Publications by year
In Press
Creanor E (In Press). A double-blind, randomised, parallel group, placebo-controlled futility trial of simvastatin as a neuroprotective treatment for Parkinson’s disease (PD STAT). JAMA Neurology
Taylor AH, Thompson TP, Ussher M, Aveyard P, Murray RL, Harris T, Creanor E, Green C, Streeter A, Chynoweth J, et al (In Press). A randomised controlled trial of tailored support to increase physical activity and reduce smoking in smokers not immediately ready to quit: Protocol for the Trial of physical Activity assisted Reduction of Smoking (TARS) study. BMJ Open
Eldabe SE, Taylor RS, Goossens S, Bouche B, Gultuna I, Green C, Tinsley J, Luyet PP, Buchser E (In Press). A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT. Health Technol Assess, 23, 1-166.
Price LRS, Wyatt K, Lloyd J, Abraham C, Creanor S, Dean S, Hillsdon M (In Press). Are we overestimating Physical Activity prevalence in children. Journal of Physical Activity and Health
Creanor E, Green C (In Press). Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme. Pilot and Feasibility Studies
Creanor E (In Press). Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study. BMJ Open
Price LRS, Wyatt K, Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M (In Press). Children’s compliance with wrist worn accelerometry within a cluster randomised controlled trial: Findings from the Healthy Lifestyles Programme (HeLP). Pediatric Exercise Science
Wyatt KM, Lloyd JJ, Green C, Hurst A, McHugh C, Logan S, Taylor R, Hillsdon M, Price L, Abraham C, et al (In Press). Cluster randomised controlled trial, economic and process evaluation to determine the effectiveness and cost effectiveness of a novel intervention (Healthy Lifestyles Programme, HeLP) to prevent obesity in school children. NIHR Public Health Research
Creanor S, Green C, Price L, Snowsill T, Creanor E (In Press). Effectiveness and cost-effectiveness of behavioural support for prolonged abstinence for smokers wishing to reduce but not quit: Randomised controlled Trial of physical Activity assisted Reduction of Smoking (TARS). Addiction
Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, et al (In Press). Evaluation of a COVID-19 Fundamental Nursing Care Guideline (COVID-NURSE) Versus Usual Care: a Cluster Randomised Controlled Trial.
Hawton AJ (In Press). Evaluation of a home-based standing frame programme in people with progressive Multiple Sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis. Lancet Neurology
Creanor E, Jones B, Britten N, Frost J (In Press). The effectiveness of a primary care based collaborative care model to improve quality of life in people with severe mental illness: the PARTNERS2 cluster randomised controlled trial. The British Journal of Psychiatry
Creanor E, Hawton A (In Press). “I’m in a very good frame of mind”: a qualitative exploration of the experience of standing frame use in people with progressive multiple sclerosis. BMJ Open
2023
Appelboam A, Osborne R, Ukoumunne O, Black S, Boot S, Richards N, Scotney N, Rhodes S, Cranston T, Hawker R, et al (2023). Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial.
BMJ Open,
13(6).
Abstract:
Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial.
INTRODUCTION: Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital. METHODS AND ANALYSIS: This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months. ETHICS AND DISSEMINATION: the study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity. TRIAL REGISTRATION NUMBER: ISRCTN16145266.
Abstract.
Author URL.
Wheat H, Weston L, Oh TM, Morgan-Trimmer S, Ingram W, Griffiths S, Sheaff R, Clarkson P, Medina-Lara A, Musicha C, et al (2023). Longitudinal realist evaluation of the Dementia PersonAlised Care Team (D-PACT) intervention: protocol.
BJGP OpenAbstract:
Longitudinal realist evaluation of the Dementia PersonAlised Care Team (D-PACT) intervention: protocol.
BACKGROUND: Different dementia support roles exist but evidence is lacking on which aspects are best, for whom, and in what circumstances, and on their associated costs and benefits. Phase 1 of the Dementia PersonAlised Care Team programme (D-PACT) developed a post-diagnostic primary care-based intervention for people with dementia and their carers and assessed the feasibility of a trial. AIM: Phase 2 of the programme aims to 1) refine the programme theory on how, when, and for whom the intervention works; and 2) evaluate its value and impact. DESIGN & SETTING: a realist longitudinal mixed-methods evaluation will be conducted in urban, rural, and coastal areas across South West and North West England where low-income or ethnic minority populations (for example, South Asian) are represented. Design was informed by patient, public, and professional stakeholder input and phase 1 findings. METHOD: High-volume qualitative and quantitative data will be collected longitudinally from people with dementia, carers, and practitioners. Analyses will comprise the following: 1) realist longitudinal case studies; 2) conversation analysis of recorded interactions; 3) statistical analyses of outcome and experience questionnaires; 4a) health economic analysis examining costs of delivery; and 4b) realist economic analysis of high-cost events and 'near misses'. All findings will be synthesised using a joint display table, evidence appraisal tool, triangulation, and stakeholder co-analysis. CONCLUSION: the realist evaluation will describe how, why, and for whom the intervention does or does not lead to change over time. It will also demonstrate how a non-randomised design can be more appropriate for complex interventions with similar questions or populations.
Abstract.
Author URL.
Taylor AH, Thompson TP, Streeter A, Chynoweth J, Snowsill T, Ingram W, Ussher M, Aveyard P, Murray RL, Harris T, et al (2023). Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT.
Health Technol Assess,
27(4), 1-277.
Abstract:
Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT.
BACKGROUND: Physical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear. OBJECTIVES: the objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective. DESIGN: This was a multicentred, two-arm, parallel-group, randomised (1 : 1) controlled superiority trial with accompanying trial-based and model-based economic evaluations, and a process evaluation. SETTING AND PARTICIPANTS: Participants from health and other community settings in four English cities received either the intervention (n = 457) or usual support (n = 458). INTERVENTION: the intervention consisted of up to eight face-to-face or telephone behavioural support sessions to reduce smoking and increase physical activity. MAIN OUTCOME MEASURES: the main outcome measures were carbon monoxide-verified 6- and 12-month floating prolonged abstinence (primary outcome), self-reported number of cigarettes smoked per day, number of quit attempts and carbon monoxide-verified abstinence at 3 and 9 months. Furthermore, self-reported (3 and 9 months) and accelerometer-recorded (3 months) physical activity data were gathered. Process items, intervention costs and cost-effectiveness were also assessed. RESULTS: the average age of the sample was 49.8 years, and participants were predominantly from areas with socioeconomic deprivation and were moderately heavy smokers. The intervention was delivered with good fidelity. Few participants achieved carbon monoxide-verified 6-month prolonged abstinence [nine (2.0%) in the intervention group and four (0.9%) in the control group; adjusted odds ratio 2.30 (95% confidence interval 0.70 to 7.56)] or 12-month prolonged abstinence [six (1.3%) in the intervention group and one (0.2%) in the control group; adjusted odds ratio 6.33 (95% confidence interval 0.76 to 53.10)]. At 3 months, the intervention participants smoked fewer cigarettes than the control participants (21.1 vs. 26.8 per day). Intervention participants were more likely to reduce cigarettes by ≥ 50% by 3 months [18.9% vs. 10.5%; adjusted odds ratio 1.98 (95% confidence interval 1.35 to 2.90] and 9 months [14.4% vs. 10.0%; adjusted odds ratio 1.52 (95% confidence interval 1.01 to 2.29)], and reported more moderate-to-vigorous physical activity at 3 months [adjusted weekly mean difference of 81.61 minutes (95% confidence interval 28.75 to 134.47 minutes)], but not at 9 months. Increased physical activity did not mediate intervention effects on smoking. The intervention positively influenced most smoking and physical activity beliefs, with some intervention effects mediating changes in smoking and physical activity outcomes. The average intervention cost was estimated to be £239.18 per person, with an overall additional cost of £173.50 (95% confidence interval -£353.82 to £513.77) when considering intervention and health-care costs. The 1.1% absolute between-group difference in carbon monoxide-verified 6-month prolonged abstinence provided a small gain in lifetime quality-adjusted life-years (0.006), and a minimal saving in lifetime health-care costs (net saving £236). CONCLUSIONS: There was no evidence that behavioural support for smoking reduction and increased physical activity led to meaningful increases in prolonged abstinence among smokers with no immediate plans to quit smoking. The intervention is not cost-effective. LIMITATIONS: Prolonged abstinence rates were much lower than expected, meaning that the trial was underpowered to provide confidence that the intervention doubled prolonged abstinence. FUTURE WORK: Further research should explore the effects of the present intervention to support smokers who want to reduce prior to quitting, and/or extend the support available for prolonged reduction and abstinence. TRIAL REGISTRATION: This trial is registered as ISRCTN47776579. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 4. See the NIHR Journals Library website for further project information.
Abstract.
Author URL.
2022
Swancutt D, Tarrant M, Ingram W, Baldrey S, Burns L, Byng R, Calitri R, Creanor S, Dean S, Evans L, et al (2022). A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol.
Pilot and Feasibility Studies,
8(1).
Abstract:
A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol
Abstract
. Background
. Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity.
.
. Methods
. This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted.
.
. Discussion
. This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients.
.
. Trial registration
. ISRCTN number 22088800.
.
Abstract.
Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, et al (2022). Evaluation of a COVID-19 Fundamental Nursing Care Guideline (COVID-NURSE) Versus Usual Care: a Cluster Randomised Controlled Trial.
Logan A, Freeman J, Kent B, Pooler J, Creanor S, Enki D, Vickery J, Barton A, Marsden J (2022). Functional standing frame programme early after severe sub-acute stroke (SPIRES): a randomised controlled feasibility trial.
Pilot Feasibility Stud,
8(1).
Abstract:
Functional standing frame programme early after severe sub-acute stroke (SPIRES): a randomised controlled feasibility trial.
BACKGROUND: Early mobilisation (> 24 h post-stroke) is recommended for people with stroke. However, there is a paucity of evidence about how to implement early mobilisation for people who have had a severe stroke. Prolonged standing and task-specific training (sit-to-stand repetitions) have separately been evaluated in the literature; however, these functionally linked tasks have not been evaluated in combination for people with severe sub-acute stroke. METHODS: the objective was to determine the feasibility of conducting a randomised controlled trial (RCT) of a functional standing frame programme compared with usual physiotherapy for people with severe sub-acute stroke. An assessor-blinded feasibility RCT with nested qualitative component (interviews and focus group) and process evaluation was adopted. Participants were aged ≥ 18 years with new diagnosis of severe sub-acute stroke (modified Rankin Scale (mRS) 4/5) from four Stroke Rehabilitation Units across South West England. Participants were randomised to receive either: (1) functional standing frame programme (30 min. standing plus sit-to-stand repetitions) plus 15 min of usual physiotherapy daily (intervention); (2) usual physiotherapy (45 min) daily (control). Both programmes were protocolised to be undertaken a minimum of five sessions per week for 3 weeks. Feasibility indicators included process, resource, management, and safety. Adherence, fidelity, and acceptability of the trial and intervention were evaluated using data recorded by therapists, observation of intervention and control sessions, interviews and one focus group. Patient measures of motor impairment, activities/participation, and quality of life were carried out by blinded assessors at baseline, 3, 15, 29, and 55 weeks post-randomisation. RESULTS: Forty-five participants (51-96 years; 42% male, mRS 4 = 80% 5 = 20%) were randomised (n = 22 to intervention). Twenty-seven (60%) participants were followed-up at all time points. Twelve participants (27%) died during the trial; no deaths were related to the trial. Adherence to the minimum number of sessions was low: none of the participants completed all 21 sessions, and only 8 participants (18%) across both groups completed ≥ 15 sessions, over the 3 weeks; 39% intervention; 51% control sessions were completed; mean session duration 39 min (SD 19) control, 37 min intervention (SD 11). Intervention group: mean standing time 13 min (SD 9); mean sit-to-stand repetitions/session 5 (SD 4). Interviews were conducted with 10 participants, four relatives and six physiotherapists. Five physiotherapists attended a focus group. CONCLUSIONS: the majority of progression criteria for this feasibility trial were met. However, adherence to the interventions was unacceptably low. This aspect of the trial design needs to be addressed prior to moving to a definitive RCT of this standing frame intervention in people with severe sub-acute stroke. Solutions have been identified to address these concerns. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ISRCTN15412695. Registration 19 December 2016.
Abstract.
Author URL.
Dhanda AD, Allende H, Allgar V, Andrade J, Bailey MP, Callaghan L, Cocking L, Goodwin E, Hawton A, Hayward C, et al (2022). Mental Imagery to Reduce Alcohol-related harm in patients with alcohol dependence and alcohol-related liver damaGE: the MIRAGE pilot trial protocol.
BMJ Open,
12(5).
Abstract:
Mental Imagery to Reduce Alcohol-related harm in patients with alcohol dependence and alcohol-related liver damaGE: the MIRAGE pilot trial protocol.
INTRODUCTION: in the UK, alcohol use is the main driver of chronic liver disease and each year results in over 1 million unplanned hospital admissions and over 25 000 deaths from alcohol-related liver disease (ArLD). The only effective treatment to prevent progression of liver damage is reducing or ceasing alcohol consumption. Psychological and pharmacological therapies for alcohol misuse are ineffective in patients with ArLD. Functional imagery training (FIT) is a novel psychological therapy that builds on motivational interviewing techniques with multisensory imagery. This pilot trial aims to test the feasibility of training alcohol liaison nurses to deliver FIT therapy and of recruiting and retaining patients with ArLD and alcohol dependence to a randomised trial of FIT and treatment as usual (TAU) versus TAU alone. METHODS AND ANALYSIS: This is a randomised pilot trial of FIT and TAU versus TAU alone in 90 patients with ArLD and alcohol dependence admitted to one of four UK centres. The primary objectives are to estimate rates of screening, recruitment, randomisation, retention, adherence to FIT/TAU and a preliminary assessment of the FIT intervention in the ArLD population. Data from the pilot study will be used to finalise the design of a definitive randomised controlled trial to assess the effectiveness and cost-effectiveness of FIT. The proposed primary outcome measure for the definitive trial is self-reported alcohol use assessed using timeline follow-back. ETHICS AND DISSEMINATION: Research ethics approval was given by the Yorkshire and Humber-Bradford Leeds Research Ethics Committee (reference: 21/YH/0044). Eligible patients will be approached and written informed consent obtained prior to participation. Results will be disseminated through peer-reviewed open access journals, international conferences and a lay summary published on the Trials Unit website and made available to patient groups. TRIAL REGISTRATION NUMBER: ISRCTN41353774.
Abstract.
Author URL.
Phillips R, Cro S, Wheeler G, Bond S, Morris TP, Creanor S, Hewitt C, Love S, Lopes A, Schlackow I, et al (2022). Visualising harms in publications of randomised controlled trials: consensus and recommendations.
BMJ,
377Abstract:
Visualising harms in publications of randomised controlled trials: consensus and recommendations.
OBJECTIVE: to improve communication of harm in publications of randomised controlled trials via the development of recommendations for visually presenting harm outcomes. DESIGN: Consensus study. SETTING: 15 clinical trials units registered with the UK Clinical Research Collaboration, an academic population health department, Roche Products, and the BMJ. PARTICIPANTS: Experts in clinical trials: 20 academic statisticians, one industry statistician, one academic health economist, one data graphics designer, and two clinicians. MAIN OUTCOME: measures a methodological review of statistical methods identified visualisations along with those recommended by consensus group members. Consensus on visual recommendations was achieved (at least 60% of the available votes) over a series of three meetings with participants. The participants reviewed and critically appraised candidate visualisations against an agreed framework and voted on whether to endorse each visualisation. Scores marginally below this threshold (50-60%) were revisited for further discussions and votes retaken until consensus was reached. RESULTS: 28 visualisations were considered, of which 10 are recommended for researchers to consider in publications of main research findings. The choice of visualisations to present will depend on outcome type (eg, binary, count, time-to-event, or continuous), and the scenario (eg, summarising multiple emerging events or one event of interest). A decision tree is presented to assist trialists in deciding which visualisations to use. Examples are provided of each endorsed visualisation, along with an example interpretation, potential limitations, and signposting to code for implementation across a range of standard statistical software. Clinician feedback was incorporated into the explanatory information provided in the recommendations to aid understanding and interpretation. CONCLUSIONS: Visualisations provide a powerful tool to communicate harms in clinical trials, offering an alternative perspective to the traditional frequency tables. Increasing the use of visualisations for harm outcomes in clinical trial manuscripts and reports will provide clearer presentation of information and enable more informative interpretations. The limitations of each visualisation are discussed and examples of where their use would be inappropriate are given. Although the decision tree aids the choice of visualisation, the statistician and clinical trial team must ultimately decide the most appropriate visualisations for their data and objectives. Trialists should continue to examine crude numbers alongside visualisations to fully understand harm profiles.
Abstract.
Author URL.
2021
Taylor A, Streeter A, Thompson T, Creanor S, Ingram W, Aveyard P, Ussher M, Harris T, Murray R, Greaves C, et al (2021). A multi-centre Trial of physical Activity assisted Reduction of Smoking (TARS): Baseline characteristics, and health trainer led intervention engagement.
Author URL.
Jones BG, Streeter AJ, Baker A, Moyeed R, Creanor S (2021). Bayesian statistics in the design and analysis of cluster randomised controlled trials and their reporting quality: a methodological systematic review.
Systematic Reviews,
10(1).
Abstract:
Bayesian statistics in the design and analysis of cluster randomised controlled trials and their reporting quality: a methodological systematic review
Abstract
. Background
. In a cluster randomised controlled trial (CRCT), randomisation units are “clusters” such as schools or GP practices. This has methodological implications for study design and statistical analysis, since clustering often leads to correlation between observations which, if not accounted for, can lead to spurious conclusions of efficacy/effectiveness. Bayesian methodology offers a flexible, intuitive framework to deal with such issues, but its use within CRCT design and analysis appears limited. This review aims to explore and quantify the use of Bayesian methodology in the design and analysis of CRCTs, and appraise the quality of reporting against CONSORT guidelines.
.
. Methods
. We sought to identify all reported/published CRCTs that incorporated Bayesian methodology and papers reporting development of new Bayesian methodology in this context, without restriction on publication date or location. We searched Medline and Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Reporting quality metrics according to the CONSORT extension for CRCTs were collected, as well as demographic data, type and nature of Bayesian methodology used, journal endorsement of CONSORT guidelines, and statistician involvement.
.
. Results
. Twenty-seven publications were included, six from an additional hand search. Eleven (40.7%) were reports of CRCT results: seven (25.9%) were primary results papers and four (14.8%) reported secondary results. Thirteen papers (48.1%) reported Bayesian methodological developments, the remaining three (11.1%) compared different methods. Four (57.1%) of the primary results papers described the method of sample size calculation; none clearly accounted for clustering. Six (85.7%) clearly accounted for clustering in the analysis. All results papers reported use of Bayesian methods in the analysis but none in the design or sample size calculation.
.
. Conclusions
. The popularity of the CRCT design has increased rapidly in the last twenty years but this has not been mirrored by an uptake of Bayesian methodology in this context. of studies using Bayesian methodology, there were some differences in reporting quality compared to CRCTs in general, but this study provided insufficient data to draw firm conclusions. There is an opportunity to further develop Bayesian methodology for the design and analysis of CRCTs in order to expand the accessibility, availability, and, ultimately, use of this approach.
.
Abstract.
Richards DA, Sugg HVR, Cockcroft E, Cooper J, Cruickshank S, Doris F, Hulme C, Logan P, Iles-Smith H, Melendez-Torres GJ, et al (2021). COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus—protocol for a cluster randomised controlled trial.
BMJ Open,
11(5), e046436-e046436.
Abstract:
COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus—protocol for a cluster randomised controlled trial
IntroductionPatient experience of nursing care is correlated with safety, clinical effectiveness, care quality, treatment outcomes and service use. Effective nursing care includes actions to develop nurse–patient relationships and deliver physical and psychosocial care to patients. The high risk of transmission of the SARS-CoV-2 virus compromises nursing care. No evidence-based nursing guidelines exist for patients infected with SARS-CoV-2, leading to potential variations in patient experience, outcomes, quality and costs.Methods and analysiswe aim to recruit 840 in-patient participants treated for infection with the SARS-CoV-2 virus from 14 UK hospitals, to a cluster randomised controlled trial, with embedded process and economic evaluations, of care as usual and a fundamental nursing care protocol addressing specific areas of physical, relational and psychosocial nursing care where potential variation may occur, compared with care as usual. Our coprimary outcomes are patient-reported experience (Quality from the Patients’ Perspective; Relational Aspects of Care Questionnaire); secondary outcomes include care quality (pressure injuries, falls, medication errors); functional ability (Barthell Index); treatment outcomes (WHO Clinical Progression Scale); depression Patient Health Questionnaire-2 (PHQ-2), anxiety General Anxiety Disorder-2 (GAD-2), health utility (EQ5D) and nurse-reported outcomes (Measure of Moral Distress for Health Care Professionals). For our primary analysis, we will use a standard generalised linear mixed-effect model adjusting for ethnicity of the patient sample and research intensity at cluster level. We will also undertake a planned subgroup analysis to compare the impact of patient-level ethnicity on our primary and secondary outcomes and will undertake process and economic evaluations.Ethics and disseminationResearch governance and ethical approvals are from the UK National Health Service Health Research Authority Research Ethics Service. Dissemination will be open access through peer-reviewed scientific journals, study website, press and online media, including free online training materials on the Open University’s FutureLearn web platform.Trial registration numberISRCTN13177364; Pre-results.
Abstract.
Plappert H, Hobson-Merrett C, Gibbons B, Baker E, Bevan S, Clark M, Creanor S, Davies L, Denyer R, Frost J, et al (2021). Evaluation of a primary care-based collaborative care model (PARTNERS2) for people with diagnoses of schizophrenia, bipolar, or other psychoses: study protocol for a cluster randomised controlled trial.
BJGP Open,
5(3).
Abstract:
Evaluation of a primary care-based collaborative care model (PARTNERS2) for people with diagnoses of schizophrenia, bipolar, or other psychoses: study protocol for a cluster randomised controlled trial.
BACKGROUND: Current NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The 'PARTNERS2' complex intervention is designed to support individuals with psychosis in a primary care setting. AIM: the trial will evaluate the clinical and cost-effectiveness of the PARTNERS2 intervention. DESIGN & SETTING: This is a cluster randomised controlled superiority trial comparing collaborative care (PARTNERS2) with usual care, with an internal pilot to assess feasibility. The setting will be primary care within four trial recruitment areas: Birmingham & Solihull, Cornwall, Plymouth, and Somerset. GP practices are randomised 1:1 to either (a) the PARTNERS2 intervention plus modified standard care ('intervention'); or (b) standard care only ('control'). METHOD: PARTNERS2 is a flexible, general practice-based, person-centred, coaching-based intervention aimed at addressing mental health, physical health, and social care needs. Two hundred eligible individuals from 39 GP practices are taking part. They were recruited through identification from secondary and primary care databases. The primary hypothesis is quality of life (QOL). Secondary outcomes include: mental wellbeing, time use, recovery, and process of physical care. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action, and look for unintended consequences. An economic evaluation will estimate its cost-effectiveness. Intervention delivery and follow-up have been modified during the COVID-19 pandemic. CONCLUSION: the overarching aim is to establish the clinical and cost-effectiveness of the model for adults with a diagnosis of schizophrenia, bipolar, or other types of psychoses.
Abstract.
Author URL.
Horrell J, Thompson TP, Taylor AH, Neale J, Husk K, Wanner A, Creanor S, Wei Y, Kandiyali R, Sinclair J, et al (2021). Qualitative systematic review of the acceptability, feasibility, barriers, facilitators and perceived utility of using physical activity in the reduction of and abstinence from alcohol and other drug use (vol 19, 100355, 2020).
MENTAL HEALTH AND PHYSICAL ACTIVITY,
20 Author URL.
Bridgewater S, Lomax J, Abbott B, Adams J, Berry A, Creanor S, Ewings P, Hewlett S, McCracken L, Ndosi M, et al (2021). TESTING AN INTERVENTION TO REDUCE FATIGUE IMPACT IN INFLAMMATORY ARTHRITIS: DESIGN AND OUTCOMES OF a SINGLE-ARM FEASIBILITY STUDY.
Author URL.
2020
Logan A, Freeman J, Pooler J, Kent B, Barton A, Vickery J, Creanor S, Enki D, Marsden J (2020). Is practising standing-up and moving between sitting and standing early after a severe stroke feasible? a feasibility randomised controlled trial. Physiotherapy, 107, e18-e19.
Carlton EW, Ingram J, Taylor H, Glynn J, Kandiyali R, Campbell S, Beasant L, Aziz S, Beresford P, Kendall J, et al (2020). Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial.
Heart,
106(20), 1586-1594.
Abstract:
Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial
IntroductionThe clinical effectiveness of a ‘rule-out’ acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown.MethodsA randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days.ResultsBetween June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days.ConclusionThe LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors.Trial registration numberISRCTN86184521.
Abstract.
Thompson TP, Horrell J, Taylor AH, Wanner A, Husk K, Wei Y, Creanor S, Kandiyali R, Neale J, Sinclair J, et al (2020). Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): a systematic review.
Ment Health Phys Act,
19Abstract:
Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): a systematic review.
The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval -0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings.
Abstract.
Author URL.
Horrell J, Thompson TP, Taylor AH, Neale J, Husk K, Wanner A, Creanor S, Wei Y, Kandiyali R, Sinclair J, et al (2020). Qualitative systematic review of the acceptability, feasibility, barriers, facilitators and perceived utility of using physical activity in the reduction of and abstinence from alcohol and other drug use.
Mental Health and Physical Activity,
19Abstract:
Qualitative systematic review of the acceptability, feasibility, barriers, facilitators and perceived utility of using physical activity in the reduction of and abstinence from alcohol and other drug use
Given the growing global increase in harm from alcohol and substance use, and the inadequacy of standard treatment to tackle the challenge, the use of physical activity (PA) interventions has received increased attention. The aim of this review is to identify common and cross cutting themes relating to how and why physical activity may impact on reduction of/abstinence from alcohol and other drug use to support future intervention design (including aspects of physical activity, barriers and facilitators, and elements of support which may have an impact). Twenty papers including qualitative data were included in the synthesis. A deductive coding framework was created and sought to identify biological, environmental and psycho-social barriers, facilitators and mechanisms of participants’ experience of engaging with physical activity interventions. Key themes supported in the evidence included how interventions influence use (e.g. reduced cravings, increases in bodily awareness and health and fitness, the development of positive focus and new identity, and increases in mood and quality of life); the impact of frequency, intensity, type, duration and timing of physical activity; perceived barriers and facilitators to engaging in physical activity (e.g. health and fitness, access and affordability, perceptions of others); and details of how much support and in what form best supports sustained changes in physical activity (e.g. social support and environment). Despite evidence being sparse, key barriers and facilitators pertinent to intervention design were identified. Recommendations for future research are indicated and the evidence promotes the need for individually tailored programmes of support for physical activity.
Abstract.
Freeman J, Marsden J, Pavlou M, Dennett R, Gibbon A, Bamiou D, Harris C, Hawton A, Jones B, Creanor S, et al (2020). Vestibular Rehabilitation in People with Multiple Sclerosis.
Author URL.
Marsden J, Pavlou M, Dennett R, Gibbon A, Knight-Lozano R, Jeu L, Flavell C, Freeman J, Bamiou DE, Harris C, et al (2020). Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo.
BMC Neurology,
20(1).
Abstract:
Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo
Abstract
. Background
. Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately.
.
. Methods/ design
. People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used.
.
. Discussion
. If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS.
.
. Trial registration
. ISRCTN Number: 27374299
. Date of Registration 24/09/2018
. Protocol Version 15 25/09/2019
.
Abstract.
2019
Freeman J, Hendrie W, Jarrett L, Hawton A, Barton A, Dennett R, Jones B, Zajicek J, Creanor S (2019). Assessment of a home-based standing frame programme in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis.
The Lancet Neurology,
18(8), 736-747.
Abstract:
Assessment of a home-based standing frame programme in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis
Background: People severely impaired with progressive multiple sclerosis spend much of their day sitting, with very few options to improve motor function. As a result, secondary physical and psychosocial complications can occur. Effective and feasible self-management strategies are needed to reduce sedentary behaviour and enhance motor function. In this study, we aimed to assess the clinical and cost effectiveness of a home-based, self-managed, standing frame programme. Methods: SUMS was a pragmatic, multicentre, randomised controlled superiority trial of people with progressive multiple sclerosis and severe mobility impairment, undertaken in eight centres from two regions in the UK. The study had assessor-blinded outcome assessments with use of clinician-rated and patient-rated measures at baseline, 20 weeks, and 36 weeks. After baseline assessment, participants were randomised (1:1) by computer-generated assignment to either a standing frame programme plus usual care or usual care alone. The intervention consisted of two home-based physiotherapy sessions (60 min each) to set up the standing frame programme, supported by six follow-up telephone calls (15 min per call). Participants were asked to stand for 30 min, three times per week over 20 weeks, and encouraged to continue in the longer term, although no further physiotherapy support was provided. The primary clinical outcome was motor function measured by the Amended Motor Club Assessment (AMCA) score at week 36, analysed in the modified intention-to-treat population (excluding only patients who were deemed ineligible after randomisation, those who withdrew from the trial and were unwilling for their previously collected data to be used, or those who did not provide baseline and week 36 measurements). A 9-point AMCA score change was considered clinically meaningful a priori. Adverse events were collected through a daily preformatted patient diary throughout the 36 weeks and analysed in the modified intention-to-treat population. An economic assessment established the resources required to provide the standing frame programme, estimated intervention costs, and estimate cost effectiveness. This trial is registered with the International Standard Randomised Controlled Trials, number ISRCTN69614598. Findings: Between Sept 16, 2015, and April 28, 2017, 285 people with progressive multiple sclerosis were screened for eligibility, and 140 were randomly assigned to either the standing frame group (n=71) or the usual care group (n=69). of these, 122 completed the primary outcome assessment (61 participants in both groups) for the modified intention-to-treat analysis. The use of the standing frame resulted in a significant increase in AMCA score compared with that for usual care alone, with a fully adjusted between-group difference in AMCA score at 36 weeks of 4·7 points (95% CI 1·9–7·5; p=0·0014). For adverse events collected through patient diaries, we observed a disparity between the two groups in the frequency of short-term musculoskeletal pain (486 [41%] of 1188 adverse events in the standing frame group vs 160 [22%] of 736 adverse events in the usual care group), which was potentially related to the intervention. The musculoskeletal pain lasted longer than 7 days in five participants (two in the standing frame group and three in the usual care group). No serious adverse events related to the study occurred. The standing frame group had a mean 0·018 (95% CI −0·014 to 0·051) additional quality-adjusted life-years (QALYs) compared with those of the usual care group, and the estimated incremental cost-per-QALY was approximately £14 700. Interpretation: the standing frame programme significantly increased motor function in people with severe progressive multiple sclerosis, although not to the degree that was considered a priori as clinically meaningful. The standing frame is one of the first physiotherapy interventions to be effective in this population. We suggest that the programme is feasible as a home-based, self-managed intervention that could be routinely implemented in clinical practice in the UK. Funding: UK National Institute of Health Research.
Abstract.
Gunn H, Andrade J, Paul L, Miller L, Stevens K, Creanor S, Green C, Ewings P, Barton A, Berrow M, et al (2019). Balance Right in Multiple Sclerosis (BRiMS): Preliminary results of a randomised controlled feasibility trial. Physiotherapy, 105, e36-e37.
Jones BG, Streeter A, Baker A, Moyeed R, Creanor S (2019). Bayesian Statistics in the design and analysis of cluster randomised controlled trials and their reporting quality: a methodological systematic review.
Author URL.
Burke FJT, Wilson NHF, Brunton PA, Creanor S (2019). Contemporary dental practice in the UK. Part 1: Demography and practising arrangements in 2015.
British Dental Journal,
226(1), 55-61.
Abstract:
Contemporary dental practice in the UK. Part 1: Demography and practising arrangements in 2015
Objectives to determine, by means of an anonymous, self-reported questionnaire, the demographic profile and practising details of general dental practitioners in the UK in 2015. Methods a previously-piloted and validated 121-question questionnaire was distributed during 2015 to 500 dentists at UK dental meetings with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results Three hundred and eighty-eight useable questionnaires were returned, giving a response rate of 77.6%. of the respondents, 60.2% were male and 39.8% female. Their mean age since graduation was 19.7 years. Just over half of the respondents (50.9%) replied that they were practice principals, 35.8% were associates and 10.6% were foundation dentists. A quarter of the respondents were in single-handed practices, the remainder being in a partnership or group practice. There was a mean of 4.2 dentists per practice, while the mean number of dental therapists in each practice was 0.3 and 1.2 hygienists. Regarding the first available NHS appointment in the respondents’ practices for non-urgent care, 23.4% could provide this on the same day, the equivalent figure for private care being 40.1%. The mean percentage of patients receiving NHS treatment was 50%, with 33.8% receiving private treatment. Just over half of respondents considered that Care Quality Commission inspections were ‘valuable for fostering patient trust and confidence in dental care.’ the collected data indicated that 55.4% of respondents had an intra-oral camera, while, with regard to recently-introduced concepts and techniques, 80.4% used nickel-titanium files, 47.4% used zirconia-based bridgework and 24.9% used tricalcium silicate. of great interest, perhaps, is the response to digital radiography/digital imaging, with the results indicating that 74.1% of respondents used this form of radiography. Regarding checking the light output of the light curing units, 53.1% stated that they did check the output, but in some cases this might be at a six-monthly interval. Conclusion Results from this survey indicated that NHS service provision has dropped to approximately 50% amongst the respondents. Regarding the staffing of dental practices, just over half the respondents were practice principals and there was a mean of 4.2 dentists per practice. The results also indicated that UK dentists continue to be innovative in the techniques that they employ.
Abstract.
Wilson NHF, Burke FJT, Brunton PA, Creanor S, Hosey MT, Mannocci F (2019). Dental practice in the UK in 2015/2016. Part 2: Aspects of direct restorations, bleaching, endodontics and paediatric dentistry.
British Dental Journal,
226(2), 110-114.
Abstract:
Dental practice in the UK in 2015/2016. Part 2: Aspects of direct restorations, bleaching, endodontics and paediatric dentistry
Objective to follow up related studies reported in 2004/2005 and 2011/2012 by investigating aspects of direct restorations, bleaching, endodontics and paediatric dentistry in general dental practice, as part of a survey of arrangements and procedures in the clinical practice of dentistry. Methods the data presented were extracted from the data obtained from a piloted, 121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. Percentages reported are based upon the number of respondents who answered each question, given that not all respondents answered all 121 questions included in the questionnaire. Results Between 2008 and 2015, composite displaced amalgam as the material most commonly used by general dental practitioners (GDPs) for the restoration of two surface cavities in premolars and permanent molar teeth. Only 24% of respondents were of the view that dental amalgam should continue to be used freely, but not because of environmental or mercury toxicity concerns. In applying minimum intervention dentistry approaches, repair rather than replacement was considered by most GDPs for the management of defective restorations, irrespective of the material forming the restoration. The provision of home-based, vital bleaching had increased since 2008, with tooth sensitivity being the most commonly reported, unwanted side effect. A small majority of respondents (54%) were of the view that facial soft tissue aesthetics should be considered the practice of dentistry. Rubber dam was widely used in endodontic procedures (85%) but not for other procedures. Rotary instrumentation was routinely used in root canal treatment by 88% of the respondents. A greater percentage of respondents indicated that they would use a preformed metal crown to restore primary molars either routinely or occasionally, compared to eight years ago (35% cf 23%). Over three quarters of the respondents had heard of the Hall crown technique, and 50% of them had used it to good effect in their practices. Conclusion Key aspects of general dental practice in the UK changed between 2008 and 2015, highlighting the dynamic nature of clinical practice and the scope of practice of dentistry. Studies of the type reported are considered important in investigating trends and developments in dentistry.
Abstract.
Jum’ah AA, Creanor S, Wilson NHF, Burke FJT, Brunton PA (2019). Dental practice in the UK in 2015/2016. Part 3: Aspects of indirect restorations and fixed prosthodontics.
British Dental Journal,
226(3), 192-196.
Abstract:
Dental practice in the UK in 2015/2016. Part 3: Aspects of indirect restorations and fixed prosthodontics
Objective This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials. Methods the data presented were extracted from the data obtained from a validated, 121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. Results a response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material. Conclusion Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pins continued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry.
Abstract.
Burke FJT, Wilson NHF, Brunton PA, Creanor S (2019). Dental practice in the UK in 2015/2016. Part 4: changes since 2002?.
British Dental Journal,
226(4), 279-285.
Abstract:
Dental practice in the UK in 2015/2016. Part 4: changes since 2002?
Objectives to determine, by means of anonymous self-report questionnaires, the changes in demographic profile, practising details and utilisation of clinical techniques/materials of general dental practitioners (GDPs) in the UK between 2002 and 2015. Method a wide-ranging, validated questionnaire, designed to elicit information on the practising arrangements and techniques and materials used, was distributed to UK-based GDPs in 2002, 2008 and 2015 with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results Questionnaires were distributed by post to 1,000 UK-based GDPs in 2004 and 2008, with an additional 500 questionnaires being distributed at postgraduate meetings in 2015. Response rates of 70%, 66% and 78% were achieved, respectively. of the respondents, 73% were male in 2002, while 67% and 60% were male in 2008 and 2015, respectively. In 2002, 65% were practice principals, falling to 51% in 2015. Regarding how patients paid for their dental care, 86% of respondents in 2002 treated patients within the NHS arrangements, compared with 57% and 50% in 2008 and 2015, respectively. The data collected in 2015 indicated that 55% of respondents had an intra-oral camera; while, with regard to recently introduced concepts and techniques, 80% used nickel-titanium files, 47% used zirconia-based bridgework, 25% used tricalcium silicate, and 17% used CAD/CAM restoration. of great interest, perhaps, is the response to digital radiography/imaging, with the results indicating that, by 2015, 74% of respondents used this form of radiography. Conclusion Results from the three surveys indicated that NHS service provision has dropped to 50%. Regarding the staffing of dental practices, just over half the respondents were practice principals. The results also indicated that UK dentists continue to be innovative and forward-looking in the techniques that they employ.
Abstract.
Logan A, Freeman J, Kent B, Marsden J, Pooler J, Barton A, Enki D, Creanor S, Vickery J (2019). Functional frame programme (standing-up and sit-to-stand repetitions) is feasible for people with severe sub-acute stroke: a feasibility RCT.
Author URL.
Chapman R, Griffiths S, Manger L, Sherriff I, Creanor S, Quinn C, Mann V, Byng R (2019). How do we optimise approach and recruitment strategies for inclusion of people with dementia in primary care clinical trials?.
Author URL.
Smith JE, Creanor S, Rockett M, Ewings P (2019). How do you solve a problem like… missing data? Lessons from the PAin SoluTions in the Emergency Setting (PASTIES) trials. Journal of the Royal Naval Medical Service, 105(1), 23-28.
Callaghan L, Thompson TP, Creanor SC, Quinn C, Senior J, Green C, Hawton AJ, Byng R, Wallace G, Sinclair J, et al (2019). Individual health trainers to support health and well-being for people under community supervision in the criminal justice system: the STRENGTHEN pilot RCT. Public Health Research, 7(20).
Logan A, Freeman J, Pooler J, Kent B, Vickery J, Creanor S, Enki D, Barton A, Marsden J (2019). Is practising standing-up and moving between sitting and standing early after a severe stroke feasible? a feasibility randomised controlled trial. Physiotherapy, 105
Carroll CB, Webb D, Stevens KN, Vickery J, Eyre V, Ball S, Wyse R, Webber M, Foggo A, Zajicek J, et al (2019). Simvastatin as a neuroprotective treatment for Parkinson's disease (PD STAT): protocol for a double-blind, randomised, placebo-controlled futility study.
BMJ Open,
9(10).
Abstract:
Simvastatin as a neuroprotective treatment for Parkinson's disease (PD STAT): protocol for a double-blind, randomised, placebo-controlled futility study.
INTRODUCTION: Parkinson's disease (PD) is a progressive neurodegenerative condition affecting approximately 185,000 people in the UK. No drug has been proven to slow disease progression. Epidemiological and pre-clinical data support simvastatin, a widely used cholesterol-lowering drug with a well-established safety profile, having neuroprotective properties. The aim of this study (Simvastatin as a neuroprotective treatment for PD (PD STAT)) is to determine whether simvastatin has the potential to slow PD progression. The study is part of the International Linked Clinical Trials initiative coordinated by the Cure Parkinson's Trust. This paper describes the protocol for the PD STAT study. METHODS AND ANALYSIS: PD STAT is a double-blind, randomised, placebo-controlled, multi-centre, parallel group, futility trial in patients with PD of mild-moderate severity. 235 participants have been recruited and randomly allocated in a 1:1 ratio to receive either oral simvastatin or matched placebo. Treatment involves a 1-month low-dose phase (40 mg daily), followed by a 23-month high-dose phase (80 mg daily) and ends with a 2-month washout period. Participants are reviewed at clinic visits at 1 month, 6, 12, 18, 24 and 26 months post-baseline, with interim telephone follow-up to monitor for adverse events.The primary outcome is the change in the Movement Disorder Society Unified Parkinson's Disease Rating Scale part III motor subscale score in the practically defined OFF medication state (OFF state) between baseline and 24 months. Primary analysis will be on a modified intention to treat basis and will include only those participants who progress to the high-dose phase of the study. ETHICS AND DISSEMINATION: the protocol has been approved by the North East-Newcastle and North Tyneside 2 Research Ethics Committee. The results will be disseminated via research articles in peer-reviewed journals and presentations at local, national and international scientific meetings, as well as disseminated via patient groups, websites and networks. A summary of the study findings will be posted to participants at the end of the study. TRIAL REGISTRATION: ISRCTN16108482 (prospectively registered); EudraCT 2015-000148-40; ClinicalTrials.gov NCT02787590; Pre-results.
Abstract.
Author URL.
Freeman J, Hendrie W, Jarrett L, Hawton A-M, Barton A, Dennett R, Jones B, Marsden J, Zajicek J, Creanor S, et al (2019). Standing up in people with progressive multiple sclerosis (SUMS): a multi-centre randomised controlled trial evaluating a home-based standing frame programme. Physiotherapy, 105, e24-e25.
Hancocks H, King J, Gude A, Callaghan L, Treweek S, Ingram W, Thompson T, Taylor A, Creanor S (2019). The effect of the method of invitation on recruitment of participants from GP practices to a trial of a smoking reduction intervention: a study within a trial.
Author URL.
Rockett M, Creanor S, Squire R, Barton A, Benger J, Cocking L, Ewings P, Eyre V, Smith JE (2019). The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain.
ANAESTHESIA,
74(1), 69-73.
Author URL.
Hendrie W, Dennett R, Jarrett L, Creanor S, Barton A, Hawton A, Marsden J, Freeman J (2019). “I’m in a very good frame of mind”: the experience of standing frame use in people with progressive multiple sclerosis.
2018
Jarrett L, Hendrie W, Dennett R, Creanor S, Barton A, Hawton AM, Marsden J, Freeman J (2018). "I'm in a very good frame of mind": the experience of standing frame use in people with progressive multiple sclerosis.
Author URL.
Hendrie W, Dennett R, Jarrett L, Creanor S, Barton A, Green C, Marsden J, Freeman JA (2018). "I'm in a very good frame of mind": the experience of standing frame use in people with progressive multiple sclerosis.
Author URL.
Gunn H, Andrade J, Paul L, Miller L, Creanor S, Stevens K, Green C, Ewings P, Barton A, Berrow M, et al (2018). Balance Right in Multiple Sclerosis (BRiMS): Preliminary results of a randomised controlled feasibility trial.
Author URL.
Freeman J, Gunn H, Andrade J, Paul L, Miller L, Stevens K, Green C, Ewings P, Barton A, Berrow M, et al (2018). Balance Right in Multiple Sclerosis (BRiMS): preliminary results of a randomised controlled feasibility trial.
Author URL.
Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, et al (2018). Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial.
The Lancet Child and Adolescent Health,
2(1), 35-45.
Abstract:
Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial
Background Although childhood overweight and obesity prevalence has increased substantially worldwide in the past three decades, scarce evidence exists for effective preventive strategies. We aimed to establish whether a school-based intervention for children aged 9–10 years would prevent excessive weight gain after 24 months. Methods This pragmatic cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a school-based obesity prevention intervention, was done in 32 schools in southwest England. All state-run primary and junior schools in Devon and Plymouth (UK) with enough pupils for at least one year-5 class were eligible. Schools were assigned (1:1) using a computer-generated sequence to either intervention or control, stratified by the number of year-5 classes (one vs more than one) and the proportion of children eligible for free school meals (
Abstract.
Thompson TP, Callaghan L, Hazeldine E, Quinn C, Walker S, Byng R, Wallace G, Creanor S, Green C, Hawton A, et al (2018). Health trainer-led motivational intervention plus usual care for people under community supervision compared with usual care alone: a study protocol for a parallel-group pilot randomised controlled trial (STRENGTHEN).
BMJ Open,
8(6).
Abstract:
Health trainer-led motivational intervention plus usual care for people under community supervision compared with usual care alone: a study protocol for a parallel-group pilot randomised controlled trial (STRENGTHEN).
INTRODUCTION: People with experience of the criminal justice system typically have worse physical and mental health, lower levels of mental well-being and have less healthy lifestyles than the general population. Health trainers have worked with offenders in the community to provide support for lifestyle change, enhance mental well-being and signpost to appropriate services. There has been no rigorous evaluation of the effectiveness and cost-effectiveness of providing such community support. This study aims to determine the feasibility and acceptability of conducting a randomised trial and delivering a health trainer intervention to people receiving community supervision in the UK. METHODS AND ANALYSIS: a multicentre, parallel, two-group randomised controlled trial recruiting 120 participants with 1:1 individual allocation to receive support from a health trainer and usual care or usual care alone, with mixed methods process evaluation. Participants receive community supervision from an offender manager in either a Community Rehabilitation Company or the National Probation Service. If they have served a custodial sentence, then they have to have been released for at least 2 months. The supervision period must have at least 7 months left at recruitment. Participants are interested in receiving support to change diet, physical activity, alcohol use and smoking and/or improve mental well-being. The primary outcome is mental well-being with secondary outcomes related to smoking, physical activity, alcohol consumption and diet. The primary outcome will inform sample size calculations for a definitive trial. ETHICS AND DISSEMINATION: the study has been approved by the Health and Care Research Wales Ethics Committee (REC reference 16/WA/0171). Dissemination will include publication of the intervention development process and findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will also be disseminated to stakeholders and trial participants. TRIAL REGISTRATION NUMBERS: ISRCTN80475744; Pre-results.
Abstract.
Author URL.
Thompson TP, Taylor AH, Wanner A, Husk K, Wei Y, Creanor S, Kandiyali R, Neale J, Sinclair J, Nasser M, et al (2018). Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): Protocol for a systematic review.
Systematic Reviews,
7(1).
Abstract:
Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): Protocol for a systematic review
Background: Alcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60-90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners. Methods: the objectives of this mixed methods systematic review are to describe and evaluate the quantitative and qualitative research obtained by a diverse search strategy on the impact of physical activity and its potential to: 1. Reduce the risk of progression to alcohol and/or substance use (PREVENTION) Discussion: This review will provide details of what is known about physical activity and the prevention, reduction, and treatment of alcohol and/or substance use. The synthesised findings will be disseminated to policymakers, service providers, and commissioners in the UK. Systematic review registration: PROSPERO number: CRD42017079322.
Abstract.
Logan A, Freeman J, Kent B, Pooler J, Creanor S, Vickery J, Enki D, Barton A, Marsden J (2018). Standing Practice in Rehabilitation Early after Stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke-a protocol for a feasibility randomised controlled trial.
Pilot Feasibility Stud,
4Abstract:
Standing Practice in Rehabilitation Early after Stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke-a protocol for a feasibility randomised controlled trial.
