Characterisation of the efficacy of endodontic medications using a three‐dimensional fluorescent tooth model: An ex vivo study

The purpose of this study was to establish a three‐dimensional fluorescent tooth model to investigate bacterial viability against intra‐canal medicaments across the thickness and surface of root dentine. Dental microbial biofilms (Enterococcus faecalis and Streptococcus mutans) were established on the external root surface and bacterial kill was monitored over time against intra‐canal medicament (Ca(OH)₂) using fluorescent microscopy in conjunction with BacLight SYTO9 and propidium iodide stains. An Olympus digital camera fitted to SZX16 fluorescent microscope captured images of bacterial cells in biofilms on the external root surface. Viability of biofilm was measured by calculating the total pixel area of green (viable bacteria) and red (non‐viable bacteria) for each image using ImageJ® software. All data generated were assessed for normality and then analysed using a Mann–Whitney t‐test. The viability of S. mutans biofilm following Ca(OH)₂ treatment showed a significant decline compared with the untreated group (P = 0.0418). No significant difference was seen for E. faecalis biofilm between the Ca(OH)₂ and untreated groups indicating Ca(OH)₂ medicament is ineffective against E. faecalis biofilm. This novel three‐dimensional fluorescent biofilm model provides a new clinically relevant tool for testing of medicaments against dental biofilms.     

Enhancing health‐care workers' understanding and thinking about people living with co‐occurring mental health and substance use issues through consumer‐led training

Background

Stigma and judgemental assumptions by health workers have been identified as key barriers to accessing health care for people living with co‐occurring mental health and substance use issues (dual diagnosis).

Objective

To evaluate the effectiveness of consumer‐led training by people with dual diagnosis in improving the knowledge, understanding and role adequacy of community health staff to work with this consumer group.

Methods

A controlled before‐and‐after study design with four waves of quantitative data collection was used. Qualitative data were collected to explore participants'' views about training. Participants were staff from two community health services from Victoria, Australia. Recruitment occurred across various work areas: reception, oral health, allied health, counselling and health promotion. At baseline, all participants attended a 4‐h clinician‐led training session. The intervention consisted of a 3‐h consumer‐led training session, developed and delivered by seven individuals living with dual diagnosis. Outcome measures included understanding of dual diagnosis, participants'' feelings of role adequacy and role legitimacy, personal views, and training outcomes and relevance.

Results

Consumer‐led training was associated with a significant increase in understanding. The combination of clinician‐led and consumer‐led training was associated with a positive change in role adequacy.

Conclusions

Consumer‐led training is a promising approach to enhance primary health‐care workers'' understanding of the issues faced by dual‐diagnosis consumers, with such positive effects persisting over time. Used alongside other organizational capacity building strategies, consumer‐led training has the potential to help address stigma and judgemental attitudes by health workers and improve access to services for this consumer group.     

Uptake and effectiveness of a community pharmacy intervention programme to improve asthma management

What is known and Objective: Pharmacists frequently see patients with asthma in the community who have suboptimal management. This study aimed to compare the uptake and effectiveness of pharmacist‐initiated mailed and face‐to‐face interventions for patients whose asthma may not be well managed. Methods: Seventy‐one community pharmacies in South Australia, Tasmania and Victoria (Australia) installed a software application that data‐mined dispensing records, generating a list of patients who had received six or more asthma reliever inhalers in the preceding 12 months. The pharmacists were randomized, by pharmacy, to perform either a mailed or face‐to‐face intervention, whereby these patients received educational material and a referral to their general practitioner (GP) for an asthma management review. Matching patients from each pharmacy were also randomly assigned to a control group for ‘usual care’. Results and Discussion: A total of 1483 patients were identified and grouped as follows: 510 (34·4%) mailed intervention, 480 (32·4%) face‐to‐face intervention and 493 (33·2%) controls. Significantly fewer face‐to‐face interventions were offered than mailed interventions (66·6% vs. 89·4%, respectively; χ² = 64·2, P < 0·0001). There were significant improvements in the preventer‐to‐reliever ratio after the intervention period (P < 0·0001) in each group. In a per‐protocol analysis, the magnitude of improvement in the face‐to‐face intervention group was greater than in the mailed intervention group. The reverse was true in an intention‐to‐treat analysis. The improvement in the P : R ratios was mainly due to significant decreases in reliever usage. What is new and Conclusion: Community pharmacy dispensing records can effectively identify patients with suboptimal asthma management, who can then be referred to their GP for review. Time constraints in busy pharmacies may limit the uptake and effectiveness of face‐to‐face interventions in the ‘real world’ setting, making mailed interventions an attractive option.