An appraisal of the quality of published qualitative dental research

Qualitative research in dental traumatology-A narrative review

This review highlights the recent contributions of qualitative research in advancing understanding of dental trauma injury and the barriers and enablers to guide policy for improved patient-centred care including transitional care. It summarises the common approaches and methods used and outlines the key factors that guide the appraisal of qualitative studies. It highlights the importance of the application of qualitative research methods in dental research to generate rich and detailed data to provide explanations and insights into people's experiences, beliefs and attitudes and the complexity of human decision-making and behaviour. In the past decade while there have been a growing number of publications of qualitative studies in dental journals, qualitative studies remain a small percentage of the published dental traumatology research. This may be because of limited understanding about the background, methods and rigour of qualitative research.

Role of Multidetector Computed Tomography Urography in the Evaluation of Obstructive Uropathy: A Review

Obstructive uropathy, a prevalent clinical problem, can irreparably harm the kidneys if not treated promptly. As a result, accurate diagnosis is necessary for prompt management. This study examines the utility of multidetector computed tomography (MDCT) urography in identifying obstructive uropathy. PubMed, Google, Embase, Medline, and other electronic databases were used to search the English-language literature. The search phrases were obstructive urinary infections or urinary bladder or kidneys or MDCT. The authors' expertise and experience in the subject area aided in archiving pertinent publications. Even though the dilated upper tract of the ureters can be seen, ultrasonography (USG) has limitations because it cannot show the middle portion of the ureters, even if they are dilated mostly due to bowel gas artifacts. The USG does not emphasize the functioning of the renal tract. To evaluate obstructive uropathy, MDCT urography plays a very important role. For speedy, effective therapy, it provides a quick diagnosis of the source of obstruction.

Hematuria as a Sign of Kidney Stone Disease Evaluated Using Computed Tomography: A Review

Kidney stone is a common cause of acute pain in the abdomen in patients presenting to casualty. Being present in roughly 12% of the world's population makes it the most prevalent pathology of the urinary system. The ureters, kidneys, and bladder frequently develop calculi, resulting in hematuria. The most effective imaging technique for evaluating calculi is unenhanced helical computed tomography. The population, intervention, control, and outcomes (PICO)-formatted question was used to generate methodological medical subject heading (MeSH) phrases, which increased the search strategy's sensitivity in finding research. Some of these names ("hematuria") included "renal calculi" (MeSH) and "cone-beam computed tomography" (MeSH). Studies that satisfied these requirements were subjected to critical evaluation. The merits of the listed studies were evaluated using a unique quality assessment scale. The most accurate imaging diagnostic test for people with hematuria is multidetector computed tomography. If a patient over 40 presents with microscopic hematuria, a non-contrast computed tomography or ultrasound study should be performed, and if gross hematuria is observed, cystoscopy should be added. Pre- and post-contrast computed tomography scans and cystoscopy should be carried out on elderly patients.

A critical review of qualitative research publications in dental implants from 2006 to 2020

OBJECTIVES

This critical review is aimed to investigate the current status of qualitative research in dental implant research and to explore the quality of available information.

MATERIAL AND METHODS

A systematic search was done on the journal databases to identify dental implant research articles that used qualitative methodology during 2006 and 2020. The resulting articles were appraised against the checklist offered by the Critical Appraisal Skills programme (CASP) tool. Also, the theories evolved from the research were reviewed to understand the value of this methodology in dental implant research.

RESULTS

Twenty-five (25) articles out of the 8,421 original results were identified as using qualitative methodology. The researchers have sought to identify the views of patients about tooth loss, dental implants, and the information they receive from dental professionals, and views of the dentists about dental implant practice. The review found that there were few inconsistencies in the quality of such research especially the qualitative data analysis.

CONCLUSIONS

The quantity of qualitative research in dental implants remains low; however, the quality has improved in the past two decades. Despite these improvements, there is still a lack of research in understanding both patients' and dentists' views on dental implant procedures and management.

Self-management in children and young people with epilepsy: A systematic review and qualitative meta-synthesis

The aim of this review was to conduct a meta-synthesis of qualitative studies exploring the self-management experiences, attitudes and perspectives of children and young people (CYP) living with epilepsy. Five databases were systematically searched up to September 2019. Fourteen papers were included. One analytical theme: self-management strategies was generated informed by four descriptive themes; concealment; medicine adherence; self-monitoring of activities; and seeking social support. The synthesis identified that while CYP with epilepsy engage in specific self-management strategies, there is limited evidence in understanding self-management and the processes underlying the use of it. Future research examining self-management in childhood is required.

