Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial.

OBJECTIVES: This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools. METHODS: Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized. RESULTS: In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold). CONCLUSION: There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

The oral health of secondary school pupils: baseline data from the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial.

Background This paper describes the sociodemographics and oral health of UK secondary school pupils. They were participants of the BRIGHT trial, which was designed to evaluate the effectiveness of a toothbrushing intervention to reduce dental caries.Methods Overall, 4,680 pupils aged 11-13 years attending 42 secondary schools in England, Scotland and Wales with above average proportion of pupils eligible for free school meals, were recruited to the trial. Sociodemographic data were collected. Participants had a clinical assessment for caries, plaque and bleeding and completed measures of oral and general health-related quality of life and oral health behaviours (frequency of toothbrushing, dental attendance and cariogenic food/drinks consumed). Regression analyses were performed.Results Over one-third (34.7%) of participants had caries experience, with 44.5% reporting their oral health had an impact on their daily lives. Factors associated with a statistically significant increased likelihood of caries experience were older age, being female, eligibility for free school meals, worse oral health-related quality of life, higher cariogenic diet, less than twice-daily toothbrushing, living in a more deprived area and lower school attendance.Conclusions The prevalence and impact of dental caries on the lives of pupils remains high, with further oral health promotion activities needed in targeted secondary schools.

Evaluation of Intrinsic Hand Musculature Reinnervation following Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer.

Supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer is commonly performed in the authors' institution to augment intrinsic hand function. Following observations of recovery patterns, the authors hypothesized that despite its more distal innervation, the first dorsal interosseous muscle recovers to a greater extent than the abductor digiti minimi muscle. The objective of this work was to evaluate the clinical and electrodiagnostic pattern of reinnervation of intrinsic hand musculature following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. A retrospective cohort of prospectively collected data included all patients who underwent a supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer. Two independent reviewers performed data collection. Reinnervation was assessed with two primary outcome measures: (1) clinically, with serial Medical Research Council strength assessments; and (2) electrodiagnostically, with serial motor amplitude measurements. Statistical analysis was performed using nonparametric statistics. Seventeen patients (65 percent male; mean age, 56.9 ± 13.3 years) were included with a mean follow-up of 16.7 ± 8.5 months. Preoperatively, all patients demonstrated clinically significant weakness and electrodiagnostic evidence of denervation. Postoperatively, strength and motor amplitude increased significantly for both the first dorsal interosseous muscle (p = 0.002 and p = 0.016) and the abductor digiti minimi muscle (p = 0.044 and p = 0.015). Despite comparable preoperative strength (p = 0.098), postoperatively, the first dorsal interosseous muscle achieved significantly greater strength when compared to the abductor digiti minimi muscle (p = 0.023). Following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer, recovery of intrinsic muscle function differs between the abductor digiti minimi and the first dorsal interosseous muscles, with better recovery observed in the more distally innervated first dorsal interosseous muscle. Further work to elucidate the underlying physiologic and anatomical basis for this discrepancy is indicated. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Assessment of the Readability, Adequacy, and Suitability of Online Patient Education Resources for Benign Vascular Tumours Using the DISCERN Instrument.

OBJECTIVE: This study aims to assess the quality and readability of Internet-based patient resources for vascular tumours in order to understand which areas require improvement. METHODS: A World Wide Web search was performed, in addition to a literature review using PubMed, Ovid MEDLINE, and EMBASE. Any material that contained information on vascular tumours pertaining to patient education was included. We evaluated resources with DISCERN and Flesch Reading Ease scores when applicable. The language of publication was restricted to English and French. This review was registered with PROSPERO (CRD42018087885). RESULTS: A total of 117 online resources were screened, with 73 resources included in the final analysis. The overall DISCERN rating for the patient resources was 1.8 (0.8). The majority of online resources failed to depict the entire spectrum of benign vascular tumours. The mean Flesch score was 36 (19), which translates to a college-level readability. CONCLUSION: The majority of resources were not adequate or comprehensive and were written at a much higher level than the average reader would be expected to comprehend.

OBJECTIF: La présente étude vise à évaluer la qualité et la lisibilité de ressources en ligne sur les tumeurs vasculaires pour les patients afin de déterminer les améliorations à apporter. MÉTHODOLOGIE: Les chercheurs ont effectué une recherche dans Internet et procédé à une analyse bibliographique dans PubMed, Ovid MEDLINE et EMBASE. Tous les documents qui contenaient de l'information sur les tumeurs vasculaires à l'intention des patients étaient inclus. Les chercheurs ont évalué les ressources à l'aide des scores de DISCERN et de Flesch Reading Ease, si la situation le justifiait. La langue des publications était restreinte à l'anglais et au français. La présente analyse a été enregistrée dans PROSPERO (CRD42018087885). RÉSULTATS: Au total, les chercheurs ont examiné 117 ressources en ligne, dont 73 ont fait partie de l'analyse définitive. La classification DISCERN globale des ressources pour les patients était de 1,8 (0,8). La majorité des ressources en ligne ne décrivaient pas tout le spectre des tumeurs vasculaires bénignes. Le score de Flesch moyen s'élevait à 36 (19), soit une lisibilité de niveau collégial. CONCLUSION: La majorité des ressources étaient inadéquates ou incomplètes et étaient rédigées à un niveau de lecture beaucoup plus élevé que ce à quoi on pourrait s'attendre chez un lecteur moyen.

Dermal regenerative matrix use in burn patients: A systematic review.

