Naresuan University Journal
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Managing chronic orofacial pain: A qualitative study of patients', doctors', and dentists' experiences
No full textOBJECTIVE: Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners. DESIGN: Qualitative interview study. METHODS: Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed. RESULTS: Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a diagnosis proved problematic but largely functional for both parties. GPs and dentists viewed COFP as a non-dental problem and felt inadequately equipped to manage the condition. GPs, unlike dentists, felt obligated to support patients using techniques for managing patients with other long-term conditions. Frustration at the current inadequacy of COFP management often led to conflict with (or disengagement from) the clinician-patient relationship. CONCLUSIONS: Current management of COFP is ineffective and unsatisfactory for patients and practitioners, which impacts on their relationship. Fundamental barriers to accessing and implementing psychological interventions for COFP arise from ineffective communication between physicians and patients, and between medical and dental practitioners. Statement of contribution What is already known on this subject? COFP is characterized by persistent pain in the face, mouth, or jaws that are not the result of organic disease or physical trauma. Patients with COFP present to both medical and dental services and receive sub-optimal care. No studies have examined the experiences of managing this problem from the perspectives of dentists, general practitioners and patients. What does this study add? Patients, dentists, and GPs recognize the role that psychological factors have in maintaining and addressing facial pain symptoms, yet principally manage it through biomedical interventions. Challenges exist over arriving at a diagnosis and managing the problem, and challenges are exacerbated by poor communication between doctors and medical services. Improvements are needed in liaison between medical and dental services and further training to support primary care clinicians to facilitate a stepped care approach to managing COFP
The acceptability and usefulness of Mindfulness Based Cognitive Therapy (MBCT) for people living with psoriasis: A qualitative study
No full textResponding to the rising power 'threat': pharmaceutical MNEs and the intellectual property 'institutional void'
No full textPurpose: This article explores how established MNEs have responded to the perceived threat from rising power firms by seeking to alter the intellectual property institutional environment in key emerging economies. Design/Methodology/approach: The key place of emerging economies in the efforts of established MNEs to seek patent law change is discussed. Two case studies review developments related to pharmaceutical patents in India and South Africa, highlighting the influence of MNEs in driving policy change and the contested nature of their actions. Findings: While India and South Africa both present evidence of MNEs seeking to influence pharmaceutical patent laws, distinct differences emerge. In India, most MNE pressure has been in response to the emergence of an active domestic industry and a patent law oriented towards generic entry, while the MNE priority in South Africa has been geared towards maintaining MNE dominance and a system which leads to generous granting of patents. Practical implications: Managers and decision-makers seeking to invest in emerging economies must take account of a plethora of institutions present, some of which may be better suited towards local industrial and societal interests and may prompt resistance to any established MNE-led attempt at institutional change. Originality/value: The article offers a comparative perspective on pharmaceutical patent laws in India and South Africa, which have been subject to significant contestation by policymakers, civil society organisations and both rising power and established MNEs. The comparison explores and questions the increasingly widespread “institutional void� thesis in international business
Reporting quality of randomized controlled trial abstracts presented at European Orthodontic Society congresses
No full textObjectives: To assess the reporting quality of randomized controlled trial (RCT) abstracts presented at the European Orthodontic Society (EOS) congresses, investigate any improvement after the release of CONSORT (CONsolidated Standards Of Reporting Trials) for Abstracts guidelines, and identify factors associated with reporting quality. Methods: Abstract books of the 2003-07 (Pre-CONSORT period) and 2010-14 (Post-CONSORT period) EOS congresses were obtained from the official website of European Journal of Orthodontics. A hand-search was conducted to identify RCTs. Reporting quality was assessed and scored using the original 17-item CONSORT for Abstracts checklist. Risk ratio and the t-test were used to compare the adequate reporting rate of each item and the overall quality in two periods, respectively. Univariate and multivariate regressions were used to identify predictors of reporting quality. Results: A total of 138 RCT abstracts were included and assessed. The mean overall CONSORT score was 4.10 (SD: 1.32) and 4.48 (1.31) in the Pre- and Post-CONSORT samples, respectively [P = 0.099; mean difference, -0.39 (95% CI: -0.84, 0.07)]. Only three CONSORT items ('objective', 'interventions', and 'conclusions') were adequately reported in most abstracts (>75 per cent). No abstract provided information regarding the corresponding author, trial registration, and source of funding. Less than 1.5 per cent of the included abstracts sufficiently reported 'randomization', 'recruitment', and 'outcome in the results section'. In the multivariate analysis, greater word count (P = 0.036) and provision of the exact P value (P = 0.006) were significantly associated with higher reporting quality. Limitations: Our final regression model can explain only about 8 per cent of the variance of reporting quality. Other predictors not included in this study may be investigated in analogous studies. Conclusions: The reporting quality of RCT abstracts presented at EOS congresses was suboptimal. Joint efforts by authors and conference committees to improve reporting are needed
Late-stage fatigue damage in a 3D orthogonal non-crimp woven composite: An experimental and numerical study
No full textLate-stage fatigue damage of an E-glass/epoxy 3D orthogonal non-crimp textile composite loaded in the warp direction has been investigated using a combination of mechanical testing, X-ray micro computed tomography (μCT), optical microscopy and finite element modelling. Stiffness reduction and energy dissipated per cycle were found to be complementary measurements of damage accumulation, occurring in three stages: a first stage characterised by rapid changes, a more quiescent second stage, followed by a third stage where the (decreasing) stiffness and (increasing) energy dissipation change irregularly and then rapidly, to failure. Microscopy of specimens cycled into the transition between the second and third stages showed macroscopic accumulations of fibre fractures in sections of warp tows which lying adjacent to the surface weft tows which are crowned-over by the Z-tows. At these locations, the warp tow fibres are subjected to stress concentrations both from transverse weft tow matrix cracks and resin pocket cracks
Locomotor flexibility in Lepilemur explained by habitat and biomechanics
No full textThere are at present few comparable studies of lemur locomotion in the wild. This has unfortunately meant we have little knowledge about locomotor variation, and hence flexibility, with regard to differences in support availability and habitat structure. Here we compare the locomotion of Lepilemur edwardsi at Ankarafantsika with that of Lepilemur ruficaudatus at Kirindy-Mitea National Park. While data were collected by two individuals, at different times, both studies used the same data collection protocol and are hence highly comparable. Locomotor mode, support diameter and orientation, heights, and distances traveled were all collected. We find that locomotor specialization, in this case for vertical leaping, has ensured that some support requirements are independent of habitat. For example, both species used vertical supports most often. However, overall support diameter does indicate a certain degree of flexibility, whereby L. ruficaudatus most often used supports ≤5 cm in diameter and L. edwardsi >5 cm in diameter. Am J Phys Anthropol 156:58–66, 2015 © 2014 Wiley Periodicals, Inc
