International journal of paediatric dentistry最新文献_第3页

Effectiveness of virtual reality glasses versus white noise on dental anxiety in children with attention-deficit hyperactivity disorder: A randomised controlled clinical trial. 虚拟现实眼镜与白噪声对注意力缺陷多动障碍儿童牙科焦虑症的疗效对比：随机对照临床试验

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-08 DOI: 10.1111/ipd.13264

Nahla A Aly, Amina M Abdelrahman, Tarek E I Omar, Karin Ml Dowidar

Background: Management of children with attention-deficit hyperactivity disorder (ADHD) can be challenging due to their disruptive behaviour. Basic behaviour management techniques (BMTs) may not be sufficient, and adjunctive strategies such as virtual reality (VR) glasses or white noise can be employed.

Aim: To assess and compare the effectiveness of VR, white noise and basic BMTs on dental anxiety and behaviour of children with ADHD.

Design: Forty-eight children with ADHD were recruited for this parallel, three-armed randomised controlled clinical trial, which involved three visits at one-week intervals, including examination, preventive measures and restorations. Children were randomly divided into three groups: VR, white noise and basic BMTs. Outcome measures were Faces Image Scale (FIS), Heart Rate (HR) and Venham's Behaviour Rating Scale (VBRS).

Results: No significant difference was found between the groups in FIS scores. White noise group had a significantly lower mean HR than control group in all visits. Scores of VBRS in VR and white noise groups were significantly lower than those in the control group during the restorative visit.

Conclusions: VR and white noise could be beneficial in managing dental anxiety and improving behaviour in children with ADHD and could be used as adjunctive strategies to basic BMTs.

背景：由于注意力缺陷多动障碍（ADHD）儿童的破坏性行为，对他们的管理具有挑战性。目的：评估并比较虚拟现实、白噪音和基本行为管理技术对多动症儿童牙科焦虑和行为的影响：这项平行、三军随机对照临床试验招募了 48 名患有多动症的儿童，每隔一周进行三次就诊，包括检查、预防措施和修复。儿童被随机分为三组：VR组、白噪声组和基本BMT组。结果测量指标为面孔形象量表（FIS）、心率（HR）和文翰行为量表（VBRS）：结果：各组之间的 FIS 分数无明显差异。白噪声组的平均心率明显低于对照组。在恢复性就诊期间，VR 组和白噪声组的 VBRS 评分明显低于对照组：VR和白噪音有助于控制多动症儿童的牙科焦虑并改善其行为，可作为基本BMT的辅助策略。

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引用次数: 0

Outcome of regenerative endodontic procedures in delayed replanted immature permanent teeth with apical periodontitis: A retrospective study. 牙根尖周炎延迟重植未成熟恒牙的再生根管治疗效果：一项回顾性研究。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-08 DOI: 10.1111/ipd.13265

Kai Sheng, Ning Ding, Shi-Min Zhao, Hui Chen, Guang-Yun Lai, Jun Wang

Background: Regenerative endodontic procedures (REPs) is effective for treating young permanent teeth with pulp necrosis. However, its efficacy on delayed replanted avulsed teeth is unclear.

Aim: This retrospective study aimed to assess the efficacy of REPs in treating delayed replanted immature permanent teeth with apical periodontitis.

Design: Avulsed teeth receiving REPs were systematically screened based on predetermined criteria. This study assessed the REP outcomes, postoperative periodontal healing, and overall treatment efficacy. Samples were grouped by REP outcomes and root development stage, with Fisher's exact tests used to compare outcomes among different groups.

Results: Among the included 17 teeth, 47.1% exhibited successful REPs and periodontal healing. Another 47.1%, due to replacement resorption or REP failure, were categorized as tooth survival. Healing of periapical lesions was observed in 88.2% of the cases, but only 41.2% demonstrated continued root development. Although differences were not significant (p = 0.05), teeth with continued root development had a higher rate of functional healing (85.7%) compared to those without (30%).

Conclusion: Within the limitations of this study, REPs presented reliable outcomes for treating delayed replanted immature permanent teeth with apical periodontitis mainly in periapical lesion healing. Teeth with continued root development after REPs exhibited a higher rate of functional healing. Further investigation is required to explore potential synergies between REP outcomes and periodontal healing.