Dental educators' attitudes towards the teaching of dental amalgam

OBJECTIVE

To ascertain dental educators' attitudes towards the teaching of dental amalgam at dental schools in Australia and identify preferred curricular approaches in a potentially "amalgamless" profession.

METHODS

A mixed methods analysis was employed based on an open-ended response survey followed by a closed-ended questionnaire. Identification of key issues from the survey helped frame the questionnaire. Participants included those with expertise in operative and restorative dentistry, with direct involvement in curriculum development or delivery, at Australian dental schools.

RESULTS

Participants numbered fifteen and represented seven of the nine dental schools in Australia. Key themes identified and explored included the following: (in)consistency of approach to teaching restorative dentistry; a perceived disconnect between undergraduate study and the "real world"; a need for a focus on teaching of alternatives to dental amalgam (80 per cent (strongly) agreeing); the contradictory nature of the evidence base and literature that is not readily understood; the need for more post-graduate education relating to adhesive restorative materials (86 per cent (strongly) agreeing); the need for dental amalgam to continue to be available; formal understandings (guidelines) as to the use of dental amalgam; dental schools in Australia being heard on these issues; and the relevance of this issue (100 per cent (strongly) agreeing the issue is topical and important).

CONCLUSION

There is a broad consensus of dental educators at Australian dental schools as how best to approach the teaching of amalgam if a phase-down is to occur and the issues any such approach may face.

The association between smoking and periapical periodontitis: a systematic review

OBJECTIVES

The purpose of this systematic review was to examine if, in adult patients, the absence or presence of smoking influenced the prevalence of periapical periodontitis (PP).

MATERIALS AND METHODS

Databases were searched, and original research manuscripts up to June 2019 were identified by two reviewers. The Newcastle-Ottawa Scale (NOS) was used for risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. A meta-analysis was performed using RevMan 5 software. Risk ratio (RR) was used for the cohort studies, and odds ratio (OR) was used for the case-control studies with 95% confidence interval (CI).

RESULTS

All the studies had many covariates and confounding variables. Three longitudinal cohort articles discussed radiographic findings as they related to the prevalence of PP in root-filled teeth. The RR of smoking and the prevalence of PP was 2.11 (95% CI 0.88-5.05, p = 0.09). Nine case-control studies focused on the prevalence of PP and smoking. There was a positive association between smoking and the prevalence of PP with an OR of 2.78 and a 95% confidence interval of 2.23-3.48, with p value < 0.05. The quality of the studies was fair per NOS, and the certainty of the literature assessment was moderate per GRADE.

CONCLUSIONS

The current best available evidence suggests that smoking was associated with the prevalence of PP but more studies are needed to report this association in the longitudinal cohort studies.

CLINICAL RELEVANCE

Smoking has a positive association with the prevalence of PP.

Empathy among dental students: A systematic review of literature

BACKGROUND

Empathy is just as relevant within dentistry, although research is limited in this field and very less is available in the current literature. The demonstration of empathy by dentists has been correlated with decreased dental fear. The authors systematically reviewed the literature to investigate empathy levels among dental students.

METHODS

A systematic review of the literature was undertaken concerning dental students' empathy, published from November 2016 to June 2018, using manual methods and the PubMed, PMC, PsycINFO, and other databases. Articles not in English and not concerned with dentistry were excluded, and intervention studies intended to enhance empathy, opinion articles, and reviews or reports of nonoriginal research were excluded. Eligible studies were those published from January 1, 2005, to May 31, 2017, in English language. A total of 34 full-text articles were obtained and assessed. Of these 34 papers, only seven publications were considered to have met the inclusion criteria and were directly related to the aim of literature search.

RESULTS

Only seven articles that provided data and evidence describing empathy among dental students were included. Four studies reported that the difference in mean empathy level across the year of study was statistically significant (P < 0.05), and one reported that there was no significant difference in empathy scores between the year levels of study. Three articles reported that males had higher mean empathy score than females, whereas vice versa was found in the remaining four articles.

CONCLUSION

This article demonstrates that there is only a limited evidence to provide the understanding of empathy among dental students. The results indicated that as patient exposure increases, the empathy level decreases among dental students. Furthermore, it is observed that education in behavioral sciences may be effective in increasing self-reported empathy, and further training may be necessary to maintain high levels.

Factors influencing national implementation of innovations within community pharmacy: a systematic review applying the Consolidated Framework for Implementation Research

Background

To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations.

