Patient satisfaction with care by dental therapists.

IntroductionPatient reported outcomes of care are increasingly used as a measure of the quality of care. There has been a recent expansion in the number of dental therapists trained in the UK, and with legislation now permitting therapists to take on a wider role in dental practice, patients' perceptions about quality of care provided by therapists is an important issue.Objectives To investigate whether there were any differences in patient satisfaction after a visit to a therapist, compared to a visit to a dentist.MethodA ten-item scale of patient satisfaction (Dental Visit Satisfaction Scale), which provides an outcome measure of overall patient satisfaction as well as three sub-scale outcomes (information-communication; understanding-acceptance; and technical competence) was used. A total of 240 questionnaires were given to consecutive patients attending an appointment with a therapist and 400 questionnaires were given to patients attending dentists, in eight different dental practices.ResultsFour hundred and thirty-one (67.3%) questionnaires were returned. Patients attending therapists were found to have a significantly higher level of overall satisfaction (p ConclusionAlthough a clear distinction in patient satisfaction according to the type of provider was found, the reasons behind this finding are unclear, and so care needs to be taken in interpreting the results, with further work undertaken to explore this phenomenon more fully

Radical changes in the Wadden Sea fauna and flora over the last 2000 years

Humans have interacted with the Wadden Sea since its origin 7,500 years ago. However, exploitation, habitat alteration and pollution have strongly increased since the Middle Ages, affecting abundance and distribution of many marine mammals, birds, fish, invertebrates and plants. Large whales and some large birds disappeared more than 500 years ago. Most small whales, seals, birds, large fish and oysters were severely reduced by the late 19th and early 20th centuries, leading to the collapse of several traditional fisheries. In the 20th century, conservation efforts have enabled some breeding birds and seals to recover. But other species declined further due to continuing exploitation, habitat destruction, pollution and eutrophication. Moreover, complex three-dimensional habitats such as oyster banks, Sabellaria reefs and subtidal eelgrass beds have been lost completely. In contrast, several opportunistic species such as gulls, polychaetes, green algae and exotic invaders increased during the 20th century. Taken together, multiple human impacts have caused dramatic losses of large predators and habitat-building species in the Wadden Sea over the last 500 years. Although still of high natural value and global importance, the Wadden Sea is a fundamentally changed ecosystem. On the other hand, reduced hunting pressure, increased habitat protection and reduced river pollution have enabled the recent recovery of several species and an increase in environmental quality. These successes, together with a historical vision of what was once possible, should guide current and future conservation, restoration and management efforts towards a more sustainable interaction between man and the sea