Scoping review of the role of shared decision making in dental implant consultations

© International & American Associations for Dental Research 2018. To what extent does dental research on implant consultations focus on the use of shared decision making? There has been an explosion in the use of implant therapies in dentistry, but very little is known about the decision-making processes involved in the provision of dental implants. The use of shared decision making (SDM) has been found to reduce undesirable outcomes and increase patient and clinician satisfaction in other health care fields. This scoping review reports on the current status of SDM in research on implant therapies. A scoping review methodology was used. Web of Knowledge, MEDLINE via OvidSP, MEDLINE via PubMed, Embase, Scopus, Cochrane, DARE, and CINAHL databases were reviewed between 1900 and December 1, 2017. The search strategy resulted in 2,289 eligible articles; 1,892 duplicated articles were deleted, resulting in a hand search of 397 titles and abstracts. These were subsequently evaluated while applying the inclusion and exclusion criteria, resulting in 48 articles for full-text evaluation. After full-text evaluation of these 48 studies, a further 27 were eliminated as not being relevant, leading to the inclusion of 21 studies for the review. No studies to date have examined how patients and dentists engage in decisions to place dental implants. Aspects that were discussed in the literature related to the decisionmaking process included a discussion about patients’ values and discussing possible treatment options. How patients and dentists interacted during implant consultations was poorly explored. Shared decision making has been shown to improve health care quality and increase clinician and patient satisfaction. Further research concerning dental implant decisions is warranted with emphasis on evaluating patients’ contributions to treatment, which is currently poorly understood. Exploring existed methods for examining the SDM process in implant consultations should facilitate improve care and consent. Knowledge Transfer Statement: The findings of this scoping review can be used by all dentists when deciding which decision-making model they wish to use when planning implant therapy. The article places special emphasis on the role of shared decision making in improving health care quality and increasing patients’ and clinicians’ satisfaction

Decision making from the experience of orthognathic surgery patients: a grounded theory approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process

A log analysis study of 10 years of ebook consumption in academic library collections

Even though libraries have been offering eBooks for more than a decade, very little is known about eBook access and consumption in academic library collections. This paper addresses this gap with a log analysis study of eBook access at the library of the University of Waikato. This in-depth analysis covers a period spanning 10 years of eBook use at this university. We draw conclusions about the use of eBooks at this institution and compare the results with other published studies of eBook usage at tertiary institutes

Fingertip whole blood as an indicator of omega-3 long-chain polyunsaturated fatty acid changes during dose-response supplementation in women: comparison with plasma and erythrocyte fatty acids

The sensitivity of fingertip whole blood to reflect habitual dietary and dose-dependent supplemental omega-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) intake in premenopausal women was compared to that of venous erythrocytes and plasma fatty acids. Samples were obtained from women in a randomised, double-blind, placebo-controlled trial in which premenopausal women (n = 53) were supplemented with DHA-rich tuna oil capsules and/or placebo (Sunola oil) capsules (6 capsules per day) for 8 weeks to achieve doses of either 0, 0.35, 0.7 or 1.05 g/day n-3 LCPUFA. All blood biomarkers were very similar in their ability to reflect dietary n-3 LCPUFA intake (r = 0.38–0.46 for EPA and DHA intake), and in their dose-dependent increases in n-3 LCPUFA levels after supplementation (R2 = 0.41–0.51 for dose effect on biomarker EPA and DHA levels (mol %)). Fingertip whole blood is an effective alternative to erythrocytes and plasma as a biomarker n-3 LCPUFA intake in premenopausal women.Barbara J. Meyer, Cassandra Sparkes, Andrew J. Sinclair, Robert A. Gibson and Paul L. Els

Children’s rights in their oral health care: How responsive are oral health professionals to children’s rights

Research on children’s rights in oral health care is lacking, and this study aims to partially fill this gap. In 2015, we conducted research in one region of New Zealand using video methods to explore the rights of 22 children during a specific oral health treatment, the placement of stainless steel crowns. Our findings show that many children did not receive a professional standard of care, there were gaps in the delivery and standard of care, and there were numerous examples of children’s rights’ violations. At the same time, however, some of the children’s dental practitioners’ (CDPs) actions may have been acceptable practice within the profession if children’s rights have not yet fully been embedded into the practice of oral health care workers. We conclude with a discussion of the implications of our findings and suggestions for a more rights based standard of oral health care

