Simple and Multistate Survival Curves

Objective and Sample: This investigation assessed the comprehension of survival curves in a community sample of 88 young and middle-aged adults when several aspects of good practice for graphical communication were implemented, and it compared comprehension for alternative presentation formats. Design, Method, and Measurements: After reading worked examples of using survival curves that provided explanation and answers, participants answered questions on survival data for pairs of treatments. Study 1 compared presenting survival curves for both treatments on the same figure against presentation via 2 separate figures. Study 2 compared presenting data for 3 possible outcome states via a single “multistate” figure for each treatment against presenting each outcome on a separate figure (with both treatments on the same figure). Both studies compared alternative forms of questioning (e.g., “number alive” versus “number dead”). Numeracy levels (self-rated and objective measures) were also assessed. Results: Comprehension was generally good—exceeding 90% correct answers on half the questions—and was similar across alternative graphical formats. Lower accuracy was observed for questions requiring a calculation but was significantly lower only when the requirement for calculation was not explicit (13%–28% decrements in performance). In study 1, this effect was most acute for those with lower levels of numeracy. Subjective (self-rated) numeracy and objective (measured) numeracy were both moderate positive predictors of overall task accuracy (r ≈ 0.3). Conclusions: A high degree of accuracy in extracting information from survival curves is possible, as long as any calculations that are required are made explicit (e.g., finding differences between 2 survival rates). Therefore, practitioners need not avoid using survival curves in discussions with patients, although clear and explicit explanations are important </jats:p

A Child With Radius Aplasia, Cleft of Lip and Palate, Microcephaly, and Unusual Chromosome Findings

We report a child with malformation syndrome of microcephaly, asymmetrical radius aplasia, and cleft of lip and palate, who was mosaic for a chromosome marker and/or ring of unknown origin. In view of the reported cases of limb deficiency with chromosome abnormalities and the unlikelihood that the patient has a recognized genetic syndrome, the cause of the patient’s syndrome may well be the extra chromosomal material

Seeing the person before the teeth: A realist evaluation of a dental anxiety service in Norway

Patients with a trauma history, whether sexual abuse or torture, or dental phobia, tend to avoid dental services due to severe dental anxiety. Subsequently, they experience poor oral health, lower quality of life, and poorer general health. In Norway, a specific service (torture, abuse, and dental anxiety [TADA]) targets these patients’ dental anxiety through cognitive behavioural therapy (CBT) prior to dental restoration. By exploring patients’ experiences with TADA services using a realist evaluation approach, this paper aims to increase our understanding of how this type of service addresses patients’ dental anxiety in terms of its mechanisms and contextual factors. Interviews with TADA patients (n = 15) were analysed through a template analysis driven by context-mechanism-outcome heuristics. The analysis revealed that patients value a dental practitioner who provides a calm and holistic approach, positive judgements and predictability elements that lean towards a person-centred care approach. Provided this, patients felt understood and cared for, their shame was reduced, self-esteem emerged, and control was gained, which led to alleviation of dental anxiety. Therefore, our findings suggest that combining CBT with a person-centred care approach helps alleviate patients’ dental anxiety. This provides insights into how dental services could be executed for these patients.publishedVersio

More than just a dental practitioner: A realist evaluation of a dental anxiety service in Norway

Patients with dental phobia or a history of trauma tend to avoid dental services, which may, over time, lead to poor oral health. In Norway, a specific service targets these patients by providing exposure therapy to treat their fear of attendance and subsequently enable oral restoration. Dental practitioners deliver the exposure therapy, which requires a role change that deviates from their traditional practice. This paper explores how – and under what circumstances – dental practitioners manage this new role of alleviating dental anxiety for patients with a history of trauma or dental phobia. Using a realist evaluation approach, this paper develops theory describing which contexts promote mechanisms that allow practitioners to alleviate dental anxiety for patients with trauma or dental phobia. A multi-method approach, comprising service documents (n = 13) and stakeholder interviews (n = 12), was applied. The data were then analysed through a content analysis and context-mechanism-outcome heuristic tool. Our findings reveal that dental practitioners must adopt roles that enable trust, a safe space, and gradual desensitisation of the patient to their fear triggers. Adopting these roles requires time and resources to develop practitioners' skills – enabling them to adopt an appropriate communication style and exposure pace for each patient.publishedVersio

Editorial: Women and leadership in higher education learning and teaching

In this Special Issue Harvey and Jones state “It is time for women academics to accept the challenge – to rightfully claim their leadership”. We recognise the many women who have challenged the system, and those whose efforts have been thwarted. We encourage women and men to work together to break down the barriers of gender, race, culture, and religion, so that our current and next generation of female academics can rightfully claim their leadership. This Special Issue is an important step to bringing to light these challenges for women and the changes required to grow and support women in leadership in higher education teaching and learning

Informing the management of pediatric heart transplant waiting lists:complementary use of simulation and analytical modeling

A clinical intervention known as `bridging to transplant', in which a patient is placed on life-sustaining support, can be used to increase the chance of an individual surviving until a donor heart becomes available. However, the impact of this on other patients on the waiting list and the wider implications for the resourcing of cardiac units remains unclear. Initial insights have previously been generated using a birth-death queuing model, but this model did not incorporate realistic donor-recipient assumptions regarding blood type and weight. Here we report on a complementary simulation study that examined how estimates from the analytical model might change if organ matching were better taken into account. Simulation results showed that system metrics changed substantially when recipient donor compatibility was modelled. However, the effects of blood type compatibility were countered by that of weight compatibility and when combined, these have a relatively small net effect on results

High background rates of positive tuberculosis-specific interferon-? release assays in a low prevalence region of UK: a surveillance study

Background: Background rates of latent tuberculosis infection in low prevalence regions of Britain are unknown. These would be valuable data for interpreting positive IGRA results, and guiding cost-benefit analyses. The management of a large outbreak of tuberculosis occurring in a rural district hospital provided an opportunity to determine the background rates and epidemiology of IGRA-positivity amongst unselected hospital patients in a low-prevalence region of U.K.Methods: As part of a public health surveillance project we identified 445 individuals exposed to the index cases for clinical assessment and testing by a TB-specific interferon-? release assay (IGRA): T-Spot.TB. Uniquely, an additional comparator group of 191 age-matched individuals without specific recent exposure, but with a similar age distribution and demographic, were recruited from the same wards where exposure had previously occurred, to undergo assessment by questionnaire and IGRA. Results: Rates of IGRA positivity were 8.7% (95%CI, 4.2-13, n=149) amongst unexposed patients, 9.5%(3.0-22, n=21) amongst unexposed staff, 22%(14–29, n=130) amongst exposed patients, 11%(6.1-16, n=142) amongst exposed staff. Amongst the individuals without history of recent exposure to the outbreak, IGRA-positivity was associated with prior TB treatment (OR11, P.04) and corticosteroid use (OR5.9, P.02). Background age-specific prevalences of IGRA-positivity amongst unexposed individuals were: age &lt;40 0%(N/A), age 40–59 15%(12–29), age 60–79 7.0%(1.1-13), age?80 10%(5.9-19).Conclusions: Background rates of IGRA-positivity remain high amongst unselected white-Caucasian hospital inpatients in U.K. These data will aid interpretation of future outbreak studies. As rates peak in the 5th and 6th decade, given an ageing population and increasing iatrogenic immunosuppression, reactivation of LTBI may be a persistent hazard in this population for several decades to come