 14 and 26/27 (n = 495), 0.85 (0.82, 0.87) for weeks 26/27 and 39/40 (n = 463), and 0.78 (0.74, 0.81) for weeks 14 and 39/40 (n = 463). Placebo/solriamfetol treatment or adherence to primary obstructive sleep apnea therapy did not affect reliability. In conclusion, across three large clinical trials of participants with narcolepsy or obstructive sleep apnea, Epworth Sleepiness Scale scores demonstrated a robust acceptable level of test–retest reliability in evaluating treatment response over time.

Satisfaction with online teaching of medical statistics during the COVID-19 pandemic: A survey by the Education Committee of the Italian Society of Medical Statistics and Clinical Epidemiology

On May 2020, after 2 months of online teaching with no face-to-face lectures, the Education Committee of the Italian scientific Society of Medical Statistics and Clinical Epidemiology conceived an online survey to assess satisfaction of Italian academics of medical statistics with online teaching and remote exams. This survey highlighted teachers' perceptions as well as opportunities and limitations of online teaching of medical statistics, biostatistics, and epidemiology. Although 61% of Italian academics of medical statistics declared to be favorable to provide online teaching of medical statistics, biostatistics, and epidemiology in the future, we recognize that distance education cannot substitute the unique value of teaching and knowledge exchange that could only be transmitted through a personal interaction between students and teachers. These indications may be useful to improve the quality of the teaching process in the future.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study

BACKGROUND

Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty.

OBJECTIVE

To determine whether foot pain can influence a greater degree of frailty.

DESIGN AND SETTING

Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain.

METHODS

A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS).

RESULTS

There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS.

CONCLUSIONS

These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Dental care during COVID-19 pandemic: follow-up survey of experts' opinion

Objectives

The purpose of the present survey is to give an update of European experts' opinion on infection control and prevention in dentistry during second wave of pandemic. The secondary aim was to analyze how experts' opinion changed in the light of the new scientific evidence since the first wave.

Material & Methods

An anonymous online 14‐item questionnaire was sent to a total of 27 leading academic experts in Oral (and Maxillofacial) Surgery from different European countries, who had completed a previous survey in April‐May 2020. The questionnaire covered the topics of dental setting safety, personal protective equipment (PPE), and patient‐related measures to minimize transmission risk. Data collection took place in November‐February 2020/21.

Results

26 experts participated in the follow‐up survey. The overall transmission risk in dental settings was scored significantly lower compared to the initial survey (p < .05), though the risk associated with aerosol‐generating procedures (AGP) was still considered to be high. Maximum PPE was less frequently recommended for non‐AGP (p < .05), whereas the majority of experts still recommended FFP2/FFP3 masks (80.8%), face shields or goggles (88.5%), gowns (61.5%), and caps (57.7%) for AGP. Most of the experts also found mouth rinse relevant (73.1%) and reported to be using it prior to treatment (76.9%). No uniform opinion was found regarding the relevance of COVID‐19 testing of staff and patients.

Conclusion

With the continuation of dental care provision, transmission risk has been scored lower compared to the first wave of pandemic. However, high risk is still assumed for AGP, and maximum PPE remained advised for the respective treatments.

Characterizing Critical Care Pharmacy Services Across the United States

Supplemental Digital Content is available in the text.

Involvement of clinical pharmacists in the ICU attenuates costs, avoids adverse drug events, and reduces morbidity and mortality. This survey assessed services and activities of ICU pharmacists.

Developing and Validating Food Choice Determinants Questionnaire: An Instrument for Exploring Food Choice Determinants in Iran

Background:

This study was carried out to design and validate a questionnaire to measure the majority of factors influencing food choices among adults in Iran.

Methods:

A sequential exploratory mixed-method approach was applied to develop the initial item pool of the Food Choice Determinants Questionnaire (FCDQ) starting with a qualitative study to explore the food choice dimensions and its components. Designing the initial questionnaire using these dimensions and the 36-item Food Choice Questionnaire (FCQ) was then performed. The face, content, and construct validity were also assessed. The construct validity of the questionnaire was assessed using the exploratory factor analysis (EFA). Cronbach's alpha was applied for each main theme to examine the internal consistency.

