COVID-19 - A MUTATION IN THE EVOLUTION OF PRE-CLINICAL DENTISTRY AT A REGIONAL UNIVERSITY

BACKGROUND: Dentistry at James Cook University (JCU) began the transition away from traditional lectures in 2018. There was slow uptake from both staff and students to embrace the new university wide pedagogy (JCU, 2017). By the beginning of semester one in 2020 the transition had entered a period of hiatus with a clear divide between those that embraced the new pedagogy and those that did not. Enter the phenomenon which is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the COVID-19 pandemic. AIMS: The aims of this study were to evaluate changes in student participation and satisfaction during enforced online learning and intense practical (clinical skills) learning on return to campus, and the impact on academic staff workload during 2020. METHODS: Participants were students enrolled in Bachelor of Dental Surgery (pre-clinical years) (n=172) and the academics who taught into the pre-clinical years (n=10). Student engagement with the online teaching was analysed and once the university was given permission to return to on-campus activities the staff and students were invited to discuss their experiences via interviews and focus groups conducted via Zoom (Zoom Video Communications, Inc. 2020) RESULTS: Student engagement was low with all online activities and continued to decrease as the semester progressed with fewer students attending “live” sessions, preferring to watch recordings of the sessions, leading to a potential lack of understanding of content. Upon return to campus and in person practical sessions, students appeared to struggle with mastering clinical skills and application of theory. This was reflected in the increase in students requiring supplementary assessment or failing outright. Staff were stressed by the increased level of unknowns as well as the increase in workload caused by the increase in meetings they were required to attend. Staff stress levels continued to remain high once they were able to return to campus due primarily to increased workload resulting from teaching under strict social distancing requirements. CONCLUSIONS: The sudden pivot in pedagogy caused by the COVID-19 pandemic caused high stress levels to students and staff. Staff reported a doubling in the number of meetings they were required to attend and felt that they were under significant stress to adjust to the enforced online teaching pedagogy. The stress levels of staff did not decrease once a return to campus was permitted as classes often had to be double or triple taught to abide by the university’s COVID-19 policies. Students reported that the level of disorganisation they saw in their subjects made studying difficult. There was a small number of students who preferred the online format and felt that their studies were not impacted by the move to online teaching. Students appeared to struggle with the application of the taught theory and mastering clinical skills, essential skills required to progress in their degree. REFERENCES 2020. Zoom (Version 5.1.3) [Computer software]. Zoom Video Communications, San Jose, California, Unites States James Cook University.2014.”Blended Learning Policy” Retrieved 26/04/2017, from https://www.jcu.edu.au/policy/learning-and-teaching/blended-learning-polic

Early Days of going blended for dental students at James Cook University

James Cook University (JCU) has an undergraduate entry Dentistry Course where students are taught with the more traditional face –to – face method using lectures and practicals. Like many universities JCU is moving towards a blended approach to learning, offering a more interactive, self-guided learning experience. The students admitted to dentistry are high achieving, and could be expected to readily engage with online material, however confirmation of this is required to ensure successful engagement and implementation of the blended approach. Aims The aim of this study was to investigate if the dental students currently enrolled in a first year introductory Anatomy and Physiology subject/ unit (n=83) and taught in the traditional method are ready to move towards a blended educational method

A systematic review investigating patient knowledge and awareness on the association between oral health and their systemic condition

Background: The prevalence of the oral-systemic relationship has accounted for potentially preventable chronic conditions and morbidity worldwide. Health literacy is a large contributing factor. This systematic review investigates the knowledge and awareness of patients with major systemic conditions, regarding the oral associations to their condition. Methods: Electronic databases including Medline (Ovid), CINAHL, The Cochrane Library, Web of Science, Informit Health Databases and Scopus were searched. All articles from 2011 to 2020, investigating knowledge of the oral-systemic link, of adult patients with the following major system conditions were searched: diabetes mellitus (DM), respiratory disease, cardiovascular disease (CVD), pregnancy and bone disease. Two independent reviewers completed screening, data extraction and quality assessment. A synthesis without meta-analysis was conducted. Twenty-four studies, from 14 different countries, were included in the systematic review. Results: Analysis showed that globally, patients with major systemic conditions have poor knowledge and awareness (< 50%) of the oral health associations to their condition. Improvements in health education are particularly necessary for patients with heart disease, bone disease and diabetes. Dentists and the media were the most common source of information. There were no relevant studies investigating the knowledge of patients with respiratory disease. Conclusion: To improve the global burden of preventable chronic conditions, it is essential to address inequalities in the dissemination of health education to at-risk populations. Improvements in patient education rely on an increase in patient-practitioner communication on the oral-systemic link, implementation of oral health educational programs and greater interdisciplinary collaboration

Droplet Distribution in a University Dental Clinic Setting: The Importance of High-Volume Evacuation

The purpose of this study is to compare droplet distribution during a piezoelectric ultrasonic debridement procedure using either high-volume or slow-volume evacuation. Droplet distribution during a crown preparation with slow-volume evacuation is also examined. Fluorescein dye is added to the water reservoir and the procedures are performed by a single operator for 15 min on a dental manikin with artificial upper and lower teeth. Placement of filter paper squares (10 cm × 10 cm) in radiating lines away from the oral cavity of the dental manikin allows for visualization of droplet dispersion. Results show minimal difference in the spread of the droplets between the two evacuators during the debridement procedure; however, the slow-volume evacuator produces a higher concentration of droplets than the high-volume evacuator. An even higher concentration of droplets in the vicinity of the dental chair is observed during the crown preparation procedure. This study recommends the use of a high-volume evacuator where possible during professional debridement and crown preparation to reduce contamination around the dental chair from potentially pathogenic microorganisms

