Dentists' perceptions of smart phone use in the clinical environment

Objective

To determine the use of smart phones in clinical practice and to determine the perceived impact on patient safety.

Study design

A closed questionnaire survey with an exploratory open question.

Setting, materials and methods

A questionnaire was sent to a sample of 216 delegates that have attended courses provided by an education provider in the North West of England between 2015–2017.

Results

There was a response rate of 49.5% which represented 107 returned questionnaires. The mean year of qualification is 2008. Of the respondents,105 were general dental practitioners, and two were hospital based dentists. Of the respondents, 82.2% had their smart phone in surgery, and of these 88% had the smart phone on silent, with the respondents on average receiving three texts, four emails and one call each session. Of the respondents, 40.9% were not aware that they received a text, 53.4% an email, and 37.5% a telephone call. Whilst 50.1% responded, in some way, to a text, 46.6% to an email and 62.5% to a telephone call. Of the respondents, 61.7% think that having a phone in the surgery is a distraction. Of the respondents, 20.7% stated that smart phones should not be allowed in the surgery under any circumstance, whilst 24.1% stated that they should be allowed if on silent and out of view, and 16.4% allowed their use but not in front of patients.

Conclusions

Eighty-eight percent of respondents had their smart phone with them in the surgery, with 61.7% reporting it to be a distraction from their clinical duties. It is our recommendation that each clinic has a protocol or policy that governs the use of smart phones focusing on patient safety.

A device for characterising the mechanical properties of the plantar soft tissue of the foot

The plantar soft tissue is a highly functional viscoelastic structure involved in transferring load to the human body during walking. A Soft Tissue Response Imaging Device was developed to apply a vertical compression to the plantar soft tissue whilst measuring the mechanical response via a combined load cell and ultrasound imaging arrangement. Accuracy of motion compared to input profiles; validation of the response measured for standard materials in compression; variability of force and displacement measures for consecutive compressive cycles; and implementation in vivo with five healthy participants. Static displacement displayed average error of 0.04 mm (range of 15 mm), and static load displayed average error of 0.15 N (range of 250 N). Validation tests showed acceptable agreement compared to a Houndsfield tensometer for both displacement (CMC > 0.99 RMSE > 0.18 mm) and load (CMC > 0.95 RMSE < 4.86 N). Device motion was highly repeatable for bench-top tests (ICC = 0.99) and participant trials (CMC = 1.00). Soft tissue response was found repeatable for intra (CMC > 0.98) and inter trials (CMC > 0.70). The device has been shown to be capable of implementing complex loading patterns similar to gait, and of capturing the compressive response of the plantar soft tissue for a range of loading conditions in vivo.

Reliability of ultrasound for measurement of selected foot structures

BACKGROUND

Understanding the relationship between the lower leg muscles, foot structures and function is essential to explain how disease or injury may relate to changes in foot function and clinical pathology. The aim of this study was to investigate the inter-operator reliability of an ultrasound protocol to quantify features of: rear, mid and forefoot sections of the plantar fascia (PF); flexor hallucis brevis (FHB); flexor digitorum brevis (FDB); abductor hallucis (AbH); flexor digitorum longus (FDL); flexor hallucis longus (FHL); tibialis anterior (TA); and peroneus longus and brevis (PER).

METHODS

A sample of 6 females and 4 males (mean age 29.1 ± 7.2 years, mean BMI 25.5 ± 4.8) was recruited from a university student and staff population. Scans were obtained using a portable Venue 40 musculoskeletal ultrasound system (GE Healthcare UK) with a 5-13 MHz wideband linear array probe with a 12.7 mm × 47.1mm footprint by two operators in the same scanning session.

RESULTS

Intraclass Correlation Coefficients (ICC) values for muscle thickness (ICC range 0.90-0.97), plantar fascia thickness (ICC range 0.94-0.98) and cross sectional muscle measurements (ICC range 0.91-0.98) revealed excellent inter-operator reliability. The limits of agreement, relative to structure size, ranged from 9.0% to 17.5% for muscle thickness, 11.0-18.0% for plantar fascia, and 11.0-26.0% for cross sectional area measurements.

CONCLUSIONS

The ultrasound protocol implemented in this work has been shown to be reliable. It therefore offers the opportunity to quantify the structures concerned and better understand their contributions to foot function.

'Focus on feet'--the effects of systemic lupus erythematosus: a narrative review of the literature

BACKGROUND

The manifestations of systemic lupus erythematosus (SLE) vary between individuals, from the severe and life-threatening renal and central nervous system involvement, to the involvement of skin, musculoskeletal and vascular system, and the complications of infection influencing the quality of life. However, as specific manifestations affecting the lower limb are perceived as receiving little focus, the purpose of this narrative literature review is to identify the specific factors associated with SLE that may have implications for lower limb and foot morbidity.

METHOD

A structured search of databases was conducted. The inclusion was restricted to publications in the English language, those that specifically investigate the feet as affected with SLE. No restriction on year of publication was imposed to reduce publication bias and to capture as many publication in relation to feet.

RESULTS

Eleven papers fulfilled the inclusion criteria. There were seven additional papers that made observations related to the articular or vascular complications of the feet. This narrative review provides some information on how SLE affects the lower limb and foot in relation to the musculoskeletal and vascular systems. However, there is a lack of literature that specifically focuses on all the manifestations of SLE and the complications associated with its management.

DISCUSSION

There are indications that SLE affects lower limb and foot morbidity but the scale of these problems is unclear and this is partly because of the absence of research and the lack of a 'gold standard' framework for the assessment of the lower limb and foot. In addition to clinical foot health assessment, ultrasonography may be a useful alternative to plain film radiography or magnetic resonance imaging (MRI) in capturing the extent of articular and extra-articular manifestations. Further, the Ankle Brachial Pressure Index (ABPI) may be useful in identifying those with atherosclerosis and ischaemia.

CONCLUSION

There are indications that SLE affects lower limb and foot morbidity but the scale of these problems and effective management of them is unclear. Therefore, further research is warranted in order to better understand the impact of SLE on the foot and lower limb and its impact on quality of life.