Dental students' experiences of treating orthodontic emergencies - a qualitative assessment of student reflections

Introduction Professional regulatory bodies in the UK and Europe state that dental graduates should be able to manage orthodontic emergency patients. Therefore, the aim of this study was to explore dental student experiences of treating orthodontic emergencies within a teaching institution. Materials and method This study was designed as a single-centre evaluation of teaching based in a UK university orthodontic department. The participants were fourth-year dental students who treated orthodontic emergency patients under clinical supervision as part of the undergraduate curriculum. Student logbook entries for one academic year detailing the types of emergencies treated and structured, reflective commentaries for each procedure were analysed using thematic analysis methods. The total numbers and types of orthodontic emergencies treated by students were presented. Overall, self-reported student confidence in managing orthodontic emergencies was calculated. Themes, which represented student reflections, were identified. Results Seventy-two students participated in the study. Overall, 69% of students stated they were confident in managing orthodontic emergencies. Students treated a range of emergencies, of which the most frequent was debonded brackets (38%). Reflections from student commentaries were housed under a primary theme of building procedural confidence. Three subthemes were identified: (i) theory-practice integration; (ii) expanding clinical experience; and (iii) importance of a supportive clinical learning environment. Conclusion The majority of dental students were confident in managing orthodontic emergencies. Theoretical knowledge supplemented by exposure to a range of clinical problems within a supported learning environment made students feel more confident

Urine Complement Proteins and the Risk of Kidney Disease Progression and Mortality in Type 2 Diabetes.

ObjectiveWe examined the association of urine complement proteins with progression to end-stage renal disease (ESRD) or death in people with type 2 diabetes and proteinuric diabetic kidney disease (DKD).Research design and methodsUsing targeted mass spectrometry, we quantified urinary abundance of 12 complement proteins in a predominantly Mexican American cohort with type 2 diabetes and proteinuric DKD (n = 141). The association of urine complement proteins with progression to ESRD or death was evaluated using time-to-event analyses.ResultsAt baseline, median estimated glomerular filtration rate (eGFR) was 54 mL/min/1.73 m2 and urine protein-to-creatinine ratio 2.6 g/g. Sixty-seven participants developed ESRD or died, of whom 39 progressed to ESRD over a median of 3.1 years and 40 died over a median 3.6 years. Higher urine CD59, an inhibitor of terminal complement complex formation, was associated with a lower risk of ESRD (hazard ratio [HR] [95% CI per doubling] 0.50 [0.29-0.87]) and death (HR [95% CI] 0.56 [0.34-0.93]), after adjustment for demographic and clinical covariates, including baseline eGFR and proteinuria. Higher urine complement components 4 and 8 were associated with lower risk of death (HR [95% CI] 0.57 [0.41-0.79] and 0.66 [0.44-0.97], respectively); higher urine factor H-related protein 2, a positive regulator of the alternative complement pathway, was associated with greater risk of death (HR [95% CI] 1.61 [1.05-2.48]) in fully adjusted models.ConclusionsIn a largely Mexican American cohort with type 2 diabetes and proteinuric DKD, urine abundance of several complement and complement regulatory proteins was strongly associated with progression to ESRD and death

Reflections on the development and implementation of interprofessional education between pharmacy and dentistry

Background: Inter-professional education (IPE) is advocated as a key approach for modern healthcare education to develop better readiness for collaborative practice. Reports indicate that it enables the professions to “learn with, from and about each other” and can optimise exchange of experience and expertise. While there have been calls for better dentistry-pharmacy inter-professional education there is limited evidence for best practice. Aim This paper describes learning and reflections and feedback from the process of developing and implementing interprofessional learning activities between dental, pharmacy and hygiene and therapy students. Methods Data collected from staff and from student “post it note” exit polls were collated and analysed using a thematic approach to data. Results The interprofessional learning sessions were most successful when delivered in a clinical setting and when students were able to interact. Challenges for delivery included issues which included timetables, room bookings, staff training/experience, capacity and attitudes. Conclusions Interprofessional educational activity development is itself a learning process of development involving a range of factors that can contribute to success. However, there are many challenges involved. Surrounding support and willingness of staff to try new things and work together to overcome the obstacles is important in the journey to success

Reflections on the development and implementation of interprofessional education between pharmacy and dentistry

Background: Inter-professional education (IPE) is advocated as a key approach for modern healthcare education to develop better readiness for collaborative practice. Reports indicate that it enables the professions to “learn with, from and about each other” and can optimise exchange of experience and expertise. While there have been calls for better dentistry-pharmacy inter-professional education there is limited evidence for best practice. Aim This paper describes learning and reflections and feedback from the process of developing and implementing interprofessional learning activities between dental, pharmacy and hygiene and therapy students. Methods Data collected from staff and from student “post it note” exit polls were collated and analysed using a thematic approach to data. Results The interprofessional learning sessions were most successful when delivered in a clinical setting and when students were able to interact. Challenges for delivery included issues which included timetables, room bookings, staff training/experience, capacity and attitudes. Conclusions Interprofessional educational activity development is itself a learning process of development involving a range of factors that can contribute to success. However, there are many challenges involved. Surrounding support and willingness of staff to try new things and work together to overcome the obstacles is important in the journey to success

