Treatment of periodontitis for glycaemic control in people with diabetes mellitus (Review)

Introduction: Patient and public involvement and engagement (PPIE) in research is an essential component of high-quality research. Patients and the public can identify which research topics are most relevant to them, contribute to study design, and interpretation and dissemination of findings. While inclusion of PPIE is widely adopted in medical research, awareness within the dental research community is more limited. Aim: To examine patient and public involvement and engagement in orthodontic research activity. Design: Identification and appraisal of use of PPIE in orthodontic research reporting and funding applications using a systematic approach. Methods: Three sources of information were examined: (1) research articles published between September 2018 and September 2019 in four major orthodontic journals. Articles were examined for reported PPIE; (2) common funding bodies for orthodontic research were assessed to establish whether PPIE was mandated (National Institute for Health Research, Medical Research Council, Wellcome Trust, Chief Scientist Office (Scotland), Health and Care Research Wales, British Orthodontic Society Foundation, Royal College of Surgeons and CLEFT); and (3) publication guidance for authors in these journals was examined to identify whether reporting of PPIE was included. Results: Of the 363 research articles, 2 (0.6%) mention patient/public involvement. None of the 363 research articles mention patient/public engagement. Of nine funding bodies, 2 (22%) request evidence of patient/public involvement as a condition of receiving funding with one (11%) expecting evidence of public engagement to be provided as a condition of receiving funding. None of the four major orthodontic journals include patient/public involvement and/or engagement in their guidance for authors. Conclusion: There is currently: (1) a notable lack of reporting of PPIE in orthodontic research; (2) variability in the requirements of funding bodies for researchers to include PPIE in funding applications and throughout the research process; and (3) no stipulation in journals’ instructions for authors.

Background To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology. Methods We conducted a pre-post study of E-consult implementation for positive ANA referrals. We retrospectively reviewed “positive ANA” referrals from 1/2015–3/2017. A statistical process control chart was created to display monthly average wait times for in-person clinic visits and to identify special cause variation. Final diagnoses, wait times and resource utilization were recorded and compared between E-consults and in-person referrals. Results There were 139 referrals for positive ANA with 126 occurring after E-consult implementation in August 2015. Forty-four percent (55/126) of referrals were E-consults; 76% did not have an in-person visit after initial electronic rheumatology recommendation. A control chart demonstrated special cause variation in the form of a shift from June 2016 – January 2017, suggesting a temporal association between decreased wait times and the implementation of E-consults. Eleven patients were diagnosed with ANA-associated rheumatic disease; the majority of patients (73%, 86/139) did not have a rheumatologic diagnosis. Overall E-consults utilized more labs than in-person visits, but this was not statistically significant. In-person visits utilized more imaging studies, which was statistically significant. Conclusion E-consults are an effective way to address positive ANA consults without significant increase in resource utilization and were temporally associated with decreased wait times for in-person visits.

ObjectivesThe importance of patient-centred care (PCC) has been increasingly recognised. However, there is limited work exploring what doctors actually understand by PCC, and how they perceive they acquire PCC skills in the workplace. The objectives of our study were to explore (1) what UK doctors, in specialist training, perceive to be the essential components of PCC, (2) if/how they acquire these skills, (3) any facilitators/barriers for engaging in PCC and (4) views on their PCC training.DesignQualitative study using in-depth individual semi-structured interviews with UK specialist trainees. Interview transcripts were thematically analysed.Setting and participantsThirty-one specialist trainee doctors, with at least 4 years postgraduate experience, were interviewed. Participants worked in various medical specialities within the Medical Directorate of an acute hospital in the East Midlands of England.ResultsInterview data were transcribed verbatim and categorised into three main themes. The first theme was ‘Understanding PCC’ where the doctors gave varied perspectives on what they understood by PCC. Although many were able to highlight key components of PCC, there were also some accounts which demonstrated a lack of understanding. The second theme was ‘Learning PCC skills: A work in progress’. Learning to be patient-centred was perceived to be an ongoing process. Within this, trainee doctors reported ‘on-the-job’ learning as the main means of acquiring PCC skills, but they also saw a place for formal training (eg, educational sessions focussing on PCC, role play). ‘Delivering PCC: Beyond the physician’ referred to the many influences the doctors reported in learning and delivering PCC including patients, the organisation and colleagues. Observing consultants taking a patient-centred approach was cited as an important learning tool.ConclusionsOur findings may assist clinical educators in understanding how trainee doctors perceive PCC, and the factors that influence their learning, thereby helping them shape PCC skills training.

