Occupational therapists’ perceptions of implementing a client-centered intervention in close collaboration with researchers: A mixed methods study

Abstract

Background: Integration of research-based knowledge in health care is challenging. Occupational therapists (OTs) need to implement new research-based interventions in clinical practice. Therefore it is crucial to recognize and understand the factors of specific barriers and facilitators affecting the implementation process.

Aim: To identify the key factors important for OTs during the implementation process of a complex intervention.

Materials and methods: A cross-sectional study with a combination of qualitative and quantitative data in a mixed method design. Forty-one OTs and 23 managers from three county councils in Sweden, responded to a questionnaire one year after the OTs participation in a workshop to prepare for implementation of a client-centered activity of daily living intervention for persons with stroke.

Results: Over 70% of the OTs benefitted from reading and discussing articles in the workshop; 60% had faith in the intervention; 69% reported usability of the intervention. High level of support from managers was reported, but less from team members. The therapists’ interaction, perceptions of own efforts and contextual influence affected the implementation process.

Conclusion: The workshop context with facilitation and access to evidence, supportive organizations and teams, sufficient interaction with researchers and satisfying self-image were successful key factors when involved in research.     

The effect of enzyme replacement therapy on clinical outcomes in female patients with Fabry disease – A systematic literature review by a European panel of experts

BackgroundHeterozygous females with Fabry disease have a wide range of clinical phenotypes depending on the nature of their mutation and their X-chromosome inactivation pattern; it is therefore important to examine outcomes of enzyme replacement therapy (ERT) in the female patient population specifically. This paper presents the findings of a systematic literature review of treatment outcomes with ERT in adult female patients.MethodsA comprehensive systematic literature review was conducted through January 2017 to retrieve published papers with original data on ERT in the treatment of Fabry disease. The review included all original articles that presented ERT outcomes data on patients with Fabry disease, irrespective of the study type.ResultsClinical evidence for the efficacy of ERT in female patients was available from 67 publications including six clinical trial publications, and indicates significant reductions in plasma and urine globotriaosylceramide (GL-3) accumulation (in female patients with elevated pre-treatment levels) and improvements in cardiac parameters and quality of life (QoL). To date, data are insufficient to conclude on the effects of ERT on the nervous system, gastrointestinal manifestations, and pain in female patients with Fabry disease.ConclusionsThis review of available literature data demonstrates that ERT in adult female patients with Fabry disease has a beneficial effect on GL-3 levels and cardiac outcomes. The current evidence also suggests that ERT may improve QoL in this patient population, though further studies are needed to examine these results.     

Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The present study tested the hypotheses that children with ADHD, particularly those exhibiting severe hyperactivity and impulsivity, have a different stress reaction (measured by salivary cortisol) during a dental recall visit and are more dentally anxious than children in a control group. Eighteen children with ADHD and a control group of 71 children, all 13 yr of age, underwent a clinical dental examination and completed the Corah Dental Anxiety Scale (CDAS). Four saliva samples were gathered for analysis of cortisol: one prior to dental examination, one after, and two the following morning. The subgroup ADHD with hyperactivity/impulsivity had statistically significantly lower cortisol levels than the control group 30 min after awakening. When cortisol values were plotted on a timeline, this subgroup always had lower cortisol concentrations than children in the control group. There was a significant correlation between CDAS scores and cortisol concentrations prior to the dental examination in both the ADHD and the control group. Behavioral expressions of anxiety in children with ADHD may be different from those in other children, not only due to the characteristics of their disorder, but also because of lower stress reactivity.     

