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Agha B, Helal NMS, Al-Khafaji TJ, Farie GA, Basri O, Fleming PS. Knowledge assessment on cleft lip and palate among recently graduated dentists: a cross-sectional study. BMC Oral Health 2023; 23:689. [PMID: 37749556 PMCID: PMC10521468 DOI: 10.1186/s12903-023-03388-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The complex presentation, associated co-morbidities and multi-disciplinary requirements dictate the requirement for in-depth knowledge in order to effectively manage patients with cleft lip and palate (CLP). We aimed to develop a validated questionnaire for cleft lip and palate knowledge assessment and to evaluate the knowledge of cleft lip and palate among a group of recently-graduated dentists. MATERIALS AND METHODS A multiple-site, cross-sectional questionnaire-based study was conducted. The study population included recently graduated dentists involved in a dental internship program. A bespoke questionnaire was developed and validated, with internal consistency assessed using Cronbach's alpha and factor analysis performed. A 47-item prototype was distilled into a 15-item questionnaire. This was distributed to the participants with a response rate of 67% obtained. RESULTS The overall proportion of correct responses among dental interns was moderate (73%). The best results were found in relation to CLP treatment including the effect of unfavorable surgical outcomes on speech (89.5%) and the impact of CLP on the occlusion (87.6%). The lowest rate of correct responses (26.7%) was identified in relation to the association between CLP and smoking. CONCLUSION A validated CLP questionnaire was developed, permitting evaluation of the knowledge of cleft lip and palate and its management among recently graduated dentists. There is limited appreciation among dental interns of the risk factors for CLP as well as post-surgical complications. Given that general dentists are often the gatekeepers for the management of patients with cleft lip and palate, it is important that the findings of this survey are used to inform the curriculum and teaching of cleft lip and palate.
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Affiliation(s)
- Bahn Agha
- Department of Pedodontics, Orthodontics and Preventive Dentistry, College of Dentistry, Mustansiriyah University, Baghdad, Iraq.
| | | | - Thaer Jaber Al-Khafaji
- Pedodontics, Orthodontics and Preventive Dentistry Department, College of Dentistry, University of Babylon, Babylon, Iraq
| | - Ghada Abdullah Farie
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Basri
- Department of Dentistry, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Padhraig S Fleming
- Dublin Dental University Hospital, The University of Dublin, Trinity College Dublin, Dublin, Ireland
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2
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Forer O, Cohen E, Ben-Bassat Y, Zini A, Shalish M. Orthodontic Treatment of Patients With Clefts: Satisfaction and Psychological Aspects. Cleft Palate Craniofac J 2023; 60:1149-1156. [PMID: 35469455 DOI: 10.1177/10556656221093934] [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] [Indexed: 11/17/2022] Open
Abstract
To assess parents' satisfaction with cleft child's facial appearance and function; compare these findings with orthodontist (expert) satisfaction and evaluate influence of various factors on satisfaction. Cross-sectional study. Sixty-three parents of non-syndromic patients with clefts (ages 7-20 years), and an orthodontist, completed the Cleft Hearing, Appearance and Speech Questionnaire. Two scores were produced: cleft-associated, and non-cleft-associated features. Additional open questions were presented to the parents. Both parents and orthodontist gave high satisfaction scores (mean: 8.4 & 8.2, respectively), significantly correlated, for the cleft-associated features (P < .001). Parents were least satisfied with appearance of teeth, then nose, then lips. Scores did not vary significantly with age and sex of patients. Higher parents' satisfaction was found in the unilateral cleft lip + alveolus (UCL + alveolus) group, compared with the unilateral cleft lip and palate (UCLP), regarding cleft-associated features, and compared with cleft palate (CP), regarding non-cleft-associated features (P < .05). Greater parents and orthodontist satisfaction were found when parents' education was >12 years. Parents of Jewish ethnicity showed higher satisfaction, compared with parents of non-Jewish ethnicity. Patients requiring future surgery received lower scores. Parents satisfaction was directly correlated to socioeconomic status. The following factors appear to lower parents' satisfaction: [1] cleft severity, [2] hearing or speech of CP/BCLP patients, [3] requirement for further surgery, and [4] low socioeconomic status. Severe cases may require additional explanation to parents in order to lower expectations. A more thorough explanation may be required in patients of lower socioeconomic status.
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Affiliation(s)
- Olga Forer
- Department of Orthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Erica Cohen
- Department of Orthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Yocheved Ben-Bassat
- Department of Orthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Avraham Zini
- Department of Community Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Miriam Shalish
- Department of Orthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
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3
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Dudding T, Martin S, Popat S. An introduction to the UK care pathway for children born with a cleft of the lip and/or palate. Br Dent J 2023; 234:943-946. [PMID: 37349451 PMCID: PMC10287563 DOI: 10.1038/s41415-023-5998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/24/2023]
Abstract
Cleft lip and/or palate includes a spectrum of congenital disorders affecting union on the lip, alveolus, hard and/or soft palate. The management of children born with an orofacial cleft requires a complex process from a multidisciplinary team (MDT) to restore form and function. Since the Clinical Standards Advisory Group (CSAG) report in 1998, the UK has reformed and restructured cleft services to improve the outcomes for children born with a cleft.The spectrum of cleft conditions, the members of the MDT and a chronological description of the stages of cleft management from diagnosis to adulthood are described using a clinical example. This paper forms the introduction to a series of more detailed papers which span all major aspects of cleft management. The papers will cover the following topics: dental anomalies; associated medical conditions among children; orthodontic management of patients; speech assessment and intervention; role of the clinical psychologist; challenges for the paediatric dentist; genetics and orofacial clefts; surgery - primary and secondary; restorative dentistry; and global perspectives.
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Affiliation(s)
- Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK; The Spires Cleft Centre, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Serena Martin
- The Spires Cleft Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sandip Popat
- The Spires Cleft Centre, John Radcliffe Hospital, Oxford, United Kingdom
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Houkes R, Smit J, Mossey P, Don Griot P, Persson M, Neville A, Ongkosuwito E, Sitzman T, Breugem C. Classification Systems of Cleft Lip, Alveolus and Palate: Results of an International Survey. Cleft Palate Craniofac J 2023; 60:189-196. [PMID: 34812658 PMCID: PMC9843539 DOI: 10.1177/10556656211057368] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. DESIGN A cross-sectional survey. PARTICIPANTS A total of 197 registrants from three international cleft/craniofacial meetings. INTERVENTIONS Participants were sent a web-based questionnaire concerning cleft classification systems. MAIN OUTCOME MEASURES Frequency of commonly used classification systems, their perceived indications and limitations. RESULTS A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. CONCLUSIONS Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.
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Affiliation(s)
- Ruben Houkes
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
| | - Johannes Smit
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
- Johannes A. Smit, Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children's Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Mossey
- Department of Dentistry, University of Dundee Dental Hospital & School, Dundee, Scotland, UK
| | - Peter Don Griot
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
| | - Martin Persson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Amanda Neville
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Edwin Ongkosuwito
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tom Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Corstiaan Breugem
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
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5
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Molyneaux C, Sherriff M, Wren Y, Ireland A, Sandy J. Changes in the Transverse Dimension of the Maxillary Arch of 5-Year-Olds Born With UCLP Since the Introduction of Nationwide Guidance. Cleft Palate Craniofac J 2021; 59:1064-1071. [PMID: 34282648 PMCID: PMC9272515 DOI: 10.1177/10556656211028511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine whether the transverse dimensions of the maxillary arch of
5-year-old children with unilateral cleft lip and palate (UCLP) have changed
following centralization of cleft services in the United Kingdom. Design: Retrospective cross-sectional study. Setting: Digital analysis of UCLP maxillary dental casts. Participants: All available maxillary dental casts from 5-year-old participants of the
Clinical Standards Advisory Group (CSAG, N = 114) and Cleft Care UK (CCUK, N
= 175) studies. Interventions: Quantitative measurements of the intercanine width (ICW), intermolar width
(IMW), and the distance from the midline to the greater and lesser side
canine (GC/LC) and greater side and lesser side second primary molar
(GE/LE). Degree measurements of the greater and lesser arch form angles,
arch length, anterior palatal depth (APD), and posterior palatal depth were
also measured. Main outcome: Differences between the transverse dimensions of the maxillary arch for the
CSAG and CCUK cohorts. Results: In 5 (ICW, IMW, LC, LE, and APD) of the 11 measurements, there was a
statistically significant difference between the CSAG and CCUK cohorts. In
all of these, the CCUK values were greater than CSAG. Conclusions: There have been small but positive improvements for the transverse maxillary
dimensions since centralization of the UK cleft service.
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Vithlani G, Stephenson K, Beale V. The Cleft Clinic Passport-Improving the Patient Experience. Cleft Palate Craniofac J 2020; 58:928-930. [PMID: 33174458 DOI: 10.1177/1055665620970420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Challenges in patient and public understanding of the cleft multidisciplinary team (MDT) clinic were highlighted in the Cleft Care UK report in 2012. An innovative personalized visual guide was designed to improve understanding of cleft MDT clinic and encourage child engagement at the Royal Manchester Children's Hospital. We demonstrate the use of Public and Patient Involvement to produce this novel visual educational tool in the Cleft MDT setting, which can form part of a personal health record.
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Affiliation(s)
- Gauri Vithlani
- 8946Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Katy Stephenson
- 8946Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Victoria Beale
- 8946Royal Manchester Children's Hospital, Manchester, United Kingdom
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7
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Grewal SS, Ponduri S, Leary SD, Wren Y, Thompson JMD, Ireland AJ, Ness AR, Sandy JR. Educational Attainment of Children Born with Unilateral Cleft Lip and Palate in the United Kingdom. Cleft Palate Craniofac J 2020; 58:587-596. [PMID: 32990032 PMCID: PMC8044616 DOI: 10.1177/1055665620959989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. Design: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. Setting: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). Patients, Participants: Five-year olds born with nonsyndromic UCLP (n = 268). Main Outcome Measure(s): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. Results: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a −2.26 (−3.55 to −0.97) lower APS compared to those with 0 to 1 poor outcomes. Conclusions: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.
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Affiliation(s)
- Sukhraj S Grewal
- 61139King's College London Dental Institute, London, United Kingdom
| | - Sirisha Ponduri
- Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, United Kingdom
| | - Sam D Leary
- NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Yvonne Wren
- Speech and Language, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - John M D Thompson
- Department of Obstetrics & Gynaecology, Faculty of Health Science and Medicine, 1415University of Auckland, Auckland, New Zealand
| | - Anthony J Ireland
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - Andy R Ness
- Epidemiology, NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Jonathan R Sandy
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
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8
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Alighieri C, Peersman W, Bettens K, Van Herreweghe V, Van Lierde K. Parental perceptions and expectations concerning speech therapy-related cleft care - a qualitative study. JOURNAL OF COMMUNICATION DISORDERS 2020; 87:106028. [PMID: 32659479 DOI: 10.1016/j.jcomdis.2020.106028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
AIMS Speech (i.e., resonance, nasal airflow and articulation) is one of the primary outcomes in individuals with a cleft of the palate with or without a cleft of the lip (CP ± L). Therefore, it is highly important to obtain information regarding parental perceptions and expectations concerning speech therapy-related cleft care. Literature investigating these parental perspectives is scarce. The present study investigated perceptions and expectations of parents of children with CP ± L concerning (outcomes of) speech therapy. METHODS Eleven parents of nine children with CP ± L were recruited from the multidisciplinary craniofacial team at the Ghent University hospital. A qualitative design, using semi-structured interviews, was used to collect data. Data were managed using NVIVO software version 10 and analyzed thematically. RESULTS The analysis resulted in three major themes: (1) service provision, (2) patient-centered care, and (3) seeking health care. Each of these identified themes were divided into three subthemes. Service provision included the effectiveness of the provided service, interdisciplinary collaboration, and expertise of the speech therapist. Information provision, child-friendly attitude and connection were categorized under patient-centered care. Seeking health care included affordability, practical considerations and the selection of a speech therapist. CONCLUSION The most prominent expectation of the parents was that they wanted to see their children progress during the speech intervention. This finding supported the importance of experienced and specialized speech-language pathologists (SLPs) in the provision of care to children with a CP ± L. Moreover, the results showed that the majority of the parents wanted more clear and comprehensive information particularly about the treatment progress, the transfer to the home environment and the prognosis. The present findings might aid SLPs, and more generally all health professionals, in gaining insight into parental perceptions and expectations concerning speech therapy-related cleft care. Thereby, treatment quality might be improved.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium.
| | - Wim Peersman
- Research Group Social and Community Work, Odisee University College, Warmoesberg 26, 1000 Brussel, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium
| | - Vienna Van Herreweghe
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Road Hillcrest, Pretoria, South Africa
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9
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Weidler EM, Britto MT, Sitzman TJ. Facilitators and Barriers to Implementing Standardized Outcome Measurement for Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 58:7-18. [PMID: 32662298 DOI: 10.1177/1055665620940187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Identify facilitators and barriers to implementing standardized outcome measurement in cleft care. DESIGN Cross-sectional, qualitative study. SETTING/PARTICIPANTS Participants included 24 providers and staff from a large, multidisciplinary cleft team in the southwest United States, 5 caregivers of children with cleft palate (with or without cleft lip) treated by this team, and 3 experts involved in implementing a cleft-specific standardized outcome measurement in the United Kingdom. INTERVENTIONS Semistructured, qualitative interviews were conducted exploring perceived facilitators and barriers to implementing standardized outcome measurement in cleft care. Interviews were audio-recorded, transcribed, and analyzed for content. The Consolidated Framework for Implementation Research was used to guide the interviews and analysis. The analysis focused on the characteristics of standardized outcome measurement that directly influence its adoption. RESULTS Participants identified both facilitators and barriers to implementing standardized outcome measurement. Facilitators included the strength and quality of evidence supporting improvements in cleft care delivery following implementation of standardized outcome measurement and the relative advantage of standardized outcome measurement over continuing the status quo. Barriers included the difficulty adapting standardized outcome measurement to meet local context and patient-specific needs and the complexity of implementing standardized outcome measurement. CONCLUSIONS Providers, staff, and caregivers involved in cleft care perceive multiple benefits from standardized outcome measurement, while also recognizing substantial barriers to its implementation. Results from this study can be used to guide development of an implementation strategy for standardized outcome measurement that builds upon perceived strengths of the intervention and reduces perceived barriers.
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Affiliation(s)
- Erica M Weidler
- Department of Clinical Research, Phoenix Children's Hospital, AZ, USA
| | - Maria T Britto
- Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
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10
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Setabutr D, Sathavornmanee T, Jitpakdee P, Nudchawong S, Krergmatukorn P. The Trend of Cleft Care at a Children's Referral Center in Thailand. Cleft Palate Craniofac J 2020; 57:1100-1104. [PMID: 32452240 DOI: 10.1177/1055665620922103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the trend in cleft care at a major children's referral center in Bangkok, Thailand. STUDY DESIGN Retrospective chart review. PATIENTS AND METHODS A review of 129 patients under 18 years of age who had underwent care by the senior author for cleft treatment between January 2015 and October 2017 was done. The impact of varying factors on patient care was analyzed. We compare our demographics and treatment timeline to that of previously published literature in more developed countries. SETTING Tertiary care medical center. RESULTS One hundred and two patient charts were reviewed with 53% male patients. Most patients had both cleft lip and cleft palate, 44%. Cleft lips most commonly were complete and occurred on the left side. In all, 77.4% of clefts were nonsyndromic. On average, primary cleft lip surgery was delayed being performed about 11 months of age. Sixteen percent of patients were treated with an obturator, while 11 patients had nasoalveolar molding use. Hearing screenings occurred on average at around 6 months of age. Abnormal tympanograms were evident in 32% of individuals. There was a significant difference in timing of surgery for patients who lived a distance greater than 30 kilometers from the hospital versus those from the Bangkok metropolis (P < .05). CONCLUSION Reviewing data from a high-volume referral center in Thailand reveals mild variance with regard to cleft care timing compared to published literature from the developed world. Distance traveled was found to impact timing of surgery.
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Affiliation(s)
- Dhave Setabutr
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.,Department of Otolaryngology, Queen Sirikit National Institutes of Health, Bangkok, Thailand
| | - Thanakrit Sathavornmanee
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.,Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Polpatt Jitpakdee
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.,Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Songphon Nudchawong
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Penpak Krergmatukorn
- Department of Plastic Surgery, Queen Sirikit National Institute of Children's Health, Bangkok, Thailand
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Leung LTF, Loock CA, Courtemanche R, Courtemanche DJ. A Cross-Sectional Analysis of the BC Children's Hospital Cleft Palate Program Waitlist. Plast Surg (Oakv) 2019; 27:311-318. [PMID: 31763331 PMCID: PMC6851733 DOI: 10.1177/2292550319876664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE A 2016 review of the BC Children's Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program's care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic. DESIGN Cross-sectional. SETTING BC Children's Hospital Cleft Palate-Craniofacial Program. PATIENTS Five hundred seventy-six waitlisted patients. MAIN OUTCOME MEASURES Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines. RESULTS Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis (P = .019), a need for formal speech assessments or evaluations (P < .001), or a requirement to see multiple specialists (P < .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment. CONCLUSION Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.
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Affiliation(s)
- Leslie Tze Fung Leung
- Division of Plastic Surgery, University of British Columbia, Vancouver,
British Columbia, Canada
| | - Christine A. Loock
- Division of Developmental Pediatrics, University of British Columbia,
Vancouver, British Columbia, Canada
| | - Rebecca Courtemanche
- Division of Plastic Surgery, University of British Columbia, Vancouver,
British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital,
Vancouver, British Columbia, Canada
| | - Douglas J. Courtemanche
- Division of Plastic Surgery, University of British Columbia, Vancouver,
British Columbia, Canada
- Division of Plastic Surgery, Department of Surgery, BC Children’s Hospital,
Vancouver, British Columbia, Canada
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12
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Stock NM, Costa B, White P, Rumsey N. Risk and Protective Factors for Psychological Distress in Families Following a Diagnosis of Cleft Lip and/or Palate. Cleft Palate Craniofac J 2019; 57:88-98. [PMID: 31378083 DOI: 10.1177/1055665619862457] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Despite the potential psychological impact of a diagnosis of cleft lip and/or palate (CL/P) on parents, few large-scale studies currently exist. Utilizing data extracted from The Cleft Collective Birth Cohort Study, the current study aimed to examine the psychological impact of the diagnosis on parent and family functioning and to identify risk and/or protective factors contributing to parental adjustment in order to inform future psychological intervention. METHODS Parent-reported questionnaire data were extracted for 1163 parents (644 mothers and 519 fathers). Outcome measures included the PedsQL-Family Impact Module, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and a condition-specific tool designed by the Psychology Clinical Excellence Network. RESULTS Overall, findings suggest that parents adjust well to the diagnosis. Factors found to be protective against psychological distress for both mothers and fathers included a positive life orientation, satisfaction with health care, and relationship satisfaction. Close friendships were also protective against depression in mothers. Risk factors for mothers included the presence of a prior mental health condition, and stressful life events during pregnancy. Risk factors for fathers included being older at the time of conception, and recently being absent from work. CONCLUSIONS Findings suggest a need for appropriate psychological screening of both parents following a diagnosis of CL/P and emphasize the importance of coordinated multidisciplinary care for psychological health. Preventative models of intervention to strengthen familial relationships and build resilience require further investigation.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Navarro-Barquín DF, Lozada-Hernández EE, Tejeda-Hernández M, DeLeon-Jasso GA, Morales-Rescalvo FE, Flores-González E, Piña-Aviles F. Use of the type A botulinum toxin in patients submitted to cheiloplasty to improve results in scarring in patients with nonsyndromic cleft lip and palate. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1488-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Thierens LA, Lewyllie A, Temmerman L, De Roo NM, Verdonck A, Cadenas de Llano Perula M, Willems G, De Pauw GA. A retrospective intercenter comparison of two surgical protocols through the dental arch relationship of 5- to 6-year-old unilateral cleft patients. Clin Oral Investig 2018; 23:1777-1784. [PMID: 30171346 DOI: 10.1007/s00784-018-2601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objectives of this retrospective equivalence trial were to assess the dental arch relationship of 5- to 6-year-old patients with unilateral cleft lip and palate (UCLP) treated in two specialized cleft centers with a different surgical protocol using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system, and to determine the correlation between these two scoring indices. MATERIALS AND METHODS The dental arch relationship of seventy-three 5- to 6-year-old patients with complete UCLP was evaluated on plaster casts using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. The sagittal occlusion, overbite, and overjet were also recorded. Inter- and intra-examiner agreement was determined using Intraclass Correlation Coefficients. RESULTS A good to very good inter- and intra-examiner agreement was found. No significant mean difference in outcome based on the 5-Year-Olds' Index, the modified Huddart/Bodenham scoring system, overjet, or overbite was detected. For mean difference in sagittal occlusion, the hypothesis that both centers are clinically equivalent was confirmed. A strong negative correlation (rs = - 0.832) between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system was found. CONCLUSIONS The dental arch relationship of 5- to 6-year-old unilateral cleft patients treated in two Belgian cleft centers is clinically equivalent based on sagittal occlusion, despite substantial differences in their treatment protocol. Clinical equivalence for other parameters was not confirmed. There is a strong correlation between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. CLINICAL RELEVANCE A well-implemented treatment protocol for cleft patients is of the utmost importance, but case load and skill of the surgeon are also important factors for the quality of the results.
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Affiliation(s)
- Laurent Am Thierens
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium. .,Centre for Congenital Facial Anomalies, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Arianne Lewyllie
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Liesbeth Temmerman
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Noëmi Mc De Roo
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - An Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Maria Cadenas de Llano Perula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Am De Pauw
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Centre for Congenital Facial Anomalies, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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15
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Ness AR, Wills AK, Waylen A, Al-Ghatam R, Jones TEM, Preston R, Ireland AJ, Persson M, Smallridge J, Hall AJ, Sell D, Sandy JR. Centralization of cleft care in the UK. Part 6: a tale of two studies. Orthod Craniofac Res 2018; 18 Suppl 2:56-62. [PMID: 26567856 PMCID: PMC4670710 DOI: 10.1111/ocr.12111] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
Objectives We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). Setting and Sample Population A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. Materials and Methods We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. Results We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. Conclusions Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.
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Affiliation(s)
- A R Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.,School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - R Al-Ghatam
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - T E M Jones
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,Musgrove Park Hospital, Taunton, UK
| | - R Preston
- Cleft Lip and Palate Association, London, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK.,Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Sell
- Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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16
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Stock NM, Anwar H, Sandy JR, Rumsey N. Centralization of Cleft Lip and Palate Services in the United Kingdom. Cleft Palate Craniofac J 2018; 55:676-681. [DOI: 10.1177/1055665617744064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult “returners” who have undergone treatment both pre- and postcentralization. Methods: Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. Results: The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients’ capacity to cope with the associated emotional challenges. Conclusions: The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research and The Cleft Collective, University of the West of England, Bristol, UK
| | - Hamza Anwar
- Regional Coordinator for the East of England, Cleft Lip and Palate Association, London, UK
| | - Jonathan R. Sandy
- Dean of the Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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17
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Dahiya A, Courtemanche R, Courtemanche DJ. Multidisciplinary Cleft Palate Program at BC Children's Hospital: Are We Meeting the Standards of Care? Plast Surg (Oakv) 2018; 26:85-90. [PMID: 29845045 DOI: 10.1177/2292550317747852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To characterize current Cleft Palate Program (CPP) practices and evaluate the timeliness of appointments with respect to patient age and diagnosis based on American Cleft Palate-Craniofacial Association (ACPA) population guidelines and CPP patient-specific recommendations. Design A retrospective review of CPP patient appointments from November 6, 2012, to March 31, 2015, was done. Data were analyzed using descriptive and inferential statistics. Setting The study was conducted using data from the CPP at BC Children's Hospital. Patients A total of 1214 appointments were considered in the analysis, including syndromic and nonsyndromic patients of 0 to 27 years of age. Main Outcome Measures Percentage of patients meeting follow-up targets by ACPA standards and CPP team recommendations. Results Our results showed patients 5 years and younger or nonsyndromic were more likely to be seen on time (P < .001). No relationship between the timeliness of an appointment and specific patient diagnoses or distance to clinic was found. With the exception of nursing (97% of appointments were on time), all disciplines had less than 45% of appointments on time with 51% of appointments meeting ACPA guidelines for timeliness and 32% of all appointments meeting CPP recommendations. Conclusion Timely care for the cleft/craniofacial patient populations represents a challenge for the CPP. Although half of patients may meet the general ACPA guidelines, only 32% of patients are meeting the CPP patient-specific recommendations. To provide better patient care, future adjustments are needed, which may include improved resource allotment and program support.
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Affiliation(s)
- Anita Dahiya
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Courtemanche
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Douglas J Courtemanche
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, Department of Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
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18
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Ness AR, Wills AR, Waylen A, Smallridge J, Hall AJ, Sell D, Sandy JR. Closing the Loop on Centralization of Cleft Care in the United Kingdom. Cleft Palate Craniofac J 2017; 55:248-251. [DOI: 10.1177/1055665617736779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. Setting: Audit clinics held in Cleft Centers in the United Kingdom. Patients, Participants: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. Interventions: Centralization of cleft care. Main Outcome Measure(s): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. Results: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. Conclusions: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.
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Affiliation(s)
- Andrew R. Ness
- Biomedical Research Unit in Nutrition, Diet and Lifestyle, National Institute for Health Research, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Andrew R. Wills
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Andrea Waylen
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Jackie Smallridge
- Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Amanda J. Hall
- Children's Hearing Centre, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Debbie Sell
- North Thames Regional Cleft Service, Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jonathan R. Sandy
- Dean of Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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19
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20
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Sell D, Southby L, Wren Y, Wills AK, Hall A, Mahmoud O, Waylen A, Sandy JR, Ness AR. Centre-level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 4. Orthod Craniofac Res 2017; 20 Suppl 2:27-39. [DOI: 10.1111/ocr.12186] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D. Sell
- North Thames Regional Cleft Service; Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health; Illness and Disability (ORCHID); Great Ormond Street Hospital NHS Foundation Trust; London UK
| | - L. Southby
- School of Social and Community Medicine; University of Bristol; Clifton Bristol UK
- Cleft.NET.East; Cambridge University Hospitals NHS Foundation Trust; Addenbrooke's Hospital; Cambridge UK
| | - Y. Wren
- Bristol Dental School; University of Bristol; Bristol UK
- Bristol Speech & Language Therapy Research Unit; North Bristol NHS Trust; Southmead Hospital; Bristol UK
| | - A. K. Wills
- Bristol Dental School; University of Bristol; Bristol UK
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition; Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
| | - A. Hall
- Life and Health Sciences; Aston University; Birmingham UK
- Children's Hearing Centre; St Michael's Hospital; Bristol UK
| | - O. Mahmoud
- School of Social and Community Medicine; University of Bristol; Clifton Bristol UK
- Department of Applied Statistics; Helwan University; Cairo Egypt
| | - A. Waylen
- Bristol Dental School; University of Bristol; Bristol UK
| | - J. R. Sandy
- Bristol Dental School; University of Bristol; Bristol UK
| | - A. R. Ness
- Bristol Dental School; University of Bristol; Bristol UK
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition; Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
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21
