A qualitative study of work-life balance amongst specialist orthodontists in the United Kingdom

Objective: To identify factors affecting work-life balance amongst male and female orthodontists in the United Kingdom. Design: A qualitative interview-based study with a cross-sectional design. Subjects: Specialist orthodontists working in specialist practice and the hospital service in the United Kingdom were selected by purposive sampling. Methods: In-depth semi-structured interviews were conducted with eighteen orthodontic specialists. Interview transcripts were analysed using Framework Analysis. Results: Four main themes pertaining to work-life balance in orthodontics were identified: work factors affecting work-life balance, life factors affecting worklife balance, perception and effects of work-life balance and suggestions for managing work-life balance within the profession. Conclusions: There was substantial variation in the work-life balance of the orthodontists interviewed in this study; however the majority reported high levels of career satisfaction despite difficulties maintaining a good work-life balance. Whilst there were some clear distinctions in the factors affecting work-life balance between the hospital environment and specialist practice (including additional professional commitments and teaching/training related issues), there were also a number of similarities. These included, the lack of flexibility in the working day, managing patient expectations, taking time off work at short notice and the ability to work part-time

Evaluation of the orthodontic component of the hypodontia care pathway

INTRODUCTION: This study evaluated patients’ experiences of the Hypodontia Care Pathway at a large teaching hospital at key stages: specifically patient expectations/experience following the diagnosis of hypodontia and then patient satisfaction with the orthodontic care received and the outcome at the end of active orthodontic treatment. METHODOLOGY: In-depth, semi-structured interviews were conducted with twenty hypodontia patients following completion of orthodontic treatment but prior to any planned prosthodontic treatment commencing. Interviews were analysed qualitatively, using a framework approach. RESULTS: The framework analysis identified four main themes: perceptions of treatment, impact of the original malocclusion and the treatment process, the care team and communication. The themes were then further divided into subthemes. DISCUSSION: There was a large amount of positive feedback and the importance of the patient-clinician relationship was evident throughout. Where negative feedback was provided it mainly related to communication and areas were identified where change could take place in the future. CONCLUSIONS: Positive feedback was received and the importance of patient-clinician rapport was highlighted in all interviews. The main areas for improvement related to the importance of ensuring optimum communication, particularly with a cohort of patients who are often undergoing complex multidisciplinary treatment. Recommendations for the service have been made

How do children with amelogenesis imperfecta feel about their teeth?

Amelogenesis imperfecta (AI) is an inherited dental condition affecting enamel, which can result in significant tooth discolouration and enamel breakdown, requiring lifelong dental care. The possible impact of this condition on children and adolescents from their perspectives is not fully understood

How do you identify the patient with ‘high expectations’ of orthodontic treatment - An empirical approach

Objectives: To identify an empirical method for identifying patients with ‘high expectations’ of orthodontic treatment with fixed appliances using a questionnaire-based approach. Design: Secondary analysis of data from four studies which collected data on patients’ expectations of orthodontic treatment using the same questionnaire. Setting: Secondary care orthodontic services. Participants: All four datasets comprised new patients aged 12–15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants. Methods: The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time. Results: For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively. Conclusion: The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients

Patient expectations: Is there a typical patient?

Objectives: To qualitatively explore, and analyse, patients’ expectations before the start of fixed appliance orthodontic treatment and determine whether typologies exist. Design: A prospective cross-sectional qualitative study, which involved 13 patients (aged 12–15 years). Setting: NHS Hospital Orthodontic Department (UK). Materials and methods: In-depth interviews were conducted with patients who consented to participate before the start of fixed appliance orthodontic treatment. The in-depth interview data were transcribed and then managed using a framework approach, followed by associative analysis. Results: The in-depth interviews revealed two major themes and associated subthemes which were: first, patients’ expectations about the treatment process and outcome; and second, patients’ expectations of themselves during and after treatment. Three typologies related to patients’ expectations of the orthodontic treatment process were also identified. The first group of participants had minimal expectations of the treatment process, did not anticipate discomfort or pain and did not anticipate that treatment would cause disruption to their daily life. The second group of participants had expectations that treatment would involve arch wire changes, dental extractions and result in some discomfort/pain, which would cause some limited disruption to their daily life (moderate expectations). The third type of participant had expectations of the treatment process involving arch wire changes and dental extractions, and anticipated that the discomfort and pain experienced would significantly affect their daily life (marked expectations). Conclusions: These results provide the clinician with information about patient typologies and provide the clinician with some direction when communicating with their patients and managing their expectations before the start of treatment

Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics.

OBJECTIVES: To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers. DESIGN: A cross-sectional, observational study. SETTING: NHS teaching hospital. PARTICIPANTS: A total of 31 adult patients and their treating clinicians were included in the study. METHODS: The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION12 scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION12 scale. RESULTS: There was excellent inter-rater reliability between the two independent raters using the OPTION12 scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323). CONCLUSIONS: The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement

Compensatory Breeding in Years Following Drought in a Desert-Dwelling Cooperative Breeder

Variation in weather patterns can influence reproductive effort and success not only within but also between breeding seasons. Where environmental conditions can be highly variable between years, the weather, and particularly extreme weather events such as heat waves and droughts, may exert a strong influence on reproductive effort (number of breeding attempts) and success (number of surviving young) from one breeding season to the next. We used a 15-year dataset for a cooperatively-breeding bird, the southern pied babbler Turdoides bicolor, to determine the impact of high temperatures and drought on reproductive effort and success. We tested the influence on reproductive effort and success of mean daily maximum air temperature and drought both within a breeding season, to determine the relative importance of current conditions, and during the previous breeding season, to determine the relative importance of compensatory effects in response to prior conditions. Reproductive effort and success were lower during breeding seasons characterised by drought, and higher in the breeding seasons that followed droughts, but were not predicted by mean daily maximum temperatures measured over the full length of the breeding season. We provide evidence of compensatory breeding following drought in a bird species endemic to a semi-arid ecosystem and suggest that compensatory mechanisms may be an important part of both long-term population persistence and post-drought population recovery.DST-NRF Centre of Excellence at the FitzPatrick Institute for African Ornithology Oppenheimer Memorial Trust (Grant No. 20747/01 to ARB) British Ornithologists’ Union Australian Research Council (Grant No. FT110100188 to ARR) National Research Foundation of South Africa (Grant No. 110506 to SJC

Effect of social media in improving knowledge among patients having fixed appliance orthodontic treatment: A single-center randomized controlled trial

Research has shown that orthodontic patients are more likely to retain information presented in an audiovisual format. However, there has been little research on the effectiveness of audiovisual information provided through different routes such as the Internet. This parallel-group randomized controlled trial assessed whether provision of audiovisual information on the YouTube (Google, San Bruno, Calif) Web site to orthodontic patients undergoing fixed appliance treatment results in improved patient knowledge when compared with conventional methods of information provision. The effects of sex and ethnicity were also investigated

A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients

Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety