Exploring Interprofessional Relationships Between Dental Hygienists and Health Professionals in Rural Canadian Communities.

Purpose: For most Canadians living in rural communities, limited access to dental care can negatively impact oral and general health. This narrative, tertiary review of the literature explores the outcomes of interprofessional relationships between dental hygienists and other health professionals on individuals residing in rural communities in Canada. Themes addressed include: implementing interprofessional education experiences in entry-to-practice health programs, interprofessional dynamics in primary health care teams, health perceptions in rural communities, and barriers and enablers to interprofessional relationships.Conclusion: Findings from this review suggest that the development of interprofessional relationships between health care professionals is complex and dynamic. Interprofessional collaboration should first be implemented at the educational level to help develop trust and understanding of each profession's role in health care. Alternative models of health care delivery, such as interprofessional collaborative practice, have the potential to reduce overall health care costs and improve access of comprehensive health care services to Canadians residing in rural communities.

Screening intervention to identify eligible patients and improve accrual to phase II-IV oncology clinical trials.

PURPOSE: Low enrolment rates in clinical trials present a barrier to the development of novel cancer therapies. Currently, only 3% of patients with cancer participate, and many studies fail to achieve necessary enrolment. The objective of this study was to evaluate whether a screening intervention to identify potentially eligible patients (PEPs) would increase accrual rates. PATIENTS AND METHODS: Over a 4-month intervention period, PEPs for 21 phase II-IV breast, gastrointestinal, genitourinary, gynecology, and lung cancer trials were identified by a screening coordinator. This individual reviewed the electronic medical records of patients attending outpatient clinics and flagged PEPs for 10 medical oncologists at the BC Cancer Agency. Patients who were already documented to be trial eligible by physicians were not flagged. Oncologists were surveyed regarding the helpfulness and accuracy of the intervention. RESULTS: During the intervention period, 73 patients were enrolled, compared with 61 patients enrolled in the 4 months prior and 51 patients in the 4 months after. A total of 2,098 charts were reviewed, and 120 PEPs were identified during the intervention period, resulting in 19 PEPs who enrolled and four PEPs who declined a clinical trial. Relative accrual rates adjusted for oncologist appointments were 0.85 (P = .15) before and 0.70 (P < .005) after, relative to the intervention period. Oncologist-returned surveys indicated that 67% of flags were helpful, and 70% were accurate. CONCLUSIONS: In this study, manually screening patient records increased enrolment to specific clinical trials. A screening intervention process, involving a dedicated screening coordinator, should be considered to improve clinical trial accrual.

Continual improvement in ventilator acquired pneumonia bundle compliance: a retrospective case matched review.

OBJECTIVES: This study aimed to describe the population of people who acquired ventilator acquired pneumonia and determine the feasibility of a larger scale study to assess the degree to which bundle compliance reduces or even eliminates, the risk of ventilator acquired pneumonia. RESEARCH METHODOLOGY/DESIGN: A retrospective matched case note review was conducted to scrutinise 10 VAP cases. Cases were matched with two controls for age, gender, APACHE score and number of ventilated days. Compliance with the VAP bundle was determined by extracting data on compliance from case notes. Binary logistic regression was used to calculate odds ratios with confidence intervals which were utilised to determine numbers needed for a larger study. SETTING: A general intensive care unit within a 750 bedded district general hospital, serving a population of approximately 270,000 people in Scotland. MAIN OUTCOME MEASURE: The outcome variable of interest was ventilator acquired pneumonia and the independent variable was ventilator acquired pneumonia bundle compliance. RESULTS: Binary logistic regression suggested that cases which did not receive the bundle reliably were more likely to develop ventilator acquired pneumonia (OR 1.33, confidence interval (CI) 0.28-6.30). Statistical results should be interpreted with caution due to the small sample size, which is demonstrated with the wide ranging confidence intervals (CIs). CONCLUSION: Wide confidence intervals enable only a cursory impression as to numbers that would be required for a full scale trial. Nonetheless, the effect size indicated in this paper contributes towards consideration as to numbers needed for future studies.