Methods

A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis.

Results

Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations.

Conclusions

This study’s focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts.

Trial registration

A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876).

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0867-5) contains supplementary material, which is available to authorized users.

Validation transculturelle de contenu de la version franco-canadienne de l’échelle COREQ

Purpose: The main purpose of this article is to produce a French-Canadian translation of the Consolidated criteria for reporting qualitative studies (COREQ) scale under the proposed name "échelle COREQ" and to assess the transcultural validity of its content. The secondary purpose is to examine the inter-rater reliability of the French-Canadian version of the COREQ scale. Method: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used. First, a parallel back-translation of the COREQ scale was performed, by both professionals and clinicians. Next, a first committee of experts(P1) examined the translations to create a first draft of the French-Canadian version of the COREQ scale. This draft was then evaluated and modified by a second committee of experts (P2). Finally, 28future professionals (master's students in physiotherapy) rated this second draft of the tool for clarity using a seven-point scale (1:very clear; 7:very ambiguous). The principal co-investigators then reviewed the problematic elements and proposed final changes. Two independent raters used this French-Canadian version of the COREQ scale to assess 13qualitative studies that were published in French after the year2007. The kappa coefficient was used to examine inter-rate reliability. Results: The different elements of the final version of the COREQ scale received an average ambiguity rating between 1.04 and 2.56. These low values show a high level of clarity for the French-Canadian version of the COREQ scale. In relation to the total score of the COREQ scale, inter-rater reliability (n = 2) is considered to be average to excellent for 62.5% of individual elements, according to the kappa values obtained. Conclusions: A valid French-Canadian version of the COREQ scale was created using this rigorous five-step process.

Appraising Qualitative Research for Evidence Syntheses: A Compendium of Quality Appraisal Tools

As the movement toward evidence-based health policy continues to emphasize the importance of including patient and public perspectives, syntheses of qualitative health research are becoming more common. In response to the focus on independent assessments of rigor in these knowledge products, over 100 appraisal tools for assessing the quality of qualitative research have been developed. The variety of appraisal tools exhibit diverse methods and purposes, reflecting the lack of consensus as to what constitutes appropriate quality criteria for qualitative research. It is a daunting task for those without deep familiarity of the field to choose the best appraisal tool for their purpose. This article provides a description of the structure, content, and objectives of existing appraisal tools for those wanting to evaluate primary qualitative research for a qualitative evidence synthesis. We then discuss common features of appraisal tools and examine their implications for evidence synthesis.

Interviews and focus groups in qualitative research: an update for the digital age

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

Evidence in Orthodontics related to qualitative research

Introduction:

Research in Orthodontics has historically followed the positivist model based on the direct relationship of cause and effect between diseases and their specific etiological factors. Despite the objectivity and the great potential of statistical procedures, quantitative methods have progressively been sharing space with other models that can encompass the multiplicity of factors that affect the health-disease process, which until such time was reduced to its biological dimension.

Objectives:

This study aims, through an integrative review, to identify orthodontics articles published over a 10-year period that have used, exclusively or not, some method of qualitative research, and analyze the main aspects of their content.

Methods:

A survey was performed on Pubmed, Medline, Scopus, and Lilacs databases from 2007 to 2016 with a focus on the applicability of the qualitative methodology in orthodontic research.

Results:

The 27 articles selected showed a trend to increase in publications, with the most recent four years concentrating almost 60% of them. Most studies were from Europe, particularly the UK, and the more frequent study objectives were related to the perception of people about the reasons for orthodontic treatment, about the aesthetic and psychosocial impact of malocclusion or orthodontic treatment, and the implications of these factors for their quality of life.

Conclusions:

Because of its potential to explore behaviours and socio-cultural attitudes sustained in subjectivity, qualitative research offers new possibilities for orthodontic studies and can be used in an exclusive or complementary way in relation to quantitative methods.

Association between Systemic Diseases and Endodontic Outcome: A Systematic Review

INTRODUCTION

To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes.

METHODS

Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers.

RESULTS

Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes.

CONCLUSIONS

Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes.

Association of genetic polymorphism and external apical root resorption

Objective:

To evaluate the relationship between genetic polymorphism and external apical root resorption.

Methodology:

The protocol was prepared and registered on PROSPERO. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies of all relevant articles and textbooks were manually searched.

Results:

Thirteen studies met the inclusion criteria. Four studies were classified as low-quality studies (score &lt;10), and nine studies were classified as high-quality studies.

