1,721,056 research outputs found
The use of clinical photographs to determine clinician’s perception of the need for orthognathic surgery in patients of different racial backgrounds presenting with class 3 skeletal discrepancy
Full text linkAim: To investigate the impact of patients’ race on clinician’s perception of the need for orthognathic surgery in patients with class 3 profiles.
Design: Prospective cross-sectional questionnaire.
Method: A questionnaire was distributed to consultant and specialist orthodontists and oral and maxillofacial surgeons in the United Kingdom and Hong Kong. It contained average composite profile images of adult male and female patients from two different racial backgrounds (Caucasian and Chinese) which had been manipulated to produce increasingly severe class 3 skeletal discrepancies in 2mm increments from baseline (0mm) in both the mandible; (+2mm, +4mm, +6mm), and maxilla; (-2mm, -4mm, -6mm). Respondents were asked whether they felt that ‘a patient presenting with this skeletal pattern would benefit from orthognathic surgery’ and ‘how do you rate the level of attractiveness of the profile?’ on a 7- point Likert scale. Multi-level logistic regression and multi-level linear regression were used to investigate factors influencing decision to recommend surgery and perception of attractiveness.
Results: The response rate was 62% (N=306). Significantly more clinicians felt that the manipulated class 3 profiles would benefit from surgery compared with baseline (p=<0.006, p<0.001). Oral and maxillofacial surgeons were 3.94 times more likely to recommend surgery than orthodontists (p=<0.001). The image’s race and gender, clinician’s years since becoming a specialist, specialty and the number of orthognathic patients treated per year were statistically significant factors for predicting perceived benefit from surgery (p<0.001). Attractiveness ratings for all manipulated class 3 profiles were statistically significantly different to baseline (p<0.001). Attractiveness ratings reduced with increasing severity of class 3 manipulation with -6mm maxilla being rated least attractive (p=<0.001). Maxillary manipulations were on average rated as less attractive than the mandibular manipulation with the same degree of discrepancy. Ethnicity was a statistically significant factor associated with attractiveness rating with Caucasian profiles rated more attractive than Chinese profiles for the same degree of manipulation (p=<0.001).
Conclusion: Oral and maxillofacial surgeons are more likely to perceive benefit from surgery in patients with class 3 skeletal profiles than orthodontists. Ethnicity significantly impacts decision making with Chinese profiles more likely to be perceived as having benefit from surgery than Caucasian profiles, and Caucasian profiles rated as more attractive than Chinese, for the same degree of discrepancy. Mild class 3 skeletal profiles are rated as significantly more attractive than baseline with attractiveness decreasing with increasing severity of the class 3 profile.
Keywords: Orthognathic surgery, class 3 profile, Chinese, Caucasian, facial attractiveness, need for surger
Reliability of Cervical Vertebrae Maturation (CVM) Staging Method using Full versus Cropped Lateral Cephalograms
Full text linkAn investigation of the predictors, barriers and facilitators to recruitment and retention of children and families to oral health trials
Full text linkThis thesis presents a detailed investigation into the predictors, barriers and facilitators to recruitment and retention of children and families in oral health trials. Study 1 is a systematic review of the predictors of recruitment and retention to RCTs involving children and families with no specific health focus. This study concludes that younger, those with low socioeconomic backgrounds, less well-educated and ethnic minority parents are less likely to be recruited and retained on RCTs; although there was disagreement between studies. Study 2 has an oral health focus and investigates study design predictors of recruitment and retention to trials involving children and families. The study findings were that trials over a year in length, set in community based settings with healthy participants were most likely to experience problems with recruitment and retention. Study 3 is a qualitative interview and focus group study with participants who continued and/or withdrew from the Salford Bright Smiles Baby Study (a community based early childhood caries trial with children ages 1-3 and their parents). Parents were motivated to take part in the study through wanting to be a better parent and wanting good oral health for their child. Facilitators to participation were flexibility in how the study was designed and delivered, e.g. nursery and home appointments and multiple forms of contact. Amongst the barriers to taking part were fear of being judged by others and the burden of participation. Finally study 4 is a quantitative analysis of the sociodemographic and oral health belief predictors of retention of participants on the Salford Bright Smiles Baby Study. This found that younger, unemployed lesser educated parents were less likely to remain on the trial to the end of the study.
The thesis also provides insight into the quality of reporting of recruitment and retention in oral health trials. Whilst study two found that use of the CONSORT guidelines has increased over time, oral health trials still have a lower use of the guidelines than other research areas.
