Development of oral health interventions for inter-professional management of diabetes

PhD ThesisBackground Periodontitis impairs glycaemic control in people with diabetes and diabetes is a major risk factor for periodontitis. Cochrane reviews have reported HbA1c reductions of up to 4 mmol/mol following treatment of periodontitis, yet many clinicians and patients with diabetes are unaware of this. Aims/objectives To develop oral health interventions for delivery in primary medical care and to explore interprofessional communication in the context of management of diabetes and periodontitis. Methods The behaviours of medical and dental practitioners in relation to published diabetes and periodontitis best practice recommendations were surveyed using theoretically designed online questionnaires to assess predictors and determinants. The questionnaires were designed using a novel combination of social cognitive theory and normalisation process theory. The survey findings were discussed in iterations of workshops with patients, and medical and dental professionals to develop and pilot interventions in primary medical care for feasibility and acceptability. Results The self-reported survey findings showed that medical and dental professionals had limited knowledge of best practice recommendations; however, the importance of improved communication to enhance patient care was valued. Clinicians from both professions expressed a preference for indirect referrals, though a case study revealed negative consequences following this approach. Through workshop development, oral health interventions to inform patients about the bidirectional relationship between diabetes and periodontitis and advise those without a dentist to attend for periodontitis assessment and treatment were designed and subsequently experienced as feasible and acceptable by nurses. Conclusions Best practice recommendations to improve the uptake of evidence-based care in the context of diabetes and periodontitis are not widely known and inter-professional communication is problematic. Nurses have an important role in the delivery of oral health interventions and future research should evaluate these interventions formally

A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis

Aims: To explore inter-professional communication and collaboration in guideline-concordant diabetes and periodontitis care. Methods: Qualitative design using iterations of workshops to identify ways to improve multidisciplinary working attended by staff from medical and dental primary care practices, and people with diabetes (n = 43). Workshops were semi-structured around a topic guide. Recruitment was via the UK Clinical Research Network, and a patient and public involvement group in the North of England. Results: Medical practice participants were unaware of the bidirectional evidence linking diabetes and periodontitis and stated that they had never received a referral from a dental professional in this context. The patient participants with diabetes reported never having been informed about the links between diabetes and periodontitis from either their family physician or dentist. Medical and dental practice participants gave negative accounts of inter-professional communication, with claims of inappropriate requests and defensive or non-responses that stymied future interaction. Indirect communication through the patient was suggested as an alternative to direct communication. Conclusions: Indirect referral, whereby the patient is signposted to a healthcare professional, was suggested by medical and dental professionals as a useful alternative to the traditional (and time consuming) letter or telephone call, particularly in the case of suspected diabetes or periodontitis

An Examination of Male and Female Students\u27 Perceptions of Relational Closeness: Does the Basic Course Have an Influence?

Several scholars have argued that men and women are socialized to establish interpersonal relationships, such as friendships, in different ways. Traditionally feminine individuals emphasize empathy, self-disclosure, and interdependence while masculine individuals rely on activities, helping behaviors, and advice/problem-solving. In spite of these differences, basic communication courses have provided students with only a model of traditionally feminine closeness skills in coursework and materials. This study sought to determine if, after 16 weeks of instruction in a basic communication course emphasizing feminine intimacy skills, male students would prefer masculine closeness behaviors. Three-hundred and seventy-three male and female students provided self-report data on the course and perceptions of relational closeness. Results indicated that male and female students did have differing perceptions of relational intimacy. Additionally, male students did indicate a preference for some of the traditionally masculine intimacy behaviors. Limitations and suggestions for future research are provided

Uptake of best practice recommendations in the management of patients with diabetes and periodontitis:A cross-sectional survey of healthcare professionals in primary care

10.1136/bmjopen-2019-032369BMJ Open1013236

Exploring the use of mouth guards in Muay Thai:a questionnaire survey

10.1038/s41405-020-00048-zBDJ Open612

Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible?:A qualitative interview study exploring the views of patients in North East England