BACKGROUND: the most common physical deficit caused by a stroke is muscle weakness which limits a person's mobility. Mobility encompasses activities necessary for daily functioning: getting in and out bed, on/off toilet, sitting, standing and walking. These activities are significantly affected in people with severe stroke who typically spend most of their time in bed or a chair and are immobile. Immobility is primarily caused by neurological damage but exacerbated by secondary changes in musculoskeletal and cardiorespiratory systems. These secondary changes can theoretically be prevented or minimised by early mobilisation, in this case standing up early post-stroke.Standing up early post-stroke has been identified as an important priority for people who have suffered a severe stroke. However, trials of prolonged passive standing have not demonstrated any functional improvements. Conversely, task-specific training such as repeated sit-to-stand has demonstrated positive functional benefits. This feasibility trial combines prolonged standing and task-specific strength training with the aim of determining whether this novel combination of physiotherapy interventions is feasible for people with severe stroke as well as the overall feasibility of delivering the trial. METHODS/DESIGN: This is a pragmatic multi-centre parallel single-blinded two-armed feasibility randomised controlled trial. Fifty people with a diagnosis of severe stroke will be randomly allocated to either the functional standing frame programme or usual physiotherapy. All patient participants will be assessed at baseline and followed up at 3 weeks, then 3, 6 and 12 months post-randomisation. Trial objectives are to determine the feasibility according to the following indicators:: (i) Process: recruitment and retention rate, ability to consent, eligibility criteria, willingness/ability of physiotherapists to recruit, willingness of patients to be randomised, and acceptability of the intervention; (ii) Resource: burden and potential costs; (iii) Management: treatment fidelity, participant adherence, acceptability and completeness of outcome measures, impact and management or orthostatic hypotension; and (iv) Safety: number and nature of adverse and serious adverse events. DISCUSSION: the functional standing frame programme addresses a key concern for people who have suffered a severe stroke. However, several uncertainties exist which need to be understood prior to progressing to a full-scale trial, including acceptability and tolerance of the functional standing frame programme intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ISRCTN15412695. Registration on 19 December 2016.
Abstract.
Author URL.
Freeman J, Hendrie W, Jarrett L, Hawton A, Barton A, Dennett R, Jones B, Marsden J, Zajicek J, Creanor S, et al (2018). Standing up in multiple sclerosis (SUMS): a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis.
Author URL.
Freeman J, Hendrie W, Jarrett L, Marie HA, Barton A, Rachel D, Jones B, Marsden J, Zajicek J, Creanor S, et al (2018). Standing up in people with progressive multiple sclerosis (SUMS): a multi-centre randomised controlled trial evaluating a home-based standing frame programme.
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Allison R, Kilbride C, Chynoweth J, Creanor S, Frampton I, Marsden J (2018). What is the Longitudinal Profile of Impairments and can We Predict Difficulty Caring for the Profoundly Affected Arm in the First Year Poststroke?.
Arch Phys Med Rehabil,
99(3), 433-442.
Abstract:
What is the Longitudinal Profile of Impairments and can We Predict Difficulty Caring for the Profoundly Affected Arm in the First Year Poststroke?
OBJECTIVES: to establish the longitudinal profile of impairments of body functions and activity limitations of the arm, and to evaluate potential predictors of difficulty caring for the profoundly affected arm poststroke. DESIGN: Prospective cohort study. SETTING: Stroke services. PARTICIPANTS: People unlikely to regain functional use of the arm (N=155) were recruited at 2 to 4 weeks poststroke, and followed up at 3, 6, and 12 months. Potential predictors at baseline were hypertonicity, pain, motor control, mood, sensation/perception, age, and stroke severity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Difficulty caring for the arm (Leeds Arm Spasticity Impact Scale), pain, hypertonicity, range of movement, arm function, and skin integrity. Multivariable linear regression identified the best fitting model for predicting Leeds Arm Spasticity Impact Scale score at 12 months. RESULTS: There were 110 participants (71%) reviewed at 1 year. There was a large variation in the profile of arm functions and activity limitations. Inability or severe difficulty caring for the arm affected 29% of participants. Hypertonicity developed in 77%, with severe hypertonicity present in 25%. Pain was reported by 65%, 94% developed shoulder contracture, and 6% had macerated skin. Difficulty caring for the arm increased with age, greater level of hypertonicity, and stroke classification; collectively, these factors accounted for 33% of the variance in Leeds Arm Spasticity Impact Scale scores. CONCLUSIONS: at 1 year poststroke, there was a high incidence of impairments of body functions and activity limitations in people with a profoundly affected arm. Individual profiles were very variable and although some predisposing factors have been identified, it remains difficult to predict who is at greatest risk.
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2017
Jones R, Kirenga BJ, Katagira W, Singh SJ, Pooler J, Okwera A, Kasiita R, Enki DG, Creanor S, Barton A, et al (2017). A pre-post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda.
Int J Chron Obstruct Pulmon Dis,
12, 3533-3539.
Abstract:
A pre-post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda.
SETTING: the study was conducted at Mulago Hospital, Kampala, Uganda. OBJECTIVE: As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD). DESIGN: in a pre-post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken. RESULTS: in all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR. CONCLUSION: PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD.
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Gunn H, Andrade J, Paul L, Miller L, Creanor S, Green C, Marsden J, Ewings P, Berrow M, Vickery J, et al (2017). Balance Right in Multiple Sclerosis (BRiMS): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised controlled trial. Pilot and Feasibility Studies, 4, 26-26.
Gunn H, Andrade J, Paul L, Miller L, Creanor S, Green C, Marsden J, Ewings P, Berrow M, Vickery J, et al (2017). Balance Right in Multiple Sclerosis (BRiMS): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised controlled trial.
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Lloyd J, Dean S, Creanor S, Abraham C, Hillsdon M, Ryan E, Wyatt KM (2017). Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation.
Int J Behav Nutr Phys Act,
14(1).
Abstract:
Intervention fidelity in the definitive cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP) trial: findings from the process evaluation.
BACKGROUND: the Healthy Lifestyles Programme (HeLP) was a novel school-located intervention for 9-10 year olds, designed to prevent obesity by changing patterns of child behaviour through the creation of supportive school and home environments using dynamic and creative delivery methods. This paper reports on both the quantitative and qualitative data regarding the implementation of the HeLP intervention in the definitive cluster randomised controlled trial, which was part of the wider process evaluation. METHODS: Mixed methods were used to collect data on intervention uptake, fidelity of delivery in terms of content and quality of delivery of the intervention, as well as school and child engagement with the programme. Data were collected using registers of attendance, observations and checklists, field notes, focus groups with children and semi-structured interviews with teachers. Qualitative data were analysed thematically and quantitative data were summarized using descriptive statistics. RESULTS: all 16 intervention schools received a complete or near complete programme (94-100%), which was delivered in the spirit in which it had been designed. of the 676 children in the intervention schools, over 90% of children participated in each phase of HeLP; 92% of children across the socio-economic spectrum were deemed to be engaged with HeLP and qualitative data revealed a high level of enjoyment by all children, particularly to the interactive drama workshops. Further evidence of child engagment with the programme was demonstrated by children's clear understanding of programme messages around marketing, moderation and food labelling. Thirteen of the intervention schools were deemed to be fully engaged with HeLP and qualitative data revealed a high level of teacher 'buy in', due to the programme's compatability with the National Curriculum, level of teacher support and use of innovative and creative delivery methods by external drama practitioners. CONCLUSION: Our trial shows that it is possible to successfully scale up complex school-based interventions, engage schools and children across the socio-economic spectrum and deliver an intervention as designed. As programme integrity was maintained throughout the HeLP trial, across all intervention schools, we can be confident that the trial findings are a true reflection of the effectiveness of the intervention, enabling policy recommendations to be made. TRIAL REGISTRATION: ISRCTN15811706.
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Freeman JA, Hendrie W, Creanor S, Jarrett L, Barton A, Hawton A, Morby D, Hooley S, Marsden J, Zajicek J, et al (2017). Standing up in Multiple Sclerosis (SUMS): Protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis.
Author URL.
Pritchard C, Smith JE, Creanor S, Squire R, Barton A, Benger J, Cocking L, Ewings P, Rockett M, Eyre V, et al (2017). The cost-effectiveness of patient-controlled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital.
Anaesthesia,
72(8), 953-960.
Abstract:
The cost-effectiveness of patient-controlled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital
The clinical effectiveness of patient-controlled analgesia has been demonstrated in a variety of settings. However, patient-controlled analgesia is rarely utilised in the Emergency Department. The aim of this study was to compare the cost-effectiveness of patient-controlled analgesia vs. standard care in participants admitted to hospital from the Emergency Department with pain due to traumatic injury or non-traumatic abdominal pain. Pain scores were measured hourly for 12 h using a visual analogue scale. Cost-effectiveness was measured as the additional cost per hour in moderate to severe pain avoided by using patient-controlled analgesia rather than standard care (the incremental cost-effectiveness ratio). Sampling variation was estimated using bootstrap methods and the effects of parameter uncertainty explored in a sensitivity analysis. The cost per hour in moderate or severe pain averted was estimated as £24.77 (€29.05, US$30.80) (bootstrap estimated 95%CI £8.72 to £89.17) for participants suffering pain from traumatic injuries and £15.17 (€17.79, US$18.86) (bootstrap estimate 95%CI £9.03 to £46.00) for participants with non-traumatic abdominal pain. Overall costs were higher with patient-controlled analgesia than standard care in both groups: pain from traumatic injuries incurred an additional £18.58 (€21.79 US$23.10) (95%CI £15.81 to £21.35) per 12 h; and non-traumatic abdominal pain an additional £20.18 (€23.67 US$25.09) (95%CI £19.45 to £20.84) per 12 h.
Abstract.
Lloyd J, Creanor S, Price LRS, Abraham C, Dean S, Green C, Hillsdon M, Pearson V, Taylor R, Tomlinson R, et al (2017). Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial. BMC Public Health
2016
Jones R, Kirenga B, Pooler J, Katagira W, Kasiita R, Enki DG, Creanor S, Barton A, Okwera A, Worodria W, et al (2016). A development study of pulmonary rehabilitation for patients with chronic lung disease in Uganda.
Author URL.
Creanor S, Lloyd J, Hillsdon M, Dean S, Green C, Taylor RS, Ryan E, Wyatt K, HeLP Trial Management Group (2016). Detailed statistical analysis plan for a cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children.
Trials,
17(1).
Abstract:
Detailed statistical analysis plan for a cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children.
BACKGROUND: the Healthy Lifestyles Programme (HeLP) trial is being conducted to determine whether a novel school-based intervention is effective and cost-effective in preventing obesity in 9-10 year-old children. This article describes the detailed statistical analysis plan for the HeLP trial, including an amendment (and rationale for amendment) made to originally planned sensitivity analyses. METHODS AND DESIGN: the HeLP trial is a definitive, pragmatic, superiority, cluster randomised controlled trial with two parallel groups and blinded outcome assessment. This update article describes in detail (1) the primary and secondary outcomes, (2) the statistical analysis principles (including which children will be included in each analysis, how the clustered nature of the study design will be accounted for, which covariates will be included in each analysis, how the results will be presented), (3) planned sensitivity analyses, planned subgroup analyses and planned adherence-adjusted analyses for the primary outcome, (4) planned analyses for the secondary outcomes and (e) planned longitudinal analyses. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) register: ISRCTN15811706. Registered on 1 May 2012.
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Fox EE, Hough AD, Creanor S, Gear M, Freeman JA (2016). Effects of Pilates-based core stability training in ambulant people with multiple sclerosis: Multicenter, assessor-blinded, randomized controlled trial.
Physical Therapy,
96(8), 1170-1178.
Abstract:
Effects of Pilates-based core stability training in ambulant people with multiple sclerosis: Multicenter, assessor-blinded, randomized controlled trial
Background. Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties. Objectives. The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises. Methods. A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]). Results. One hundred participants (mean age = 54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements] = 0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements] = −0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure. Limitations. In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance, accelerometry to assess walking, or a specific trunk assessment scale might have been more responsive in detecting changes in outcome. Conclusion. Participants did not improve significantly, either in the short term or at the 4-week follow-up, on the 10MTW after 12 weeks of Pilates exercises compared with 12 weeks of relaxation.
Abstract.
Freeman JA, Hendrie W, Creanor S, Jarrett L, Barton A, Green C, Marsden J, Rogers E, Zajicek J (2016). Standing up in Multiple Sclerosis (SUMS): Protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis. BMC Neurol, 16, 62-62.
Smith J, Squire R, Pritchard C, Ewings P, Barton A, Rockett M, Creanor S, Hayward C, Eyre V, Cocking L, et al (2016). THE COST-EFFECTIVENESS OF PATIENT CONTROLLED ANALGESIA VERSUS ROUTINE CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT IN PAIN, WHO ARE SUBSEQUENTLY ADMITTED TO HOSPITAL. Emergency Medicine Journal, 33(12).
2015
Smith JE, Rockett M, Creanor S, Squire R, Hayward C, Ewings P, Barton A, Pritchard C, Eyre V, Cocking L, et al (2015). PAin SoluTions in the Emergency Setting (PASTIES)--patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial.
BMJ (Clinical research ed.),
350Abstract:
PAin SoluTions in the Emergency Setting (PASTIES)--patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial
OBJECTIVE: to determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain.
Abstract.
Smith JE, Rockett M, Creanor SS, Squire R, Hayward C, Ewings P, Barton A, Pritchard C, Eyre V, Cocking L, et al (2015). PAin SoluTions in the Emergency Setting (PASTIES)-patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial.
BMJ-BRITISH MEDICAL JOURNAL,
350 Author URL.
Lai CW, Starkie T, Creanor S, Struthers RA, Portch D, Erasmus PD, Mellor N, Hosie KB, Sneyd JR, Minto G, et al (2015). Randomized controlled trial of stroke volume optimization during elective major abdominal surgery in patients stratified by aerobic fitness.
British Journal of Anaesthesia,
115(4), 578-589.
Abstract:
Randomized controlled trial of stroke volume optimization during elective major abdominal surgery in patients stratified by aerobic fitness
Background the benefits of stroke volume optimization during surgery are unclear, with recent data not replicating the positive effects of earlier studies. Methods This was a randomized controlled trial of standard fluid therapy with or without supplementary blinded intraoperative stroke volume optimization in 220 patients having major elective rectal resection or cystectomy with ileal conduit. All patients were treated using a contemporary enhanced recovery pathway. Interventional fluid challenges used Gelofusine (B Braun, Germany), guided by stoke volume variability measured by LiDCOrapid (LiDCO, UK). Participants were stratified by aerobic fitness (characterized by preoperative cardiopulmonary exercise test), surgical specialty, and intended surgical approach (open or laparoscopic). The primary outcome was the prevalence of moderate or severe complications on day 5 after surgery, defined using the postoperative morbidity survey (POMS) criteria. Results Patients received ∼13 ml kg-1 h-1 of i.v. fluids during surgery. The intervention group received an additional mean (sd) 956 (896) ml Gelofusine. There were no statistically significant differences between groups in any primary or secondary end point. A positive POMS on postoperative day 5 was noted in 54 of 111 control subjects (48.6%) and 55 of 109 participants in the intervention group [50.5%; adjusted odds ratio 0.90 (95% confidence interval 0.52-1.57), P=0.717]. Mean (sd) hospital length of stay was 9.6 (6.8) days in the control group and 11.8 (11.5) days in the intervention group (adjusted difference -2.1 (-4.6 to 0.3) days, P=0.091). There was no statistical interaction between stroke volume optimization and aerobic fitness in terms of rate of complications or length of stay. Conclusions Algorithm-driven stroke volume optimization is of no benefit when superimposed on a liberal baseline fluid regimen in patients having elective major abdominal surgery, when stratified to minimize differences in fitness and surgical approach between groups. Clinical trial registration ISRCTN21597243.
Abstract.
Creanor S, Vickery J, Eyre V, Zajicek J, Ball S, Elm J, Carroll C (2015). Two-arm randomised futility trials: PD-stat - a futility trial of a potential neuroprotective treatment in people with Parkinson's disease.
Author URL.
2014
Gunn H, Creanor S, Haas B, Marsden J, Freeman J (2014). Frequency, characteristics, and consequences of falls in multiple sclerosis: Findings from a cohort study.
Archives of Physical Medicine and Rehabilitation,
95(3), 538-545.
Abstract:
Frequency, characteristics, and consequences of falls in multiple sclerosis: Findings from a cohort study
Objective to evaluate falls rate and the characteristics of falls (including fall-related injuries) in a multiple sclerosis (MS) cohort. Design As part of a study evaluating falls risk, a cohort of 150 participants prospectively recorded actual and near fall events using a daily diary over 3 months, as well as the circumstances of each fall including related injuries. Setting Community setting. Participants a population-based sample of people (N=150) with a confirmed diagnosis of MS (Expanded Disability Status Scale, 3.5-6.5) was recruited via a patient-centered longitudinal study database of disease course in people with MS. Interventions Not applicable. Main Outcome Measures Rate of actual and near falls, circumstances and consequences of falls (including rates and type of injury plus follow-up care). Results the response rate for the falls diary was 92.7%. A total of 672 actual falls and 3785 near falls were recorded, with a moderate correlation between the numbers of actual and near falls per person (ρ=.474; 95% confidence interval.34-.59). Men recorded significantly more falls than women. Falls were associated with a range of activities, although 27.6% occurred during general mobility activities such as walking, turning, and moving between positions. Injuries occurred in 11.1% of falls, with 6 individuals requiring medical attention. Conclusions People with MS experience high numbers of falls, with associated injuries. Falls occur during a wide range of activities, reflecting their potential impact on daily life. Evaluating the characteristics of individuals who experience frequent near falls but few actual falls may be valuable for research and clinical practice. © 2014 by the American Congress of Rehabilitation Medicine.
Abstract.
Smith JE, Rockett M, Squire R, Hayward C, Creanor S, Ewings P, Barton A, Pritchard C, Benger J (2014). PAIN SOLUTION IN THE EMERGENCY SETTING (PASTIES); AN OPEN-LABEL RANDOMISED TRIAL OF PATIENT-CONTROLLED ANALGESIA (PCA) VERSUS ROUTINE CARE IN PATIENTS ATTENDING THE EMERGENCY DEPARTMENT WITH TRAUMATIC INJURIES. Emergency Medicine Journal, 31(9), 785.2-786.
Creanor S, Millward BA, Demaine A, Price L, Smith W, Brown N (2014). Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting.
British Dental Journal,
216(1).
Abstract:
Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting
Aim to determine the attitudes of patients attending routine appointments at primary care dental clinics and general dental practices towards the possibility of chair-side screening for medical conditions, including diabetes, in the dental setting.Methods a brief, anonymous, self-Administered questionnaire distributed to adult patients (≥18 years) attending 2 primary care dental clinics and 16 general dental practices in South-West England.Results One hundred and ninety-seven completed questionnaires were received from patients at primary care dental clinics and 429 from general dental practice patients. Overall, 87% of respondents thought that it was important or very important that dentists screened patients for medical conditions such as diabetes; 79% were very willing to let a dental team member carry out screening. The majority indicated willingness to be screened for various medical conditions during a visit to the dentist, with significantly higher proportions of respondents in the primary care clinics indicating willingness (hypertension: 83% vs 74%; heart disease: 77% vs 66%; diabetes 82% vs 72% [all p
Abstract.
Brown F, O'Mahoney C, Creanor S, Shaw N, Millward BA (2014). Screening for diabetes in the SW peninsula: assessing the use of different risk scores and HbA1c.
Author URL.
Langford R, Brown I, Vickery J, Mitchell K, Pritchard C, Creanor S (2014). Study protocol for a double blind, randomised, placebo-controlled trial of continuous subpectoral local anaesthetic infusion for pain and shoulder function following mastectomy: SUB-pectoral Local anaesthetic Infusion following MastEctomy (SUBLIME) study.
BMJ Open,
4(9).
Abstract:
Study protocol for a double blind, randomised, placebo-controlled trial of continuous subpectoral local anaesthetic infusion for pain and shoulder function following mastectomy: SUB-pectoral Local anaesthetic Infusion following MastEctomy (SUBLIME) study.
INTRODUCTION: over 16â€
000 mastectomies are performed in England and Wales annually. Acute postoperative pain and nausea are common. The most frequently occurring long-term complications are chronic pain (up to 50%) and reduced shoulder function (reported at 35%). Regional techniques that improve acute postoperative pain relief may reduce the incidence of these complications. This study assesses the effectiveness of a 24-hour continuous local anaesthetic in the subpectoral plane in improving postoperative pain and quality of life in patients undergoing mastectomy. METHODS AND ANALYSIS: This is a randomised, double blind, placebo-controlled, two-centre, parallel group trial in women undergoing mastectomy with or without axillary involvement. One hundred and sixty participants will be randomised in a 1:1 ratio to receive either 0.25% levobupivacaine or 0.9% saline by subpectoral infusion postoperatively for 24â€
h. All participants will be provided with an intravenous morphine patient-controlled analgesia (PCA) system. Participants will be followed-up for 24â€
h in hospital and at approximately 14â€
days and 6â€
months postoperatively. Joint primary outcome measures are total morphine consumption and total pain score (captured via patient-recorded visual analogue scale (VAS) 4 hourly) during the first 24â€
h postoperatively. Primary statistical analysis of total pain is based on the area under the curve of pain versus time graph. Secondary outcomes include PCA attempts in first 24â€
h; VAS pain scores and shoulder function by goniometry at 24â€
h, 14â€
days (approximately) and 6â€
months; Verbal Rating Scale pain scores in first 24â€
h; Brief Pain Inventory and Oxford Shoulder Score at 6â€
months; duration of hospital stay; incidence of postoperative nausea and vomiting; cost-effectiveness. ETHICS AND DISSEMINATION: the study is approved by the South West England Research Ethics Committee (12/SW/0149). RESULTS: will be published in a peer-reviewed journal and presented at local, national and international scientific meetings. TRIAL REGISTRATION: ISRCTN46621916. EudraCT 2011-005775-16.
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2013
Starkie T, Struthers R, Creanor S, Sneyd JR, Wrigley S, Minto G (2013). Comparison of three advanced haemodynamic monitors to measure circulating volume status during major rectal surgery.
Author URL.
Millward BA, Creanor S, Demaine AG, Brown N, Smith W, Creanor ES (2013). General dental practice patients' attitudes towards screening for diabetes and other medical conditions in the dental setting.
Author URL.
Smith JE, Rockett M, Squire R, Hayward CJ, Creanor S, Ewings P, Barton A, Pritchard C, Benger JR (2013). PAin SoluTions in the Emergency Setting (PASTIES); a protocol for two open-label randomised trials of patient-controlled analgesia (PCA) versus routine care in the emergency department.
BMJ Open,
3(2).
Abstract:
PAin SoluTions in the Emergency Setting (PASTIES); a protocol for two open-label randomised trials of patient-controlled analgesia (PCA) versus routine care in the emergency department
Introduction: Pain is the commonest reason that patients present to an emergency department (ED), but it is often not treated effectively. Patient controlled analgesia (PCA) is used in other hospital settings but there is little evidence to support its use in emergency patients. We describe two randomised trials aiming to compare PCA to nurse titrated analgesia (routine care) in adult patients who present to the ED requiring intravenous opioid analgesia for the treatment of moderate to severe pain and are subsequently admitted to hospital. Methods and analysis: Two prospective multicentre open-label randomised trials of PCA versus routine care in emergency department patients who require intravenous opioid analgesia followed by admission to hospital; one trial involving patients with traumatic musculoskeletal injuries and the second involving patients with non-traumatic abdominal pain. In each trial, 200 participants will be randomised to receive either routine care or PCA, and followed for the first 12 h of their hospital stay. The primary outcome measure is hourly pain score recorded by the participant using a visual analogue scale (VAS) over the 12 h study period, with the primary statistical analyses based on the area under the curve of these pain scores. Secondary outcomes include total opioid use, side effects, time spent asleep, patient satisfaction, length of hospital stay and incremental cost effectiveness ratio. Ethics and dissemination: the study is approved by the South Central-Southampton a Research Ethics Committee (REC reference 11/SC/0151). Data collection will be completed by August 2013, with statistical analyses starting after all final data queries are resolved. Dissemination plans include presentations at local, national and international scientific meetings held by relevant Colleges and societies. Publications should be ready for submission during 2014. A lay summary of the results will be available to study participants on request, and disseminated via a publically accessible website.