Results:

After content and face validity process, a 60-item FCDQ was developed with total items' content validity index (CVI) of 0.69 indicating a reasonable level. The Cronbach's alpha coefficients for each of the six constructs in the scale have shown satisfactory internal consistency.

Conclusions:

This instrument is valid and reliable to measure food choice determinants in adults and could be applied to design interventions aiming to better food choice.

Does facility type and location impact upon patient experiences in emergency departments? Secondary analysis of a state-wide, cross-sectional survey

OBJECTIVE

To identify the extent to which patient experiences in the ED differ depending on facility type (based on bed numbers, services available and annual separations), and location (level of remoteness).

METHODS

Data from a 2015 state-wide (Queensland, Australia) public ED patient experience survey were linked to sociodemographic and presentation-related characteristics data. Survey items were individually scored (from 0 to 100), and averaged across 13 pre-determined patient experience topic areas. Descriptive statistics were used to report on patient sociodemographic and presentation-related characteristics. One-way analysis of variance tests were used to identify associations between patient-reported experience scores, facility types and location.

RESULTS

A total of 10 553 patients over the age of 16 years completed the survey. All patients reported scores above 75 for 7 of the 13 patient experience topic areas (0 = lowest score, 100 = highest score). Patients from very remote and outer regional EDs reported the highest scores for the topic Environment and facilities, and remote facility patients reported the highest scores for the topic Leaving the ED - Delays. The same two topic areas were scored most highly by patients from smaller facilities in comparison to principal referral hospital EDs.

CONCLUSIONS

Patients attending smaller and more rurally located EDs reported more positive experiences than those attending larger, metropolitan EDs on two of the 13 topic areas. However, these differences were marginal. Future research should aim to determine what constitutes clinically meaningful differences between groups when comparing patient-reported experience scores, and understand the characteristics of small and rural EDs that may be associated with better patient experiences.

Management of initial carious lesions: Iowa survey

BACKGROUND

The authors explore Iowa dentists' agreement with the International Caries Classification and Management System (ICCMS) in the nonsurgical management of initial carious lesions in patients at low, moderate, and high caries risk and identify factors related to their agreement.

METHODS

Electronic surveys were mailed to 916 actively practicing dentists who are alumni of the College of Dentistry at The University of Iowa. Questions included clinical scenarios that used text, clinical photographs, and radiographic images of initial carious lesions. Dentists were asked what type of treatment they would recommend. Treatment options included no treatment, nonsurgical treatment, or surgical treatment. Logistic regression analyses were used to assess associations among agreement with ICCMS, characteristics of the dentist's practice, and patients' caries risk level.

RESULTS

A total of 138 Iowa dentists responded to the survey. Agreement with ICCMS regarding nonsurgical management of initial carious lesions for patients at low, moderate, and high risk levels were 73%, 59%, and 51% respectively. Compared with their counterparts, dentists who agreed with the recommendations for nonsurgical treatment were more likely to dry the teeth during caries detection (95% confidence interval [CI], 1.02 to 12.67, P = .0468), use magnification (95% CI, 1.16 to 7.17, P = .0225) for caries detection, have graduated less than 20 years ago (P = .0024), practice in public health settings (P = .0089), and perform a caries risk assessment (95% CI, 1.10 to 4.29, P = .0262).

CONCLUSIONS

Dentists who dry teeth, use magnification for caries detection, graduated in the past 20 years, practice in a public health setting, and perform a caries risk assessment were significantly more likely to make decisions that were consistent with the guidelines of the ICCMS.

PRACTICAL IMPLICATIONS

Knowledge of evidence-based options personalized for a patient's risk status is essential for applying the best management of initial caries lesions.