Discussion:

The results of the present review suggest that, although some authors have reported that genetic polymorphism may play a role in external apical root resorption, others have not supported this association. Future studies should be more consistent in their research methodologies to determine with clarity whether an association exists.

Conclusion:

Future investigations should include larger sample sizes with matching cases/controls, adjust for confounders, provide power calculation and odds ratios, and report genetic analyses with the Hardy-Weinberg equilibrium. The current investigation suggests guidelines and recommendations for future investigators studying genetic polymorphism in patients undergoing orthodontic treatment.

Evidence-based recommendations for antibiotic usage to treat endodontic infections and pain: A systematic review of randomized controlled trials

BACKGROUND

The purpose of this investigation was to identify evidence-based scientific methodologies to aid dental clinicians in establishing the indications for prescribing antibiotics for endodontic infection or pain.

METHODS

The authors prepared and registered a protocol on PROSPERO. They conducted electronic searches in MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov. In addition, the authors hand searched the bibliographies of all relevant articles, the gray literature, and textbooks for randomized controlled clinical studies. The authors independently selected the relevant articles.

RESULTS

The overall quality of the studies was fair with a low risk of bias, but 2 studies had a moderate risk of bias.

CONCLUSIONS

The best available clinical evidence signals no indications for prescribing antibiotics preoperatively or postoperatively to prevent endodontic infection or pain unless the spread of infection is systemic, the patient is febrile, or both. Generally, an accurate diagnosis coupled with effective endodontic treatment will decrease microbial flora enough for healing to occur.

PRACTICAL IMPLICATIONS

To help decrease the number of drug-resistant microbes, oral health care providers should not prescribe antibiotics when they are not indicated.

Experiences of UK health-care services for people with Multiple Sclerosis: a systematic narrative review

BACKGROUND

Multiple Sclerosis (MS) is a chronic, degenerative condition with an estimated UK prevalence of 100 000. Contact with health-care services is frequent and long-term; however, little research has investigated the experiences of health care for MS in the UK.

OBJECTIVE

The aim of this systematic narrative review was to critically review qualitative studies reporting patients' experiences of health-care services in the UK.

SEARCH STRATEGY

EMBASE, CINAHL, Medline, psychINFO and MS Society databases were searched with no date restrictions using search terms denoting 'Multiple Sclerosis', 'health-care services', 'patient', 'experience' and 'qualitative research'. Snowballing and hand searching of journals were used.

INCLUSION CRITERIA

Studies were included if they used qualitative methods of data collection and analysis to investigate adult patient's experiences of health-care services for MS in the UK.

DATA EXTRACTION AND SYNTHESIS

Data were extracted independently and analysed jointly by two reviewers. Studies were appraised for the quality of evidence described using the Critical Appraisal Skills Programme's qualitative tool. Due to the breadth of areas covered, the data were too heterogeneous for a synthesis and are presented as a narrative review.

MAIN RESULTS AND DISCUSSION

Five studies were included. Studies primarily investigated diagnosis or palliative care. Themes of importance were the emotional experience of health care, continuity of care and access to services, and support from health-care professionals. Studies were mainly poor quality and focussed on a homogenous sample.

CONCLUSIONS

This study provides the first review of the UK evidence base of experiences of health care for MS. Future research should investigate experiences of care after diagnosis in a more varied sample of participants.

The acceptability of care provided by dental auxiliaries: A systematic review

BACKGROUND

Dental auxiliaries undertaking a limited range of intraoral clinical procedures normally performed by dentists could increase access to care and control costs, yet their acceptability to patients has been questioned. The aim of this study was to assess data on the social acceptability and patient satisfaction of dental auxiliaries performing intraoral clinical procedures.

METHODS

The authors searched 14 electronic databases and 2 trial registries for studies of any design (from inception to November 2013). They searched gray literature databases (from inception to July 2014), reference lists of included studies, and high-yield journals (from January 2000 to December 2014). Risk of bias was assessed, and data were extracted.

RESULTS

The authors identified 29 studies: 25 considered experiential and 4 on social acceptability. Twenty-three were cross-sectional, 2 were qualitative, 1 was mixed-methods, and 3 had unclear methods. The authors found that patients reported high acceptability of care, comparable or better than that from dentists. Social acceptability varied, with care for children being less acceptable. One-fifth of people were unwilling to receive any treatment from a dental auxiliary. All studies were at high risk of bias, and quality of the evidence was low.