To date very few studies have investigated predictors of recruitment and retention with children and families, even fewer in the field of oral health. This thesis presents a unique investigation into the actual barriers and facilitators to participation and provides findings that can be applied to future research with children and families. Specifically, recommendations to increase participation in longitudinal, community based oral health trials are presented
A review of multiple hypothesis testing in relation to the use of lateral cephalometric variables as the outcome measure in orthodontic research
Full text linkThe health inequalities associated with post-stroke visual impairment
Full text linkAim: The aim of this project was to explore the possible health inequalities facing visually impaired stroke survivors and any possible means of overcoming these.
Methods: This research consisted of three phases of work. The first phase included the development of three systematic reviews, investigating the overall health inequalities previously identified within this population, along with a review of the inequalities in assessing and treating post-stroke visual impairments. The second phase involved the recruitment of 1500 stroke admissions into an epidemiological clinical study across three hospital sites in the North West of England. Longitudinal follow-up assessments of their visual impairments was used to statistically analyse the recovery rates of post-stroke visual impairments between different patient groups. The third phase explored the long-term health inequalities facing stroke survivors as a result of their visual impairments. This was conducted using qualitative and thematic analysis of patient responses from telephone conversations regarding non-attendance of hospital appointments. Moreover, descriptive analysis of a nationwide survey of orthoptists was used to investigate an orthoptic home visit service as a potential means of addressing the health inequalities identified through the telephone conversations. Finally, thematic analysis of focus groups and one-to-one interviews with stroke survivors further explored additional, long-term issues caused by post-stroke visual impairments.
Results: Health inequalities exist before the onset of stroke, during hospital care and following hospital discharge. The findings from this research have identified older patients, those that suffer severe strokes and those discharged to supportive forms of living are most at risk of the following health inequalities: suffering visual impairment after stroke, poor access to outpatient services and poor recovery of the visual impairments. Patient gender, ethnicity, area deprivation and whether the patient had an infarction or haemorrhage were not found to be significant factors in the above inequalities. Additional, inequalities identified from interviews with visually impaired stroke survivors were found to impact on the physical being, the psychosocial being, and the organisation of healthcare services.
Conclusion: Key recommendations from this research include the need to incorporate vision as a priority of stroke care nationally. Where patients struggle to attend appointments due to stroke and visual disabilities, efforts should be made to address the barriers to attending. A domiciliary orthoptic service and the contribution of vision services to early supported discharge teams could address a small number of the identified inequalities. Furthermore, addressing the possible long-term, physical and psychosocial impact of post-stroke visual impairments prior to hospital discharge could further reduce some of the health inequalities facing this population
The non-pharmaceutical impact of silicon dioxide nanoparticles in the reduction of fungal growth (Candida albicans) on Vacuum Formed Retainers
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Teaching Orthodontic Emergencies Using The "Flipped Classroom" Method Of Teaching - A Mixed Methods Randomised Controlled Trial
Full text linkIntroduction: The General Dental Council requires newly graduated dentists are competent when managing orthodontic emergencies. Undergraduate students typically receive limited exposure to clinical orthodontics, with the ideal management of these scenarios largely delivered through conventional lectures. The flipped classroom method of teaching involves knowledge being acquired in students’ own time, with class time instead focussing on construction of meaning.
Methods: 61 undergraduate dental students were randomised into either a flipped or conventional group. The conventional group (n=30) attended a lecture describing the management of six common emergencies. The flipped group (n=31) were given access to six videos via a virtual learning environment and later completed practical tasks related to the material. Both groups completed a SBA assessment. Perceptions of flipped classroom teaching were explored via focus groups.
Results: For questions on orthodontic emergencies, the conventional group had a mean exam result of 70.5% (S.D. 8.0%) compared with the flipped group result of 72.8% (S.D. 12.9%). There was no significant difference between the groups (p=0.532). For regular orthodontic questions the conventional group had a mean exam result of 64.8% (S.D. 19.9%) compared with 78.3% (S.D. 21.7%). There was no significant difference between the groups (p=0.083). Thematic analysis identified the following themes: ways in which videos encourages more effective learning, improved engagement, awareness of learning needs and proposed teaching / curriculum changes. The overarching theme was facilitating an experiential learning cycle using flipped classroom teaching.
Conclusions: The flipped classroom method of teaching resulted in comparable exam performance and improved levels of satisfaction
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