Abstract.
Lai CW, Minto G, Challand CP, Hosie KB, Sneyd JR, Creanor S, Struthers RA (2013). Patients' inability to perform a preoperative cardiopulmonary exercise test or demonstrate an anaerobic threshold is associated with inferior outcomes after major colorectal surgery.
British Journal of Anaesthesia,
111(4), 607-611.
Abstract:
Patients' inability to perform a preoperative cardiopulmonary exercise test or demonstrate an anaerobic threshold is associated with inferior outcomes after major colorectal surgery
Background. Surgical patients with poor functional capacity, determined by oxygen consumption at anaerobic threshold (AT) during cardiopulmonary exercise testing (CPET), experience longer hospital stays and worse short- and medium-term survival. However, previous studies excluded patients who were unable to perform a CPET or who failed to demonstrate an AT. We hypothesized that such patients are at risk of inferior outcomes after elective surgery. Methods. All patients undergoing major colorectal surgery attempted CPET to assist in the planning of care. Patients were stratified by their test results into Fit (AT ≥ 11.0 mlO2 kg-1 min-1), Unfit (AT < 11.0 ml O2 kg-1 min-1), or Unable to CPET groups (failed to pedal or demonstrate anAT). Foreachgroup,we determined hospital stayand mortality. Results. Between March 2009 and April 2010, 269 consecutive patients were screened, and proceeded to bowel resection. Median hospital stay was 8 days (IQR 5.1-13.4) and there were 44 deaths (16%) at 2 yr; 26 (9.7%) patients were categorized as Unable to CPET, 69 (25.7%) Unfit and 174 (64.7%) Fit. There were statistically significant differences between the three groups in hospital stay [median (IQR) 14.0 (10.5-23.8) vs 9.9 (5.5-15) vs 7.1 (4.9-10.8) days, P < 0.01] and mortality at 2 yr [11/26 (42%) vs 14/69 (20%) vs 19/174 (11%), respectively (P < 0.01)] although the differences between Unable and Unfit were not statistically different. Conclusions. Patients' inability to perform CPET is associated with inferior outcomes after major colorectal surgery. Future studies evaluating CPET in risk assessment for major surgery should report outcomes for this subgroup. © the Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.
Abstract.
Gunn H, Creanor S, Haas B, Marsden J, Freeman J (2013). Risk factors for falls in multiple sclerosis: an observational study.
Multiple Sclerosis Journal,
19(14), 1913-1922.
Abstract:
Risk factors for falls in multiple sclerosis: an observational study
Background: People with multiple sclerosis (MS) experience frequent falls, which are associated with impairments and limitations to activities and participations. Objective: the objective of this paper is to evaluate falls risk factors using robust clinical measures. Methods: a total of 150 individuals (confirmed MS diagnosis, Expanded Disability Status Scale (EDSS) 3.5-6.5) were recruited, with 148 participants included in the final analysis. Demographic data were collected and performance assessed in eight predictor measures (Physiological Profile Assessment (PPA), Brief Ataxia Rating scale, Ashworth scale (Ashworth), Modified Falls Efficacy scale, Symbol Digit Modalities Test, dual-task interference, lying/standing blood pressure, static/dynamic visual acuity). Participants prospectively recorded falls over three months using a daily diary. People were classified as "fallers" based on reports of ≥ two falls. Results: a total of 104 participants recorded 672 falls; 78 (52.7%) reported ≥ two falls. Continence issues, previous falls history and use of prescribed medications were each associated with increased risk of being a "faller". Ashworth and PPA risk score contributed significantly to a logistic regression model predicting faller/non-faller classification. The reduced model (Ashworth, PPA, EDSS) showed fair-to-good predictive ability (ROC c-statistic 0.73, sensitivity 70%, specificity 69%). Conclusion: This study confirms the high prevalence of falls in ambulant people with MS. Important potentially modifiable risk factors are identified, suggesting aspects to target in falls interventions. © the Author(s) 2013.
Abstract.
Wyatt KM, Lloyd JJ, Abraham C, Creanor S, Dean S, Densham E, Daurge W, Green C, Hillsdon M, Pearson V, et al (2013). The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
Trials,
14Abstract:
The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial.
BACKGROUND: over the last three decades there has been a substantial increase in the proportion of children who are overweight or obese. The Healthy Lifestyles Programme (HeLP) is a novel school-based intervention, using highly interactive and creative delivery methods to prevent obesity in children. METHODS/DESIGN: We describe a cluster randomised controlled trial to evaluate the effectiveness and cost effectiveness of HeLP. The intervention has been developed using intervention mapping (involving extensive stakeholder involvement) and has been guided by the Information, Motivation, Behavioural Skills model. HeLP includes creating a receptive environment, drama activities, goal setting and reinforcement activities and runs over three school terms. Piloting showed that 9 to 10 year olds were the most receptive and participative. This study aims to recruit 1,300 children from 32 schools (over half of which will have ≥19% of pupils eligible for free school meals) from the southwest of England. Participating schools will be randomised to intervention or control groups with baseline measures taken prior to randomisation. The primary outcome is change in body mass index standard deviation score (BMI SDS) at 24 months post baseline. Secondary outcomes include, waist circumference and percent body fat SDS and proportion of children classified as overweight or obese at 18 and 24 months and objectively measured physical activity and food intake at 18 months. Between-group comparisons will be made using random effects regression analysis taking into account the hierarchical nature of the study design. An economic evaluation will estimate the incremental cost-effectiveness of HeLP, compared to control, from the perspective of the National Health Service (NHS)/third party payer. An in-depth process evaluation will provide insight into how HeLP works, and whether there is any differential uptake or engagement with the programme. DISCUSSION: the results of the trial will provide evidence on the effectiveness and cost effectiveness of the Healthy Lifestyles Programme in affecting the weight status of children. TRIAL REGISTRATION: ISRCTN15811706.
Abstract.
Author URL.
Fox EE, Hough AD, Creanor S, Gear M, Freeman JA (2013). The effects of Pilates-based core stability training in ambulant people with multiple sclerosis: a multicentre, block randomised, double blinded placebo controlled trial.
Author URL.
Creanor S, Millward A, Coelho A (2013). Worrying attitudes. British Dental Journal, 215(5).
2012
Lloyd JJ, Wyatt KM, Creanor S (2012). Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme.
BMJ Open,
2(3).
Abstract:
Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme.
OBJECTIVES: to assess the behavioural and weight status outcomes in English children in a feasibility study of a novel primary school-based obesity prevention programme. DESIGN: Exploratory cluster randomised controlled trial of the Healthy Lifestyles Programme. SETTING: Four city primary schools (two control and two intervention) in the South West of England. PARTICIPANTS: 202 children aged 9-10 years, of whom 193 and 188 were followed up at 18 and 24 months, respectively. No child was excluded from the study; however, to be eligible, schools were required to have at least one single Year 5 class. INTERVENTION: Four-phase multicomponent programme using a range of school-based activities including lessons, assemblies, parents' evenings, interactive drama workshops and goal setting to engage and support schools, children and their families in healthy lifestyle behaviours. It runs over the spring and summer term of Year 5 and the autumn term of Year 6. PRIMARY AND SECONDARY OUTCOMES: Weight status outcomes were body mass index, waist circumference and body fat standard deviation scores (SDS) at 18 and 24 months, and behavioural outcomes were physical activity, television (TV) viewing/screen time and food intake at 18 months. RESULTS: at 18 months of follow-up, intervention children consumed less energy-dense snacks and more healthy snacks; had less 'negative food markers', more 'positive food markers', lower mean TV/screen time and spent more time doing moderate-vigorous physical activity each day than those in the control schools. Intervention children had lower anthropometric measures at 18 and 24 months than control children, with larger differences at 24 months than at 18 months for nearly all measures. CONCLUSIONS: Results from this exploratory trial show consistent positive changes in favour of the intervention across all targeted behaviours, which, in turn, appear to affect weight status and body shape. A definitive trial is now justified.
Abstract.
Author URL.
Brunton PA, Burke FJT, Sharif MO, Creanor S, Hosey MT, Mannocci F, Wilson NHF (2012). Contemporary dental practice in the UK in 2008: Aspects of direct restorations, endodontics and bleaching.
British Dental Journal,
212(2), 63-67.
Abstract:
Contemporary dental practice in the UK in 2008: Aspects of direct restorations, endodontics and bleaching
Objective: to investigate, by postal questionnaire, aspects of the selection and use of direct restorative materials, endodontic techniques and approaches to bleaching by general dental practitioners in the UK, and to compare and contrast the findings with those of a related study reported in 2004. Methods: a questionnaire comprising 18 questions, each of a number of elements, was sent to 1,000 general dental practitioners in the UK, selected at random from the Dentists Register. Non-responders were sent a second copy of the questionnaire after a period of four weeks had elapsed. Results: a total of 662 useable responses were returned, giving a response rate of 66%. Key findings included: dental amalgam was found to be the most commonly used material in the restoration of occlusoproximal cavities in premolar (59% of respondents) and molar teeth (75% of respondents); glass-ionomer cements and related materials were applied extensively in the restoration of deciduous molars (81% of respondents) and for the luting of indirect restorations (67% of respondents); the use of rubber dam was limited, in particular as an adjunct to procedures in operative dentistry (18% of respondents); relatively few respondents used preformed stainless steel crowns, and among the users only occasionally in the restoration of deciduous molars (23%); and bleaching, predominantly home-based (nightguard) vital bleaching (81% of respondents) was widely practised. Conclusion: it is concluded that, for the practitioners surveyed, factors other than best available evidence influenced various aspects of the use of direct restorative materials and the clinical practice of endodontics. As a consequence, many of the features of general dental practice revealed in the process of the investigation were at variance with teaching in dental schools. Bleaching, in particular home-based (nightguard), vital bleaching, was provided by >80% of respondents, indicating widespread interest among patients in enhanced dental attractiveness. © 2012 Macmillan Publishers Limited. All rights reserved.
Abstract.
Brunton PA, Sharif MO, Creanor S, Burke FJT, Wilson NHF (2012). Contemporary dental practice in the UK in 2008: Indirect restorations and fixed prosthodontics.
British Dental Journal,
212(3), 115-119.
Abstract:
Contemporary dental practice in the UK in 2008: Indirect restorations and fixed prosthodontics
Objectives to investigate, by postal questionnaire, various aspects of primary dental care provision in the United Kingdom. Additionally, to compare the results of this survey with a similar survey completed four years previously.Methods a questionnaire containing 89 questions was sent to 1,000 general dental practitioners selected at random from databases of practitioners throughout the United Kingdom. Non-responders were sent another questionnaire after a period of four weeks had elapsed.Results Overall a response rate of 66.2% was achieved. Amalgam was the preferred material for the core build up of vital teeth for 65% of the respondents. Dentine pins were still being used by practitioners, with stainless steel pins being preferred by 34% of respondents. 39.7% of dentists that had graduated between 0-10 years previously reported using no pins. Indirect posts were still used most widely, by 55% of the practitioners in the study, with increasing use of fibre posts noted (34%). Addition cured silicone impression materials were still the most frequently used impression material (71%) with reduced use (10%) of condensation cured silicone impression materials recorded. Glass ionomer luting cements (48%) and zinc phosphate (28%) were the most commonly used luting cements.Conclusions Within the limitations of this study, the following conclusions can be drawn: amalgam is still the preferred material for the core build-up of vital teeth; dentine pins are still used widely, but not by younger practitioners; fibre posts are being increasingly used by practitioners; addition cured silicone is still the most widely used impression material; traditional glass ionomer cements are still the most widely used luting cements; veneers are still the preferred indirect restoration for restoring anterior teeth; and CAD/CAM systems are increasingly being used by practitioners. © 2012 Macmillan Publishers Limited. All rights reserved.
Abstract.
Brunton PA, Burke T, Sharif MO, Muirhead EK, Creanor S, Wilson NHF (2012). Contemporary dental practice in the UK: Demographic details and practising arrangements in 2008.
British Dental Journal,
212(1), 11-15.
Abstract:
Contemporary dental practice in the UK: Demographic details and practising arrangements in 2008
Objectives: to determine, by postal questionnaire, the demographic profile and practising details of general dental practitioners in the UK in 2008.Methods: a piloted 89 question postal questionnaire was distributed in 2007/2008 to 1,000 dentists, with effective addresses in the UK, whose names and addresses were obtained by random selection from the General Dental Council (GDC) register.Results: Six hundred and ninety-one questionnaires were returned, of which 662 were useable - an acceptable 66% useable response rate. of the respondents, 69% were male and 59% were practice principals. Fifty-three percent of the respondents' practices were in town or city centres with a wide geographic distribution. Single-handed practitioners accounted for 17% of respondents, with the mean number of dentists per practice being 3.6 (median 3.0). Typically, respondents' practices provided a mean of 26 patient care sessions per week, with each dentist treating on average 15 patients per session - 16 minutes per patient on average including surgery turnaround time, assuming 4 hour sessions. Hygienists typically treated seven patients per session - 34 minutes per patient on average including surgery turnaround time, assuming 4 hour sessions. Respondents stated that 57% of patients were treated under the NHS arrangements, with 28% being private, 7% independent and 7% insurance-based. Responses indicated that 73% of the respondents used a computerised patient management system, 67% had an internet connection and 60% used email, principally for correspondence, ordering materials and other uses such as referrals and research. Forty-five percent of respondents owned an intra-oral camera, with 45% of those using it routinely. Regarding new concepts, the use of nickel-titanium endodontic files (61%), digital imaging (28%) and zirconia all-ceramic bridgework (27%) were the most frequently cited innovations currently used by the respondents. Regarding the most notable changes in findings when compared with a related study conducted in 2000, these were connected to the method of payment with the proportion of NHS patients dropping to 57% compared with 86%; the volume of postgraduate education undertaken by dentists, with a 50% increase in the proportion of respondents having attended five or more courses each year (63% compared with 40% in 2000); and the use of zirconia all-ceramic bridgework (27% of respondents).Conclusions: the findings of the present study are considered to indicate increasing commercialism of dentistry in the UK, with evidence of many practitioners adopting new technologies, underpinned by substantial participation in postgraduate education. © 2012 Macmillan Publishers Limited. All rights reserved.
Abstract.
Creanor S, Barton A, Marchbank A (2012). Effectiveness of a gentamicin impregnated collagen sponge on reducing sternal wound infections following cardiac surgery: a meta-analysis of randomised controlled trials.
Annals of the Royal College of Surgeons of England,
94(4), 227-231.
Abstract:
Effectiveness of a gentamicin impregnated collagen sponge on reducing sternal wound infections following cardiac surgery: a meta-analysis of randomised controlled trials.
Gentamicin impregnated collagen sponges are licensed for use after cardiac surgery in over 50 countries but their effectiveness at preventing sternal wound infections (SWIs) remains uncertain. The aim of this meta-analysis was to assess the current evidence for effectiveness of such sponges at preventing SWIs in patients after cardiac surgery. A systematic search of the literature was undertaken and meta-analyses were performed on the results of the identified, eligible studies. Using random effects models, odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated for all SWIs and deep SWIs for: a) all participants, and b) participants deemed as high risk. Three unique randomised controlled trials (published between 2005 and 2010) involving 3,994 participants met the inclusion criteria. There was insufficient evidence of a significant difference between intervention and control groups for all SWIs (all participants: OR: 0.66, 95% CI: 0.39-1.14; high risk participants: OR: 0.60, 95% CI: 0.24-1.52). There was insufficient evidence of a significant benefit of the sponge in deep SWIs across all participants (OR: 0.72, 95% CI: 0.47-1.10) but some evidence of benefit in terms of reducing the incidence of deep SWIs in high risk participants (OR: 0.62, 95% CI: 0.39-0.98). There is insufficient evidence of the effectiveness (or otherwise) of gentamicin impregnated sponges in preventing SWIs following cardiac surgery. However, some evidence does exist that such sponges can reduce the incidence of deep infections in high risk patients.
Abstract.
Hodge PJ, Robertson D, Paterson K, Smith GLF, Creanor S, Sherriff A (2012). Periodontitis in non-smoking type 1 diabetic adults: a cross-sectional study.
Journal of Clinical Periodontology,
39(1), 20-29.
Abstract:
Periodontitis in non-smoking type 1 diabetic adults: a cross-sectional study
Aim to compare levels of periodontitis in non-smoking type 1 diabetic patients and controls. Material and Methods Type 1 diabetic patients, aged 20-55 years, were recruited from outpatient clinics at five hospitals in Glasgow, UK. Control subjects were recruited from physiotherapy clinics, using the buddy system and through an advertisement in a free newspaper. The primary outcome was severe periodontitis defined by clinical attachment level ≥6 mm on ≥1 tooth. Results There were 34 well controlled patients (HbA1c ≤amp; 7.5%), 169 poorly controlled patients and 112 non-diabetic subjects. Prevalence of severe periodontitis was higher in all type 1 diabetic patients [24.1% (95% CI: 18.4-30.6%)] and poorly controlled patients [27.2% (20.7-34.6%)] than in controls [20.5% (13.5-29.2%)]. The fully adjusted odds ratios (ORs) in never smokers comparing the whole diabetic group, and the poorly controlled group, with the control group were 1.35 [0.66-2.8] (p = 0.41) and 1.58 [0.75-3.33] (p = 0.23), respectively. Mean clinical attachment level was higher in all type 1 diabetic and poorly controlled patients than in controls (both p ;lt& 0.001). Conclusions These results indicate worse periodontal health in type 1 diabetic patients than in control subjects. Trial registration This study was registered with the UKCRN, ID: 9314 and Scottish Diabetes Research Network registration number: 128. © 2011 John Wiley & Sons A/S.
Abstract.
Gunn H, Freeman J, Marsden J, Haas B, Creanor S, Zajicek J (2012). Risk factors associated with falls in people with multiple sclerosis.
Author URL.
Stewardson D, Creanor S, Thornley P, Bigg T, Bromage C, Browne A, Cottam D, Dalby D, Gilmour J, Horton J, et al (2012). The survival of Class v restorations in general dental practice: Part 3, five-year survival.
Abstract:
The survival of Class v restorations in general dental practice: Part 3, five-year survival
Abstract.
2011
Creanor S, Creanor S, Alharthy N (2011). A comparison of in vitro erosion-like mineral loss between continuous and intermittent acidic exposure with and without human saliva.
Archives of Oral Biology,
56(7), 703-708.
Abstract:
A comparison of in vitro erosion-like mineral loss between continuous and intermittent acidic exposure with and without human saliva
Aim: This in vitro study aimed to compare erosion-like mineral loss following intermittent or continuous acidic exposures, and considered the role that human saliva may play. Materials and methods: 180 bovine enamel blocks were divided randomly into four equally-sized groups and exposed to one of the 4 protocols 6 times daily over 6 days (total acidic exposure time of 6 h): Group 1, continuous 10 min in orange juice (OJ) followed by 10 min in deionised water; Group 2, continuous 10 min in OJ followed by 10 min in stimulated saliva; Group 3, ten 1-min OJ exposures alternating with ten 1-min deionised water exposures; Group 4, ten 1-min OJ exposures alternating with ten 1-min stimulated saliva exposures. Specimens were stored in a remineralising solution between acidic exposures. Sections were cut and transverse microradiography was used to measure lesion depth in each specimen. Results: Mean (sd) lesion depths were 21.5 (8.1), 21.2 (6.2), 81.7 (12.2) and 72.8 (12.4) μm for Groups 1-4, respectively. Significant differences existed between all protocols except Groups 1 and 2 (mean difference -0.3 μm, 95% CI: -6.1 to 5.5). The mean difference between Groups 3 and 4 was 8.9 μm (95% CI: 3.2-14.7). Conclusions: Repeated, intermittent exposure to an acidic drink in vitro resulted in greater lesion depth than a continuous exposure of the same duration. Saliva offered some protection against intermittent acidic exposure. © 2011 Elsevier Ltd.
Abstract.
Blacker SM, Creanor SL, Creanor S (2011). An in vitro investigation of the initial pH and titratable acidity of a selection of fruit smoothies.
Dental update,
38(9).
Abstract:
An in vitro investigation of the initial pH and titratable acidity of a selection of fruit smoothies.
Four commercially-available fruit smoothie drinks were assessed for both initial/baseline pH and titratable acidity. A commercially-available smooth orange juice drink was used as a positive control. Baseline pH and titratable acidity were measured by titrating each fruit smoothie with 0.5 mL increments of 1M sodium hydroxide (NaOH), and measuring the pH following the addition of each increment, until pH 7 and pH 10 were reached. Each of the fruit smoothies investigated demonstrated a low baseline pH and had relatively high titratable acidity. Owing to both their low pH and high titratable acidity, it would be advisable to limit the consumption of such fruit smoothies to meal times. CLINICAL RELEVANCE: Fruit smoothies, which are made from pure fruit blended with 100% fruit juice, are a relatively new addition to the soft drinks market. It is recommended that they be consumed through a straw, similar to the advice given for other acidic soft drinks.
Abstract.
Wyatt K, Edwards V, Franck L, Britten N, Creanor S, Maddick A, Logan S (2011). Cranial osteopathy for children with cerebral palsy: a randomised controlled trial.
Arch Dis Child,
96(6), 505-512.
Abstract:
Cranial osteopathy for children with cerebral palsy: a randomised controlled trial.
OBJECTIVES: to estimate the effect of cranial osteopathy on the general health and wellbeing, including physical functioning, of children with cerebral palsy. DESIGN: Pragmatic randomised controlled trial. PARTICIPANTS: 142 children from Greater London and the South West of England, aged 5-12 years with cerebral palsy. INTERVENTION: Participants were randomised to six sessions of cranial osteopathy with a registered osteopath or a waiting list with partial attention control (parents invited to participate in two semistructured interviews). PRIMARY OUTCOME MEASURES: Blind assessment of motor function by physiotherapists using the Gross Motor Function Measure-66 (GMFM-66) and quality of life using the Child Health Questionnaire (CHQ) PF50 at 6 months. SECONDARY OUTCOME MEASURES: Parents' assessment of global health and sleep at 6 months, pain and sleep diaries at 10 weeks and 6 months, CHQ PF50 at 10 weeks and quality of life of main carer (Short Form 36) at 10 weeks and 6 months. RESULTS: Compared with children in the control group, children in the osteopathy group demonstrated no statistically significant differences in GMFM-66 (mean difference 4.9, 95% CI -4.4 to 14.1), CHQ Physical Summary Score (mean difference 2.2, 95% CI -3.5 to 8.0) or CHQ Psychological Summary Score (mean difference 3.4, 95% CI -0.8 to 7.7). There were no significant differences between groups with respect to pain; sleep (either 'time asleep' or 'time to sleep'); or main carer's quality of life. Compared with children in the control group, carers of children receiving cranial osteopathy were nearly twice as likely to report that their child's global health had 'improved' at 6 months rather than 'decreased' or 'remained the same' (38% vs 18%; odds ratio 2.8, 95% CI 1.1 to 6.9). CONCLUSIONS: This trial found no statistically significant evidence that cranial osteopathy leads to sustained improvement in motor function, pain, sleep or quality of life in children aged 5-12 years with cerebral palsy nor in quality of life of their carers.
Abstract.
Author URL.
Creanor S, Cooper N, Creanor SL (2011). Statistics: a learning needs assessment.
Med Teach,
33(9), 775-776.
Author URL.
Wyatt KM, Lloyd, Creanor S, Logan GS (2011). The development, feasibility and acceptability of a school-based obesity prevention programme: results from three phases of piloting. British Medical Journal
Stewardson DA, Thornley P, Bigg T, Bromage C, Browne A, Cottam D, Dalby D, Gilmour J, Horton J, Roberts E, et al (2011). The survival of Class V restorations in general dental practice. Part 2, early failure.
Br Dent J,
210(11).
Abstract:
The survival of Class V restorations in general dental practice. Part 2, early failure.
OBJECTIVE: to evaluate Class V restorations placed by UK general practitioners comparing those failing or surviving after two years, and to identify factors associated with early failure. DESIGN: Prospective longitudinal cohort multi-centre study. Setting UK general dental practices. MATERIALS & METHODS: Ten dentists each placed 100 Class V restorations and recorded selected clinical information at placement and recall visits. Univariate associations were assessed between recorded clinical factors and whether restorations had failed or not at two years. Multi-variable binary logistic regression was also undertaken to identify which combination of factors had a significant effect on the probability of early failure. RESULTS: at two years, 156 of 989 restorations had failed (15.8%), with 40 (4%) lost to follow-up. Univariate analysis showed a significant association between restoration failure and increasing patient age, payment method, the treating practitioner, non-carious cavities, cavities involving enamel and dentine, cavity preparation and restoration material. Multi-variable analysis indicated a higher probability of early failure associated with the practitioner, older patients, glass ionomer and flowable composite, bur-preparation and moisture contamination. CONCLUSIONS: Among these practitioners, both analytic methods identified significant associations between early failure of Class V restorations and the practitioner, cavity preparation method, restoration material and patient's age.
Abstract.
Author URL.
2010
Joshi S, Lewis SJ, Creanor S, Ayling RM (2010). Age-related faecal calprotectin, lactoferrin and tumour M2-PK concentrations in healthy volunteers.
Ann Clin Biochem,
47(Pt 3), 259-263.
Abstract:
Age-related faecal calprotectin, lactoferrin and tumour M2-PK concentrations in healthy volunteers.
OBJECTIVE: Measurement of the faecal markers calprotectin, lactoferrin and tumour M2-PK has been reported to be useful in the diagnosis and management of a range of gastrointestinal disorders in both children and adults. The aim of this study was to investigate the requirement for age-related reference ranges. METHODS: Faecal samples were obtained from 132 healthy subjects and analysis of calprotectin, lactoferrin and tumour M2-PK performed using commercially available enzyme-linked immunosorbent assay. RESULTS: in the healthy subjects median concentrations were as follows: for calprotectin - 2-9 y, 34 microg/g, 10-59 y, 22 microg/g and > or =60 y, 27 microg/g; for lactoferrin - 2-9 y, 2.2 microg/g, > or =10 y, 0.5 microg/g; and for tumour M2-PK all subjects
Abstract.
Author URL.
Smith AJ, Lockhart DEA, McDonald E, Creanor S, Hurrell D, Bagg J (2010). Design of dental surgeries in relation to instrument decontamination.
Journal of Hospital Infection,
76(4), 340-344.
Abstract:
Design of dental surgeries in relation to instrument decontamination
Recent guidelines advise that the decontamination of dental instruments should be undertaken outwith the treatment area. The aim of this study was to determine the physical area of rooms in dental surgeries that decontaminate instruments within and outwith the treatment area respectively, and other factors relating to practice layout and ventilation. Data were collected by interview and observation of dental healthcare workers in dental practice in Scotland, UK. Room layouts were recorded and measured at floor, benchtop and above benchtop heights. Thirteen surgeries with instrument decontamination processes occurring in the treatment area and seven surgeries with instrument decontamination outwith the treatment area were selected at random for detailed analysis of room dimensions. of the 179 dental surgeries surveyed, 55% were located in converted residential premises and most practitioners (91%) did not share premises with other healthcare providers. The median number of rooms in the practices was 8 (range: 2-21) and the median number of surgeries present was 3 (range: 1-6). Regardless of whether instrument decontamination facilities were housed within the treatment area or not, the average treatment area room size for both was 15.8m2 (range: 7.3-23.9) (P=0.862), with 20% of the room area available as work surfaces. The median size of the seven instrument decontamination rooms (local decontamination units) was 7.6m2 (range: 2.9-16.0), with, on average, 63% of the room used for work surfaces. This survey suggests that the historical location of dental surgeries in converted residential properties places many restrictions on appropriate design for healthcare premises. © 2010 the Hospital Infection Society.
Abstract.
Thiagarajah R, Creanor S, Gormally J, Gutteridge C, Dubbins P (2010). Infection control in the ultrasound department.
Ultrasound,
18(1), 31-35.
Abstract:
Infection control in the ultrasound department
Despite the great amount of publicity dedicated to infection control policies, many hospital staff are 'uncertain' and have 'limited knowledge' with regard to the practical details of policies and procedures for infection control. The aim of this audit was to evaluate current understanding among our ultrasound staff of Trust policies relating to the transfer of a patient where there is an identified infection risk. To this aim, brief questionnaires were distributed to all staff members in the ultrasound department, during one working day, based on five clinical scenarios. The questionnaires were designed to test staff knowledge of current hospital policy. Good practice dictates that all staff are aware of standard procedures and precautions, in accordance with the system of clinical governance set out by the Department of Health. Each of the five questions was used as a separate indicator for each clinical scenario. The questions were derived from clinical scenarios encountered within the previous six months and the set target was 100% understanding. The correct responses for each of the five scenarios ranged from 50% to 95%. The results were presented at a subsequent audit meeting attended by the Trust Infection Control Nurse, where the rationale for patient transfer policies was explained. Infection control policy forms part of annual statutory training. A review of the training programme content and presentation is recommended.
Abstract.
Zajicek JP, Ingram WM, Vickery J, Creanor S, Wright DE, Hobart JC (2010). Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS) 1: protocol and baseline characteristics of cohort.
BMC NEUROLOGY,
10 Author URL.
2009
Hill KB, Morris AJ, White DA, McHugh S, Atwal R, Burke FJT (2009). A comparison of Personal Dental Service (PDS) and General Dental Service (GDS) patients in terms of reported interventions, oral health and dentists' perceptions.
Community Dent Health,
26(3), 170-176.
Abstract:
A comparison of Personal Dental Service (PDS) and General Dental Service (GDS) patients in terms of reported interventions, oral health and dentists' perceptions.
AIMS: the aim of the study was to investigate the reported working patterns, dentist perceptions and patient oral health for dentists in a Personal Dental Services (PDS) pilot and compare this with that of matched dentists working in the General Dental Services (GDS) arrangements in the same part of England. METHOD: Ten dentists were recruited, five each from PDS and GDS practices in Warwickshire, UK. The number of interventions carried out for adult patients in the year to April 2003 was obtained from the Dental Practice Board (DPB) for the two groups and compared. An Oral Health Index (OHX) (Burke and Wilson, 1995) was used to determine the oral health of a selection of patients from the two groups of dentists in the study. The final stage of the study involved semi-structured interviews with the dentists. RESULTS: the average age of dentists was similar, in the early to mid 40's (p>0.05). Both groups were, on average, around 20 years post qualification. The GDS dentists made an average of 3,507 activity reports to the Dental Practice Board in the year examined, compared with 3,441 from the PDS dentists. PDS dentists provided fewer simple periodontal treatments than GDS dentists, but otherwise the pattern of reported activity was similar. Both PDS and GDS dentists suggested that GDS dentists carried out more fillings because of a perverse incentive to provide fillings compared with PDS arrangements. PDS dentists believed that their treatment profiles had not changed significantly since changing to PDS, and suggested that their prescribing was based on clinical need only and was not influenced by the remuneration system. A total of 225 OHX scores were obtained for patients attending PDS dentists and a further 214 from patients attending GDS dentists. Overall, the mean OHX score was lower in the GDS patients than for PDS patients. CONCLUSIONS: PDS dentists provided fewer simple periodontal treatments than their GDS counterparts. There was no difference in the oral health of patients treated under either system. Although there was some evidence of a difference in attitude between GDS and PDS dentists towards charging and claiming for simple periodontal treatment, there was no uniformity of opinion within either group. There would appear to be a number of complex factors impacting upon decisions to treat or monitor dental conditions.
Abstract.
Author URL.
Saleem S, Mani V, Chadwick MA, Creanor S, Ayling RM (2009). A prospective study of causes of haemolysis during venepuncture: tourniquet time should be kept to a minimum.
Ann Clin Biochem,
46(Pt 3), 244-246.
Abstract:
A prospective study of causes of haemolysis during venepuncture: tourniquet time should be kept to a minimum.
BACKGROUND: Haemolysis is defined as the release of cellular components of erythrocytes and other blood cells into the extracellular space of blood. These cellular components can cause interference in laboratory measurements, potassium being a commonly measured analyte to be affected. A number of factors have been implicated in the aetiology of haemolysis. We undertook this study to enable us to identify and hence rectify causes of haemolysis in samples from patients on acute medical and surgical wards. METHODS: We performed a prospective study of 353 blood sampling events during February and March 2007. A proforma was used to obtain detailed information of each blood-taking episode. Information from the proforma was linked to the incidence of haemolysis obtained from the hospital computer system. RESULTS: the incidence of haemolysis among the samples studied was 6.5%. While staff group, method of sampling, tourniquet time and number of attempts at venepuncture were each univariately associated with haemolysis, stepwise logistic regression resulted in a final model which only included tourniquet time (odds ratio for haemolysis if tourniquet time >1 min was 19.5 [95% confidence interval [CI] 5.6-67.4%]). CONCLUSION: Tourniquet time of more than a minute is associated with a significant increase in risk of haemolysis. Advice on tourniquet time is included in phlebotomy training within the hospital; hence a campaign of appropriately channelled continuing education on this issue may be successful in reducing the haemolysis rate.
Abstract.
Author URL.
Edwards G, Johnstone L, Paterson G, McIntyre J, McHugh S, Smith AJ (2009). Hand hygiene undertaken by students and staff in a dental teaching hospital.
J Hosp Infect,
71(2), 188-189.
Author URL.
Smith A, Smith G, Creanor S, Hurrell D, Bagg J, Lappin D (2009). Handpiece decontamination survey. British Dental Journal, 6(4), 37-38.
Smith A, Creanor S, Hurrell D, Bagg J, McCowan M (2009). Management of infection control in dental practice.
Journal of Hospital Infection,
71(4), 353-358.
Abstract:
Management of infection control in dental practice
This was an observational study in which the management policies and procedures associated with infection control and instrument decontamination were examined in 179 dental surgeries by a team of trained surveyors. Information relating to the management of a wide range of infection control procedures, in particular the decontamination of dental instruments, was collected by interview and by examination of practice documentation. This study found that although the majority of surgeries (70%) claimed to have a management policy on infection control, only 50% of these were documented. For infection control policies, 79% of surgeries had access to the British Dental Association Advice Sheet A12. Infection control policies were claimed to be present in 89% of surgeries, of which 62% were documented. Seventy-seven per cent of staff claimed to have received specific infection control training, but for instrument decontamination this was provided mainly by demonstration (97%) or observed practice (88%). Many dental nurses (74%) and dental practitioners (57%) did not recognise the symbol used to designate a single-use device. Audit of infection control or decontamination activities was undertaken in 11% of surgeries. The majority of surgeries have policies and procedures for the management of infection control in dental practice, but in many instances these are not documented. The training of staff in infection control and its documentation is poorly managed and consideration should be given to development of quality management systems for use in dental practice. © 2009 the Hospital Infection Society.
Abstract.
Smith AJ, Creanor S, Hurrell DJ (2009). Survey of instrument decontamination in dental surgeries located in Scottish prisons.
American Journal of Infection Control,
37(8), 689-690.
Abstract:
Survey of instrument decontamination in dental surgeries located in Scottish prisons
We describe an observational study in which the policies and procedures of dental surgeries in 14 of the 15 Scottish prisons for sterilizing instruments were viewed directly by a trained surveyor. The survey found that several key elements in the decontamination cycle, ranging from procurement of devices, cleaning, sterilizing, testing, maintenance, quality management and training were deficient in a number of aspects. The use of a central sterile supply service may be a more cost effective approach for the provision of compliant instrument reprocessing facilities in the sites surveyed. © 2009 Association for Professionals in Infection Control and Epidemiology, Inc.
Abstract.
Smith GWG, Smith AJ, Creanor S, Hurrell D, Bagg J, Lappin DF (2009). Survey of the decontamination and maintenance of dental handpieces in general dental practice © 2009 British Dental Journal.
British Dental Journal,
207(4).
Abstract:
Survey of the decontamination and maintenance of dental handpieces in general dental practice © 2009 British Dental Journal
Objectives to determine how dental handpieces are decontaminated and maintained in general dental practice. Design Observational survey.Setting the survey was carried out in general dental practice in Scotland. Survey visits ran from January 2003 until the end of March 2004.Methods Data were collected by interview and observation in 179 dental surgeries in Scotland.Results in virtually all surgeries, handpieces were cleaned before disinfection or autoclaving (99%; n = 177), most commonly by wiping the external surface with a cloth impregnated with disinfectant. Most surgeries lubricated their handpieces after cleaning and before sterilisation (91%; n = 162), although a number of surgeries (24%; n = 42) also lubricated their handpieces after sterilisation. In the majority (97%; n = 174) of dental surgeries, all handpieces were autoclaved after use, most frequently (89%; n = 160) in a bowl and instrument steriliser. In 38 surgeries (21%), handpieces were being wrapped (paper pouches) before sterilisation in bowl and instrument sterilisers. A minority of surgeries (20%; n = 36) had a dedicated handpiece for surgical procedures.Conclusions: the majority of dental handpieces are manually cleaned externally with a disinfectant impregnated cloth and processed in a type N (bowl and instrument) bench top steam steriliser. Handpieces are lubricated with non-water soluble lubricants at different stages of reprocessing, indicating clarification is required in this area. More work is required by manufacturers to establish a validated cleaning and lubrication process to facilitate the sterilisation of handpieces. © 2009 British Dental Journal.
Abstract.
2008
Nicol AJ, Creanor S, Hall AF, Macpherson LMD (2008). A randomised, observer-blind, clinical study investigating the effect of fluoridated milk on artificially created early enamel caries using transverse microradiography.
CARIES RESEARCH,
42(4), 305-311.
Author URL.
Sharifi A, Jones R, Ayoub A, Moos K, Walker F, Khambay B, McHugh S (2008). How accurate is model planning for orthognathic surgery?.
Int J Oral Maxillofac Surg,
37(12), 1089-1093.
Abstract:
How accurate is model planning for orthognathic surgery?
The purpose of this study was to evaluate the accuracy of model surgery prediction after orthognathic surgery and to identify possible errors associated with the prediction process. The study included 46 patients who had undergone orthognathic surgical procedures; 22 in Group a who had had a Le Fort I osteotomy; and 24 in Group B who had had a Le Fort I osteotomy and mandibular setback surgery. The immediate postoperative and preoperative lateral cephalograms were analysed to calculate surgical changes; these were compared with those obtained from model surgery prediction and a statistical analysis was undertaken. The maxilla was more under-advanced and over-impacted anteriorly than predicted by model surgery. The amount of mandibular setback was more than that predicted by model surgery. None of the differences between prediction planning and actual surgical changes was statistically significant at p
Abstract.
Author URL.
Elgalaid TO, Creanor SL, Creanor S, Hall AF (2008). The permeability of artificial dentine carious lesions.
ARCHIVES OF ORAL BIOLOGY,
53(8), 744-750.
Author URL.
Elgalaid TO, Creanor SL, Creanor S, Hall AF (2008). The repeatability of human dentine permeability measurement in vitro.
Journal of Dentistry,
36(1), 42-48.
Abstract:
The repeatability of human dentine permeability measurement in vitro
Objective: the aim of this study was to determine the repeatability of apparatus designed to assess dentine permeability at two different pressures. Method: Forty-five human coronal tooth portions were prepared and permeability was measured at two separate time points, 5 h apart, at 14 cm H2O pressure and then at 100 cm H2O pressure. Repeatability was determined using the limits of agreement (LOA) method. Results: the results showed equal mean permeability of 0.6 μl at both time 1 and time 2 at 14 cm H2O pressure, and 2.7 and 2.5 μl at time 1 and time 2, respectively, at 100 cm H2O pressure. At 14 cm H2O pressure, the LOA were (-0.4, 0.4) μl and at 100 cm H2O pressure the LOA were (-0.2, 0.6) μl. Conclusion: Although repeatability measurement at 14 cm H2O pressure appeared to be acceptable, the higher permeability values at 100 cm H2O pressure may make the latter the pressure of choice despite the small bias. © 2007 Elsevier Ltd. All rights reserved.
Abstract.
2007
Nunu YH, Bell A, McHugh S, Moos KF, Ayoub AF (2007). 3D assessment of morbidity associated with lower eyelid incisions in orbital trauma.
Int J Oral Maxillofac Surg,
36(8), 680-686.
Abstract:
3D assessment of morbidity associated with lower eyelid incisions in orbital trauma.
This study compared the morbidity associated with transconjunctival and transcutaneous approaches for orbital floor exploration with respect to the position of the lower eyelid following surgery. Two groups of 32 volunteers and 32 patients (12 transconjunctival and 20 transcutaneous) were recruited and three-dimensional (3D) imaging was carried out at 6 months following surgery. In the transcutaneous group, there were significant variations in the shape of the lower eyelid, with more medial displacement of the exocanthion. No significant differences were detected in the transconjunctival group compared to controls. The use of a 3D imaging system provided an objective method of assessing this aspect of morbidity associated with the use of lower eyelid incisions.
Abstract.
Author URL.
Smith AJ, Hurrell D, Bagg J, McHugh S, Mathewson H, Henry M (2007). A method for surveying instrument decontamination procedures in general dental practice.
Br Dent J,
202(8).
Abstract:
A method for surveying instrument decontamination procedures in general dental practice.
OBJECTIVE: This paper describes an objective method for assessing the decontamination procedures used for reprocessing dental instruments in primary dental care facilities. MATERIALS AND METHODS: the study population comprised all general dental practitioners in Scotland with an NHS list number. A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratified random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there were more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey. A set of data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination. Specific training for the survey team members was provided during a three day course, to ensure consistency of approach. The data collection forms were piloted in 20 dental surgeries. RESULTS: a methodology was developed, which utilised both staff interviews and direct observation of decontamination processes. Data were collected on a set of 28 standard forms, which could be machine read. Three hundred and seventy-three dentists were selected at random from the dental practitioners list held by Practitioner Services, Scotland. One hundred and eighty-nine practitioners either declined to participate or could not be contacted at the address supplied. One hundred and eighty-four surgeries were surveyed, data were available for analysis from 179 sites. Data from five sites were rejected because of illegibility (three) and incomplete data (two). Each surgery survey was undertaken by a team of two surveyors, comprising one infection control/decontamination expert and one experienced dental practitioner. The survey team interviewed the dental practitioner and dental nurse, reviewed documentation relevant to the survey, directly observed decontamination practices and recorded the physical layout of the premises. CONCLUSION: the use of machine readable data collection forms, trained survey staff and direct observation of decontamination protocols provides a workable method for accurate collection of decontamination practice in primary care facilities.
Abstract.
Author URL.
Binnie VI, McHugh S, Jenkins W, Borland W, Macpherson LM (2007). A randomised controlled trial of a smoking cessation intervention delivered by dental hygienists: a feasibility study.
BMC Oral Health,
7Abstract:
A randomised controlled trial of a smoking cessation intervention delivered by dental hygienists: a feasibility study.
BACKGROUND: Tobacco use continues to be a global public health problem. Helping patients to quit is part of the preventive role of all health professionals. There is now increasing interest in the role that the dental team can play in helping their patients to quit smoking. The aim of this study was to determine the feasibility of undertaking a randomised controlled smoking cessation intervention, utilising dental hygienists to deliver tobacco cessation advice to a cohort of periodontal patients. METHODS: One hundred and eighteen patients who attended consultant clinics in an outpatient dental hospital department (Periodontology) were recruited into a trial. Data were available for 116 participants, 59 intervention and 57 control, and were analysed on an intention-to-treat basis. The intervention group received smoking cessation advice based on the 5As (ask, advise, assess, assist, arrange follow-up) and were offered nicotine replacement therapy (NRT), whereas the control group received 'usual care'. Outcome measures included self-reported smoking cessation, verified by salivary cotinine measurement and CO measurements. Self-reported measures in those trial participants who did not quit included number and length of quit attempts and reduction in smoking. RESULTS: at 3 months, 9/59 (15%) of the intervention group had quit compared to 5/57 (9%) of the controls. At 6 months, 6/59 (10%) of the intervention group quit compared to 3/57 (5%) of the controls. At one year, there were 4/59 (7%) intervention quitters, compared to 2/59 (4%) control quitters. In participants who described themselves as smokers, at 3 and 6 months, a statistically higher percentage of intervention participants reported that they had had a quit attempt of at least one week in the preceding 3 months (37% and 47%, for the intervention group respectively, compared with 18% and 16% for the control group). CONCLUSION: This study has shown the potential that trained dental hygienists could have in delivering smoking cessation advice. While success may be modest, public health gain would indicate that the dental team should participate in this activity. However, to add to the knowledge-base, a multi-centred randomised controlled trial, utilising biochemical verification would be required to be undertaken.
Abstract.
Author URL.
Alexopoulos E, Hope A, Clark SL, McHugh S, Hosey MT (2007). A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation.
Eur Arch Paediatr Dent,
8(2), 82-86.
Abstract:
A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation.
AIM: to report on two separate child sedation cohorts; one undergoing propofol intravenous sedation (IVS) and the other, nitrous oxide inhalation sedation (IS) in respect to changes in dental anxiety and subject characteristics. STUDY DESIGN: the age, gender, level of social deprivation and amount of treatment performed and observed patient behaviour during treatment, using the Frankl and a VAS scale, were recorded for each subject. Anxiety questionnaires were completed before and after treatment. These were: - Modified Child Dental Anxiety Scale (MCDAS); Children's Fear Survey Schedule- Dental Subscale (CFSS-DS) and two Visual Analogue Scales (VAS). RESULTS AND STATISTICS: Participants (36) attended for treatment under IS and 40 attended for treatment under propofol IVS. The IVS cohort was older (p0.05). The observed behaviour was good for both cohorts. CONCLUSION: Propofol target-controlled intravenous sedation and nitrous oxide inhalation sedation were similarly efficacious at anxiety reduction in referred dentally anxious children. Subjects undergoing propofol IVS were older than those undergoing IS. Propofol TCI may offer the opportunity for more treatment at each visit. Further propofol TCI conscious sedation studies are required.
Abstract.
Author URL.
Bagg J, Smith AJ, Hurrell D, McHugh S, Irvine G (2007). Cleaning re-usable instruments in general practice.
British Dental Journal,
202(9), 550-551.
Abstract:
Cleaning re-usable instruments in general practice
Objective: This study examined the policies, procedures, environment and equipment used for the cleaning of dental instruments in general dental practice. Materials and methods: a total of 179 surgeries were surveyed. This was an observational based study in which the cleaning processes were viewed directly by a trained surveyor. Information relating to surgery policies and equipment was also collected by interview and viewing of records. Data were recorded onto a standardised data collection form prepared for automated reading. Results: the BDA advice sheet A12 was available in 79% of surgeries visited. The most common method for cleaning dental instruments was manual washing, with or without the use of an ultrasonic bath. Automated washer disinfectors were not used by any surgery visited. The manual wash process was poorly controlled, with 41% of practices using no cleaning agent other than water. Only 2% of surgeries used a detergent formulated for manual washing of instruments. When using ultrasonic baths, the interval that elapsed between changes of the ultrasonic bath cleaning solution ranged from two to 504 hours (median nine hours). Fifty-eight percent of surgeries claimed to have a dedicated area for instrument cleaning, of which 80% were within the patient treatment area. However, in 69% of surgeries the clean and dirty areas were not clearly defi ned. Virtually all cleaning of dental instruments was undertaken by dental nurses. Training for this was provided mainly by demonstration and observed practice of a colleague. There was little documentation associated with training. Whilst most staff wore gloves when undertaking manual cleaning, 51% of staff did not use eye protection, 57% did not use a mask and 7% used waterproof overalls. Conclusions: in many dental practices, the cleaning of re-usable dental instruments is undertaken using poorly controlled processes and procedures, which increase the risk of cross infection. Clear and unambiguous advice must be provided to the dental team, especially dental nurses, on appropriate equipment, chemicals and environment for cleaning dental instruments. This should be facilitated by appropriate training programmes and the implementation of quality assurance procedures at each stage of the cleaning process. © 2007 Nature Publishing Group.
Abstract.
Bagg J, Smith AJ, Hurrell D, McHugh S, Irvine G (2007). Pre-sterilisation cleaning of re-usable instruments in general dental practice.
Br Dent J,
202(9).
Abstract:
Pre-sterilisation cleaning of re-usable instruments in general dental practice.
OBJECTIVE: This study examined the policies, procedures, environment and equipment used for the cleaning of dental instruments in general dental practice. MATERIALS AND METHODS: a total of 179 surgeries were surveyed. This was an observational based study in which the cleaning processes were viewed directly by a trained surveyor. Information relating to surgery policies and equipment was also collected by interview and viewing of records. Data were recorded onto a standardised data collection form prepared for automated reading. RESULTS: the BDA advice sheet A12 was available in 79% of surgeries visited. The most common method for cleaning dental instruments was manual washing, with or without the use of an ultrasonic bath. Automated washer disinfectors were not used by any surgery visited. The manual wash process was poorly controlled, with 41% of practices using no cleaning agent other than water. Only 2% of surgeries used a detergent formulated for manual washing of instruments. When using ultrasonic baths, the interval that elapsed between changes of the ultrasonic bath cleaning solution ranged from two to 504 hours (median nine hours). Fifty-eight percent of surgeries claimed to have a dedicated area for instrument cleaning, of which 80% were within the patient treatment area. However, in 69% of surgeries the clean and dirty areas were not clearly defined. Virtually all cleaning of dental instruments was undertaken by dental nurses. Training for this was provided mainly by demonstration and observed practice of a colleague. There was little documentation associated with training. Whilst most staff wore gloves when undertaking manual cleaning, 51% of staff did not use eye protection, 57% did not use a mask and 7% used waterproof overalls. CONCLUSIONS: in many dental practices, the cleaning of re-usable dental instruments is undertaken using poorly controlled processes and procedures, which increase the risk of cross infection. Clear and unambiguous advice must be provided to the dental team, especially dental nurses, on appropriate equipment, chemicals and environment for cleaning dental instruments. This should be facilitated by appropriate training programmes and the implementation of quality assurance procedures at each stage of the cleaning process.
Abstract.
Author URL.
Smith AJ, Bagg J, Hurrell D, McHugh S (2007). Sterilization of re-usable instruments in general dental practice.
Br Dent J,
203(8).
Abstract:
Sterilization of re-usable instruments in general dental practice.
OBJECTIVE: to examine the methods used for sterilisation of re-usable instruments in general dental practice, including the installation, commissioning and testing of benchtop steam sterilisers. MATERIALS AND METHODS: This was an observational study in which the policies and procedures for sterilising instruments were viewed directly by trained surveyors at practice premises. Information relating to the installation, commissioning and testing of benchtop steam sterilisers was also collected by interview and observation of records. Data were recorded onto a standardised data collection form prepared for automated reading. RESULTS: Data were available fom 179 surgeries surveyed. Dental practices reprocess a range of instruments from critical to non-critical. The most common type of benchtop steam steriliser is a type N, or bowl and instrument (B&I) steriliser (88%). The remainder were type B, or vacuum sterilisers, though one surgery had access to a hot air steriliser. Sterilisers were usually installed by manufactures or suppliers (69%). Only 51% of sterilisers were tested on installation and 26% were commissioned, of which 38% were tested to SHTM 2010 standard. In most cases it was difficult to determine from the documentation available whether daily, weekly, quarterly or annual testing was undertaken in accordance with recognised standards. Written instructions for the operation of the steriliser were unavailable in 61% of practices. Insurance cover for pressure vessels was available in 79% of the surgeries with a B&I steriliser. In many instances there was inadequate separation of clean and dirty areas for segregating processed from unprocessed instruments. Ninety-six percent of surgeries did not have a procedure for the identification and traceability of instruments used on patients. There was no documentation of staff training in the use of sterilisers in 90% of surgeries. CONCLUSION: There has been significant uptake of the use of steam sterilisation to reprocess used dental instruments. However, there are significant shortcomings at various stages of the process, including installation, commissioning and periodic testing of sterilisers. These potentially compromise safety and the time, money and effort currently put into sterilising dental instruments. Complicit in these deficiencies are the manufacturers and suppliers of equipment that is inadequately installed and tested. There is a need for enhanced education and training in the use of sterilisers and the management of the process at all levels, from supplier to user. Improved access to appropriate technical advice on decontamination would also be a major benefit for the profession.
Abstract.
Author URL.
Smith AJ, Hurrell D, Bagg J, McHugh S, Mathewson H, Henry M (2007). Surveying instrument decontamination procedures.
British Dental Journal,
202(8), 472-473.
Abstract:
Surveying instrument decontamination procedures
Objective: This paper describes an objective method for assessing the decontamination procedures used for reprocessing dental instruments in primary dental care facilities. Materials and methods: the study population comprised all general dental practitioners in Scotland with an NHS list number. A two-stage process was used to identify which surgeries were to be surveyed, using a proportional stratifi ed random sampling method. First, practices were randomly selected in proportion to the distribution of practices within each of the health boards. Then, if there was more than one dentist within a selected practice, simple random sampling was used to identify a single dentist within the selected practice to be approached. The surgery that the dentist worked from and its associated decontamination facilities were the subject of the survey. A set of data collection forms provided questions designed to investigate compliance with extant guidance documents on decontamination. Specifi c training for the survey team members was provided during a three day course, to ensure consistency of approach. The data collection forms were piloted in 20 dental surgeries. Results: a methodology was developed, which utilised both staff interviews and direct observation of decontamination processes. Data were collected on a set of 28 standard forms, which could be machine read. Three hundred and seventy-three dentists were selected at random from the dental practitioners list held by Practitioner Services, Scotland. One hundred and eighty-nine practitioners either declined to participate or could not be contacted at the address supplied. One hundred and eighty-four surgeries were surveyed, data were available for analysis from 179 sites. Data from fi ve sites were rejected because of illegibility (three) and incomplete data (two). Each surgery survey was undertaken by a team of two surveyors, comprising one infection control/decontamination expert and one experienced dental practitioner. The survey team interviewed the dental practitioner and dental nurse, reviewed documentation relevant to the survey, directly observed decontamination practices and recorded the physical layout of the premises. Conclusion: the use of machine readable data collection forms, trained survey staff and direct observation of decontamination protocols provides a workable method for accurate collection of decontamination practice in primary care facilities. © 2007 Nature Publishing Group.
Abstract.
Elalaid TO, Creanor SL, Creanor S, Hall AF (2007). The permeability of natural dentine caries before and after restoration: an in vitro study.
JOURNAL OF DENTISTRY,
35(8), 656-663.
Author URL.
Delargy S, Busby M, McHugh S, Matthews R, Burke FJT (2007). The reproducibility of the Denplan Oral Health Score (OHS) in general dental practitioners.
Community Dent Health,
24(2), 105-110.
Abstract:
The reproducibility of the Denplan Oral Health Score (OHS) in general dental practitioners.
OBJECTIVE: to assess the reproducibility of the Denplan Oral Health Score (OHS) and to examine whether general dental practitioners are more reproducible at measuring oral health when they use the OHS than when they use their usual method of examining patients. DESIGN: This was a single centre study designed to compare dentists' reproducibility using the Oral Health Score with their reproducibility when using the method of examination that they normally employ in general practice. SETTING: the study was carried out at the University of Birmingham School of Dentistry during 2001. PARTICIPANTS: Ten local general dental practitioners were recruited by advertising. The patients were selected from various clinics in the University of Birmingham School of Dentistry to provide a broad spectrum of oral health. MAIN OUTCOME MEASURES: the dentists scored oral health by two methods; firstly on a 10 cm linear scale after using their everyday method of examination and secondly using the structured format of the OHS examination, where the Oral Health Scores were expressed as a percentage. RESULTS: Overall, the majority of the participating dentists demonstrated better intra-examiner reproducibility with the OHS than with their own method of examination. There was also higher inter-examiner reproducibility with the OHS than with the dentists' own method.
Abstract.
Author URL.
Jones RM, Khambay BS, McHugh S, Ayoub AF (2007). The validity of a computer-assisted simulation system for orthognathic surgery (CASSOS) for planning the surgical correction of class III skeletal deformities: single-jaw versus bimaxillary surgery.
Int J Oral Maxillofac Surg,
36(10), 900-908.
Abstract:
The validity of a computer-assisted simulation system for orthognathic surgery (CASSOS) for planning the surgical correction of class III skeletal deformities: single-jaw versus bimaxillary surgery.
The aim of this study was to assess the accuracy of the two-dimensional profile prediction produced by the computer-assisted simulation system for orthognathic surgery (CASSOS), for the correction of class III facial deformities. Correction was by maxillary advancement (n=17) or bimaxillary surgery (n=16). The mean age was 24 years (range 18-42). The surgical and dental movements obtained from the postoperative cephalogram were used to produce a CASSOS profile prediction, which was compared with the soft-tissue profile. The prediction was superimposed onto the postoperative radiograph, and a coordinate system was used to measure linear differences. For the maxillary advancement group there were statistical differences for three horizontal landmarks: superior labial sulcus (p=0.017), labrale superious (p=0.038) and labiomental fold (p=0.014). In the bimaxillary group only the landmark vertical labrale superious (p=0.002) showed a statistical difference. Generally, CASSOS produced useful profile predictions for maxillary advancement surgery or bimaxillary surgery for Class III patients, although there was considerable individual variation. The main areas of inaccuracy were the lips. The major difference between the two types of surgery was that most of the errors in the maxillary surgery group were in the horizontal direction, whilst for the bimaxillary surgery the errors were mainly in the vertical direction.
Abstract.
Author URL.
Smith AJ, Bagg J, Hurrell D, McHugh S (2007). Use of benchtop steam sterilisers.
British Dental Journal,
203(8), 468-469.
Abstract:
Use of benchtop steam sterilisers
Objective: to examine the methods used for sterilisation of re-usable instruments in general dental practice, including the installation, commissioning and testing of benchtop steam sterilisers. Materials and methods: This was an observational study in which the policies and procedures for sterilising instruments were viewed directly by trained surveyors at practice premises. Information relating to the installation, commissioning and testing of benchtop steam sterilisers was also collected by interview and observation of records. Data were recorded onto a standardised data collection form prepared for automated reading. Results: Data were available from 179 surgeries surveyed. Dental practices reprocess a range of instruments from critical to non-critical. The most common type of benchtop steam steriliser is a type N, or bowl and instrument (B&I) steriliser (88%). The remainder were type B, or vacuum sterilisers, though one surgery had access to a hot air steriliser. Sterilisers were usually installed by manufacturers or suppliers (69%). Only 51% of sterilisers were tested on installation and 26% were commissioned, of which 38% were tested to SHTM 2010 standard. In most cases it was difficult to determine from the documentation available whether daily, weekly, quarterly or annual testing was undertaken in accordance with recognised standards. Written instructions for the operation of the steriliser were unavailable in 61% of practices. Insurance cover for pressure vessels was available in 79% of surgeries with a B&I steriliser. In many instances there was inadequate separation of clean and dirty areas for segregating processed from unprocessed instruments. Ninety-six percent of surgeries did not have a procedure for the identification and traceability of instruments used on patients. There was no documentation of staff training in the use of sterilisers in 90% of surgeries. Conclusion: There has been significant uptake of the use of steam sterilisation to reprocess used dental instruments. However, there are signifi cant shortcomings at various stages of the process, including installation, commissioning and periodic testing of sterilisers. These potentially compromise safety and the time, money and effort currently put into sterilising dental instruments. Complicit in these deficiencies are the manufacturers and suppliers of equipment that is inadequately installed and tested. There is a need for enhanced education and training in the use of sterilisers and the management of the process at all levels, from supplier to user. Improved access to appropriate technical advice on decontamination would also be a major benefit for the profession. © 2007 Nature Publishing Group.
Abstract.
2006
Aladangady N, McHugh S, Aitchison TC, Wardrop CAJ, Holland BM (2006). Infants' blood volume in a controlled trial of placental transfusion at preterm delivery.
Pediatrics,
117(1), 93-98.
Abstract:
Infants' blood volume in a controlled trial of placental transfusion at preterm delivery.
OBJECTIVE: to investigate whether it was possible to promote placental blood transfer to infants at preterm delivery by (1) delaying cord clamping, (2) holding the infant below the placenta, and (3) administering an oxytocic agent to the mother, we measured the infants' blood volumes. DESIGN: Randomized study. METHODS: Forty-six preterm infants (gestational age: 24[0/7] to 32[6/7] weeks) were assigned randomly to either placental blood transfer promotion (delayed cord clamping [DCC] group, ie, > or =30 seconds from moment of delivery) or early cord clamping (ECC) with conventional management (ECC group). Eleven of 23 and 9 of 23 infants assigned randomly to DCC and ECC, respectively, were delivered through the vaginal route. The study was conducted at a tertiary perinatal center, the Queen Mother's Hospital (Glasgow, United Kingdom). RESULTS: the infants' mean blood volume in the DCC group (74.4 mL/kg) was significantly greater than that in the ECC group (62.7 mL/kg; 95% confidence interval for advantage: 5.8-17.5). The blood volume was significantly increased by DCC for infants delivered vaginally. The infants in the DCC group delivered through cesarean section had greater blood volumes (mean: 70.4 mL/kg; range: 45-83 mL/kg), compared with the ECC group (mean: 64.0 mL/kg; range: 48-77 mL/kg), but this was not significant. Additional analyses confirmed the effect of DCC (at least 30 seconds) to increase average blood volumes across the full range of gestational ages studied. CONCLUSIONS: the blood volume was, on average, increased in the DCC group after at least a 30-second delay for both vaginal and cesarean deliveries. However, on average, euvolemia was not attained with the third stage management methods outlined above.
Abstract.
Author URL.
Khambay BS, McHugh S, Millett DT, Ireland T (2006). Magnitude and reproducibility of forces generated by clinicians during laceback placement. Journal of Orthodontics, 33(4).
Khambay BS, McHugh S, Millett DT (2006). Magnitude and reproducibility of forces generated by clinicians during laceback placement.
J Orthod,
33(4), 270-275.
Abstract:
Magnitude and reproducibility of forces generated by clinicians during laceback placement.
OBJECTIVE: to determine the magnitude and reproducibility of forces generated by clinicians during laceback placement using a force-measuring typodont. SETTING: an in vitro investigation. MATERIALS AND METHODS: an in vitro typodont model was developed, which incorporated strain gauges attached to a personal computer to allow measurement of the force generated on application of lacebacks. Ten operators were instructed to place lacebacks five times, on two separate occasions (T1 and T2). Inter-operator and intra-operator forces produced at T1 and T2 were compared. MAIN OUTCOME MEASURES: Forces generated by laceback placement. RESULTS: the forces generated by clinicians ranged from 0 to 11.1 N. There were significant differences in the mean forces generated by the different operators (P < 0.001), with differences between time points not being consistent across all operators (P < 0.001). Some operators were more consistent than others in the forces generated. CONCLUSION: in vitro, there was a large inter-operator variation in the forces produced during laceback placement. With the in vitro model used in this study, few operators applied similar forces when placing lacebacks on two separate occasions.
Abstract.
Author URL.
Smith A, Bagg J, McHugh S (2006). No to chlorhexidine.
Br Dent J,
200(1).
Author URL.
Hosey MT, Bryce J, Harris P, McHugh S, Campbell C (2006). The behaviour, social status and number of teeth extracted in children under general anaesthesia: a referral centre revisited.
Br Dent J,
200(6), 331-327.
Abstract:
The behaviour, social status and number of teeth extracted in children under general anaesthesia: a referral centre revisited.
OBJECTIVE: to report on the changing profile of children attending for Dental General Anaesthetic extractions (DGA) at the same centre in 1998 and again in 2004 compared to 1991. DESIGN: Prospective clinical. SETTING: Glasgow Dental Hospital DGA service during August 1999 and August/September 2004. SUBJECTS AND METHOD: Children presenting for DGA extractions. Data recorded: age, gender, number of teeth extracted and level of behaviour using the Frankl scale. RESULTS: in 1999: 190 children (97 boys) mean age five years. In 2004: 106 children (55 boys) mean age five years. There was a significant increase in the mean number of teeth extracted (p < 0.001), 4.2 (1-16) and 7.8 (1-17) in 1999 and 2004 respectively, compared to 3.7 in 1991. Twenty-six per cent of children had between six and 16 teeth extracted in 1999 compared to 74% in 2004. Significantly fewer children demonstrated "definitely positive" behaviour compared to 1991. Children were in the poorest socioeconomic groups, reflecting the geographic area. CONCLUSION: over half of the children were aged five years and under. Fewer highly co-operative children were treated. More teeth were extracted per child, suggesting that there should be greater opportunities to carry out restorations, not just extractions under general anaesthesia.
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Author URL.
2005
Letters S, Smith AJ, McHugh S, Bagg J (2005). A study of visual and blood contamination on reprocessed endodontic files from general dental practice.
Br Dent J,
199(8), 522-525.
Abstract:
A study of visual and blood contamination on reprocessed endodontic files from general dental practice.
OBJECTIVE: This study examined methods used for reprocessing endodontic instruments in general dental practice and determined the degree of residual visual contamination and blood contamination on 250 reprocessed files collected from 25 general dental practices. MATERIALS AND METHODS: a questionnaire was administered to 25 general dental practitioners to obtain information on the re-processing of used endodontic files. Ten files which had been used and reprocessed were also collected from each practice. These were examined visually under a dissecting light microscope for residual contamination and then tested for blood deposits using the Kastle-Meyer test. RESULTS: Nineteen of the 25 practices used stainless steel hand files. No practitioners used endodontic files as single use devices. Ninety-two per cent of the practitioners discarded and replaced files when they were bent or damaged. Several decontamination methods were reported. The two combinations employed most frequently were manual cleaning and autoclaving or manual cleaning, followed by ultrasonic cleaning and autoclaving. of the 250 files, 75% showed some degree of visual contamination and seven percent tested positive for residual blood. Blood contaminated files were significantly more heavily contaminated when examined visually. Large variations were found in residual contamination of files collected from practices using the same methods of decontamination. CONCLUSIONS: While all practitioners re-used endodontic files, the variations in decontamination methods reported indicate a lack of clarity on best practice. This study demonstrates that endodontic files are not reliably decontaminated by methods currently employed in dental practice.
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Khambay B, Millett D, McHugh S (2005). Archwire seating forces produced by different ligation methods and their effect on frictional resistance.
Eur J Orthod,
27(3), 302-308.
Abstract:
Archwire seating forces produced by different ligation methods and their effect on frictional resistance.
The aims of this study were to determine the mean tensile force of four different elastomeric modules, the archwire seating force of different ligation methods, and its effect on frictional resistance. To determine the mean tensile force, each elastomeric module (purple, grey, Alastik, and SuperSlick) was extended by 5 mm using two hooks attached to a load cell using a Nene M3000 testing machine. To assess the median archwire seating force, a maxillary premolar bracket (3M Unitek) was welded to a sheet of stainless steel (SS) and glued to a Perspex block. The bracket base was removed and the cut continued into the Perspex below. A length of test wire was taken and bent to form a "U" shape, with the middle portion 20 mm in length. The free ends of the wire were secured to the load cell of the Nene testing machine. Two wire sizes were tested, 0.017 x 0.025 and 0.019 x 0.025 inch SS. The load cell was activated and the force with which the wire was displaced into the slot by the ligation method was measured. Four types of elastomeric module were tested together with a pre-formed 0.09 inch SS ligature. The experimental method used to determine the mean frictional force of each module and wire size was carried out using a method described previously. Statistically significant differences existed in the mean tensile forces and median archwire seating forces between the elastomeric modules. Grey modules with either size wire produced the lowest median archwire seating force, whereas SS ligatures produced the highest forces. SS ligatures with either wire produced the lowest mean frictional forces, whereas grey modules produced significantly higher mean frictional force (P < 0.01). The force with which the wire was seated into the bracket did not seem to be related to the subsequent amount of mean frictional force produced.
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Jones RM, Faqir A, Millett DT, Moos KF, McHugh S (2005). Bridging and dimensions of sella turcica in subjects treated by surgical-orthodontic means or orthodontics only.
Angle Orthod,
75(5), 714-718.
Abstract:
Bridging and dimensions of sella turcica in subjects treated by surgical-orthodontic means or orthodontics only.
The aim of the study was to compare the incidence of sella turcica bridging and sella turcica dimensions in 150 Caucasian subjects who had combined surgical-orthodontic correction of their malocclusion with a randomly selected group of 150 Caucasian subjects who were treated contemporaneously by orthodontic means only. Pretreatment lateral cephalometric radiographs were scanned and analyzed. A sella turcica bridge was identified as a continuous band of bony tissue extending from the anterior cranial fossa to the posterior cranial fossa. The dimensions of the sella turcica were measured. In the group treated by combined surgical-orthodontic means, the incidence of bridging was 16.7%, whereas it was 7.3% in the orthodontics-only group (P =. 012). Significant increases in the mean surface area (P =. 02) and mean perimeter of the sella turcica (P =. 01) were found for the combined surgical-orthodontic group compared with the orthodontics-only group. The mean interclinoid distance was significantly smaller in the surgical-orthodontic group (P =. 02). These findings appear to indicate the greater likelihood of sella turcica bridging and abnormal sella turcica dimensions in subjects treated by combined surgical-orthodontic means rather than by orthodontics only.
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Nicol R, Petrina Sweeney M, McHugh S, Bagg J (2005). Effectiveness of health care worker training on the oral health of elderly residents of nursing homes.
Community Dent Oral Epidemiol,
33(2), 115-124.
Abstract:
Effectiveness of health care worker training on the oral health of elderly residents of nursing homes.
OBJECTIVES: the aim of this study was to evaluate the effect of a staff training programme on mouth care on the oral health of elderly residents of long-term care institutions. METHODS: Seventy-eight residents of five long-stay institutions were enrolled and underwent a baseline oral health assessment. Staff caring for residents in three of the sites received intensive training in mouth care. This comprised lecture and video material complemented by clinical demonstrations. The oral health of residents at all five sites was reassessed at periods of 3 and 9 months. Staff caring for residents in the remaining two institutions were then provided with mouth care training and all patients were reassessed at 18 months. Statistical analyses were undertaken to examine for significant changes in selected oral health parameters after training, within each group. RESULTS: Oral mucosal disease and oral dryness were common at baseline. The staff training was well received. Following staff training, there was a significant reduction in the number of residents left to undertake their own oral care. There were significant improvements in denture hygiene and a reduction in the number of residents wearing dentures overnight. The prevalence of oral mucosal disease dropped, with significant reductions in angular cheilitis and denture stomatitis. CONCLUSION: This education programme was effective in changing oral health care procedures within long-stay institutions for the elderly, with measurable improvements in oral health of the residents.
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Campbell C, Hosey M-T, McHugh S (2005). Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial.
Paediatr Anaesth,
15(10), 831-838.
Abstract:
Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial.
BACKGROUND: the aim of this study was to establish the efficacy of two different preparation packages, a paper-based cartoon and an interactive computer, at facilitating coping behavior in children undergoing dental general anesthetic (DGA) tooth extraction. METHOD: a total of 198 children were allocated randomly to computer, cartoon or control groups. A Visual Analog Scale (VAS) and Modified Child Dental Anxiety Scale (MCDAS) were used to compare preoperative anxiety levels between the three study groups. Blinded observers then scored behavior at both anesthesia induction and upon recovery using a VAS for each (0 = coped/no distress and 10 = no coping/high distress). RESULTS: the children's median age was 5 (range 3-10) years, 57% were boys, a median of seven teeth were extracted (range 1-20). Preoperative anxiety was similar for all preparation groups; with 24% of all children categorized 'phobic' using MCDAS. The median induction (coping) VAS level for both the computer and the cartoon groups was '1' (range 0-10), compared with the control group level of '3' (range 0-10). The median recovery (coping) VAS levels were: computer group: 0 (range 0-10), cartoon group: 4 (range 0-10) and control group: 2.5 (range 0-10). The Mann-Whitney U-test showed that the computer group coped significantly better than the control group at induction (P = 0.014) and significantly better than the cartoon group upon recovery (P = 0.016). The statistical power for detecting differences between groups (computer/cartoon versus control) was calculated to be 90%, based on pilot study data. CONCLUSIONS: the computer preparation package facilitated coping behavior in children undergoing DGA induction.
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Smith A, Letters S, Lange A, Perrett D, McHugh S, Bagg J (2005). Residual protein levels on reprocessed dental instruments.
J Hosp Infect,
61(3), 237-241.
Abstract:
Residual protein levels on reprocessed dental instruments.
Reduction of the initial bioburden on instruments, prior to sterilization, is believed to reduce transmission risks of iatrogenic Creutzfeldt-Jakob disease. Endodontic files are used in the preparation of root canals and are likely to have close contact and become contaminated with neural material from branches of the maxillary and mandibular cranial nerves. This study examined methods used by 22 dental practices to clean endodontic files, and scored visible debris and residual protein levels adhering to 220 dental endodontic files that had been used, cleaned, autoclaved and were deemed ready for re-use. Visible debris was scored after examination under a dissecting light microscope. Residual protein was quantified using a fluorescent assay based on reaction of proteins with o-phthaldialdehyde/N-acetyl cysteine. There was wide variation in the methods used by practices to clean endodontic files. The cleaning process varied from a wipe with an alcohol-impregnated cloth to hand scrubbing and/or use of an ultrasonic bath. Surface debris was visually detected on 98% of files. Residual protein was detected on all the files examined (median amount: 5.4 microg; range: 0.5-63.2 microg). These results demonstrate that the cleaning of some instruments reprocessed routinely in primary care is incomplete, and such instruments cannot be excluded as a potential source of cross-infection.
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Burke FJT, McHugh S, Shaw L, Hosey M-T, Macpherson L, Delargy S, Dopheide B (2005). UK dentists' attitudes and behaviour towards Atraumatic Restorative Treatment for primary teeth.
Br Dent J,
199(6), 365-369.
Abstract:
UK dentists' attitudes and behaviour towards Atraumatic Restorative Treatment for primary teeth.
BACKGROUND: Atraumatic Restorative Treatment (ART) was introduced a decade ago as a minimal intervention treatment for caries in unindustrialised countries, but UK general dental practitioners (GDPs) may also be using this technique. OBJECTIVE: This study aimed to determine the materials and techniques used by a group of UK GDPs to treat caries in primary teeth. METHOD: a questionnaire, designed to determine GDPs' use of materials and techniques in the restoration of caries in primary teeth, was distributed to 600 GDPs in Scotland and England, with an explanatory letter and reply-paid envelope. The questionnaire included colour illustrations of two carious cavities in primary molar teeth and a request that respondents draw the cavity outline that they would use on the illustrations. The cavity outlines were assessed independently by two examiners. All other data were collated and analysed. RESULTS: 390 usable replies were received, a response rate of 65%. of the respondents, 99% treated child patients and 42% of respondents were aware of ART. For treatment of a small Class II cavity, 37% drew a cavity outline without extension beyond removal of caries and a majority suggested use of an adhesive material (51% glass ionomer, 13% compomer). For cavity preparation, 47% of respondents used a drill, 10% an excavator and 41% used both. For treatment of a large occluso-lingual cavity, again most used an adhesive technique (44% glass ionomer, 12% compomer) for its restoration, while 50% used a drill, 7% an excavator and 42% used both for cavity preparation. CONCLUSION: Most respondents used adhesive materials for restoration of caries in primary molars, but, despite 42% of respondents stating that they were aware of the treatment, "true" ART was adopted by fewer than 10% of respondents.
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2004
Leitch JA, Anderson K, Gambhir S, Millar K, Robb ND, McHugh S, Kenny GNC (2004). A partially blinded randomised controlled trial of patient-maintained propofol sedation and operator controlled midazolam sedation in third molar extractions.
Anaesthesia,
59(9), 853-860.
Abstract:
A partially blinded randomised controlled trial of patient-maintained propofol sedation and operator controlled midazolam sedation in third molar extractions.
Patient-maintained sedation using propofol has recently been shown to be effective for dental surgery. We compared this new technique to the established technique of operator administered midazolam. The two groups were compared before, during and after sedation. The two primary outcomes were time until discharge and oxygen saturation. Vital signs, anxiety and psychomotor skills were also compared. State anxiety was reduced to a greater extent in the propofol group (mean difference 10 (SD 4) mm; p = 0.010. Propofol patients recovered quicker (mean difference 7 (SD 1.4) min; p = 0.001). Propofol patients had a smaller reduction in arterial oxygen saturation (mean difference 0.8 (SD 0.3)%; p = 0.030), and a reduced increase in heart rate (mean difference 9 (SD 2) beats.min(-1); p < 0.001). Both techniques were well tolerated and safe. Propofol sedation offered superior anxiolysis, quicker recovery, less amnesia and less depression of simple psychomotor function.
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Burke FJ, Busby M, McHugh S, Mullins A, Matthews R (2004). A pilot study of patients' views of an oral health scoring system.
Prim Dent Care,
11(2), 37-39.
Abstract:
A pilot study of patients' views of an oral health scoring system.
UNLABELLED: an oral health scoring system (Oral Health Score: OHS) has been designed to provide a numerical measure of the overall state of a patients oral health by means of a series of simple clinical examinations. OBJECTIVE: to assess, by means of a questionnaire, patients opinions of the value of the OHS. METHODS: Eight general dental practitioners who used the OHS were asked to participate in the project. The participating dentists were requested to explain the aims of the project to 50 patients. Patients who agreed to participate were asked to complete a questionnaire after a visit during which the OHS was used. These patients were provided with a reply-paid envelope for the return of the questionnaire. RESULTS: Completed usable questionnaires were received from 315 patients. of respondents, 97% considered that the OHS gave them a better understanding of the condition of their mouth and 98% considered that the OHS was a good method for communication between dentist and patient. CONCLUSION: the results of the present study indicate that, within the study group, the OHS is considered by a large majority of patients to be a good method for communication of the patient's oral health between dentist and patient.
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Girkin JM, Rousseau C, Hall AF, Strang R, Whitters CJ, Creanor SL, Ribeiro AC (2004). Blue laser diode excited fluorescence spectroscopy of natural carious lesions.
Abstract:
Blue laser diode excited fluorescence spectroscopy of natural carious lesions
Abstract.
Burke FJT, McHugh S, Randall RC, Meyers IA, Pitt J, Hall AC (2004). Direct restorative materials use in Australia in 2002.
Aust Dent J,
49(4), 185-191.
Abstract:
Direct restorative materials use in Australia in 2002.
BACKGROUND: This study aimed to determine the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Australia. METHOD: a questionnaire was developed to elicit this information. The names and addresses of 1000 dentists in Australia were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. RESULTS: a total of 560 replies were received. Regarding choice of material, 99 per cent of respondents cited clinical indication as an influencing factor, although patients' aesthetic demands (99 per cent of respondents), patients' wish (96 per cent), patients' financial situation (82 per cent), and lecturers' suggestions (72 per cent) were also reported to influence respondents' choice of materials. Twelve per cent of respondents used composite 'always', 29 per cent 'often', 32 per cent 'sometimes', 23 per cent 'seldom' and 4 per cent 'never' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 84 per cent 'always', 'often' or 'sometimes' used the total etch technique, 84 per cent used a thick glass-ionomer layer and 36 per cent never used rubber dam. Fifty-nine per cent of respondents reported a decreased use of amalgam over the previous five years. Sixty-eight per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Seventy-five per cent considered that the growth in the use of composites increased the total cost of oral health care. CONCLUSIONS: of the respondents from Australia 73 per cent place large composite restorations in molar teeth and their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.
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Khambay B, Millett D, McHugh S (2004). Evaluation of methods of archwire ligation on frictional resistance.
Eur J Orthod,
26(3), 327-332.
Abstract:
Evaluation of methods of archwire ligation on frictional resistance.
The aim of the study was to investigate the effect of elastomeric type and stainless steel (SS) ligation on frictional resistance using a validated method. To assess the validity of the new test system to measure mean frictional forces, SS and TMA wires, each with dimensions of 0.017 x 0.025 and 0.019 x 0.025 inches, were used in combination with a self-ligating Damon II bracket or a conventional preadjusted edgewise premolar SS bracket without ligation. Four types of elastomeric module, purple, grey, Alastik or SuperSlick, and a pre-formed 0.09 inch SS ligature were then assessed as methods of ligation using preadjusted edgewise premolar SS brackets. The specimens were tested on a Nene M3000 testing machine, with a crosshead speed of 5 mm/minute and each test run lasted for 4 minutes. Each bracket/wire combination with each method of ligation was tested 10 times in the presence of human saliva and the mean frictional force was recorded. The mean frictional forces were compared using three-way analysis of variance. The Damon II self-ligating bracket and unligated conventional SS bracket produced negligible mean frictional forces with any of the wires tested. For the 0.017 x 0.025 SS, 0.019 x 0.025 SS or 0.019 x 0.025 inch TMA wires, SS ligatures produced the lowest mean frictional forces. With the 0.017 x 0.025 TMA wire, purple modules produced the lowest mean frictional force. There was no consistent pattern in the mean frictional forces across the various combinations of wire type, size and ligation method. Under the conditions of this experiment, the use of passive self-ligating brackets is the only method of almost eliminating friction.
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Elgalaid TO, Youngson CC, McHugh S, Hall AF, Creanor SL, Foye RH (2004). In vitro dentine permeability: the relative effect of a dentine bonding agent on crown preparations.
Journal of Dentistry,
32(5), 413-421.
Abstract:
In vitro dentine permeability: the relative effect of a dentine bonding agent on crown preparations
Objective. The aim of this study was to determine whether a dentine bonding agent (DBA) had an effect in reducing fluid filtration under cemented provisional crowns. Methods. Crown preparations on 34 premolars, randomly allocated to two equal-sized test and control groups, were assessed for dentine permeability by a fluid filtration technique. In the test group, prepared crowns were acid-etched and then treated with a DBA (Prime & Bond NT). In the control group, no such DBA was applied. Provisional crowns were cemented on both groups of teeth using non-eugenol zinc oxide cement. Fluid filtration rates were measured repeatedly after crown preparation, at cementation, 1 h, 1 day, 1 week and 3 weeks following crown cementation for both groups. Filtration rates were also measured after acid-etching and dentine bonding for the test group. Results. There was insufficient evidence to suggest any statistically significant differences either between the two groups or, on average, across the five time points in each group in terms of the relative percentage of fluid filtration. Conclusion. The DBA used did not seal dentinal tubules any more than did the smear layer and provisional crowns luted with a non-eugenol ZnO cement. © 2004 Elsevier Ltd. All rights reserved.
Abstract.
Stewardson DA, Crisp RJ, McHugh S, Lendenmann U, Burke FJT (2004). The Effectiveness of Systemp.desensitizer in the treatment of dentine hypersensitivity.
Prim Dent Care,
11(3), 71-76.
Abstract:
The Effectiveness of Systemp.desensitizer in the treatment of dentine hypersensitivity.
PURPOSE: This study reports the effectiveness of Systemp.desensitizer (Ivoclar Vivadent, Schaan, Liechtenstein), when used both with and without an acid-etch step, in the treatment of patients with dentine hypersensitivity in UK dental practices. MATERIALS AND METHODS: Ten general dental practitioners (GDPs) were selected from two practice-based research groups. The GDPs were each requested to use Systemp.desensitizer in the treatment of at least ten patients who presented with pain due to dentine hypersensitivity. Systemp.desensitizer was applied to the sensitive dentine area in strict accordance with the manufacturer's handling instructions, except that the patients were divided into two groups. For the first, group NE, the procedure was to isolate the tooth, gently blot it dry with cotton wool pellets, rub Systemp.desensitizer into the tooth for 20 seconds, then gently air-dry it. For the second, group E, the procedure was identical except that after isolation, the treatment area was etched for 15 seconds with 35% phosphoric acid. Patients were asked to complete a pro forma using a 10 cm visual analogue scale designed to provide details of the extent of their pain before treatment, 24 hours post-treatment, one week post-treatment, one month post-treatment, and three months post-treatment. The zero end of the scale was marked 'no pain' and the 10 cm end was marked 'extreme pain'. The percentage change in the patients' perception of their pain, relative to pretreatment, was calculated using repeated measures analysis and suitable follow-up confidence intervals for the mean changes in perceived pain. Comparisons were then made between the treatment groups NE and E. RESULTS: Ninety-one patients completed the first pro forma and 77 completed all the pro formas. Overall, there was a significant reduction in pain at each of the time points after treatment but the pattern of pain reduction across the two groups was different. In general, the non-etched group (group NE) saw an 'immediate' reduction in pain which was then fairly consistent across the longer term, whilst, in general, the etched group (group E) saw less reduction in pain 24 hours after treatment, and then further reduction in pain at both one week and one month after treatment. Thus the non-etched group experienced an early reduction whilst the etched group took longer to perceive a reduction in pain; however, there were no statistically significant differences between the reductions in pain scores between the two groups at any of the time points after treatment. CONCLUSION: it is concluded that Systemp.desensitizer was effective in reducing pain from dentine hypersensitivity in the patients treated, and this finding was unaffected by whether or not the tooth was acid-etched prior to application of the reagent.
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Stewardson DA, Burke FJT, Elkhazindar MM, McHugh ES, Mellor AC, Coulter WA, Palenik CJ (2004). The incidence of occupational exposures among students in four UK dental schools.
Int Dent J,
54(1), 26-32.
Abstract:
The incidence of occupational exposures among students in four UK dental schools.
OBJECTIVES: to evaluate: the incidence of occupational exposures (OE) to patient body fluids among a sub-group of dental students; the rate of reporting of incidents; and the association of various factors. DESIGN: Multicentre retrospective analysis. SETTING: Four UK dental schools in 2000. SUBJECTS: Dental students from 4 UK schools completed a confidential questionnaire at the end of the clinical years of their undergraduate course. RESULTS: the response rates ranged from 71-100%, showing that 12-40% of students among the schools had experienced one or more OE incidents since starting their course. No statistically significant association was found between OE incidence and age, sex, dominant hand or time of day; most OE occurred with handling of local anaesthetic syringes. 61-78% of incidents were penetrative in nature, and 28-53% of students had not reported their last OE. OE incidence was associated with school, year of course, presence of patient and presence of an assistant. There were substantial differences in the numbers of students experiencing OE among the schools. CONCLUSIONS: Within the limitations of the survey and variations within the clinical activity of schools, it may be seen that improvements are needed in some schools to reduce cross-infection risks, and increase reporting of incidents. Suggestions are offered which may increase the safety of dental treatment.
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Binnie V, McHugh S, Macpherson L, Borland B, Moir K, Malik K (2004). The validation of self-reported smoking status by analysing cotinine levels in stimulated and unstimulated saliva, serum and urine.
Oral Dis,
10(5), 287-293.
Abstract:
The validation of self-reported smoking status by analysing cotinine levels in stimulated and unstimulated saliva, serum and urine.
OBJECTIVES: Cotinine, a nicotine metabolite, can be used to measure exposure to tobacco smoke. The aim of this study was to compare cotinine levels in different biological fluids collected from both smokers and non-smokers and to relate the findings to self-reported smoking status. Data were also collected concerning the acceptability of the differing methods of sample collection. MATERIAL AND METHOD: Patients recruited to the study were asked to provide samples of urine, blood and saliva (both stimulated and unstimulated). Data collected from patients by questionnaire included information on smoking behaviour such as daily number of cigarettes and environmental exposure to smoke. After the sample collection, patients were asked to rate the acceptability of each sampling method. Samples were analysed using enzyme immunoassay (EIA) kits. RESULTS: in total, 80 patients participated, with 49 being smokers and 31 being non-smokers. There was clear differentiation between smokers and non-smokers (P < 0.001) for all the different samples in terms of cotinine. A significant relationship was seen between cotinine and daily number of cigarettes for both salivas and urine (all P < 0.001) but not for serum. Participants found serum and urine collection methodologies 'very acceptable' (67 and 66%, respectively) whereas 9% found collection of stimulated saliva 'not at all acceptable'. CONCLUSION: Cotinine, whatever the collection method and analysed by EIA kits, shows good differentiation between smokers and non-smokers. Salivary samples have the advantage of being non-invasive, although collection methodology is important, as cotinine levels may vary.
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Sharland MR, Burke FJT, McHugh S, Walmsley AD (2004). Use of dental photography by general dental practitioners in Great Britain.
Dent Update,
31(4), 199-202.
Abstract:
Use of dental photography by general dental practitioners in Great Britain.
This study assesses, by means of a postal questionnaire, the numbers of general dental practitioners who use clinical photography, and the uses to which this is applied. The questionnaire was distributed to 1000 randomly selected GDPs in Great Britain. A response rate of 76% was achieved. of the respondents, 36% used clinical photography, with 65% of those using an intra-oral 35 mm camera, 18% a digital camera and 12% an intra-oral digital video camera. Principal uses of clinical photography were patient instruction/motivation (72%), medico-legal reasons (68%), treatment planning (63%), and liaison with laboratory (43%).
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2003
Randall RC, Meyers IA, Pitt J, Hall AC, McHugh S, Burke FJT (2003). Amalgam and composite use in 2002 in general dental practice in Australia.
Author URL.
Burke FJT, McHugh S, Hall AC, Randall RC, Widstrom E, Forss H (2003). Amalgam and composite use in UK general dental practice in 2001.
Br Dent J,
194(11), 613-618.
Abstract:
Amalgam and composite use in UK general dental practice in 2001.
OBJECTIVE: This study determined the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Great Britain. METHOD: a questionnaire was developed to elicit this information. The names and addresses of 1,000 UK-based dentists were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. RESULTS: Six hundred and fifty four replies were received. Regarding choice of material, 100% of respondents cited clinical indication as the most influential factor, although patients' aesthetic demands (99%), patients' choice (95%) and patients' financial situation (92%) were also reported to influence respondents' choice. Thirty-five per cent of respondents used composite 'sometimes', 15% 'often', and 1% 'always' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 92% 'always', 'often' or 'sometimes' used the total etch technique and 53% never used rubber dam. Seventy per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Eighty-one per cent considered that the growth in the use of composites increased the total cost of oral healthcare. CONCLUSIONS: Forty nine per cent of the respondents from England and Wales seldom or never place large composite restorations in molar teeth. Their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.
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Author URL.
Jones RM, Faqir A, Millett DT, McHugh S (2003). Bridging and dimensions of sella turcica - orthognathic versus orthodontic patients.
Author URL.
Binnie V, Mchugh S, Macpherson LM, Jenkins W, Borland W (2003). Dental hygienists' delivery of smoking cessation: 3-month outcomes.
Author URL.
Burke FJT, Busby M, McHugh S, Delargy S, Mullins A, Matthews R (2003). Evaluation of an oral health scoring system by dentists in general dental practice.
Br Dent J,
194(4), 215-218.
Abstract:
Evaluation of an oral health scoring system by dentists in general dental practice.
UNLABELLED: an Oral Health Index (OHX) has been designed to provide a numerical measure of the overall state of a patient's oral health by means of a series of simple clinical examinations. This has been amended to produce the Oral Health Score (OHS). OBJECTIVE: to assess, by means of a questionnaire, the ease of use and understanding of the OHS by general dental practitioners. METHODS: 350 GDPs were asked to participate in the project, of whom 329 agreed. These dentists were given a lecture of 2 hours' duration on the OHS. The participating dentists were requested to use the OHS for a period of 1 year. At the end of this period, a questionnaire was delivered to them by post, with an explanatory letter and reply-paid envelope. RESULTS: Completed, usable questionnaires were received from 239 GDPs, a 77% response rate. Ninety three percent of respondents considered the OHS instructions to be satisfactory. The respondents' views on the criteria on which the OHS component assessments are based indicated that over 90% of respondents agreed with the criteria for caries, adequacy of restorations, periodontal assessment, mucosal assessment and assessment of dentures. A majority of respondents agreed that the OHS provided a valid representation of oral health. CONCLUSION: the results of the present study indicate that the OHS is considered to be an easy-to-use measure of a patient's oral health and that it provides a valid representation of a patient's oral health.
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Author URL.
Sharland MR, McHugh S, Walmsley AD, Burke FJT (2003). General dental practitioners' use of clinical photography in Great Britain.
Author URL.
Bagg J, Sweeney MP, Lewis MAO, Jackson MS, Coleman D, Al MA, Baxter W, McEndrick S, McHugh S (2003). High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer.
Palliat Med,
17(6), 477-481.
Abstract:
High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer.
Oral fungal infections frequently develop in individuals with advanced cancer. This study examined the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease. Demographic details and a clinical history were documented from each participant. A tongue swab was collected and cultured on CHROMAgar Candida (CHROMAgar Paris, France). All yeasts were identified by germ tube test, API ID 32C profiles and, for Candida dubliniensis, by species-specific PCR. Susceptibility to fluconazole and itraconazole was determined by a broth microdilution assay according to the National Committee for Clinical Laboratory Standards (NCCLS). At time of sampling, 54 (26%) of the 207 subjects had clinical evidence of a fungal infection and yeasts were isolated from 139 (67%) individuals. In total, 194 yeasts were isolated, of which 95 (49%) were Candida albicans. There was a high prevalence of Candidia glabrata (47 isolates) of which 34 (72%) were resistant to both fluconazole and itraconazole. All nine isolates of C. dubliniensis recovered were susceptible to both azoles. No relationship was established between anti-fungal usage in the preceding three months and the presence of azole resistant yeasts. This study of patients with advanced cancer has demonstrated a high incidence of oral colonization with non-C. albicans yeasts, many of which had reduced susceptibility to fluconazole and itraconazole. The role of improved oral care regimes and novel anti-fungal drugs merits further attention, to reduce the occurrence of fungal infection in these patients.
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Lang M, McHugh S, Burke FJT (2003). In vitro fracture resistance of teeth with dentin-bonded ceramic crowns and core build-ups.
Am J Dent,
16 Spec No, 88A-96A.
Abstract:
In vitro fracture resistance of teeth with dentin-bonded ceramic crowns and core build-ups.
PURPOSE: to assess the fracture strength of dentin-bonded crowns placed on cores of amalgam, resin composite and viscous glass-ionomer. METHODS: 40 sound maxillary premolar teeth were selected. These were mounted in acrylic resin in stainless steel molds. The palatal cusp of each tooth was removed in a standardized manner to simulate a core build-up preparation. Teeth were randomly divided into four groups, and each group was allocated a core material. For Group A, the core was pin-retained amalgam, for Group B the core was bonded amalgam, for Group C the core material was resin composite and for Group D the core material was high-viscosity glass-ionomer material. Cores were then constructed to the original tooth dimensions. A standardized crown preparation was made, impressions taken and an all-ceramic crown constructed in feldspathic porcelain. The crowns were luted in position using a dentin-bonding agent/dual cure resin-composite cement and the completed specimens subjected to compressive loading in a Universal Testing machine at 1 mm/minute. RESULTS: the mean forces to produce fracture of the crowns were 1.58 kN (+/- 0.41), 1.35 kN (+/- 0.44), 1.25 kN (+/- 0.24), and 1.12 kN (+/- 0.25) respectively for groups A, B, C and D. Statistical analysis by ANOVA indicated that the pinned amalgam group performed significantly better than the glass-ionomer group (P > 0.05).
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Binnie VI, McHugh S, Macpherson LM, Jenkins W, Borland W (2003). Nicotine dependence and cotinine & carbon monoxide levels in smokers.
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Stewardson DA, McHugh S, Palenik CJ, Burke FJT (2003). Occupational exposures occurring among dental assistants in a UK dental school.
Prim Dent Care,
10(1), 23-26.
Abstract:
Occupational exposures occurring among dental assistants in a UK dental school.
PURPOSE: the cross-infection risks for dentists have been well recognised, and much has been published regarding the incidence of occupational exposures to patient body fluids. Less has been reported regarding the risks to dental assistants. The purpose of this study was to evaluate the incidence of occupational exposures to patient body fluids among dental assistants, to assess the rate of reporting of such incidents, and to evaluate the association of various factors with these exposures. METHOD: all 84 dental assistants working at Birmingham Dental Hospital were asked to complete a confidential questionnaire to provide retrospective information regarding the nature and incidence of any occupational exposures they had experienced. RESULTS: an overall response rate of 94% was achieved. Dental nurses experienced fewer occupational exposures than dental students at the same institution, and reported incidents more frequently. More injuries occurred after the treatment session. Handling local anaesthetic syringes was associated with more injuries, and percutaneous injuries predominated. Trainee nurses had experienced more occupational injuries in the preceding six months than their qualified colleagues. There was no significant association with any of the other factors evaluated. CONCLUSIONS: the general incidence of occupational exposures among the dental assistants in this survey was low in comparison to dental students at the same institution. A further reduction may be possible by increasing the training of unqualified nurses with particular regard to post-treatment handling of sharp dental instruments and equipment.