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Ness AR, Wills AK, Mahmoud O, Hall A, Sell D, Smallridge J, Southby L, Stokes D, Toms S, Waylen A, Wren Y, Sandy JR. Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications. Orthod Craniofac Res 2017; 20 Suppl 2:48-51. [DOI: 10.1111/ocr.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- A. R. Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; The University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
- Bristol Dental School; University of Bristol; Bristol UK
| | - A. K. Wills
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; The University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
- Bristol Dental School; University of Bristol; Bristol UK
| | - O. Mahmoud
- School of Social and Community Medicine; University of Bristol; Bristol UK
- Department of Applied Statistics; Helwan University; Cairo Egypt
| | - A. Hall
- Life and Health Sciences; Aston University; Birmingham UK
- Children's Hearing Centre; St Michael's Hospital; Bristol UK
| | - D. Sell
- North Thames Regional Cleft Service, Speech and Language Therapy Department; Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID); Great Ormond Street Hospital NHS Foundation Trust; London UK
| | - J. Smallridge
- Cleft.NET. East; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital; Cambridge UK
| | - L. Southby
- School of Social and Community Medicine; University of Bristol; Bristol UK
- Cleft.NET. East; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital; Cambridge UK
| | - D. Stokes
- Cleft Lip and Palate Association; London UK
| | - S. Toms
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; The University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
| | - A. Waylen
- Bristol Dental School; University of Bristol; Bristol UK
| | - Y. Wren
- Bristol Dental School; University of Bristol; Bristol UK
- Bristol Speech & Language Therapy Research Unit; North Bristol NHS Trust, Southmead Hospital; Bristol UK
| | - J. R. Sandy
- Bristol Dental School; University of Bristol; Bristol UK
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22
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Wills AK, Mahmoud O, Hall A, Sell D, Smallridge J, Southby L, Toms S, Waylen A, Wren Y, Ness AR, Sandy JR. Centre-level variation of treatment and outcome in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento-facial outcomes. Orthod Craniofac Res 2017; 20 Suppl 2:1-7. [PMID: 28661082 PMCID: PMC5836895 DOI: 10.1111/ocr.12183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Outline methods used to describe centre-level variation in treatment and outcome in children in the Cleft Care UK (CCUK) study. Report centre-level variation in dento-facial outcomes. SETTING AND SAMPLE POPULATION Two hundred and sixty-eight five-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS Between January 2011 and December 2012, data were collected on a comprehensive range of outcomes. Child facial appearance and symmetry were assessed using photographic pictures. Dental arch relationships were assessed from standardized dental study models. Hierarchical statistical models were used to predict overall means and the variance partition coefficient (VPC)-a measure of amount of variation in treatment or outcome explained by the centre. RESULTS Data on dento-alveolar arch relationships and facial appearance were available on 197 and 252 children, respectively. The median age of the children was 5.5 years, and 68% were boys. Variation was described across 13 centres. There was no evidence of centre-level variation in good or poor dento-alveolar arch relationships with a VPC of 4% and 3%, respectively. Similarly, there was no evidence of centre-level variation in good or poor facial appearance with a VPC of 2% and 5%, respectively. CONCLUSIONS There was no evidence of centre-level variation for dento-facial outcomes although this study only had the power to detect large variation between sites.
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Affiliation(s)
- A. K. Wills
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleThe University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - O. Mahmoud
- School of Social and Community MedicineUniversity of BristolBristolUK
- Department of Applied StatisticsHelwan UniversityCairoEgypt
| | - A. Hall
- Life and Health SciencesAston UniversityBirminghamUK
- Children’s Hearing CentreSt Michael’s HospitalBristolUK
| | - D. Sell
- North Thames Regional Cleft Service, Speech and Language Therapy DepartmentCentre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID)Great Ormond Street Hospital NHS Foundation TrustLondonUK
| | - J. Smallridge
- Cleft Net East Cleft NetworkAddenbrooke's HospitalCambridgeUK
| | - L. Southby
- Bristol Speech Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
| | - S. Toms
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleThe University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
| | - A. Waylen
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - Y. Wren
- Bristol Dental SchoolUniversity of BristolBristolUK
- Bristol Speech Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
| | - A. R. Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleThe University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - J. R. Sandy
- Bristol Dental SchoolUniversity of BristolBristolUK
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23
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Waylen A, Mahmoud O, Wills AK, Sell D, Sandy JR, Ness AR. Centre-level variation in behaviour and the predictors of behaviour in 5-year-old children with non-syndromic unilateral cleft lip: The Cleft Care UK study. Part 5. Orthod Craniofac Res 2017; 20 Suppl 2:40-47. [PMID: 28661083 PMCID: PMC5836977 DOI: 10.1111/ocr.12187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aims of this study were to describe child behavioural and psychosocial outcomes associated with appearance and speech in the Cleft Care UK (CCUK) study. We also wanted to explore centre-level variation in child outcomes and investigate individual predictors of such outcomes. SETTING AND SAMPLE POPULATION Two hundred and sixty-eight five-year-old children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. MATERIALS AND METHODS Parents completed the Strengths and Difficulties questionnaire (SDQ) and reported their own perceptions of the child's self-confidence. Child facial appearance and symmetry were assessed using photographs, and intelligibility of speech was derived from audio-visual speech recordings. Centre-level variation in behavioural and psychosocial outcomes was examined using hierarchical models, and associations with clinical outcomes were examined using logit regression models. RESULTS Children with UCLP had a higher hyperactive difficulty score than the general population. For boys, the average score was 4.5 vs 4.1 (P=.03), and for girls, the average score was 3.8 vs 3.1 (P=.008). There was no evidence of centre-level variation for behaviour or parental perceptions of the child's self-confidence. There is no evidence of associations between self-confidence and SDQ scores and either facial appearance or behaviour. CONCLUSIONS Children born with UCLP have higher levels of behaviour problems than the general population.