背景：牙髓再生术（REPs）对治疗牙髓坏死的年轻恒牙很有效。目的：这项回顾性研究旨在评估牙髓再生术（REPs）在治疗患有根尖牙周炎的延迟再植未成熟恒牙方面的疗效：设计：根据预先确定的标准系统地筛选出接受 REP 治疗的乳牙。本研究评估了 REP 的结果、术后牙周愈合情况以及总体治疗效果。根据 REP 结果和牙根发育阶段对样本进行分组，使用费雪精确检验比较不同组间的结果：结果：在纳入的 17 颗牙齿中，47.1% 的牙齿成功完成 REP 并实现牙周愈合。另外 47.1%的牙齿由于替代吸收或 REP 失败而被归类为存活牙齿。88.2%的病例观察到根尖周病变愈合，但只有41.2%的病例显示牙根继续发育。虽然差异不显著（P = 0.05），但牙根继续发育的牙齿的功能性愈合率（85.7%）高于未继续发育的牙齿（30%）：结论：在本研究的局限性范围内，REP 对治疗延迟再植的未成熟恒牙根尖牙周炎具有可靠的疗效，主要体现在根尖周病变的愈合上。REP后牙根继续发育的牙齿显示出更高的功能性愈合率。还需要进一步的研究来探索 REP 的疗效与牙周愈合之间潜在的协同作用。

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引用次数: 0

Dental screening pathway for paediatric nephrology patients: A service development and evaluation 儿科肾病患者的牙科筛查路径：服务开发与评估。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13248

C. K. Wallace, V. Hind

Some children and young people with kidney disease are at increased risk of opportunistic and severe oral infections due to their immunocompromised status arising from their renal disease, medical comorbidities and use of immunosuppressant medications. Untreated oral disease can also adversely affect renal patients' oral health-related quality of life.1 Furthermore, poor oral health may also lead to patients being refused or delayed a kidney transplant due to concerns about post-transplant opportunistic infection. Caries has been shown to be prevalent amongst children and young people with kidney diseases (although less prevalent than the general population).2, 3 Developmental defects of enamel are also more common in young people with kidney diseases3 and drug-induced gingival overgrowth can arise from antihypertensive and antirejection medications.Regular dental surveillance is especially important for those on immunosuppressants who are at increased risk of systemic cancers including lip and oral cancer and lymphoma.4 An estimated 1%–2% of paediatric kidney transplant recipients will develop post-transplant lymphoproliferative disease within 5 years,5 presenting signs of which could be oral soft tissue changes, neck or parotid lumps.Invasive dental treatment in this group can also prove challenging due to complex medical histories which may necessitate specialist involvement. Early prevention, diagnosis and management of dental disease may therefore allow patients to avoid more invasive dental procedures and receive simpler treatment in a more convenient primary care setting. Due to the added complexity of dental care and potential effects of renal disease on the developing dentition, specialist paediatric dentistry input is recommended for all paediatric renal patients to optimise their oral health.As such, a screening pathway was developed at Newcastle Dental Hospital for paediatric nephrology patients attending the Great North Children's Hospital. An initial pilot was completed in August 2020 of nine patients to assess project feasibility and troubleshoot the practicalities of inpatient-based ward screening. Pilot numbers were restricted due to the impact of the COVID-19 pandemic. The paediatric nephrology dental screening service then formally restarted in November 2021. A Microsoft Excel® (Microsoft Corporation, Redmond, USA) database was developed alongside the paediatric nephrology team to allow systematic screening, starting with those with the most impaired renal function. Efforts were made to co-ordinate screening appointments with existing medical appointments to minimise patient burden. Where possible, staff would complete screening on nephrotic and post-transplant outpatient clinics and peritoneal dialysis and haemodialysis wards. If dental concerns were identified, a subsequent appointmen

一些患有肾脏疾病的儿童和青少年由于肾脏疾病、并发症和使用免疫抑制剂等原因导致免疫力下降，因而患机会性和严重口腔感染的风险增加。1 此外，口腔健康状况不佳还可能导致患者因担心移植后机会性感染而拒绝或推迟肾移植。2, 3 患有肾脏疾病的年轻人中，釉质发育缺陷也更为常见3 ，药物诱发的牙龈增生可能源于降压药和抗排斥药。定期进行牙科监测对于服用免疫抑制剂的患者尤为重要，因为他们患全身性癌症（包括唇癌、口腔癌和淋巴瘤）的风险会增加4。据估计，1%-2% 的小儿肾移植受者会在 5 年内患上移植后淋巴增生性疾病，5 表现为口腔软组织变化、颈部或腮腺肿块。因此，牙科疾病的早期预防、诊断和管理可以让患者避免更多的侵入性牙科治疗，在更方便的初级保健环境中接受更简单的治疗。由于牙科护理的复杂性增加以及肾病对发育中的牙齿的潜在影响，建议对所有儿科肾病患者进行专科儿科牙科治疗，以优化他们的口腔健康。因此，纽卡斯尔牙科医院为在大北方儿童医院就诊的儿科肾病患者制定了筛查路径。2020 年 8 月，纽卡斯尔牙科医院对九名患者进行了初步试点，以评估项目的可行性，并解决住院病房筛查的实际问题。由于 COVID-19 大流行的影响，试点人数受到限制。随后，儿科肾病学牙科筛查服务于 2021 年 11 月正式重新启动。我们与儿科肾病团队共同开发了 Microsoft Excel® （微软公司，美国雷德蒙德）数据库，以便从肾功能受损最严重的患者开始进行系统筛查。我们努力协调筛查预约与现有医疗预约的时间，以尽量减轻患者的负担。在可能的情况下，工作人员会在肾病和移植后门诊以及腹膜透析和血液透析病房完成筛查。如果发现牙科方面的问题，则会安排随后的预约，以便在牙科医院进行更全面的评估并拍摄X光片。临床检查结果会记录在案，并通过信件和电子病历反馈给患者的医疗团队。记录的信息包括患者姓名、医院编号、肾脏诊断、合并症、分配的专科护士姓名、上次牙科评估日期、牙科诊断、牙科治疗结果和下次牙科复查日期。截至 2023 年 8 月，158 名目标群体中的 93 名患者（59%）接受了筛查。自 2021 年 11 月以来，80% 的预约（n = 51/64）与现有的医疗预约同时进行。所有血液透析（9 人）、腹膜透析（7 人）、移植后（29 人）和慢性肾脏病 5 期（5 人）患者都接受了筛查。表 1 汇总了接受筛查的肾病患者类别。在评估期间，如果患者的肾功能恶化、接受移植手术或移植手术失败而不得不恢复透析，他们可能会改变类别。最常见的肾病诊断是肾病综合征（28 例）、肾发育不良（19 例）、急性肾损伤（10 例）和膀胱输尿管反流（6 例）。其他并发症也很常见。这些疾病包括心脏病（12 例）、肝病（8 例）和神经病（8 例）。6名患者曾接受过癌症治疗，8名患者接受过其他器官移植（心脏/肺/肝），20名患者有额外的特殊护理需求（如学习障碍、自闭症或严重视力障碍）。总而言之，三分之一的患者（n = 32）牙科状况良好，出院后回到了普通牙科医生处。然而，每三名患者中就有一名存在牙釉质发育缺陷（人数=33），每五名患者中就有一名存在龋齿（人数=20）。

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引用次数: 0

Conference Abstracts 特刊：2024 年 9 月 12-13 日召开的 "2024 年生物安全和疾病防治科学年会，正确的护理在正确的时间 "摘要。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13243

引用次数: 0

Improving dental trauma management in primary care: A team-based approach 改善初级保健中的牙科创伤管理：以团队为基础的方法。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13247

V. Stevens

Dental trauma has a high prevalence, with one in three preschool children sustaining a traumatic dental injury to the primary dentition and one in four school children to the permanent dentition.1 Primary care provides a first-line contact for paediatric patients accessing emergency care within England. General Dental Practitioners are often the first clinicians to see children after they have sustained dental trauma.2 Initial management can influence the long-term outcome for the teeth involved,3 and dental trauma can have life-long implications on quality of life.1 It is therefore important that the correct clinical care is provided at the first appointment, in a timely manner, with assessment made regarding the need for onward referral to a paediatric specialist.The primary care practice in this service evaluation is situated in Yorkshire, England, and can refer children via an online referral system to either the local Community Dental Service (secondary care) or Leeds Dental Institute (tertiary care) for specialist paediatric dentistry. The practice has a patient base of both National Health Service (NHS) and private patients; children are seen on an NHS basis within the practice.The International Association of Dental Traumatology (IADT) have produced comprehensive guidance for the management of traumatic dental injuries (TDIs), which provide a gold standard for dentists managing dental trauma. Primary care dentists, however, have been shown to have lower confidence levels in dealing with complex dental trauma.2 Anecdotally within the practice, the dentists felt that there was an increase in the number of trauma cases that were presenting. The dentists' experience differed in number of years qualified and experience in dealing with traumatic dental injuries (TDIs). The service evaluation aimed to review the current management of TDI within the practice.To evaluate the management of TDIs within a general dental practice setting.Clinical records were retrospectively evaluated between the period of January 2021 to March 2023. Appointments that had been booked as ‘trauma’ on the practice electronic software were reviewed, and TDIs in primary and permanent dentitions were included. Data collection occurred pertaining to patient age, trauma history diagnosis, treatment provided, radiographs taken, onward referral and whether initial assessment and management of trauma was in line with IADT guidelines. Onward referrals were reviewed as to whether they met current local protocols for referral; the following injuries (in permanent teeth) were taken to be appropriate for referral to specialist care; avulsed teeth, crown–root fractures, luxation injuries and complicated enamel dentine fractures with open apices. Descriptive analysis of the results was undertaken.An anonymous online survey was sen

牙外伤的发病率很高，每三个学龄前儿童中就有一个受到初级牙外伤，每四个学龄儿童中就有一个受到恒牙外伤。全科牙科医生通常是儿童遭受牙外伤后第一位接诊的临床医生。2 最初的处理会影响所涉牙齿的长期治疗效果，3 而且牙外伤会对生活质量产生终生影响。因此，在首次就诊时及时提供正确的临床治疗并评估是否需要转诊至儿科专科医生非常重要。本次服务评估中的初级保健诊所位于英格兰约克郡，可通过在线转诊系统将儿童转诊至当地的社区牙科服务机构（二级医疗机构）或利兹牙科研究所（三级医疗机构）接受儿童牙科专科治疗。国际牙科创伤协会（IADT）制定了全面的牙科创伤（TDI）管理指南，为牙医管理牙科创伤提供了黄金标准。然而，事实证明初级保健牙医在处理复杂牙科创伤方面的信心水平较低。2 在诊所内，牙医们感觉到牙科创伤病例的数量有所增加。牙医们的从业年限和处理牙外伤（TDI）的经验各不相同。此次服务评估的目的是审查该诊所目前对创伤性牙外伤（TDI）的管理情况。对 2021 年 1 月至 2023 年 3 月期间的临床记录进行了回顾性评估。对诊所电子软件中被预约为 "外伤 "的预约进行了审查，其中包括基牙和恒牙的TDI。收集的数据涉及患者年龄、外伤史诊断、提供的治疗、拍片、转诊以及外伤的初步评估和处理是否符合 IADT 指南。对转诊患者是否符合当地现行的转诊规定进行了审查；以下损伤（恒牙）被认为适合转诊至专科医疗机构：牙齿脱落、牙冠-牙根骨折、牙齿松动损伤和复杂的牙釉质牙本质骨折且牙根尖开放。我们向诊所的四位牙医发送了一份匿名在线调查。调查采用李克特量表对牙医自我感觉在处理牙科创伤方面的知识和信心进行了调查，5 分表示高度自信。在 2021 年 1 月至 2023 年 3 月期间，有 12 名患者的 15 颗牙齿出现了 TDI，其中有 8 种不同的 TDI 诊断。大多数 TDI 发生在恒牙上（80%，n = 12）。所有病例在初次就诊时均按照 IADT 指南进行管理。牙医对处理 TDI 的信心相对较低，自我报告的平均信心分数为 2.5（5 分）（范围为 2-4）。自由文本数据详细说明了信心不足的领域，包括转诊的适当性、使用牙冠成形器修复釉质牙本质骨折、部分髓核切开术以及夹板和复查的时间表。此外，该项目还提供了普通牙科诊所中牙科创伤管理的相关数据，为该领域有限的现有文献做出了贡献。2A 记录牙科创伤的标准化数据集方法有助于提高护理质量，并可对牙科创伤后的结果进行比较。本项目中的干预措施可能导致了转诊的减少，因为牙医在内部处理创伤病例时感到更加得心应手，了解当地关于适当转诊创伤病例的协议，并且在需要时可以通过电话获得专家建议。