Assessing adequacy of informed consent for elective surgery by student-administered interview

BACKGROUND

Studies show that patients often sign consent documents without fully comprehending the risks, benefits and potential complications. There is currently no Asian study performed analysing adequacy of informed consent. This study aims to assess adequacy of informed consent by evaluating patient understanding and retention of key information and complications pertaining to surgery via medical student-administered interview.

METHODS

A prospective study was performed on 48 patients undergoing groin hernia surgery, laparoscopic cholecystectomy and total thyroidectomy from 2017 to 2018 in a teaching hospital. Standardized assessment forms including major common complications and key details of the surgery were prepared. Structured one-to-one interviews between students and patients were performed and recorded on the morning of surgery.

RESULTS

Although 93.8% of the patients claimed to have understood the information regarding their surgery, only 19.4%, 44.4% and 62.5% of the patients could actually recall the serious complications of groin hernia surgery, laparoscopic cholecystectomy and thyroidectomy, respectively. Elderly patients (>65 years) had poorer understanding of surgical procedure compared to the young (80% versus 100%, respectively, P = 0.008) with 26.7% of elderly patients claiming that they did not understand the indication for surgery. High satisfaction rates with this preoperative interview were reported by both patients and students (95.8% and 97.9%, respectively). Time interval from informed consent to surgery did not make any difference.

CONCLUSION

Understanding of information and key complications was generally low, especially in the elderly population. The structured preoperative interview achieved the dual goal of reinforcing patient gaps in knowledge and improving student communication skills.

PALLIA-10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: A prospective multicentric study (PREPA-10)

Purpose

The identification and referral of patients in need of palliative care should be improved. The French society for palliative support and care recommended to use the PALLIA‐10 questionnaire and its score greater than 3 to refer patients to palliative care. We explored the use of the PALLIA‐10 questionnaire and its related score in a population of advanced cancer patients.

Methods

This prospective multicentric study is to be conducted in authorized French comprehensive cancer centers on hospitalized patients on a given day. We aimed to use the PALLIA‐10 score to determine the proportion of palliative patients with a score >3. Main secondary endpoints were to determine the proportion of patients already managed by palliative care teams at the study date or referred to palliative care in six following months, the prevalence of patients with a score greater than 5, and the overall survival using the predefined thresholds of 3 and 5.

Results

In 2015, eighteen French cancer centers enrolled 840 patients, including 687 (82%) palliative patients. 479 (69.5%) patients had a score >3, 230 (33.5%) had a score >5, 216 (31.4%) patients were already followed‐up by a palliative care team, 152 patients were finally referred to PC in the six subsequent months.

The PALLIA‐10 score appeared as a reliable predictive (adjusted OR_Ref≤3: 1.9 [1.17‐3.16] and 3.59 [2.18‐5.91]) and prognostic (adjusted HR_Ref≤3 = 1.58 [95%CI 1.20‐2.08] and 2.18 [95%CI 1.63‐2.92]) factor for patients scored 4‐5 and >5, respectively.

Conclusion

The PALLIA‐10 questionnaire is an easy‐to‐use tool to refer cancer inpatients to palliative care in current practice. However a score greater than 5 using the PALLIA‐10 questionnaire would be more appropriate for advanced cancer patients hospitalized in comprehensive cancer center.

Clinical Efficacy of Allergen-Specific Immunotherapy from Patient and Physician Perspectives

PURPOSE

Allergen-specific immunotherapy (AIT) is the only curative treatment for allergic diseases, but a few allergic patients receive AIT. In this multicenter cross-sectional study, we aimed to explore patient and physician perspectives on AIT through a questionnaire survey.

MATERIALS AND METHODS

Allergic patients who received subcutaneous immunotherapy for at least 1 year were asked to answer a questionnaire developed by an expert panel of allergen and immunotherapy workgroup in Korea.