CONCLUSIONS

Experiential acceptability of dental auxiliaries by patients appeared high in this study, but their social acceptability varied.

PRACTICAL IMPLICATIONS

Given the age of the studies, their settings, and their quality, generalizability to dental practices is limited. Additional high-quality, methodologically rigorous studies are needed.

Short-term use of nonsteroidal anti-inflammatory drugs and adverse effects: An updated systematic review

BACKGROUND

In this article, the authors examine the available scientific evidence regarding adverse effects of short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Short-term use was defined as 10 days or fewer.

METHODS

The authors reviewed randomized controlled clinical trials and cohort and case-controlled clinical studies published between 2001 and June 2015 in which the investigators reported on the safety of nonselective cyclooxygenase inhibitors and of cyclooxygenase-2 selective inhibitor NSAIDs.

RESULTS

The systematic review process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines allowed the authors to identify 40 studies that met the inclusion criteria.

CONCLUSIONS

On the basis of the available scientific evidence, NSAIDs may be considered relatively safe drugs when prescribed at the most effective dose and for the shortest duration of time, which was defined to be 10 days or fewer.

PRACTICAL IMPLICATIONS

Although the US Food and Drug Administration recommends the use of NSAIDs beyond 10 days to be accompanied by a consultation with a health care provider, the use of NSAIDs may be considered relatively safe when prescribed at the most effective dose and for the shortest duration of time, which was defined as 10 days or fewer. Exceptions would be for patients at risk of developing NSAID-exacerbated respiratory disease, patients with prior myocardial infarction who are receiving antithrombotic therapy, patients with asthma, and patients with a history of renal disease.

The Contradictions of Telehealth User Experience in Chronic Obstructive Pulmonary Disease (COPD): A Qualitative Meta-Synthesis

OBJECTIVE

As the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake.

METHOD

Systematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool.

FINDINGS

705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking-(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of 'work' practices (causes burden or empowerment).

CONCLUSION

Findings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at an earlier stage of telehealth/service development.

Patients' experience of partial tooth loss and expectations to treatment: a qualitative study in Danish and Swedish patients

Knowledge of impairments, wishes and expectations is essential to make correct decisions regarding oral rehabilitation. The purpose of this study was to investigate discomforts, wishes and expectations in patients' with partial edentulism before entering oral rehabilitation. In Copenhagen, Denmark, and Malmö, Sweden, respectively, 20 patients with partial edentulism seeking rehabilitation were interviewed in a semistructured qualitative manner. The interviews were transcribed and analysed yielding overall domains. Six themes appeared as overall domains: (i) experienced impairments, (ii) experienced social awareness, (iii) expectation to treatment, (iv) expectation to durability/survival, (v) coping strategies dealing with the tooth loss including explanations of the tooth loss and (vi) modifications to experienced impairment. The impairments were mostly experienced as problems in social settings. Most participants expressed a simple wish to function normally; a fixed solution was preferred. Many Danish participants accepted a removable solution whereas only few Swedish participants did so. The domains 'coping strategies' and 'modifications' were not part of the chosen topics of interest, indicating a high wish of the participants to explain their tooth loss and how they coped with it. In conclusion, a large degree of social impairment was found in the patient group along with several coping strategies. The impairments were modified by a number of factors indicating that highly individualised care and treatment is needed. A state of normality was described as the primary treatment wish with a higher acceptance of removable solutions in Denmark than in Sweden. For final decision-making, surrounding factors seemed to influence the patients' choices.

Perspectives on next steps in classification of oro-facial pain - part 2: role of psychosocial factors

This study was initiated by a symposium, in which the present authors contributed, organised by the International RDC/TMD Consortium Network in March 2013. The purpose of the study was to review the status of biobehavioural research - both quantitative and qualitative - related to oro-facial pain (OFP) with respect to the aetiology, pathophysiology, diagnosis and management of OFP conditions, and how this information can optimally be used for developing a structured OFP classification system for research. In particular, we address representation of psychosocial entities in classification systems, use of qualitative research to identify and understand the full scope of psychosocial entities and their interaction, and the usage of classification system for guiding treatment. We then provide recommendations for addressing these problems, including how ontological principles can inform this process.

Implementation of intersectoral community approaches targeting childhood obesity: a systematic review

The implementation of intersectoral community approaches targeting childhood obesity (IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies.

Patient-centred care in general dental practice--a systematic review of the literature

Background

Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice.

Methods

A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice.

Results

Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework.

Conclusions

This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research.

