Patient-centred care in general dental practice--a systematic review of the literature.

Journal ArticleResearch Support, Non-U.S. Gov'tReviewBACKGROUND: Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with "patient experience" likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. METHODS: A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. RESULTS: Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. CONCLUSIONS: This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients' views should be central to this research.NIH

Modelling Noninvasively Measured Cerebral Signals during a Hypoxemia Challenge: Steps towards Individualised Modelling

Noninvasive approaches to measuring cerebral circulation and metabolism are crucial to furthering our understanding of brain function. These approaches also have considerable potential for clinical use “at the bedside”. However, a highly nontrivial task and precondition if such methods are to be used routinely is the robust physiological interpretation of the data. In this paper, we explore the ability of a previously developed model of brain circulation and metabolism to explain and predict quantitatively the responses of physiological signals. The five signals all noninvasively-measured during hypoxemia in healthy volunteers include four signals measured using near-infrared spectroscopy along with middle cerebral artery blood flow measured using transcranial Doppler flowmetry. We show that optimising the model using partial data from an individual can increase its predictive power thus aiding the interpretation of NIRS signals in individuals. At the same time such optimisation can also help refine model parametrisation and provide confidence intervals on model parameters. Discrepancies between model and data which persist despite model optimisation are used to flag up important questions concerning the underlying physiology, and the reliability and physiological meaning of the signals

Performance comparison of the MOXY and PortaMon near-infrared spectroscopy muscle oximeters at rest and during exercise

The purpose of the study was to compare muscle oxygenation as measured by two portable, wireless near-infrared spectroscopy (NIRS) devices under resting and dynamic conditions. A recently developed low-cost NIRS device (MOXY) was compared against an established PortaMon system that makes use of the spatially resolved spectroscopy algorithm. The influence of increasing external pressure on tissue oxygen saturation index (TSI) indicated that both devices are stable between 2 and 20 mmHg. However, above this pressure, MOXY reports declining TSI values. Analysis of adipose tissue thickness (ATT) and TSI shows a significant, nonlinear difference between devices at rest. The devices report similar TSI (%) values at a low ATT ( 10mm the difference remains constant ( −14.7±2.8% ). The most likely explanation for this difference is the small source–detector separation (2.5 cm) in the MOXY resulting in lower tissue penetration into muscle in subjects with higher ATT. Interday test–retest reliability of resting TSI was evaluated on five separate occasions, with the PortaMon reporting a lower coefficient of variation (1.8% to 2.5% versus 5.7% to 6.2%). In studies on male subjects with low ATT, decreases in the TSI were strongly correlated during isometric exercise, arterial occlusion, and incremental arm crank exercise. However, the MOXY reports a greater dynamic range, particularly during ischemia induced by isometric contraction or occlusion ( Δ74.3% versus Δ43.7% ; hyperemia MAX—occlusion MIN). This study shows that in this subject group both MOXY and PortaMon produce physiologically credible TSI measures during rest and exercise. However, the absolute values obtained during exercise are generally not comparable between devices unless corrected by physiological calibration following an arterial occlusion

Underwater near-infrared spectroscopy measurements of muscle oxygenation: laboratory validation and preliminary observations in swimmers and triathletes

The purpose of this research was to waterproof a near-infrared spectroscopy device (PortaMon, Artinis Medical Systems) to enable NIR measurement during swim exercise. Candidate materials were initially tested for waterproof suitability by comparing light intensity values during phantom-based tissue assessment. Secondary assessment involved repeated isokinetic exercises ensuring reliability of the results obtained from the modified device. Tertiary assessment required analysis of the effect of water immersion and temperature upon device function. Initial testing revealed that merely covering the PortaMon light sources with waterproof materials considerably affected the NIR light intensities. Modifying a commercially available silicone covering through the addition of a polyvinyl chloride material (impermeable to NIR light transmission) produces an acceptable compromise. Bland-Altman analysis indicated that exercise-induced changes in tissue saturation index (TSI %) were within acceptable limits during laboratory exercise. Although water immersion had a small but significant effect upon NIR light intensity, this resulted in a negligible change in the measured TSI (%). We then tested the waterproof device in vivo illustrating oxygenation changes during a 100 m freestyle swim case study. Finally, a full study compared club level swimmers and triathletes. Significant changes in oxygenation profiles when comparing upper and lower extremities for the two groups were revealed, reflecting differences in swim biomechanics

Anomalous post-death encounters and their positive impact on experients

During the bereavement process, people often report anomalous experiences that may be interpreted as evidence of the survival of the deceased’s ‘spirit’, ‘soul’, or ‘personality’. For example, Rees (1971) and Castelnovo et al. (2015) found that between 50-60% of bereaved individuals reported spontaneous anomalous experiences – most notably, ‘sensing the presence’ of the deceased. The experiences typically take the form of dreaming of the dead (Barrett, 1991-92) and sensing the presence of the deceased (Steffen & Coyle, 2011), but also include the seeing of apparitions and physical effects that are characteristic of the deceased (see Cooper, Roe, & Mitchell, 2015). Experients report that they find such experiences comforting and serve to help them come to terms with their loss (see Krippner, 2006). The present study was intended to explore these experiences in much greater depth, focusing on how they might engender ‘hope’ (Snyder, 1994), as suggested by several previous researchers (e.g., Devers, 1997; Drewry, 2003; Guggenheim & Guggenheim, 1995)

The phenomenology and impact of hallucinations concerning the deceased

Background People who have suffered the loss of a loved one may subsequently report sensory experiences of the deceased (termed ‘after-death communications’, or ADCs). Such encounters are common and can be a source of comfort to the bereaved. Nevertheless, there has been limited empirical investigation of this phenomenon, and consequently mental health professionals feel ill-equipped to support those who disclose them. Aims To map the phenomenology of ADCs, and identify covariates and effects upon the recipient. Method We conducted an online mixed-methods survey comprising 194 items about all aspects of ADCs. A purposive sample of 1004 respondents across three language groups (English, French and Spanish) completed the survey. Results The most common form of ADC was during sleep, but large numbers of cases involved sensory modalities of touch, sight, hearing, smell and sense of presence that externalised the phenomenon for the recipient. Variations in incidence with participant gender and language group suggest a psychosocial component. ADCs were typically regarded by the participant as deeply meaningful and comforting. Respondents reported significant increases in their sense of spirituality, but not religiosity. Conclusions ADCs are a common feature of bereavement that occur unexpectedly, and are independent of any underlying pathology or psychological need. For the person experiencing the hallucination, they are important and meaningful events that they interpret in terms of continuing bonds with the deceased. This adaptive outcome may be stymied where mental health professionals trivialise or pathologise disclosures about ADCs