BackgroundSince 2000, vitamin D requests have increased 2–6 fold with no evidence of a corresponding improvement in the health of the population. The ease of vitamin D requesting may contribue to the rapid rise in its demand and, hence, pragmatic interventions to reduce vitamin D test ordering are warranted.AimTo study the effect on vitamin D requests following a redesign of the electronic forms used in primary care. In addition, any potential harms were studied and the potential cost-savings associated with the intervention were evaluated.Design & settingAn interventional study took place within primary care across Leicestershire, England.MethodThe intervention was a redesign of the electronic laboratory request form for primary care practitioners across the county. Data were collected on vitamin D requests for a 6-month period prior to the change (October 2016 to March 2017) and the corresponding 6-month period post-intervention (October 2017 to March 2018), data were also collected on vitamin D, calcium, and phosphate levels.ResultsThe number of requests for vitamin D decreased by 14 918 (36.2%) following the intervention. Changes in the median calcium and phosphate were not clinically significant. Cost-modelling suggested that if such an intervention was implemented across primary care in the UK, there would be a potential annual saving to the NHS of £38 712 606.ConclusionA simple pragmatic redesign of the electronic request form for vitamin D test led to a significant reduction in vitamin D requests without any adverse effect on the quality of care.

Objective: The search for anti-calculi drugs from natural sources has been believed of greater importance. Hence, the present study explored the effectiveness of lycopene against experimentally induced nephrolithiasis. Methods: The experimental study lasted for 28 days. Adult male Wistar rats were divided into six groups. Group I (Normal control) received drinking water. Group II (Disease control) received 0.75% ethylene glycol and 1% ammonium chloride in drinking water to induce nephrolithiasis. Group III–V was treated with lycopene (50 mg/kg, 100 mg/kg, and 200 mg/kg, p.o.) along with 0.75% ethylene glycol and 1% ammonium chloride. Group VI treated standard (750 mg/kg, p.o.) along with 0.75% ethylene glycol and 1% ammonium chloride. Results: The study results showed significantly high levels of urinary and serum creatinine, urea, calcium, and uric acid levels and a decrease in magnesium levels in Group II (Disease control) compared with Group I (Normal control). Treatment with lycopene (50 mg/kg, 100 mg/kg, and 200 mg/kg) restored the elevated urinary and serum parameters in Group III–VI compared with Group II. Ethylene glycol administrations lead to the production of oxidative stress and decrease superoxide dismutase, reduced glutathione, and catalase activity. Lycopene treatment restored the elevated oxidative stress parameters to normal. Histologically, lycopene has alleviated the damaged integrity of the renal structure. Conclusion: Supplementation with lycopene (100 mg/kg and 200 mg/kg) reduces and prevents the toxicity caused by ethylene glycol administration and protects the renal cells from damage.

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Aim: This study aims to gather information about Oral Surgery training programmes by carrying out a survey of the trainees currently in post. Materials and methods: A web-based questionnaire was sent to current Oral Surgery trainees. Questions about training environment, clinical exposure, examinations and future career aspirations were included. Results: Thirty of the 40 trainees contacted responded by part or fully completing the questionnaire. The mean time period of qualification from dental school to Oral Surgery training was 5.1 years. The majority, 80%, of trainees were on a 3-year full-time programme that entitled them to sit the Membership in Oral Surgery Examination (M Oral Surg) only. Four trainees who responded were eligible to sit both M Oral Surg and the Intercollegiate Specialty Fellowship Exam. Conclusions: The questionnaire highlighted areas Oral Surgery trainees perceived to be important for their training and development. Identification of these issues will allow attention to be focused in addressing them. Clinical relevance Scientific rationale for studyTo gain information about variations between Oral Surgery training programmes including whether trainees feel their clinical experience is sufficient and their views on their own career progression. Principal findingsThere is variation in the clinical and specifically implantology experience being gained by trainees in different training programmes. Practical implicationsWith some trainees feeling they lack clinical experience to make them competent in basic implantology, training developments should be focused towards addressing this concern. This will prevent trainees completing training with unacceptable levels of variation in their logbooks.