Adjuncts for the evaluation of potentially malignant disorders in the oral cavity

BACKGROUND: Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity. TYPES OF STUDIES REVIEWED: The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice

Dental hygienists\u27 perceptions of their professional status and prestige

A national survey of dental hygienists was conducted to determine their perceptions of their professional status and prestige. In addition, this study was used to determine if differences exist between the perceptions of dental hygienists who are leaders in the field, directors of dental hygiene education programs, dental hygiene educators and private practitioners. Currently, there is no information within the dental hygiene literature that examines this relationship or makes comparisons between groups. A simple random sampling procedure was used to determine the sampled populations of dental hygienists who are leaders, directors of dental hygiene programs, dental hygiene educators and practitioners. Hall\u27s Occupational Inventory and the Allied Health Professions Prestige Rating Scale were used. Two mailings of the instrument were conducted to establish an adequate response rate. A total of 1145 of the 1491 participants returned usable surveys yielding a 76.79 percent response rate. Mean scores for Hall\u27s Occupational Inventory indicated that leaders had the strongest perception of professional status followed by directors, practitioners and educators. The ANOVA test revealed a statistically significant difference among the groups in terms of the total scale scores. Examination of control variables such as level of education and number of years involved in dental hygiene using ANCOVA did not reveal any significant differences among the groups. In terms of occupational prestige, the sampled population ranked dental hygiene third of thirteen allied health occupations. The ANOVA test revealed a statistically significant difference among the groups in terms of the relative ranking of dental hygiene as an occupation. The ANCOVA test did not reveal significant differences when the control variables were considered. The findings provide baseline information relative to the development of dental hygiene as a profession. Dental hygienists demonstrated strong perceptions of professional status and prestige. These perceptions may enable dental hygienists to understand how professional status and prestige impacts the development of dental hygiene as a profession

A Qualitative Study on Preparing Baccalaureate Nursing Students for Community/Public Health Nursing as Perceived by Nurse Educators and Administrators

Abstract Background: Educational preparation of baccalaureate nurses remains entrenched in yesterday’s health care, hospital-centric environment. A culture change among nurse educators and in nursing education is needed to prepare competent practitioners capable of practicing from a health promotion/ disease prevention, community/population focused construct.Objective: This study utilized a qualitative phenomenological research design to determine the belief systems and values of baccalaureate nurse educators and administrators in preparing baccalaureate nursing students for community/public health nursing.Population: Thirteen nurse educators and six nurse administrators from two urban baccalaureate university schools of nursing participated in the study.Methods: An in-depth semi-structured interview based on Kotter’s 8-Step Change model was conducted.Results: Six distinct belief systems and five personal and professional values emerged from analysis of the data. The six belief systems were: health care is really changing, nursing curriculum needs to change, nursing care begins in the community, nursing continues to be a growing and emerging profession, the baccalaureate nursing degree needs to be the entry level degree for nursing practice, and the motivation for being a nurse is to help others. The five values were: professionalism, compassionate care, collaborative practice, community service, and honesty, integrity, and credibility. Change, conflict, and challenge emerged as the major themes. Interpretation:  A need for re-envisioning nursing education and practice to improve patient care and promote patient health and wellness from a community and population focused perspective is prompting the need for nurse educators and administrators to re-define and prepare a new nursing workforce for the 21st century. For a change in the educational approach to preparing baccalaureate nursing students to occur, it is critical that baccalaureate nurse educators and administrators acknowledge the role their belief systems and values play in preparing baccalaureate nursing students for practice in the changing national and global societal and health care environment.Conclusion:  Further research is needed to determine the best curricular approach for preparing baccalaureate nursing students for community/public health nursing practice

Adjuncts for the evaluation of potentially malignant disorders in the oral cavity Diagnostic test accuracy systematic review and meta-analysis—a report of the American Dental Association

BackgroundOral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.Types of studies reviewedThe authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsThe authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence).Conclusions and practical implicationsCytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice