Pediatric obesity-related curricular content and training in dental schools and dental hygiene programs: systematic review and recommendations

OBJECTIVES

The authors conducted a systematic review to determine: a) What dental schools and dental hygiene programs are doing to promote knowledge and skills related to addressing childhood obesity and to reduce consumption of sugar-sweetened beverages (SSBs) and b) What else these schools and programs could do to better equip future oral health professionals to address childhood obesity and reduce consumption of SSBs.

METHODS

The authors searched PubMed, Scopus, Education Full Text (EBSCOHost), and ERIC (EBSCOHost) to identify peer-reviewed publications reporting on obesity or dietetic-related curricula in dental and dental hygiene education within the last 20 years. Three studies met inclusion and exclusion criteria. Outcomes of the identified studies were abstracted and summarized independently by two investigators.

RESULTS

The first study describes a 2009 survey of pediatric dentistry residents. Approximately, half had received formal training yet they lacked essential knowledge or skills for managing children who were obese. The second study describes nutrition-related coursework offered in the second year of a predoctoral dental school curriculum in Saudi Arabia, and the third study reports on the development of an "oral health rotation" dietetic internship in a pediatric dentistry clinic, in the context of interprofessional education (IPE).

CONCLUSIONS

Evidence of dental schools' and dental hygiene programs' efforts to address obesity and SSB consumption in children in their curricula is scant, while Commission on Dental Accreditation standards make sporadic mentions of diet and nutrition. Opportunities exist to leverage existing resources and innovative, experiential approaches, including IPE, to formally, and effectively address this important issue in predoctoral oral health education.

A Systematic Review of Strategies to Prevent Cisplatin-Induced Nephrotoxicity

INTRODUCTION

Cisplatin, a platinum-based antineoplastic agent, is the cornerstone for the treatment of many malignancies. Nephrotoxicity is the primary dose-limiting toxicity, and various hydration regimens and supplementation strategies are used to prevent cisplatin-induced kidney injury. However, evidence-based recommendations on specific hydration regimens are limited. A systematic review was performed to evaluate clinical studies that have examined hydration and supplementation strategies to prevent cisplatin-induced nephrotoxicity.

MATERIALS AND METHODS

PubMed and Excerpta Medica databases were searched from 1966 through October 2015 for clinical trials and other studies focused on hydration regimens to prevent nephrotoxicity in cancer patients treated with cisplatin. The University of Oxford Centre for Evidence-Based Medicine criteria were used to grade level of evidence.

RESULTS

Among the 1,407 identified studies, 24 were included in this systematic review. All studies differed on type, volume, and duration of hydration. Among the 24 studies, 5 evaluated short-duration hydration, 4 evaluated low-volume hydration, 4 investigated magnesium supplementation, and 7 reviewed forced diuresis with hydration. Short-duration and lower-volume hydration regimens are effective in preventing cisplatin-induced nephrotoxicity. Magnesium supplementation may have a role as a nephroprotectant, and forced diuresis may be appropriate in some patients receiving cisplatin.

CONCLUSION

Hydration is essential for all patients to prevent cisplatin-induced nephrotoxicity. Specifically, short-duration, low-volume, outpatient hydration with magnesium supplementation and mannitol forced diuresis (in select patients) represent best practice principles for the safe use of cisplatin. The Oncologist 2017;22:609-619 IMPLICATIONS FOR PRACTICE: The findings contained within this systematic review show that (a) hydration is essential for all patients to prevent cisplatin-induced nephrotoxicity, (b) short-duration, low-volume, outpatient hydration regimens appear to be safe and feasible, even in patients receiving intermediate- to high-dose cisplatin, (c) magnesium supplementation (8-16 milliequivalents) may limit cisplatin-induced nephrotoxicity, and (d) mannitol may be considered for high-dose cisplatin and/or patients with preexisting hypertension. These findings have broad implications for clinical practice and represent best practice principles for the prevention of cisplatin-induced nephrotoxicity.

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

INTRODUCTION

This systematic review examines the excess cost of chronic conditions on the economic burden of cancer survivorship among adults in the US. Areas covered: Twelve published studies were identified. Although studies varied substantially in populations, comorbidities examined, methods, and types of cost reported, costs for cancer survivors with comorbidities generally increased with greater numbers of comorbidities or an increase in comorbidity index score. Survivors with comorbidities incurred significantly more in total medical costs, out-of-pocket costs, and costs by service type compared to cancer survivors without additional comorbidities. Expert commentary: Cancer survivors with comorbidities bear significant excess out-of-pocket costs and their care is also more expensive to the healthcare system. On-going evaluation of different payment models, care coordination, and disease management programs for cancer survivors with comorbidities will be important in monitoring impact on healthcare costs.

A Novel Core Competencies-Based Academic Medicine Curriculum: Description and Preliminary Results

BACKGROUND

Physicians practice health care in a rapidly changing system that requires more than the delivery of safe and effective care. Modern physicians must also acquire skills beyond direct patient care. Residency programs must, therefore, prepare physicians to meet these demands by providing appropriate education and training.

METHODS

We designed, implemented and assessed an academic medicine curriculum in the first post-graduate year. This curriculum provides comprehensive exposure to necessary non-patient contact related physician skills. Topics centered around four domains: critical appraisal of literature of literature, quality improvement, professional development, and teaching. Each of these domains is linked to the six core competencies established by the Accreditation Council for Graduate Medical Education's (ACGME). Instruction includes small-group learning sessions with additional time for self-directed online modules and a faculty-mentored quality improvement research project that is presented at a graduation symposium. All residents completed a survey evaluation of the curriculum before and after the course via open-ended questions and Likert responses (0-5). We assessed improvement in resident confidence with each curricular domain using mean Likert score change and 95% confidence intervals (CI).

RESULTS

Residents improved at all curricular domains measured. The most significant mean changes included confidence in: poster presentations (2.7; 95% CI: 1.9-3.5), plan-do-check-act cycle (2.5; 95% CI: 2.1-2.9), quality improvement projects (2.4; 95% CI: 1.9-2.9), and abstract presentation (2.3; 95% CI: 1.6-3.0).

CONCLUSIONS

We found that the academic medicine rotation (AMR) is feasible in a large academic setting. Furthermore, the AMR allows early exposure to and improvement in essential non-patient contact related physician skills required by the ACGME core competencies and assessed through the milestones.

Building capacity in a health sciences library to support global health projects

This paper describes how a large, academic health sciences library built capacity for supporting global health at its university and discusses related outcomes. Lean budgets require prioritization and organizational strategy. A committee, with leadership responsibilities assigned to one librarian, guided strategic planning and the pursuit of collaborative, global health outreach activities. A website features case studies and videos of user stories to promote how library partnerships successfully contributed to global health projects. Collaborative partnerships were formed through outreach activities and from follow-up to reference questions. The committee and a librarian's dedicated time established the library's commitment to help the university carry out its ambitious global agenda.

The importance of preventive dental visits from a young age: systematic review and current perspectives

BACKGROUND

Dental caries, the most common childhood chronic disease, disproportionately affects vulnerable parts of the population and confers substantial impacts to children, families, and health systems. Because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation secondary to disease development, early preventive dental visits (EPDVs) are widely advocated by professional and academic stakeholders. The aim of this comprehensive review was to critically review and summarize available evidence regarding the effectiveness of EPDVs in improving children's oral health outcomes.

MATERIALS AND METHODS

A systematic literature search of the PubMed and Embase electronic databases was undertaken to identify peer-reviewed publications investigating the effectiveness of EPDVs on oral health outcomes, including clinical, behavioral, and cost end points up to October 30, 2013. Outcomes of the identified studies were abstracted and summarized independently by two investigators.

RESULTS

Four manuscripts met the inclusion criteria and were included in the review. All studies were conducted in the US and employed a retrospective cohort study design using public insurance-claims data, whereas one study matched claims files with kindergarten state dental surveillance data. That study found no benefit of EPDVs in future clinically determined dental caries levels in kindergarten. The other three studies found mixed support for an association of EPDVs with subsequent more preventive and fewer nonpreventive visits and lower nonpreventive service-related expenditures. Selection bias and a problem-driven dental care-seeking pattern were frequently articulated themes in the reviewed studies.

CONCLUSION

The currently available evidence base supporting the effectiveness of EPDVs and the year 1 first dental visit recommendation is weak, and more research is warranted. The benefits of EPDVs before the age of 3 years are evident among children at high risk or with existing dental disease. However, EPDVs may be associated with reduced restorative dental care visits and related expenditures during the first years of life.

Estimating error in using residential outdoor PM2.5 concentrations as proxies for personal exposures: a meta-analysis

BACKGROUND

Studies examining the health effects of particulate matter <or= 2.5 microm in aerodynamic diameter (PM2.5) commonly use ambient PM2.5 concentrations measured at distal monitoring sites as proxies for personal exposure and assume spatial homogeneity of ambient PM2.5. An alternative proxy-the residential outdoor PM2.5 concentration measured adjacent to participant homes-has few advantages under this assumption.

OBJECTIVES

We systematically reviewed the correlation between residential outdoor PM2.5 and personal PM2.5 (-rj) as a means of comparing the magnitude and sources of measurement error associated with their use as exposure surrogates.

METHODS

We searched seven electronic reference databases for studies of the within-participant residential outdoor-personal PM2.5 correlation.

RESULTS

The search identified 567 candidate studies, nine of which were abstracted in duplicate, that were published between 1996 and 2008. They represented 329 nonsmoking participants 6-93 years of age in eight U.S. cities, among whom -rj was estimated (median, 0.53; range, 0.25-0.79) based on a median of seven residential outdoor-personal PM2.5 pairs per participant. We found modest evidence of publication bias (symmetric funnel plot; pBegg = 0.4; pEgger = 0.2); however, we identified evidence of heterogeneity (Cochran's Q-test p = 0.05). Of the 20 characteristics examined, earlier study midpoints, eastern longitudes, older mean age, higher outdoor temperatures, and lower personal-residential outdoor PM2.5 differences were associated with increased within-participant residential outdoor-personal PM2.5 correlations.

CONCLUSIONS

These findings were similar to those from a contemporaneous meta-analysis that examined ambient-personal PM2.5 correlations (rj = median, 0.54; range, 0.09-0.83). Collectively, the meta-analyses suggest that residential outdoor-personal and ambient-personal PM2.5 correlations merit greater consideration when evaluating the potential for bias in studies of PM2.5-mediated health effects.

Analysis of the reporting of search strategies in Cochrane systematic reviews

BACKGROUND

The Cochrane Handbook for Systematic Reviews of Interventions provides instructions for documenting a systematic review's electronic database search strategy, listing elements that should be in the description. Complete documentation of the search strategy allows readers to evaluate the search when critically appraising a review's quality.

OBJECTIVE

The research analyzed recently published Cochrane reviews to determine whether instructions for describing electronic database search strategies were being followed.

METHODS

Eighty-three new reviews added to the Cochrane Database of Systematic Reviews in the first quarter of 2006 were selected for analysis. Eighteen were subsequently excluded because their searches were conducted only in the specialized registers of Cochrane review groups. The remaining sixty-five reviews were analyzed for the seven elements of an electronic database search strategy description listed in the Cochrane Handbook, using dual review with consensus.

RESULTS

Of the 65 reviews analyzed, none included all 7 recommended elements. Four reviews (6%) included 6 elements. Thirty-two percent (21/65) included 5 or more elements, with 68% (44/65) including 4 or fewer. Three included only 2 elements. The 65 reviews represented 41 different Cochrane review groups.

CONCLUSION

The instructions from the Cochrane Handbook for reporting search strategies are not being consistently employed by groups producing Cochrane reviews.

Promotion and evaluation of a virtual live reference service

The University of North Carolina at Chapel Hill Health Sciences Library began providing virtual live reference service in the fall of 2001. The library was interested in exploring new ways to interact with users accessing electronic resources from outside the library. This article describes the background for starting the service, the methods used to promote the service, and the results of an evaluation conducted after the first seven months of operation. The service was lightly used during these months with only 82 interactions. An analysis of the transcripts examined referring Web pages, types of questions asked, software features used, and user login data. Text of two user surveys is included, with the data from the in-person survey analyzed.

The phylogenetic relationship and complete nucleotide sequence of human papillomavirus type 35

The 7851-bp nucleotide sequence of human papillomavirus (HPV) type 35 was determined. HPV 35 is associated with high-grade cervical intraepithelial neoplasia and invasive carcinomas. From the HPV 35 sequence, open reading frames encoding putative proteins E6, E7, E1, E2, E4, E5, L2, and L1, common to other mucosal HPV types, were identified. Structural and control elements present in the long control region (LCR) conserved among other mucosal HPV types were also present in HPV 35. Analysis of the LCR revealed an additional 20-bp sequence element present in all HPV types associated with malignant proliferation. To further classify HPV 35 with regard to oncogenic potential, phylogenetic analysis of the E6 and E7 proteins from the anogenital HPV types 6, 11, 16, 18, 31, 33, 35, 39, 43, 44, 45, and 51 was performed. This analysis indicated three distinct HPV subgroups; those associated with benign lesions and two branches of those HPV types more often associated with malignant proliferation. HPV 35 is most closely related to HPV types 31 and 16.