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Sabbagh S, Moradi S, Haghi-Ashtiani G, Bakhtibekov G, Manaseki-Holland S, Ravaghi V. Parental acceptance of Silver Diamine Fluoride in two lower-middle-income countries: Iran and Tajikistan. BMC Oral Health 2024; 24:686. [PMID: 38872123 PMCID: PMC11170867 DOI: 10.1186/s12903-024-04434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Using Silver Diamine Fluoride (SDF) may be an effective public health approach for managing dental caries in children. Parental acceptance of SDF has rarely been investigated in low-income and middle-income countries (LMICs). The aim of this study was to evaluate parental acceptance of SDF to manage dental caries in children aged 2-12 in Iran and Tajikistan. METHODS This cross-sectional study was conducted in the Kurdistan province of Iran and Khatlon region of Tajikistan, 2022-2023. Parents watched a video about SDF and its weaknesses and strengths as compared to conventional approaches before completing the questionnaire. We also reported Prevalence Ratios with 95% confidence intervals for the relationship between parental acceptance and associated demographic factors as well as dental attitude and experience. RESULTS Participants were 245 and 160 parents in Iran and Tajikistan, respectively. In both countries, a majority (Iran: 61.6%, Tajikistan: 77.9%) accepted SDF over conventional treatments for all primary teeth. The majority also accepted SDF only for posterior permanent teeth (Iran: 73.5%, Tajikistan: 78.7%). Black discoloration was the main reason for rejecting SDF. Overall, demographic factors and dental experience and attitude were not significantly associated with SDF acceptance. CONCLUSIONS SDF was widely accepted by Iranian and Tajik parents. Establishing parental acceptance of SDF is an important step toward its application in LMICs where inexpensive solutions are needed.
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Affiliation(s)
- Sedigheh Sabbagh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sara Moradi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Gelareh Haghi-Ashtiani
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Samira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
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Nanu CA, Plaiasu MC, Edu A. Geographic and Specialty-Specific Disparities in Physicians' Legal Compliance: A National-Scale Assessment of Romanian Medical Practice. Healthcare (Basel) 2023; 11:healthcare11040499. [PMID: 36833032 PMCID: PMC9957268 DOI: 10.3390/healthcare11040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Physicians must respect their patients' rights to informed consent, privacy, access to medical records, non-discrimination, treatment by a qualified doctor, and a second medical opinion. Compliance with patients' rights is mandatory, and legal breaches are considered medical malpractice under Romanian law. This is the first study to assess physicians' practices nationally and create a geographical map of legal compliance. RESULTS We examined survey responses of 2978 physicians, including 1587 general practitioners and 1391 attending physicians from high-risk specialties. According to the findings, 46.67% of physicians' practices adhered to the law. Physicians' practices were homogenous across the country's regions. General practitioners were significantly more legally compliant than attending physicians were. Additionally, 94.02% of the physicians acknowledged malpractice anxiety, whereas only 17.67% had been accused of malpractice. CONCLUSIONS Our findings emphasize the need for further research and to voice issues about Romanian physicians' low level of legal compliance. This study provides a starting point for future studies to evaluate the benefits of interventional strategies in this field. Healthcare facilities should provide physicians with easily available resources when they are unsure about their legal obligations, and establish an observer organization that can detect unlawful conduct. Interventions should concentrate on education programs and expert guidance.
