Dietary treatment of hypoglycaemia: should the Australian recommendation be increased?

Australian recommendations for treatment of hypoglycaemia are 15 g of carbohydrate repeated at 10-15 min if hypoglycaemia persists. Cited evidence is expert opinion or older studies not pertinent to current insulin regimens. This study aimed to determine the effect of increasing initial treating carbohydrate and decreasing wait-time to retreatment on resolution of hypoglycaemia in 92 free-living adults on current insulin regimens. The results support an initial treatment of 20-g carbohydrate, with a 10-min wait to repeat treatment as an optimal recommendation for the insulin-treated individual self-treating hypoglycaemia.     

Preterm infants with chronic lung disease: Are protein and energy intakes after discharge sufficient for optimal growth?

Aim: To document post‐discharge feeding practices of preterm infants with chronic lung disease (CLD) and determine if sufficient protein and energy is consumed for optimal growth. Method: Protein and energy intakes of preterm infants with CLD were quantified through detailed analysis of measured food and fluid intakes at four corrected age (CA) assessments, post‐discharge. Most of the infants were in hospital for the term assessment. Milk intake from breastfeeding was determined by test weighing. Protein and energy intakes were compared with the Australian and New Zealand Nutrient Reference Values (NRV) for healthy term‐born infants, and CA z‐scores for weight, length and head circumference were calculated using Australian national gestational growth data and Centre for Disease Control 2000 growth data. Results: Ten of the 28 CLD infants who were exclusively receiving expressed breast milk in hospital were transitioned to infant formula within 1 month of discharge. Complementary foods were introduced at a median CA of 3.6 months. Protein intakes almost always exceeded the NRV for healthy term‐born infants, and at each assessment, at least 63% of infants met the energy NRV. Longitudinal growth data are available for 20 infants, four of whom had been small for gestational age. At the 12‐month assessment, 10 of these infants weighed less than the 10th percentile. Conclusion: Preterm infants who develop CLD do not always achieve reference growth in their first year following discharge, despite protein and energy intakes being mostly comparable to those recommended for healthy term‐born infants.     

Evaluating childsmile,Scotland's National Oral Health Improvement Programme for children

In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. ‘Childsmile’ aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.     

Aligning orthodontic education: Investigating the use of a digital app to improve the performance in managing orthodontic problems

Introduction

General dentists are qualified to manage orthodontic emergencies within their scope of practice. This may involve advice, hands-on intervention or referral to a specialist orthodontist. This study aimed to assess the effect of an orthodontic app on dental undergraduates' ability to manage common orthodontic issues. In addition, this study aimed to determine the confidence of dental students in finding information related to orthodontic emergencies (CFI) as well as their confidence in managing orthodontic emergencies (CMOE).

Materials and Methods

Students were randomised into one-of-three groups, an app group, an internet group and a closed-book, exam-style group. All participants self-reported their CFI and CMOE. Following this, all participants were asked to complete a multiple-choice question (MCQ) paper based on clinical orthodontic scenarios. In addition, the app group were instructed to complete an app usability questionnaire (MAUQ).

Results

Approximately, 91.40% of students (n = 84) had not received clinical training in managing orthodontic emergencies, and 97.85% (n = 91) had not managed an orthodontic emergency clinically within the last 6 months of their training. The mean score for CFI was 0.10 out of 1.0 (SD 0.11) and CMOE was 0.28 out of 1.0 (SD 0.23). Statistically significant better MCQ scores were found in the app group, and no statistically significant difference was found between the internet and exam-style group.

Conclusions

This study is the first to consider the use of an orthodontic app to aid in the management of orthodontic issues. It has practical implications for how mobile apps can aid in learning and can be incorporated into the wider dental field.