Restorative treatment and use of local anesthesia in free and subsidized public dental services in Helsinki, Finland

Our aim was to evaluate restorative treatment and the use of local anesthetics in free and subsidized public dental care in Helsinki, Finland. Public dental clinics are open to all patients under the age of 36, and to some specific groups above that age. Patients up to age 19 receive all treatment free of charge and others at highly subsidized rates. Data were collected in May 2001 during a maximum 2-week period covering all public dental clinics in Helsinki. A one-page questionnaire was sent to all dentists (n = 140) in clinical fields. The data requested included the patient's gender and year of birth, and details on restorations: which tooth and which surfaces were filled, the reason for placement or replacement, the material used, and use of local anesthetic. The response rate was 96%. Of all restorations (n = 3057) placed, 14% were in primary teeth and in permanent teeth: 17% in premolars, 17% in incisors, and 52% in molars; the restorative material most often used was composite resin (69%). Glass-ionomer/compomers dominated in the primary teeth. Local anesthetic was used least (35%) in patients under 13 years of age. Replacements of restorations accounted for 10% of all in the free service (under 20 years of age) and 46% in subsidized dental care (20 and older). The major reasons for replacement were secondary caries (41%) and fractured or lost restoration (40%).     

Intraindividual effect of daily supervised flossing on caries in schoolchildren.

The aim was to study the effect of flossing on proximal caries in children grouped according to different combinations of dietary and oral hygiene habits. 140 12--13-year-old children flossed the right or the left lateral region of the mouth once every school-day for 2 years by pulling a waxed floss once up and down through the proximal contacts. Proximal caries was recorded on bitewing films, taken at the baseline and at the 2-year registration. Diet history was obtained four times during the period. Oral hygiene was classified according to the number of bleeding points registered with a feather-loaded probe at the final examination. Caries increments on the control side during the experimental period were calculated for groups with the same habits. A logical border with respect to the amount of new caries was then established between suitable and unsuitable dietary habits as well as between sufficient and insufficient oral hygiene. No statistically significant difference was found between the control and experimental subgroups in the different combinations of dietary and oral hygiene habits, neither with respect to the whole material nor comparable contralateral surfaces. The numerical differences were so small that the technique of flossing studied here cannot be recommended.     

Adsorption from black tea and red wine onto in vitro salivary pellicles studied by ellipsometry

The adsorption of black tea and red wine components onto a pellicle-like protein layer formed in vitro by adsorption from whole unstimulated saliva on hydroxyapatite discs were studied by in situ ellipsometry. It was found that components from black tea readily adsorbed to the pellicle. Subsequent exposure to saliva led to further adsorption of salivary components to give an overall increase in the amounts adsorbed. The amounts adsorbed increased still further following a third tea and saliva exposure. Components of red wine gave significantly greater amounts of adsorption to the pellicle than black tea. The adsorption of components of black tea gave a concomitant increase in colour or stain as measured by a reflectance chromameter. In all cases, the black tea- and red wine-modified pellicles were not eluted by either phosphate buffer or sodium dodecyl sulphate (SDS) rinses. Thus, black tea and red wine components have been shown to have a profound effect on in vitro pellicle maturation, causing thickened layers of stained material to build up, which are not readily removed.     

Four-year clinical evaluation of Class II nano-hybrid resin composite restorations bonded with a one-step self-etch and a two-step etch-and-rinse adhesive

Objective

The objective of this prospective clinical trial was to evaluate the 4-year clinical performance of an ormocer-based nano-hybrid resin composite (Ceram X; Dentsply/DeTrey) in Class II restorations placed with a one-step self-etch (Xeno III; Dentsply/DeTrey) and two-step etch-and-rinse adhesive (Ivoclar Vivadent).

Methods

Seventy-eight participants received at random at least two, as similar as possible, Class II restorations of the nano-hybrid resin composite bonded with either a single step self-etch adhesive or a control 2-step etch-and-rinse adhesive. The 165 restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 4 years.

Results

162 restorations were evaluated at 4 years. Postoperative sensitivity was observed in 6 patients (3 Xeno III, 3 Exite) between 1 and 3 weeks. Eleven failed restorations (6.8%) were observed during the follow up. Seven in the one-step self-etch adhesive group (7.7%) and four in the 2-step etch-and-rinse group (5.6%). This resulted in non-significant different annual failure rates of 1.9% and 1.4%, respectively. Fracture of restoration was the main reason for failure.

Conclusion

The ormocer-based nano-hybrid resin composite showed a good clinical performance in Class II cavities during the 4 year evaluation. No significant difference was seen in overall clinical effectiveness between the two adhesives.