INTRODUCTION Head and neck cancer (HNC) is the eighth most common cancer in the United Kingdom. Survival rates improve when the cancer is diagnosed at an early stage, highlighting a key need to identify at-risk patients. This study aimed to explore opportunistic HNC identification and referral by community pharmacists (CPs) using a symptom-based risk assessment calculator, from the perspective of patients with a diagnosis of HNC. METHODS Purposive sampling was used to recruit patients from the HNC pathway in three large teaching hospitals in Northern England. Qualitative methodology was used to collect data through an iterative series of semistructured telephone interviews. Framework analysis was utilised to identify key themes. RESULTS Four main themes were constructed through the analytic process: (1) HNC presentation and seeking help; (2) the role of the CP; (3) public perception of HNC and (4) the role of a symptom-based risk calculator. Participants agreed that CPs could play a role in the identification and referral of suspected HNCs, but there were concerns about access as patients frequently only encounter the medicine counter assistant when they visit the pharmacy. HNC symptoms are frequently attributed to common or minor conditions initially and therefore considered not urgent, leading to delays in seeking help. While there is public promotion for some cancers, there is little known about HNC. Early presentation of HNC can be quite variable, therefore raising awareness would help. The use of a symptom-based risk calculator was considered beneficial if it enabled earlier referral and diagnosis. Participants suggested that it would also be useful if the public were made aware of it and could self-assess their symptoms. CONCLUSION In principle, CPs could play a role in the identification and referral of HNC, but there was uncertainty as to how the intervention would work. Future research is needed to develop an intervention that would facilitate earlier identification and referral of HNC while not disrupting CP work and that would promote HNC and the risk calculator more widely. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement and engagement (PPIE) was integrated throughout the project. Initially, the proposal was discussed during a Cancer Head and Neck Group Experience (CHANGE) PPIE meeting. CHANGE was set up to support HNC research in 2018. The group is composed of seven members (four female, three male) with an age range of 50-71 years, who were diagnosed at Sunderland Royal Hospital. A patient representative from the University of Sunderland PPIE group and a trustee of the Northern HNC Charity were recruited as co-applicants. They attended project management group meetings and reviewed patient-facing documentation

Seismicity and state of stress in the central and southern Peruvian flat slab

We have determined the Wadati–Benioff Zone seismicity and state of stress of the subducting Nazca slab beneath central and southern Peru using data from three recently deployed local seismic networks. Our relocated hypocenters are consistent with a flat slab geometry that is shallowest near the Nazca Ridge, and changes from steep to normal without tearing to the south. These locations also indicate numerous abrupt along-strike changes in seismicity, most notably an absence of seismicity along the projected location of subducting Nazca Ridge. This stands in stark contrast to the very high seismicity observed along the Juan Fernandez ridge beneath central Chile where, a similar flat slab geometry is observed. We interpret this as indicative of an absence of water in the mantle beneath the overthickened crust of the Nazca Ridge. This may provide important new constraints on the conditions required to produce intermediate depth seismicity. Our focal mechanisms and stress tensor inversions indicate dominantly down-dip extension, consistent with slab pull, with minor variations that are likely due to the variable slab geometry and stress from adjacent regions. We observe significantly greater variability in the P-axis orientations and maximum compressive stress directions. The along strike change in the orientation of maximum compressive stress is likely related to slab bending and unbending south of the Nazca Ridge

Care pathways in persistent orofacial pain: qualitative evidence from the DEEP study

Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the “fluidity of the care pathway,” in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a “failure to progress,” where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the “effects of unmanaged pain,” where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways

Ability of matrix metalloproteinase-8 biosensor, IFMA, and ELISA immunoassays to differentiate between periodontal health, gingivitis, and periodontitis

Publisher Copyright: © 2022 The Authors. Journal of Periodontal Research published by John Wiley & Sons Ltd.Objective: The aim of this study was to determine the diagnostic utility of an MMP-8 biosensor assay in differentiating periodontal health from gingivitis and periodontitis and compare it with an established time-resolved immunofluorescence assay (IFMA) and enzyme-linked immunosorbent assay (ELISA). Background: Currently available antibody-based assays display a wide variability in their ability to accurately measure matrix metalloproteinase-8 (MMP-8) levels in saliva. Methods: Salivary MMP-8 levels were analyzed in 189 systemically healthy participants using an antibody-based biosensor prototype that operates using a surface acoustic wave technology and compared with IFMA and ELISA antibody assays. Participants were categorized into 3 groups: periodontal health (59), gingivitis (63), and periodontitis (67). A sub-population of participants (n = 20) with periodontitis received periodontal treatment and were monitored for 6 months. Results: All the assays demonstrated significantly higher salivary MMP-8 concentrations in participants with periodontitis versus gingivitis, periodontitis versus health, and gingivitis versus health (all p <.05). The biosensor data demonstrated significant correlations with IFMA (r =.354, p <.001) and ELISA (r =.681, p <.001). Significant reductions in salivary MMP-8 concentrations were detected by the biosensor (p =.030) and IFMA (p =.002) in participants with periodontitis 6 months after non-surgical periodontal treatment. IFMA had the best sensitivity (89.2%) for detecting periodontitis and gingivitis versus health and 96.6% for detecting periodontitis versus health and gingivitis. The biosensor had an AUC value of 0.81 and diagnostic accuracy of 74.2% for differentiating periodontitis and gingivitis from health; an AUC value of 0.86 and diagnostic accuracy of 82.8% for periodontitis versus health and gingivitis. Conclusions: The biosensor, IFMA, and ELISA assays differentiated between periodontal health, gingivitis, and periodontitis based on salivary MMP-8 levels. Only the biosensor and, particularly, IFMA identified an effect of periodontal treatment in the participants with periodontitis. Our findings support the potential utility of salivary oral fluid aMMP-8-based point-of-care technology in the future of periodontal diagnostics.Peer reviewe