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引用次数: 0

Feasibility, acceptability, and perceived effectiveness of weighted blankets during paediatric dental care. 在儿童牙科护理过程中使用加重毯的可行性、可接受性和感知效果。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13263

Leah I Stein Duker, Riley McGuire, Jocelyn Hernandez, Elizabeth Goodman, José C Polido

Background: Weighted blankets are one method to provide deep pressure touch sensations, which are associated with a calming effect on the nervous system. Weighted blankets have been reported to elicit a calming effect during stressful dental encounters and routine prophylactic visits in older adolescents and adults. Preliminary research suggests that weighted blankets are safe and feasible for children in both hospital and home settings; this, however, has not yet been examined in a paediatric dental environment.

Aim: To examine the feasibility, acceptability, and perceived effectiveness of a weighted blanket during paediatric dental care.

Design: This cross-sectional study examined child, caregiver, and dentist-reported responses to survey questions asking about their experience with the weighted blanket during care (n = 20 each per child and caregiver group, n = 9 dentists).

Results: The use of a weighted blanket is feasible, acceptable, and appropriate as reported by caregivers and dentists (means ≥ 4.70 on the Feasibility of Intervention, Acceptability of Intervention, and Intervention Appropriateness Measures). Few problems were described, and all groups overwhelmingly responded with enthusiasm, noted the blanket's potential for future use, and perceived that a weighted blanket improved care (means ≥ 4.10).

Conclusions: Study findings support the feasibility and acceptability of using a weighted blanket during a routine, noninvasive paediatric dental care.

背景：配重毯是提供深压触感的一种方法，这种触感对神经系统有镇静作用。有报道称，在青少年和成年人紧张的牙科就诊和例行预防性就诊中，配重毯能起到镇静作用。初步研究表明，配重毯对医院和家庭环境中的儿童来说都是安全可行的；但是，在儿科牙科环境中还没有进行过这方面的研究：这项横断面研究考察了儿童、护理人员和牙医对调查问题的回答，这些问题询问了他们在护理过程中使用加重毯的体验（每组儿童和护理人员各20人，牙医9人）：结果：根据护理人员和牙医的报告，使用加重毯是可行、可接受和适当的（干预可行性、干预可接受性和干预适当性测量的平均值≥4.70）。几乎没有出现任何问题，所有群体都积极响应，指出了毯子在未来使用中的潜力，并认为加权毯改善了护理（平均值≥4.10）：研究结果表明，在常规非侵入性儿科牙科护理中使用加压毯具有可行性和可接受性。

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引用次数: 0

Editorial BSPD Supplement 2024 编辑：《BSPD 2024 年补编

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13242

Chris Vernazza

It is a pleasure once again to introduce our BSPD supplement. As ever, the 2024 supplement includes our annual conference abstracts and the Quality Improvement Bulletin. Our conference this year will be hosted by the South Wales Branch in Cardiff where the presidency will transfer from Prof Paula Waterhouse to Dr Shannu Bhatia. The conference has been organised under the local chair, Dr Rohini Mohan, and I am looking forward to an excellent programme, the usual networking opportunities as well as seeing the abstracts presented.

Reviewing the abstracts has provided an excellent insight into the breadth and quality of work going on in the speciality, and it is encouraging to see new innovations, new applications of methods and work putting children at the heart of what we do. I would especially like to thank members of the Conference Abstracts and Prizes Committee for their very hard work in reviewing the abstracts and in advance for their judging of the prize competitions.