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Affiliation(s)
- Codrut Andrei Nanu
- Department No. 14 of Orthopedics, Anesthesia and Intensive Care, University of Medicine and Pharmacy “Carol Davila” Bucharest, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Maria Cristina Plaiasu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St, 200349 Craiova, Romania
- Correspondence: ; Tel.: +40-770-112-453
| | - Antoine Edu
- Department No. 14 of Obstetrics and Gynecology, University of Medicine and Pharmacy “Carol Davila” Bucharest, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
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Chapman HR, Golijani-Moghaddam N. Loss of situational control. Br Dent J 2022; 233:981-982. [PMID: 36526747 DOI: 10.1038/s41415-022-5363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Liew J, Zainal Abidin I, Cook N, Kanagasingam S. Clinical decision-making in complex endodontic cases between postgraduate students across dental specialties at a UK dental school: A pilot study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:707-716. [PMID: 34936724 DOI: 10.1111/eje.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/03/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Treatment decisions for a heavily restored endodontically treated tooth vary amongst clinicians owing to multitude of factors. This phenomenon not only often poses dilemmas to clinicians of different clinical backgrounds, but also exerts a degree of treatment difficulty to the treating clinician. Previous studies indicated that specialty training and clinical experience significantly impacted clinical decision-making process. MATERIALS AND METHODS Master of Science postgraduate students in endodontics, prosthodontics, periodontics, oral surgery and implantology participated in a questionnaire-based cross-sectional study. The dental specialties were further categorised into restorative and surgical dentistry. A multiple-choice questionnaire with three clinical cases was distributed to the students. Data were analysed for trends using descriptive statistics. RESULTS There was a 44% response rate; the majority of respondents were from restorative dentistry specialties. Cases 1 and 2 were rated as moderate to high difficulty, and Case 3 was predominantly rated as high difficulty with procedure predictability being the main factor affecting their clinical decision-making in three cases. Endodontic retreatment was selected as the preferred treatment in Cases 1 and 2 and periradicular surgery in Case 3. The students were fairly confident in managing Cases 1 and 2, but not in Case 3. Referral patterns were consistent in Cases 1 and 2 with endodontists being the first choice of referral except for Case 3 where 48% preferred to refer to oral surgeons and 35% choosing endodontists. Some indication of differences between specialties were noted throughout. Years in practice appeared to be related to the importance of predictability in Case 3 only. CONCLUSION Considerable inter-clinician variability was noted whereby specialty postgraduate training impacted on clinical decision-making. Overall, procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most highly ranked factors affecting clinical decision-making. Evidence-based treatment guidelines and dental curricula should be reviewed to enhance inter-clinician agreement in clinical decision-making, ultimately improving patient care.
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Affiliation(s)
| | - Imran Zainal Abidin
- International Islamic University Malaysia, Faculty of Dentistry, Kuantan, Malaysia
| | - Neil Cook
- University of Central Lancashire, School of Dentistry, Preston, UK
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Scott H, Cope AL, Wood F, Joseph-Williams N, Karki A, Roberts EM, Lovell-Smith C, Chestnutt IG. A qualitative exploration of decisions about dental recall intervals - part 2: perspectives of dentists and patients on the role of shared decision making in dental recall decisions. Br Dent J 2022:10.1038/s41415-022-4046-8. [PMID: 35304591 DOI: 10.1038/s41415-022-4046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022]
Abstract
Introduction Patients are sensitive to both the frequency and costs of dental recall visits. Shared decision making (SDM) is a principle of patient-centred care, advocated by the National Institute for Health and Care Excellence and policymakers, whereby joint decisions are made between clinicians and patients.Aims To explore NHS dentists' and patients' attitudes towards SDM in decisions about recall interval.Methods Semi-structured telephone interviews were conducted with 25 NHS patients and 25 NHS general dental practitioners in Wales, UK. Transcripts were thematically analysed.Results While many patients would be happy to accept changes to their recall interval, most wanted to be seen at least annually. Most patients were willing to be guided by their dentist in decisions about recall interval, as long as consideration was given to issues such as time, travel and cost. This contrasted with the desire to actively participate in decisions about operative treatment. Although the dentists' understanding of SDM varied, practitioners considered it important to involve patients in decisions about their care. However, dentists perceived that time, patient anxiety and concerns about potential adverse outcomes were barriers to the use of SDM.Conclusions Since there is uncertainty about the most clinically effective and cost-effective dental recall strategy, patient preference may play a role in these decisions.