Nurses' emotions and oral care for hospitalised adults

Background: It is reported that hospitalised adults require daily oral care to prevent respiratory infections and maintain oral health but patient oral health declines in hospital. Enhancing knowledge and attitudes has not proven effective for changing behaviours or improving oral health. Reports suggest that some nurses find providing oral care unpleasant, therefore, emotions may influence care provision. Aim: To understand how nurses’ and student nurses’ emotional experiences and reactions influence the provision of oral care for hospitalised adult patients. Methods: The initial study explored emotional experiences, reactions and oral care practices. Eight focus groups and ten one-to-one semi-structured interviews with 48 subjects were used to collect data. These were analysed with Grounded Theory. A second study developed and tested methods to measure student nurses’ emotions towards oral care. This used a self-report questionnaire, interviews and Stroop tests. In the final study, 248 student nurses completed a revised self-report questionnaire, a disgust sensitivity questionnaire and two oral care attitude measures; 41 participants additionally completed emotional Stroop tests, implicit association tests and interviews. Qualitative data were analysed with thematic analysis. Χ2 tests, correlations, and Principal Component Analysis were used to analyse quantitative data. Results: Nurses and student nurses experience emotions towards the social, moral and physical aspects of providing oral care; emotions vary with different situations. Unclean mouths are associated with unpleasantness. Failure to provide oral care evokes moral disgust and anxiety. Providing oral care can evoke anxiety and disgust in unpleasant situations, this leads to student nurses reporting altering oral care procedures. Conclusions: Nurses’ and student nurses’ emotions of disgust and anxiety influence oral care. Although these emotions can motivate nurses to provide care, anxiety and disgust can lead to the selection of procedures that avoid aspects of oral care thus reducing the quality of care provided. Nurses’ oral care training programmes need to address these emotions to improve the quality of oral care for patients in hospitals

Professionalism and dental education:in search of a shared understanding

Professionalism has profound historical origins; however, the current health care environment in the UK dental sphere is changing, which presents new professional dilemmas that require continued learning and debate. Professionalism is a key aspect of the education of dental students and the lifelong learning and development of dental practitioners. However, 'being' professional can be challenging because while it is recognised as a social good, there is much debate on what professionalism means and how best it can be learned and assessed. Since 2017, the UK Council for the Dental Teachers of Professionalism, consisting of educators from UK dental schools and dental therapy hygiene institutions, has been exploring and debating the role and place of professionalism, as well as sharing challenges and good practice within UK dental education. This paper includes a narrative overview of current thinking in the academic literature on professionalism to consider the use of a shared understanding of professionalism to facilitate conversations between various stakeholders

Family and friends: supporting oral care in care homes

Objective To consider the role of family and friends in supporting oral care. Background People who live in care homes are susceptible to oral health problems, which can be detrimental to their health and personal and social well‐being. External support from family members and friends has been indicated as being important for maintaining oral health for this vulnerable group of care home residents. Materials and methods Qualitative one‐to‐one interviews were undertaken with care home residents, in Cardiff, UK. Further interviews were undertaken with care home personnel with responsibility for oral health care in order to contextualise residents’ interview data. Interviews were audio recorded, transcribed and analysed using a thematic approach. Results A total of 26 interviews were conducted with care home residents and four interviews with care home personnel, across five care homes. Three main themes emanated from the data relating to co‐supporting oral care: supplying oral care products; accessing dental care and enabling self‐management of oral care problems. There were no spouse caregivers; family and friends acted as co‐supporters of oral care providing a link to residents’ pre‐care home lives by informing the care home personnel of their relatives’ normal routines. An overarching theme “balancing roles – maintaining the equilibrium” emerged from the data reflecting the roles that both care home personnel and family and friends had in balancing the needs, care and well‐being of the resident. Conclusion This study suggests that there are opportunities to improve oral health by providing support for family and friends of those people who are living in care, especially in relation to supplying oral care products, enabling self‐management of oral care problems and accessing dental care

Dentistry: Studying for a chosen career and the role of family, friends and support in that journey

Introduction Well‐being issues are increasing amongst dental students. Social relationships can be important for student support during their studies. The aim of the study was to explore dental students' feelings towards studying dentistry, social networks and chosen support during this journey. Materials and Methods An anonymous electronic cross‐sectional survey was carried out. All dental students in a single dental school were invited to participate. Participation and answering questions was voluntary. Descriptive analyses were used for categorical data, and qualitative data were analysed thematically. Results In total, 109 students responded. One third reported having a family member from a healthcare profession but most were not related to dental professionals. The majority of students 83% liked the course, 14% said they felt “neutral”, and 5% said they did not like it. The following three themes explained this: (a) demands of the course, (b) being suited to dentistry (eg patient care) and (c) passion for dentistry as a career (or lack of). Most felt their peers were friendly (92%) and supportive (78%) but also competitive (64%). Irrespective of stress, 70% of participants sought help from family and two thirds sought help from student peers. Discussion Most students enjoy studying dentistry despite the demands of the course. Support, workload, feeling suited to the course and a passion for dentistry as a career can affect the experience. Conclusions Family and friends are an important source of support in this process. Further work is needed to explore mechanisms to help family and friends support students