The Arabic version of the modified dental anxiety scale Psychometrics and normative data for 15-16 year olds

Objectives: To prepare an Arabic version of the Modified Dental Anxiety Scale (MDAS) and provide normative information including evidence to support the validity of the measure.Methods: The MDAS was translated into Arabic and back-translated into English. Data collection took place in Amman, Jordan from March 2009 to March 2010. One thousand and six hundred two 10th grade students took part in the study (15-16 years of age) sampled from 32 schools. Questionnaire consisted not only of the MDAS, but also (i) a single global question on dental anxiety to test concurrent validity, (ii) a question on helplessness in the dental surgery to test construct validity and (iii) demographic profile.Results: The level of missing data was minimal for the translated scale. The internal consistency for this sample using the Arabic MDAS was 0.87 (95% confidence interval was 0.86-0.88). The measure was a one-dimensional scale. The proportion of the sample that was highly dentally anxious was 22% (&gt;= 19 cut-off score). Expected differences between gender and self-reported dental attendance were observed. There were clear significant relationships as predicted between the Arabic MDAS and (i) a single item measure of dental anxiety and (ii) feeling helpless in the dental chair on a previous occasion.Conclusion: The Arabic version of the MDAS can be employed for brief assessment of dental anxiety.</p

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)