BACKGROUND: Dermal regenerative matrices (DRMs) have been used for several decades in the treatment of acute and reconstructive burn injury. The objective of this study was to perform a systematic review of the literature to assess clinical outcomes and safety profile of DRMs in full-thickness burn injury. METHODS: Comprehensive searches of MEDLINE, EMBASE, CINAHL, and Cochrane Library were performed from 1988 to 2017. Two independent reviewers completed preliminary and full-text screening of all articles. English-language articles reporting on DRM use in patients with full-thickness burn injury were included. RESULTS: Literature search generated 914 unique articles. Following screening, 203 articles were assessed for eligibility, and 72 met inclusion criteria for analysis. DRM was applied to1084 patients (74% acute burns, 26% burn reconstruction). Of the twelve studies that described changes in ROM, significant improvement was observed in 95% of reconstructive patients. The most frequently treated reconstructive sites were the neck, hand/wrist, lower extremity, and axilla. Vancouver scar scale was used in eight studies and indicated a significant improvement in the scar quality with DRM. The overall complication rate was 13%, most commonly infection, graft loss, hematoma formation, and contracture. CONCLUSIONS: Although variability in functional and cosmetic outcomes was observed, DRM demonstrates improvements in ROM and scar appearance without objective regression. Essential demographic data were lacking in many studies, highlighting the need for future standardization of reporting outcomes in burns following application of dermal substitutes.

Surgical Exploration and Discovery Program: Early Exposure to Surgical Subspecialties and Its Influence on Student Perceptions of a Surgical Career.

OBJECTIVE: Interest in pursuing a surgical career has been declining among North American medical students. Numerous factors are known to influence student interest in pursuing surgery as a career, such as prestige, income potential, and overall lifestyle. Given that many of these factors are rooted in bias, it may be possible to properly address several of these stereotypes through first-hand, early exposure to the field of surgery via the Surgical Exploration and Discovery (SEAD) Program. The purpose of this study is twofold: (1) to investigate whether participation in an intensive, 2-week surgical program may alter student opinion, bias, and/or preconceived assumptions of a career in surgery, and (2) to determine whether these changes in perception, if present, has an impact on student interest in pursuing a surgical career compared to baseline. DESIGN: This was a prospective cohort study. The analysis cohort consisted of 30 first-year medical students who participated in the 2-week SEAD program. The control group consisted of 29 first-year medical students who did not participate in the SEAD program. Both the SEAD and control groups completed two surveys: (1) an entry survey distributed prior to the start of the SEAD program, and (2) an exit survey distributed upon completion of the SEAD program. The surveys were designed to assess students' motivations for choosing a specialty in medicine, previous surgical experience, as well as perceptions and biases surrounding a surgical career, pre- and post-exposure. SETTING: Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada. PARTICIPANTS: 30 medical students in the SEAD group, and 29 in the control group. RESULTS: Students' perceptions of the lifestyle, call schedule as a staff or resident, diversity of practice and gender changed significantly following the SEAD program compared to students in the control group. Furthermore, students' perceptions of surgeons as intimidating declined following the 2-week program (p = 0.003), however they were more likely to view surgery as a field requiring physical strength (p = 0.022). Overall, there was no significant change with regards to desire to pursue a career in surgery in the treatment group (p = 0.625) or in the control group (p = 1.00). CONCLUSIONS: Early exposure to surgery through the SEAD program alters student perceptions of surgical specialties, yet it does not significantly influence students to pursue a career in the surgical field. Nonetheless, participation in the SEAD program continues to assist medical students with career decision making.

Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the unsatisfactory outcomes with traditional treatments, there is growing interest in nerve transfers to reestablish ankle dorsiflexion in peroneal nerve palsy. The objective of this work was to perform a systematic review and meta-analysis of the primary literature to assess the effectiveness of nerve transfer surgery in restoring ankle dorsiflexion in patients with peroneal nerve palsy. METHODS: Methodology was registered with PROSPERO, and PRISMA guidelines were followed. MEDLINE, EMBASE, and the Cochrane Library were systematically searched. English studies investigating outcomes of nerve transfers in peroneal nerve palsy were included. Two reviewers completed screening and extraction. Methodological quality was evaluated with Newcastle-Ottawa Scale. RESULTS: Literature search identified 108 unique articles. Following screening, 14 full-text articles were reviewed. Four retrospective case series met inclusion criteria for meta-analysis. Overall, 41 patients underwent nerve transfer for peroneal nerve palsy. The mean age of the patients was 36.1 years, mean time to surgery was 6.3 months, and the mean follow-up period was 19.0 months. Donor nerve was either tibial (n = 36) or superficial peroneal branches/fascicles (n = 5). Recipient nerve was either deep peroneal (n = 24) or tibialis anterior branch (n = 17). Postoperative ankle dorsiflexion strength demonstrated a bimodal distribution with a mean Medical Research Council of 2.1. There were no significant differences in dorsiflexion strength between injury sites (p = 0.491), injury mechanisms (p = 0.125), donor (p = 0.066), or recipient nerves (p = 0.496). There were no significant correlations between dorsiflexion strength and patient age (p = 0.094) or time to surgery (p = 0.493). CONCLUSIONS: There is variability in dorsiflexion strength following nerve transfer in peroneal nerve palsy, whereby there appear to be responders and non-responders. Further studies are needed to better define appropriate patient selection and the role of nerve transfers in the management of peroneal nerve palsy.