Developing agreement on never events in primary care dentistry:an international eDelphi study

Introduction: Never events (NEs) are a subset of serious patient safety incidents that should not occur if appropriate preventive measures are implemented. Although there is a consensus in medicine, there is no agreement on NEs in dentistry. Aim: To identify NEs in primary care dentistry. Method: We undertook an electronic Delphi exercise to develop an international agreement on NEs for primary care dentistry. Results: We initially identified candidate NEs through a scoping review of the literature and then analysed dentistry-related reports in a national incident reporting system. Next, we invited an international panel of 41 experts to complete two rounds of questionnaires; 32 agreed to participate (78%) and completed the first round and 29/41 (71%) members completed the second round. We provided anonymised controlled feedback between rounds and used a cut-off of 80% agreement to define consensus. Consensus was achieved for 23 out of 42 candidate NEs. These related to routine assessment, and pre-operative, intra-operative and post-operative stages of dental procedures. Discussion and conclusion: To our knowledge, this is the first international expert consensus-based approach that has identified NEs for primary care dentistry. We suggest that dental regulators consider these to support quality assessment and governance activities

Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

Study design:Retrospective, longitudinal analysis of sensory, motor and functional outcomes from individuals with thoracic (T2-T12) sensorimotor complete spinal cord injury (SCI).Objectives:To characterize neurological changes over the first year after traumatic thoracic sensorimotor complete SCI.Methods:A dataset of 399 thoracic complete SCI subjects from the European Multi-center study about SCI (EMSCI) was examined for neurological level, sensory levels and sensory scores (pin-prick and light touch), lower extremity motor score (LEMS), ASIA Impairment Scale (AIS) grade, and Spinal Cord Independence Measure (SCIM) over the first year after SCI.Results:AIS grade conversions were limited. Sensory scores exhibited minimal mean change, but high variability in both rostral and caudal directions. Pin-prick and light touch sensory levels, as well as neurological level, exhibited minor changes (improvement or deterioration), but most subjects remained within one segment of their initial injury level after 1 year. Recovery of LEMS occurred predominantly in subjects with low thoracic SCI. The sensory zone of partial preservation (ZPP) had no prognostic value for subsequent recovery of sensory levels or LEMS. However, after mid or low thoracic SCI, 3 segments of sensory ZPP correlated with an increased likelihood for AIS grade conversion.Conclusion:The data suggest that a sustained deterioration of three or more thoracic sensory levels or loss of upper extremity motor function are rare events and may be useful for tracking the safety of a therapeutic intervention in early phase acute SCI clinical trials, if a significant proportion of study subjects exhibit such an ascent.Spinal Cord advance online publication, 12 October 201

Sizeism

People who are considered to be overweight or obese (as the medical terms have it) or fat (as many fat activists prefer to call their body size) suffer discrimination and humiliation (Lupton D. What does fat discrimination look like? The conversation. 3 Jan 2013. Retrieved from https://theconversation.com/what-does-fat-discrimination-look-like-10247). Being fat is a stigmatised condition and living as a fat person often includes being treated with disdain and disregard. People living with fat stigma impacts how they experience being in the world, including how they interact with healthcare professionals and their access to healthcare. Community attitudes and experiences of discrimination inevitably impact on a person’s ability to live well. The relationship between fat stigma and mental health is examined, and further brought into focus through scholarly discourse and personal experiences. Experiential activities where the learner can question and challenge stereotypes, their own perceptions and gain a better understanding of environmental, social and systemic issues faced by people living with fat stigma conclude this chapter