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Affiliation(s)
- Hannah Scott
- Research Associate, Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, University Dental Hospital, Heath Park, Cardiff, CF14 4XY, UK
| | - Anwen L Cope
- Honorary Lecturer in Dental Public Health, Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, University Dental Hospital, Heath Park, Cardiff, CF14 4XY, UK.
| | - Fiona Wood
- Professor of Medical Sociology, Division of Population Medicine, School of Medicine, Cardiff University and PRIME Centre Wales, Heath Park, Cardiff, CF14 4YS, UK
| | - Natalie Joseph-Williams
- Senior Lecturer, Division of Population Medicine, School of Medicine, Cardiff University and PRIME Centre Wales, Heath Park, Cardiff, CF14 4YS, UK
| | - Anup Karki
- Consultant in Dental Public Health, Public Health Wales, Capital Quarter, Cardiff, CF10 4BZ, UK
| | - Emyr M Roberts
- Principal Dentist, The Courtyard Dental Care, Cardiff, UK; Dental Practice Advisor, Cardiff and Vale University Health Board, Woodland House, Cardiff, CF14 4TT, UK
| | | | - Ivor G Chestnutt
- Professor and Honorary Consultant, Dental Public Health, School of Dentistry, Cardiff University and PRIME Centre Wales, UK; Clinical Director, University Dental Hospital, Cardiff and Vale University Health Board, UK; Director of Postgraduate Studies, School of Dentistry, Cardiff University, University Dental Hospital, Heath Park, Cardiff, CF14 4XY, UK
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Failure to obtain informed consent should also be considered an adverse event. J Dent Sci 2020; 15:232-233. [PMID: 32595908 PMCID: PMC7305433 DOI: 10.1016/j.jds.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/30/2019] [Indexed: 11/20/2022] Open
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Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention. Adv Prev Med 2020; 2020:6752342. [PMID: 32518697 PMCID: PMC7256733 DOI: 10.1155/2020/6752342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
Oral diseases are highly prevalent and a global burden. Accordingly, their prevention appears essential. Recently, different strategies have been developed, mainly focusing on the presence of singular oral diseases or conditions. This article aims to construct a contemporary concept of individualized preventive care in dentistry whereby the focus is switched from viewing oral health in isolation to viewing the patient as a whole. The basis for individualized prevention measures is the case-oriented profile, including the synthesis of risk- and need-oriented parameters. The risk profile comprises different risk factors within the fields of systemic diseases, medications, and lifestyle that inherently pose a potential risk of complications (e.g., infectious endocarditis) and/or oral diseases (e.g., periodontitis). The needs profile includes factors originating from the aspects of oral diseases, dental restorations/appliances, and dental results with a potential risk of pathogenesis (e.g., the de novo development of caries) and/or the potential progression of oral diseases (e.g., an existing caries lesion). Based on these parameters, the general framework and content of prevention measures, as well as the maintenance interval, should be adapted to the individual patient. The implications of this concept might increase the safety, effectiveness, and efficiency of prevention in dental care. A further area of focus is primary prevention, that is, a focus on the preservation of oral health instead of a disease-related approach. However, clinical validation is needed to prove the benefits of the model presented. Individualized prevention promotes a shift from a disease-focused model to a whole-patient-focused model and provides a potential approach for establishing a contemporary concept for preventive care in dentistry.
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Loughlin M, Buetow S, Cournoyea M, Copeland SM, Chin-Yee B, Fulford KWM. [Not Available]. J Eval Clin Pract 2019; 25:911-920. [PMID: 31733025 DOI: 10.1111/jep.13297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022]
Abstract
There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as "ethical add-ons" but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that "sits within the minds" of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to 'integrate' different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts.
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Affiliation(s)
- Michael Loughlin
- European Institute for Person-Centred Health and Social Care, University of West London, London, UK
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Michael Cournoyea
- Institute for the History and Philosophy of Science, University of Toronto, Toronto, Canada
| | - Samantha Marie Copeland
- Ethics and Philosophy of Technology Section, Department of Values, Technology and Innovation, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | | | - K W M Fulford
- Collaborating Centre for Values Based Practice, University of Oxford, Oxford, UK
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