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Affiliation(s)
- A. Waylen
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - O. Mahmoud
- School of Social and Community MedicineUniversity of BristolBristolUK
- Department of Applied StatisticsHelwan UniversityCairoEgypt
| | - A. K. Wills
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - D. Sell
- North Thames Regional Cleft ServiceSpeech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID)Great Ormond Street Hospital NHS Foundation TrustLondonUK
| | - J. R. Sandy
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - A. R. Ness
- Bristol Dental SchoolUniversity of BristolBristolUK
- National Institute for Health Research (NIHR) Biomedical Research Unit in NutritionDiet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
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24
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Lewis CW, Jacob LS, Lehmann CU, Krol D, Gereige R, Karp J, Fisher-Owens S, Braun P, Jacob L, Segura A. The Primary Care Pediatrician and the Care of Children With Cleft Lip and/or Cleft Palate. Pediatrics 2017; 139:peds.2017-0628. [PMID: 28557774 DOI: 10.1542/peds.2017-0628] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Orofacial clefts, specifically cleft lip and/or cleft palate (CL/P), are among the most common congenital anomalies. CL/P vary in their location and severity and comprise 3 overarching groups: cleft lip (CL), cleft lip with cleft palate (CLP), and cleft palate alone (CP). CL/P may be associated with one of many syndromes that could further complicate a child's needs. Care of patients with CL/P spans prenatal diagnosis into adulthood. The appropriate timing and order of specific cleft-related care are important factors for optimizing outcomes; however, care should be individualized to meet the specific needs of each patient and family. Children with CL/P should receive their specialty cleft-related care from a multidisciplinary cleft or craniofacial team with sufficient patient and surgical volume to promote successful outcomes. The primary care pediatrician at the child's medical home has an essential role in making a timely diagnosis and referral; providing ongoing health care maintenance, anticipatory guidance, and acute care; and functioning as an advocate for the patient and a liaison between the family and the craniofacial/cleft team. This document provides background on CL/P and multidisciplinary team care, information about typical timing and order of cleft-related care, and recommendations for cleft/craniofacial teams and primary care pediatricians in the care of children with CL/P.
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Affiliation(s)
- Charlotte W. Lewis
- Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, Washington
| | - Lisa S. Jacob
- Georgetown Pediatric Dentistry and Orthodontics, Georgetown, Texas; and
| | - Christoph U. Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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25
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Feragen KB, Semb G, Heliövaara A, Lohmander A, Johannessen EC, Boysen BM, Havstam C, Lundeborg I, Nyberg J, Pedersen NH, Bogh-Nielsen J, Eyres P, Bradbury E, Rumsey N. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child. J Plast Surg Hand Surg 2017; 51:81-87. [DOI: 10.1080/2000656x.2016.1254642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristin Billaud Feragen
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
- Department of Speech and Language Disorders, Statped Sørøst, Oslo, Norway
| | - Gunvor Semb
- Dental School, University of Manchester, Manchester, UK
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Centre, Helsinki University Central Hospital, Helsinki, Finland
| | - Anette Lohmander
- Division of Speech and Language Pathology, Karolinska Institutet, Karolinska University Hospital, Sweden
| | | | - Betty Marie Boysen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark
| | - Christina Havstam
- Division of Speech and Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Lundeborg
- Division of Speech and Language Pathology, Linköping University, Linköping, Sweden
| | - Jill Nyberg
- Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Philip Eyres
- Dental School, University of Manchester, Manchester, UK
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Feragen KB, Rumsey N, Heliövaara A, Boysen BM, Johannessen EC, Havstam C, Marcusson A, Nyberg J, Pedersen NH, Bogh-Nielsen J, Eyres P, Bradbury E, Semb G. Scandcleft randomised trials of primary surgery for unilateral cleft lip and Palate: 9. Parental report of social and emotional experiences related to their 5-year-old child's cleft diagnosis. J Plast Surg Hand Surg 2017; 51:73-80. [DOI: 10.1080/2000656x.2016.1254643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Arja Heliövaara
- Department of Plastic Surgery, Cleft Palate and Craniofacial Centre, Helsinki University Central Hospital, Helsinki, Finland
| | - Betty Marie Boysen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark
| | | | - Christina Havstam
- Division of Speech and Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agneta Marcusson
- Department of Dentofacial Orthopedics, Maxillofacial Unit, University Hospital Linköping, Linkjöping, Sweden
| | - Jill Nyberg
- Division of Speech and Language Pathology, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Philip Eyres
- Dental School, University of Manchester, Manchester, UK
| | | | - Gunvor Semb
- Dental School, University of Manchester, Manchester, UK
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
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