RESULTS

A total of 267 patients (adults, 60.3%) with allergic rhinitis (91.4%), asthma (42.7%), or atopic dermatitis (20.2%) from referred hospitals completed the survey. Among patients and physicians, respectively, the overall rates of satisfaction with AIT for allergic rhinitis were 86.4% and 83.3% (kappa agreement=0.234, p<0.001), and those for asthma were 85.3% and 72.9% (kappa agreement=0.373, p<0.001). Moreover, pediatric asthmatic patients reported a significantly higher satisfaction rate than adult asthmatic patients after AIT (p=0.040). Symptom severity (p<0.001, respectively) and drug use for allergic rhinitis and asthma decreased after AIT. However, there was no significant difference in satisfaction rates between children and adults in allergic rhinitis (p=0.736). Interestingly, 35.7% and 35% of allergic rhinitis and asthma patients, respectively, reported experiencing improvement in their symptoms within 6 months of starting AIT.

CONCLUSION

In this study evaluating the perspectives of patients and physicians on AIT, the majority of patients were satisfied with the efficacy and safety of AIT, but not its cost. AIT should be recommended for AR and allergic patients.

Estimating plate-based model food proportions in adults living in Scotland using short dietary assessment questionnaires

AIM

To determine whether a food frequency questionnaire (FFQ) and a short dietary assessment tool can be used to accurately estimate the Eatwell Guide proportions (a plate-based food model) of diets of adults living in Scotland.

METHODS

The cross-sectional study was conducted as a follow up of the 2010 Scottish Health Survey (participants aged 18-65 years old). Proportions of the Eatwell Guide food groups (starchy carbohydrates, fruits and vegetables (F&V), dairy and alternatives, protein foods and oils and spreads) were calculated from the Scottish Health Survey Eating Habits Module (SHeS EHM), Scottish Collaborative Group FFQ (SCG FFQ) and a seven-day estimated food diary (reference method), and compared using the Aitchison method and Wilcoxon Signed-Rank Test. Bland-Altman analyses assessed mean difference and 95% limits of agreement between the methods for each food group.

RESULTS

Ninety-six adults were included (mean (SD) age = 51.4 (11.1) years; body mass index = 27.1 (4.9) kg/m² ; 58% female). The SCG FFQ scored a lower median Aitchison distance (1.47) than the SHeS EHM (1.99) (P < 0.001), showing greater agreement with the reference method (P < 0.001). Bland-Altman plots also showed better agreement for the SCG FFQ than the SHeS EHM. Poorest agreement was for starchy carbohydrates (both methods), protein foods (SHeS EHM) and dairy (SCG FFQ).

CONCLUSIONS

The SCG FFQ could be used to estimate Eatwell Guide proportions and monitor compliance to the Eatwell Guide recommendations and could be improved with small changes. The SHeS EHM is less suitable, but additional questions on dairy foods, and oils and spreads would improve its ability to estimate the Eatwell Guide proportions.

The Use of Mobile Health Applications to Improve Patient Experience: Cross-Sectional Study in Chinese Public Hospitals

Background

The proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits.

Objective

The purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps.

Methods

We used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience.

Results

The users and nonusers differed in age (χ²₂=12.2, P=.002), education (χ²₃=9.3, P=.03), living place (χ²₁=7.7, P=.006), and the need for specialists (χ²₄=11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t₂₉₈=3.919, P<.001), the 18 items and the 5 dimensions of physician-patient communication (t₂₉₈=2.93, P=.004), health information (t₂₉₈=3.556, P<.001), medical service fees (t₂₉₈=3.991, P<.001), short-term outcome (t₂₉₈=4.533, P<.001), and general satisfaction (t₂₉₈=4.304, P<.001). Multiple linear regression results showed that the use of mobile health apps during hospital visits influenced patient experience (t₂₈₉=3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional results from the study found that the self-rated health status (t₂₈₉=3.746, P<.001) and monthly income of patients (t₂₈₉=2.416, P=.02) influenced the patient experience as well.

Conclusions

The use of mobile health apps could improve patient experience, especially with regard to accessing health information, making physician-patient communication more convenient, ensuring transparency in medical charge, and ameliorating short-term outcomes. All of these may contribute to positive health outcomes. Therefore, we should encourage the adoption of mobile health apps in health care settings so as to improve patient experience.