Influence of mHealth interventions on gender relations in developing countries: a systematic literature review

INTRODUCTION

Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women's empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities.

METHODS

A systematic literature review was conducted to examine the empirical evidence of changes in men and women's interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study's characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences.

RESULTS

Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple's health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women's decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women's participation.

CONCLUSION

Efforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed.

How do dentists and their teams incorporate evidence about preventive care? An empirical study

OBJECTIVES

To identify how dentists and their teams adopt evidence-based preventive care.

METHODS

A qualitative study using grounded theory methodology was conducted. We interviewed 23 participants working in eight dental practices about their experience and work processes, while adopting evidence-based preventive care. During the study, Charmaz's grounded theory methodology was employed to examine the social process of adopting preventive dental care in dental practices. Charmaz's iteration of the constant comparative method was used during the data analysis. This involved coding of interview transcripts, detailed memo-writing and drawing diagrams. The transcripts were analyzed as soon as possible after each round of interviews in each dental practice. Coding was conducted primarily by AS, supported by team meetings and discussions when researchers compared their interpretations.

RESULTS

Participants engaged in a slow process of adapting evidence-based protocols and guidelines to the existing logistics of the practices. This process was influenced by practical, philosophical, and historical aspects of dental care, and a range of barriers and facilitators. In particular, dentists spoke spontaneously about two deeply held 'rules' underpinning continued restorative treatment, which acted as barriers to provide preventive care: (i) dentists believed that some patients were too 'unreliable' to benefit from prevention; and (ii) dentists believed that patients thought that only tangible restorative treatment offered 'value for money'. During the adaptation process, some dentists and teams transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. Resources were needed for the adaptation process to occur, including: the ability to maintain the financial viability of the practice, appropriate technology, time, and supportive dental team relationships.

CONCLUSIONS

The findings from this study show that with considerable effort, motivation and coordination, it is possible for dental practices to work against the dental 'mainstream' and implement prevention as their clinical norm. This study has shown that dental practice is not purely scientific, but it includes cultural, social, and economic resources that interfere with the provision of preventive care.

Impact of dentofacial deformity and motivation for treatment: a qualitative study

INTRODUCTION

Satisfaction with the outcome of orthognathic treatment is generally high; however, an important minority remains dissatisfied with the results. The reasons for this could be inadequate patient understanding and preparation, external motivation, and unrealistic expectations. In-depth appreciation of these issues can be obtained using qualitative research methods, but there is a paucity of qualitative research in this field.

METHODS

This was a cross-sectional qualitative study of orthognathic patients conducted at a teaching hospital. In-depth interviews were conducted with 18 prospective orthognathic patients. The data were managed by using the framework approach and analyzed by using the critical qualitative theory.

RESULTS

Two main themes were explored in the interviews: the impact of the dentofacial deformity and the motivation for treatment. Both the everyday problems of living with a dentofacial deformity and the motivation for seeking treatment could be classified either as exclusively practical (including functional and structural), exclusively psychological (including psychosocial and esthetic), or a combination. Different coping strategies were also described. The sources of motivation ranged between purely external to purely internal, with most subjects between these 2 extremes.

CONCLUSIONS

In this article, we present a classification of the impact of dentofacial deformity that is a refinement of the traditional one that includes esthetic, functional, and psychosocial factors. The motivating factors, together with the triggers for accessing treatment and the source of motivation, are generally linked directly or indirectly to the problem and the impact of the condition. However, in a few patients, the motivation might not relate to the impact of the problem but to a complex array of other factors such as personality, upbringing, and relationships. Therefore, clinicians should not make assumptions but explore these factors on an individual basis without preconceived ideas.

Methodological challenges in the study of dental occlusion

This narrative review describes the methodological challenges in the study of dental occlusion. The reigning confusion about the scope of this topic is discussed, and a conceptual framework for understanding dental occlusion research is suggested. The characteristics of clinical studies used in the study of dental occlusion are presented within this proposed framework consisting of a triad comprising the relative positions of the teeth-mandible-maxilla, the oral functions and oral appearance. Challenges in the preparation for a clinical study of dental occlusion are reviewed, which include a discourse on the objectives of a clinical study and appropriateness of different study designs. Guidelines are provided for the conduct of studies with a central focus on dental occlusion and diagnostic tests, prognosis, therapy and aetiology, respectively. Summarising chapters present methodological challenges in designing a clinical study of dental occlusion and threats to the proper conduct of a clinical study.