A scoping review of interventions to improve oral health in prison settings

OBJECTIVE: To describe the characteristics of oral health interventions implemented in prison settings and explore the barriers and facilitators towards implementation. METHODS: Following Joanna Briggs Institute scoping review methodology, six databases were searched including Medline (R), Emcare, Embase, AMED, Cochrane and PsycINFO. A total of 978 studies were returned and screened. The inclusion criteria were those studies conducted in a prison population, with an intervention to address oral health and published since 2000. RESULTS: Ten studies published between 2008 and 2021 were included. All were conducted in high-income countries. Three intervention types were identified: health education (n = 5), teledentistry (n = 3) and screening or triaging (n = 2). The barriers and facilitators to successful implementation were grouped into a framework of four overarching concepts. These included prison environment, population makeup, compliance and staffing. CLINICAL SIGNIFICANCE: Evidence suggests that oral health interventions in prisons are focused on improving access to services and oral health messages. A range of drivers including the prison environment, staffing levels, recruitment and intervention compliance influence implementation and the success of interventions

Symptom-based stratification of patients with primary Sjögren's syndrome: multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials

Background Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjögren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. Methods We did hierarchical cluster analysis using five common symptoms associated with primary Sjögren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjögren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. Findings In the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, κ-free light chain, β2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo. Interpretation Stratification on the basis of patient-reported symptoms of patients with primary Sjögren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases. Funding UK Medical Research Council, British Sjogren's Syndrome Association, French Ministry of Health, Arthritis Research UK, Foundation for Research in Rheumatology

Researching professional development leaders: investigating support for ‘remote’ professional development leaders

Professional development leaders are those who design, deliver and coordinate professional development for teachers. In comparison to processes of teacher professional learning and the content and delivery of professional development, professional development leaders are under-researched (van Driel et al. 2012, Kennedy 2016, Perry & Boylan 2018). Therefore, we lack understanding of how they can be effectively supported in their roles and their professional learning needs, and their skills and expertise are often under-valued (Perry & Bevins 2019, Perry 2020). Numerous organisations in England engage professional development leaders to support the delivery of teacher professional development programmes. These professional development leaders often operate remotely, both in relation to their geographic locations and their terms of employment with their ‘host’ organisation, and, in some ways, in their levels of autonomy and independence. Professional development leaders often lack formalised opportunities for support and development (Perry 2020), and this may be particularly acute for those operating in these remote roles. The Ogden Trust (Ogden Trust 2021) and the Primary Science Quality Mark (University of Hertfordshire 2021) both engage ‘remote’ professional development leaders to coordinate, support and, in some cases, facilitate, professional development for teachers and schools. In 2021, Sheffield Hallam University was commissioned by the Ogden Trust to carry out a small-scale study into the professional development leaders who work with and for the two organisations. The aim of the study is to better understand the ways in which these professional development leaders, and others who operate in similar roles for other organisations, can be supported, thereby contributing to our collective understanding of effective practice in supporting practitioners operating in the role of professional development leaders, such as how they learn and develop their roles. In this report, we describe the approach taken to the study. We explain our findings, including consideration of how professional development leaders are recruited, their professional learning needs and the support offered by the organisations they work for. We found that professional development leaders feel that their professional learning needs are largely met, through a combination of support offered by their ‘host’ organisations and activity within their wider professional networks and identify three groupings of professional learning outcomes: operational knowledge, knowledge of science education and contribution to a shared community enterprise. We end by offering some recommendations for the organisations involved, for other organisations who use ‘remote’ professional development leaders and for further research. These include: • analysis of the diversity of professional development leaders across the system and consideration of how this might be increased through more open recruitment processes; • sharing practice across the sector in relation to induction, ongoing support and quality assurance of professional development leaders, including the use of frameworks of expertise and regular review meetings; • maintenance and further development, across the sector, of models to identify and meet professional development leaders’ learning needs, which take into consideration their varying backgrounds, other professional roles and the relative impact of different activities and delivery models (such as online or face-to-face); • analysis of how professional development leaders’ subject knowledge is developed, including identification of opportunities for collaboration between organisations; • further research into professional development leaders’ perceptions of contributing to a shared community enterprise, such as through analysis of professional networks, informal learning and comparison with other subject areas and phases; • consideration of how to raise the profile of and celebrate professional development leaders’ expertise and contributions to the system