Development and psychometric validation of the gum health experience questionnaire

Aim To develop and validate a new health-related quality of life measure to capture a wide range of gum-related impacts. Materials and Methods The measure was developed using a multi-stage approach and a theoretical model. Development involved semi-structured interviews, pilot testing, cross-sectional analysis among a general population (n = 152) to assess psychometric properties and test–retest reliability among a subsample (n = 27). Results Psychometric analysis supports the validity and reliability of the measure's impact scale. The measure has excellent internal reliability (nearly all item-total correlations above .4; Cronbach's alpha between .84 and .91 for subscales), with test–retest reliability also performing well (Intra-class correlation coefficient [ICC] of .91–.97 for subscales). Good content validity (indicated by large standard deviations for item and total scores) and construct validity (correlations of .54–.73 with global gum health rating for subscales, all p < .05) were also observed. Qualitative and quantitative data indicate that people with gum health-related symptoms experience different degrees of discomfort and impacts caused by their condition. Conclusions The gum health experience questionnaire holds substantial promise as a measure of gum-related quality of life in people across the gum health–disease continuum. Further face validity, refining and reducing the number of items and longitudinal studies to test evaluative properties are required before the measure can be used with confidence

The effect of near-surface plastic deformation on the hot corrosion and high temperature corrosion-fatigue response of a nickel-based superalloy

Surface treatments such as shot peening to inhibit fatigue crack initiation are essential processes when designing gas turbine components for aerospace applications. It is therefore crucial to understand the effects of shot peening in representative service environments. Here, the influence of surface treatment on the high temperature corrosion fatigue response of a polycrystalline nickel-based superalloy is considered, an area that has not previously been explored. Two shot peening conditions; 110H 7A 200% and 330H 7A 200%, along with a polished surface were chosen. Specimens were salted and exposed to SO2 gas during fatigue testing at 700 °C. A range of novel techniques including SEM, EBSD and axial chromatism profilometry were used to analyse the near surface cold work and surface condition before and after testing. EBSD local misorientation maps, paired with an increase in corrosion-fatigue life, suggest that a greater depth of cold work produced by the smaller shot size (110H), is providing a significant benefit in terms of hot corrosion and corrosion-fatigue performance. This paper concludes that the presence of a substantial layer of cold work is required to account for any metal loss due to the effects of hot corrosion. It is also evident that cold work hinders fatigue crack initiation and delays the onset of pit to crack transition

How Many CMEs Have Flux Ropes? Deciphering the Signatures of Shocks, Flux Ropes, and Prominences in Coronagraph Observations of CMEs

We intend to provide a comprehensive answer to the question on whether all Coronal Mass Ejections (CMEs) have flux rope structure. To achieve this, we present a synthesis of the LASCO CME observations over the last sixteen years, assisted by 3D MHD simulations of the breakout model, EUV and coronagraphic observations from STEREO and SDO, and statistics from a revised LASCO CME database. We argue that the bright loop often seen as the CME leading edge is the result of pileup at the boundary of the erupting flux rope irrespective of whether a cavity or, more generally, a 3-part CME can be identified. Based on our previous work on white light shock detection and supported by the MHD simulations, we identify a new type of morphology, the `two-front' morphology. It consists of a faint front followed by diffuse emission and the bright loop-like CME leading edge. We show that the faint front is caused by density compression at a wave (or possibly shock) front driven by the CME. We also present high-detailed multi-wavelength EUV observations that clarify the relative positioning of the prominence at the bottom of a coronal cavity with clear flux rope structure. Finally, we visually check the full LASCO CME database for flux rope structures. In the process, we classify the events into two clear flux rope classes (`3-part', `Loop'), jets and outflows (no clear structure). We find that at least 40% of the observed CMEs have clear flux rope structures. We propose a new definition for flux rope CMEs (FR-CMEs) as a coherent magnetic, twist-carrying coronal structure with angular width of at least 40 deg and able to reach beyond 10 Rsun which erupts on a time scale of a few minutes to several hours. We conclude that flux ropes are a common occurrence in CMEs and pose a challenge for future studies to identify CMEs that are clearly not FR-CMEs.Comment: 26 pages, 9 figs, to be published in Solar Physics Topical Issue "Flux Rope Structure of CMEs