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Mchugh S, Binnie V, Macpherson LM, Jenkins W, Borland W (2003). Prediction of primary and secondary outcomes in a smoking cessation trial.
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Delargy S, McHugh S, Hall AC, Burke FJT (2003). Reproducibility of an index of oral health among general dental practitioners.
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Busby M, Delargy S, McHugh S, Matthews R, Burke FJT (2003). Reproducibility of an oral health score in general dental practitioners.
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Burke FJT, Busby M, Matthews R, McHugh S, Mullins A (2003). Restorations omitted from oral health scoring system - the authors respond.
BRITISH DENTAL JOURNAL,
194(10), 531-531.
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Reekie D, Burke FJT, Busby M, Matthews R, McHugh S, Mullins A (2003). Restorations omitted from oral health scoring system [2] (multiple letters). British Dental Journal, 194(10), 530-531.
Bissell V, McKerlie RA, Kinane DF, McHugh S (2003). Teaching periodontal pocket charting to dental students: a comparison of computer assisted learning and traditional tutorials.
Br Dent J,
195(6), 333-336.
Abstract:
Teaching periodontal pocket charting to dental students: a comparison of computer assisted learning and traditional tutorials.
AIM: the aim of this study was to compare the effectiveness of a computer assisted learning (CAL) programme with that of traditional small group tutorials in teaching theoretical and practical aspects of periodontal pocket charting. METHOD: Sixty-one third year undergraduate dental students were randomized to either receive a tutorial or to work through the CAL programme. Students using the CAL programme completed questionnaires relating to previous computer experience and the ease of use of the programme. All students were assessed immediately after the intervention by means of a confidence log, a practical exercise and a further confidence log. They were assessed again three weeks later by means of a confidence log and a multiple-choice written test. RESULTS: There were very few significant differences between groups for any of the assessments used. However, subjective comments indicated that students occasionally felt disadvantaged if they had not received a tutorial. CONCLUSION: CAL and traditional teaching methods are equally effective in teaching periodontal pocket charting to undergraduate dental students.
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Burke FJT, Mchugh S, Macpherson L, Hosey MT, Shaw L, Delargy S, Dopheide B (2003). Uk dental practitioners' understanding of art.
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2002
Smith AJ, McHugh S, McCormick L, Stansfield R, McMillan A, Hood J (2002). A cross sectional study of water quality from dental unit water lines in dental practices in the West of Scotland.
Br Dent J,
193(11), 645-648.
Abstract:
A cross sectional study of water quality from dental unit water lines in dental practices in the West of Scotland.
OBJECTIVE: to determine the microbiological quality of water from dental units in a general practice setting and current practice for disinfection of units. DESIGN: a cross-sectional study of the water quality from 40 dental units in 39 general practices and a questionnaire of the disinfection protocols used in those practices. SETTING: NHS practices in primarydental care. SUBJECTS: Thirty-nine general practices from the West of Scotland. METHODS: Water samples were collected on two separate occasions from dental units and analysed for microbiological quality by the total viable count (TVC) method. Water specimens were collected from the triple syringe, high speed outlet, cup filler and surgery tap. Each participating practitioner was asked to complete a questionnaire. Results Microbial contamination was highest from the high speed outlet followed by the triple syringe and cup filler. On average, the TVC counts from the high speed water lines at 37 degrees C and for the high speed lines, triple syringe and cup filler at 22 degrees C were significantly higher than that from the control tap water specimens. The study included units from 11 different manufacturers with ages ranging from under one year to over eight years. The age of the dental unit analysed did not appear to influence the level of microbial contamination. Five of the practices surveyed used disinfectants to clean the dental units but these had no significant effect on the microbiological quality of the water. The majority of dental units (25 out of 40) were never flushed with water between patients. A number of different non-sterile irrigants were used for surgical procedures. CONCLUSION: the microbiological quality of water from dental units in general dental practice is poor compared with that from drinking water sources. Suitable sterile irrigants should be used for surgical procedures in dental practice. Further work is required for pragmatic decontamination regimens of dental unit water lines in a general dental practice setting
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Lowe AH, Bagg J, Burke FJT, MacKenzie D, McHugh S (2002). A study of blood contamination of Siqveland matrix bands.
Br Dent J,
192(1), 43-45.
Abstract:
A study of blood contamination of Siqveland matrix bands.
UNLABELLED: AIMS to use a sensitive forensic test to measure blood contamination of used Siqveland matrix bands following routine cleaning and sterilisation procedures in general dental practice. MATERIALS AND METHODS: Sixteen general dental practices in the West of Scotland participated. Details of instrument cleaning procedures were recorded for each practice. A total of 133 Siqveland matrix bands were recovered following cleaning and sterilisation and were examined for residual blood contamination by the Kastle-Meyer test, a well-recognised forensic technique. RESULTS: Ultrasonic baths were used for the cleaning of 62 (47%) bands and retainers and the remainder (53%) were hand scrubbed prior to autoclaving. Overall, 21% of the matrix bands and 19% of the retainers gave a positive Kastle-Meyer test, indicative of residual blood contamination, following cleaning and sterilisation. In relation to cleaning method, 34% of hand-scrubbed bands and 32% of hand-scrubbed retainers were positive for residual blood by the Kastle-Meyer test compared with 6% and 3% respectively of ultrasonically cleaned bands and retainers (P < 0.001). CONCLUSIONS: If Siqveland matrix bands are re-processed in the assembled state, then adequate pre-sterilisation cleaning cannot be achieved reliably. Ultrasonic baths are significantly more effective than hand cleaning for these items of equipment.
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Lowe AH, Burke FJT, McHugh S, Bagg J (2002). A survey of the use of matrix bands and their decontamination in general dental practice.
Br Dent J,
192(1), 40-42.
Abstract:
A survey of the use of matrix bands and their decontamination in general dental practice.
AIMS: the aims of this study were to determine the pattern of use and re-use of matrix bands in general practice in Scotland, to demonstrate which type of matrix band is most commonly used and to examine infection control measures of relevance to the safe use and re-use of matrix bands. SUBJECTS: 621 of Scotland's 1,849 general dental practitioners were randomly selected. DATA COLLECTION: a 19-item self-reported questionnaire was mailed in June 1999 with a follow-up mailing sent in August 1999. ANALYSIS: Data analysis involved descriptive statistics and cross-tabulation. Where appropriate, differences between categories were tested for significance by a Chi-square test. RESULTS: a total of 479 questionnaires were returned, representing a response rate of 77%. Reported compliance with routine glove wearing was high (91%). Most dentists (92%) provided training on instrument cleaning and sterilisation for their dental nurses. Ultrasonic baths were used by 59% of practitioners; the remainder soaked or manually scrubbed instruments to remove debris before autoclaving. The Siqveland matrix was the matrix of choice for 96% of respondents. 7% provided a new matrix band for each patient. Most (64%) changed bands only when they were bent or damaged; 29% changed them daily or weekly. Deterrents to use of a new band for each patient were cost (39%) and time (52%). A total of 54% of respondents considered matrix band replacement unnecessary between patients. CONCLUSIONS: the Siqveland matrix band is the most popular among the study group of dental practitioners. Re-use of matrix bands is common. Guidelines for the safe re-use of matrix bands are required.
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Burke FJT, Hall AC, McHugh S, Randall RC, Widstrom H, Forss H (2002). Algann and composite use in 2001 in Great Britain.
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Crisp RJ, Burke FJT, McHugh S, Lendenmann U (2002). Effectiveness of Systemp.desensitizer in controlling dentinal hypersensitivity.
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Smith AJ, McHugh S, Aitken I, Hood J (2002). Evaluation of the efficacy of Alpron disinfectant for dental unit water lines.
Br Dent J,
193(10), 593-596.
Abstract:
Evaluation of the efficacy of Alpron disinfectant for dental unit water lines.
AIMS: to assess the efficacy of a disinfectant, Alpron, for controlling microbial contamination within dental unit water lines. METHODS: the microbiological quality of water emerging from the triple syringe, high speed handpiece, cup filler and surgery hand wash basin from six dental units was assessed for microbiological total viable counts at 22 degrees C and 37 degrees C before and after treatment with Alpron solutions. RESULTS: the study found that the use of Alpron disinfectant solutions could reduce microbial counts in dental unit water lines to similar levels for drinking water. This effect was maintained in all units for up to six weeks following one course of treatment. In four out of six units the low microbial counts were maintained for 13 weeks. CONCLUSIONS: Disinfectants may have a short term role to play in controlling microbial contamination of dental unit water lines to drinking water quality. However, in the longer term attention must be paid to redesigning dental units to discourage the build up of microbial biofilms.
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Stewardson DA, Palenik CJ, McHugh ES, Burke FJT (2002). Occupational exposures occurring in students in a UK dental school.
Eur J Dent Educ,
6(3), 104-113.
Abstract:
Occupational exposures occurring in students in a UK dental school.
BACKGROUND: Students whilst training may encounter a number of incidents where infection from patient body fluids may occur, especially as their manual skills are underdeveloped and their clinical experience is limited. PURPOSE OF STUDY: (a) to assess the nature of the occupational exposures occurring to students in a UK dental school, (b) to assess the rate of reporting of incidents, and (c) to evaluate the association of various factors with these exposures. Students in the third, fourth and final years of the 5-year undergraduate dental course at the University of Birmingham were asked to complete a questionnaire that inquired into personal details, number and nature of incidents, their reporting and follow-up. A 100% response rate was achieved. RESULTS: Across the years, there was no significant correlation (p > 0.01) between sex, dominant hand, use of protective glasses or time of day. Slightly more exposures occurred in males, right-handed students, and in the afternoon. A significant decrease in exposures (p < 0.01) occurred within final year, and when an assistant was employed. Significantly more incidents occurred while a patient was being treated than during operational clean-up procedures. A substantial number of dental students had experienced one or more occupational exposures during training. of these, percutaneous injuries predominated. Junior students appear to be more likely to experience exposures, and in these students, needlestick injuries are the most common source. CONCLUSIONS: to reduce the incidence of these exposures, more instruction and training may be required in the earlier clinical years and more chairside assistance. Improvements are required in the monitoring of post-screening for seroconversion after HBV immunization, and in the reporting of test results in the event of an exposure incident. Under-reporting of incidents is common and ways to encourage and facilitate reporting should be sought.
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Stewardson DA, McHugh ES (2002). Patients' attitudes to rubber dam.
Int Endod J,
35(10), 812-819.
Abstract:
Patients' attitudes to rubber dam.
AIM: the aims of this study were to record patients' views of their experience of RD use in an objective manner, and to evaluate the influence of some personal and clinical factors on patients' opinion. METHODOLOGY: a questionnaire was designed which was then distributed to patients receiving dental treatment under RD by (a) final-year dental students at Birmingham Dental School, and (b) general dental practitioners. Patients completed the confidential questionnaire anonymously after treatment, outside the treatment room. After 100 correctly completed forms were collected from group (a) and 106 from group (b), data were entered into a database and subsequently analyzed using SPSS. Analyses were confined to simple cross-tabulations of the patients' responses and potential associated factors, with chi-square analysis and appropriate follow-up comparisons wherever necessary. RESULTS: in both groups, the majority of patients said they would prefer RD to be used at their next appointment, and most had a positive opinion of the experience. No statistically significant association between age, sex, procedure, application time or duration of use and preference for rubber dam was found. Prolonged RD use showed some association with a negative opinion of the experience of RD. Compared with the dentists, students took longer to apply rubber dam and it was in place for longer. Fewer student patients preferred RD next time, and were less positive about its use than the dentists' patients. CONCLUSIONS: Further evidence is presented that (i) Patients generally are not averse to RD. (ii) Placement of rubber dam does not take long. (iii) Operator experience improves patient compliance.
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Sweeney MP, Manton S, MacPherson LM, McHugh S (2002). Provision of domiciliary dental care in Scotland: a pilot study.
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Coldero LG, McHugh S, MacKenzie D, Saunders WP (2002). Reduction in intracanal bacteria during root canal preparation with and without apical enlargement.
Int Endod J,
35(5), 437-446.
Abstract:
Reduction in intracanal bacteria during root canal preparation with and without apical enlargement.
AIM: to compare in vitro intracanal bacterial reduction using nickel-titanium rotary instruments with and without apical enlargement. METHODOLOGY: Thirty-eight palatal roots of maxillary molar teeth, with mature apices were subdivided according to lengths and then randomly assigned to two experimental and one control groups. The roots were sterilized and then reinfected with Enterococcus faecalis, which served as a bacteriological marker. All roots in the experimental groups were prepared in a step-down sequence with engine-driven GT rotary files at 350 rpm. In experimental group a (n = 16) additional apical enlargement to ISO size 35 was performed. In group B (n = 16) a serial step-back technique was followed with no apical enlargement. This was combined in groups a and B with irrigation with NaOCl and EDTA. In the control group (group C, n = 6) irrigation only was carried out, with no mechanical preparation. Samples were then taken from the root canals to determine the numbers of remaining bacteria. RESULTS: in groups a and B, 15 (94%) and 13 (81%) specimens were rendered bacteria-free, respectively. In the control group C none of the specimens were bacteria-free. There was a significant difference (P < 0.001) in the antibacterial effects of experimental and control regimens. There was, however, no significant difference (P = 0.276) between the preparation methods used in the experimental groups. CONCLUSIONS: There was no significant difference in intracanal bacterial reduction when Ni-Ti GT rotary preparation with NaOCl and EDTA irrigation was used with or without apical enlargement preparation technique. It may therefore not be necessary to remove dentine in the apical part of the root canal when a suitable coronal taper is achieved to allow satisfactory irrigation of the root canal system with antimicrobial agents.
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Almyroudi A, Mackenzie D, McHugh S, Saunders WP (2002). The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study.
J Endod,
28(3), 163-167.
Abstract:
The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study.
The purpose of this study was to compare in vitro the suitability of four disinfectants as intracanal medications: calcium hydroxide, chlorhexidine gel, chlorhexidine in the form of a controlled-release delivery system (PerioChip), and the combination of chlorhexidine gel with calcium hydroxide. Saline was used as the control. The disinfectants were tested at three different time periods (3, 8, and 14 days) by using human tooth specimens that had been previously contaminated with Enterococcus faecalis. Calcium hydroxide worked very efficiently in killing E. faecalis in the 3-day group and 8-day group. It was not as effective in the 14-day group. The different chlorhexidine formulations were also found to be effective for all time periods. More specifically, the combination of chlorhexidine gel with calcium hydroxide and the chlorhexidine gel worked slightly better than the PerioChip, but there was no significant difference among the medications.
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2001
Murray CA, Burke FJ, McHugh S (2001). An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice.
Br Dent J,
190(7), 377-380.
Abstract:
An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice.
OBJECTIVE: to investigate the puncture resistance of a recently introduced non-latex, nitrile dental glove in comparison with a latex glove worn during routine clinical dental procedures. SETTING: Dentists in general dental practice working within the UK during 1999. SUBJECTS AND METHODS: 2,020 gloves worn by five general dental practitioners were examined for punctures following standard clinical use by a water inflation method. Procedures undertaken during glove usage and length of time worn were recorded. RESULTS: Following clinical use, 1.9% of the latex gloves and 5.3% of the nitrile gloves had punctures, a statistically significant difference (P < 0.0001). The puncture resistance of the nitrile gloves was superior to the puncture resistance of previously tested worn non-latex (vinyl) gloves. There was no evidence of a statistically significant difference between operators for the percentage or incidence of punctured gloves (P = 0.787) after correcting for glove type. No statistically significant difference was noted between incidence of puncture in the control, unused gloves (n = 200 for each type) and the gloves examined following clinical use (P = 0.907 for nitrile, P = 0.613 for latex). CONCLUSION: No increase in the number of punctures was noted following clinical use for either glove type. This could be considered to indicate good puncture resistance of the gloves tested in clinical use.
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Murray CA, Burke FJT, McHugh S (2001). For those of you allergic to latex, nitrile could be the glove material for you - an assessment of the incidence of punctures in latex ann non-latex dental examination gloves in routine clinical practice.
BRITISH DENTAL JOURNAL,
190(7), 371-371.
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Burke FJT, Lang M, McHugh S (2001). Fracture strength of dentine-bonded crowns with different care materials.
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McCaul LK, McHugh S, Saunders WP (2001). Influence of training and experience on clinical decision making in endodontics.
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Gordon BL, Burke FJ, Bagg J, Marlborough HS, McHugh ES (2001). Systematic review of adherence to infection control guidelines in dentistry.
J Dent,
29(8), 509-516.
Abstract:
Systematic review of adherence to infection control guidelines in dentistry.
OBJECTIVES: the purpose of this study was to determine the knowledge and attitudes of dental health care workers (DHCWs) towards infection control procedures, to examine DHCWs' practising behaviour in respect of infection control, and to determine whether a relationship exists between knowledge, attitudes and behaviour. METHODS: Within this systematic review, study quality was assessed in line with selection criteria relating to study design, participants, interventions and outcome measures. Following data extraction, the heterogeneity of study design, targeted participants, sample size and outcome measures precluded a quantitative analysis. Qualitative data synthesis followed. RESULTS: Overall, the quality of the studies reviewed was poor. Only 71 studies meeting the selection criteria were identified. Data indicated that over the period of the review there have been substantial improvements with compliance in some areas of infection control in dentistry, for example glove wearing. However, other aspects, such as the effective management of needlestick injuries, remain problematic. CONCLUSIONS: More rigorously designed studies are required to assess accurately dental team members' adherence to infection control guidelines.
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McCaul LK, McHugh S, Saunders WP (2001). The influence of specialty training and experience on decision making in endodontic diagnosis and treatment planning.
Int Endod J,
34(8), 594-606.
Abstract:
The influence of specialty training and experience on decision making in endodontic diagnosis and treatment planning.
AIM: the purpose of this study was to compare the diagnostic and treatment-planning decision making of cohorts of dental surgeons with different experiences and specialty backgrounds. METHODOLOGY: Periapical radiographs of 20 teeth in patients referred for an opinion regarding the provision of endodontic surgical retreatment were taken using a paralleling technique and a film holder. The radiographs were photographed and black and white photographic prints produced to provide an image 10.5 times larger than the original radiograph. Each image was related to a clinical scenario. Each participant was asked to assess whether a periradicular lesion, as manifested by a radiolucency, was present and what clinical management would be prescribed. Ten participants in each of seven groups took part in the study. These groups were chosen to represent those dentists who were most likely to be involved in decision making in similar cases. RESULTS: in 12 out of 20 cases interobserver agreement for radiographic analysis was 'excellent' (above 90%) or 'good' (between 70 and 90%). There was less agreement for treatment decisions than for radiographic analysis and the order of agreement for cases for diagnosis was not the same as for treatment. No case achieved 'excellent' percentage interobserver agreement. The average percentage interobserver agreement of the endodontists was significantly greater than the average percentage interobserver agreement for the other groups for both radiographic assessment and treatment decisions. CONCLUSIONS: Differences in specialty backgrounds amongst the participants in this study affected both endodontic diagnostic and treatment decisions. Endodontists showed the most consistent agreement amongst the specialty groups.
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2000
Moir K, Malik K, Binnie V, Macpherson L, Borland W, McHugh S (2000). Cotinine estimation in biological fluids - Patient acceptability.
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Burke FJT, Gordon B, Bagg J, McHugh S (2000). Dental healthcare-workers' adherence to infection control guidelines: a Cochrane-Style review.
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McHugh ES, Shinn AP, Kay JW (2000). Discrimination of the notifiable pathogen Gyrodactylus salaris from G. thymalli (Monogenea) using statistical classifiers applied to morphometric data.
Parasitology,
121 ( Pt 3), 315-323.
Abstract:
Discrimination of the notifiable pathogen Gyrodactylus salaris from G. thymalli (Monogenea) using statistical classifiers applied to morphometric data.
The identification and discrimination of 2 closely related and morphologically similar species of Gyrodactylus, G. salaris and G. thymalli, were assessed using the statistical classification methodologies Linear Discriminant Analysis (LDA) and k-Nearest Neighbours (KNN). These statistical methods were applied to morphometric measurements made on the gyrodactylid attachment hooks. The mean estimated classification percentages of correctly identifying each species were 98.1% (LDA) and 97.9% (KNN) for G. salaris and 99.9% (LDA) and 73.2% (KNN) for G. thymalli. The analysis was expanded to include another 2 closely related species and the new classification efficiencies were 94.6% (LDA) and 98.% (KNN) for G. salaris; 98.2% (LDA) and 72.6% (KNN) for G. thymalli; 86.7% (LDA) and 91.8% (KNN) for G. derjavini; and 76.5% (LDA) and 77.7% (KNN) for G. truttae. The higher correct classification scores of G. salaris and G. thymalli by the LDA classifier in the 2-species analysis over the 4-species analysis suggested the development of a 2-stage classifier. The mean estimated correct classification scores were 99.97% (LDA) and 99.99% (KNN) for the G. salaris-G. thymalli pairing and 99.4% (LDA) and 99.92% (KNN) for the G. derjavini-G. truttae pairing. Assessment of the 2-stage classifier using only marginal hook data was very good with classification efficiencies of 100% (LDA) and 99.6% (KNN) for the G. salaris G. thymalli pairing and 97.2% (LDA) and 99.2% (KNN) for the G. derjavini-G. truttae pairing. Paired species were then discriminated individually in the second stage of the classifier using data from the full set of hooks. These analyses demonstrate that using the methods of LDA and KNN statistical classification, the discrimination of closely related and pathogenic species of Gyrodactylus may be achieved using data derived from light microscope studies.
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Lang M, Burke FJT, McHugh S (2000). Fracture resistance of teeth with amalgam cores and dentine-bonded crowns.
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Stevenson B, Forsyth DO, Millett DT, Logan G, Brocklebank LM, Andrews F, McHugh S, Atchison T (2000). In vitro comparative evaluation of digital and conventional panoramic radiographs.
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Murray CA, Burke FJT, McHugh S (2000). Incidence of punctures in latex and non-latex dental examination gloves.
Author URL.
Gordon BL, Burke FJT, Bagg J, Marlborough HS, McHugh ES (2000). Systematic review of dental team's adherence to infection control guidelines.
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Malik K, Moir K, Binnie V, MacPherson L, Borland W, McHugh S (2000). The effect of nicotine exposure on cotinine levels in smokers.
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Binnie V, McHugh S, Malik K, Moir K, Macpherson L, Borland W (2000). The effect of passive smoking on cotinine levels.
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Burke FJ, Malik R, McHugh S, Crisp RJ, Lamb JJ (2000). Treatment of dentinal hypersensitivity using a dentine bonding system.
Int Dent J,
50(5), 283-288.
Abstract:
Treatment of dentinal hypersensitivity using a dentine bonding system.
AIMS AND OBJECTIVES: Many agents have been used in treatment of dentinal hypersensitivity in the past, but dentine bonding systems have recently been suggested as being effective. This study examined the effectiveness of a dentine bonding system in the treatment of dentinal hypersensitivity in dental practice conditions. METHODS: Dentists in two dental practices agreed to carry out the project. One practice was in the UK, the other in India. A total of 34 patients who were diagnosed to have dentinal hypersensitivity were treated using the dentine bonding system. Patients were requested to record their perception of their pain on a 100mm linear scale, pre-treatment, one day and one week post-treatment. RESULTS: all patients experienced relief of pain, both 1 day and 1 week after treatment. Profile plots of the patients' perceived pain scores for the two practices separately indicated that there was a general trend across both practices for these to fall quite sharply one day after treatment and then generally level out one week post-treatment. There was evidence indicating a possible difference in pain perception in the two communities from which the patients were drawn. CONCLUSION: the dentine bonding system evaluated was successful in reducing the pain of dentinal hypersensitivity, at least in the short term.
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