Involving psychological therapy stakeholders in responsible research to develop an automated feedback tool: Learnings from the ExTRAPPOLATE project

Understanding stakeholders’ views on novel autonomous systems in healthcare is essential to ensure these are not abandoned after substantial investment has been made. The ExTRAPPOLATE project applied the principles of Responsible Research and Innovation (RRI) in the development of an automated feedback system for psychological therapists, ‘AutoCICS’. A Patient and Practitioner Reference Group (PPRG) was convened over three online workshops to inform the system's development. Iterative workshops allowed proposed changes to the system (based on stakeholder comments) to be scrutinized. The PPRG reference group provided valuable insights, differentiated by role, including concerns and suggestions related to the applicability and acceptability of the system to different patients, as well as ethical considerations. The RRI approach enabled the anticipation of barriers to use, reflection on stakeholders’ views, effective engagement with stakeholders, and action to revise the design and proposed use of the system prior to testing in future planned feasibility and effectiveness studies. Many best practices and learnings can be taken from the application of RRI in the development of the AutoCICS system

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients &lt;18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

The biodegradable lethal ovitrap as a control method for dengue in Cairns, North Queensland with a focus on post four week deployment

Dengue is a mosquito-borne flavivirus and is the leading arboviral cause of mortality and morbidity in the world. The World Health Organization estimates there are ca. 50 million dengue cases yearly, with 2 billion people at risk of contracting dengue. In Australia, 27 outbreaks of dengue have occurred in North Queensland since 2000, resulting in over 2,500 notifiable cases, including two deaths in 2004 and another dengue related death in 2009. The mosquito Aedes aegypti (Linnaeus) (Diptera: Culicidae) transmits dengue in Australia.\ud \ud In Australia current dengue control consists of a combination of source reduction and deployment of Lethal Ovitraps (LO). With increasing numbers and spread of dengue cases a fast, cost-effective control tool was required. This need lead to the development of the Biodegradable Lethal Ovitrap (BLO), an ovitrap made from a starch-based plastic which could be set in the field and allowed to biodegrade over time. If the BLO was to be a true "set and forget" tool against Ae.aegypti (and dengue) it was important to determine what happened to the BLO after the standard four week control period. The aim of this research was to determine the effectiveness of the BLO as a dengue control tool post four weeks deployment. This research also aimed to investigate what impact, if any, the BLO might have on the non-target fauna in the immediate area around where the ovitrap was set. It was also hoped that the research could also determine public acceptability of the BLO as a personal protective tool against mosquito borne diseases.\ud \ud Our results suggest that the BLO is still an effective control tool against Ae.aegypti twenty-two weeks post deployment. The ability of Culex quinquefasciatus (Say) (Diptera: Culicidae) to breed in the BLOs post nine weeks deployment was an important discovery, especially if the BLOs are to be deployed in countries where Cx.quinquefasciatus act as disease vectors. The research did raise the question of chemical resistance becoming an issue with the BLOs in the field for such extended periods of time.\ud \ud The research also found little impact on non-target fauna populations when compared against other non-target studies. Our results suggest that numerous (<90) insect Families are attracted to the BLOs with limited impact on their numbers. Further studies on specific non-targets could be of interest, especially to a broader international audience. Due to the limited number of participants in our BLO public acceptability research, our results were inconclusive, but suggested a limited acceptability. Further research into the acceptability and understanding of mosquito control tools such as the BLOs would be beneficial to mosquito control activities in the future

Lethal ovitrap deployment for Aedes aegypti control: potential implications for non-target organisms

In Australia, dengue control combines source reduction with lethal ovitraps to reduce Aedes aegypti populations during outbreaks. Lethal ovitraps are considered a sustainable and environmentally friendly method of controlling container-inhabiting mosquitoes, however, to-date, this claim has not been quantified. This study assesses the potential impact of lethal ovitraps on non-target organisms when used to control Ae. aegypti in tropical Australia. For retention of specimens, we substituted standard sticky ovitraps for lethal ovitraps. We collected 988 Ae. aegypti and 44,132 non-target specimens over 13 months from 16 sites. Although Ae. aegypti comprised only 2.2% of the total collection, they were were the eighth most dominant taxa collected, on the 93rd percentile. Of the non-target organisms, Collembola were the dominant taxa, 44.2%, with 36.8% and 10.5% Diptera and Hymenoptera, respectively. Of the Dipterans, 61% were family Phoridae. Lethal ovitraps were visited by 90 insect or invertebrate families in total. Ovitraps are attractive to Collembola, Phoridae, Sciaridae, Formicidae, and Culicidae, with minimal attraction by Apidae and other commonly monitored non-target organisms. For container-inhabiting mosquitoes, LOs are cost effective operationally, requiring minimal staff resources for placement and retrieval

Efficacy of methyl bromide fumigation and insecticidal dips against Aedes eggs on lucky bamboo

Importation of lucky bamboo (Dracaena sp.) stalk clusters has led to the accidental importation of Aedes albopictus in some countries. Current methods of fumigation using methyl bromide are harmful to live plants and thus are not acceptable. We exposed Aedes aegypti eggs to methyl bromide at rates of 32 g/m3 for 2 and 3 h and 48 g/m3 for 3 h, achieving complete control in 0/5, 1/5, and 5/5 replicates, respectively. Submersion for 1 min in aqueous solutions of 0.04% active ingredient (AI) lambda-cyhalothrin, 0.04% AI bifenthrin and carbaryl + malathion (both 0.1% AI) + petroleum oil (1% AI) provided 100% control of Ae. aegypti eggs laid on Dracaena stalk clusters. These methods, apparently harmless to plants, would have application in preventing the importation of exotic Aedes eggs on lucky bamboo shipments