Our Quality Improvement Briefing editor Dr Cheryl Somani has created an informative and interesting set of articles with a thought-provoking invited feature on virtual clinics from Lexy Lyne and Joe Noar. I must extend a warm congratulations to Cheryl and the rest of the QIB team, Armaana Ahmad and Claudia Heggie, for this important aspect of BSPD's work.

很高兴再次介绍我们的《BSPD》增刊。一如既往，2024 年增刊包括我们的年度会议摘要和《质量改进公报》。今年的会议将由位于加的夫的南威尔士分会主办，会议主席将由 Paula Waterhouse 教授移交给 Shannu Bhatia 博士。会议由当地主席罗希尼-莫汉（Rohini Mohan）博士负责组织，我期待着会议的精彩节目、一如既往的交流机会以及论文摘要的提交。通过审查论文摘要，我们可以很好地了解本专业工作的广度和质量，看到新的创新、新方法的应用以及将儿童作为工作核心的工作令人鼓舞。我特别要感谢会议摘要和奖项委员会的成员们，感谢他们在审阅摘要和评奖方面所付出的辛勤劳动。我们的《质量改进简报》编辑谢丽尔-索马尼（Cheryl Somani）博士撰写了一组内容丰富、生动有趣的文章，其中特邀莱克西-莱恩（Lexy Lyne）和乔-诺尔（Joe Noar）撰写的关于虚拟诊所的特稿发人深省。我必须热烈祝贺谢丽尔和质量改进简报团队的其他成员阿尔玛娜-艾哈迈德（Armaana Ahmad）和克劳迪娅-赫吉（Claudia Heggie）为英国公共卫生学院的这项重要工作做出的贡献。

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引用次数: 0

Oral health assessment of newly diagnosed oncology patients—Who are we missing? 新确诊肿瘤患者的口腔健康评估--我们漏掉了谁？

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13246

L. Roocroft, C. Dixon, A. Shepherd, C. Hood

An estimated 1:500 children are diagnosed with cancer each year.1 When assessed on a global scale, there is a higher incidence of childhood cancer in countries of a high human development index (HDI), compared to that of a low development index (LDI).2In the UK, all children are treated at designated specialist Principal Treatment Centres (PTC), including Royal Manchester Children's Hospital (RMCH), to standardise clinical care and follow-up.3 Approximately 120 new malignant disease diagnoses are seen per year at RMCH from across the region, all of whom require a range of treatment modalities including chemotherapy, radiotherapy, proton beam therapy, stem cell transplant and surgical management.4The Royal College of Surgeons England has recommended that all children diagnosed with cancer should have access to dental care, including a full initial assessment with radiographs at time of diagnosis, before commencement of treatment.4 Paediatric dental units working with oncology centres should have a mechanism of notification for new patients.5During oncology treatment, oral care can become neglected with changes in oral health routines, particularly for children undergoing inpatient treatments.6 Additional nutritional intake requirements and oral manifestations such as mucositis and opportunistic infections further impact oral health and increase caries risk. Poor oral health can adversely impact oncology treatment, increasing morbidity risk and length of inpatient hospital stays.3 Furthermore, long-term oral complications following curative cancer treatments may require specialist-led care for oral rehabilitation in future.Following an urgent general anaesthetic procedure for a child receiving cancer treatment with severe dental decay, it became apparent that not all newly diagnosed oncology patients at RMCH were referred for a baseline dental assessment at time of diagnosis. Analysis of the previous month highlighted multiple urgent ward visits for dental assessments for patients in pain who were unknown to the department and had not seen a dental practitioner for assessment prior to commencing cancer treatment. This highlighted a clinical need to improve dental care for this cohort, and thus provided stimulus for this quality improvement project which was conducted using the Plan-Do-Study Act (PDSA) model.Improvements were made in each PDSA cycle for referral of children to the DHU at the point of cancer diagnosis, with an overall improvement of 48%. With 90% (n = 36) of children referred in Cycle 3, this improvement was felt to be supported by the integration of direct electronic referral into the new Trust wide electronic record system (Epic™). Previous cycles required an electronic document referral to be sent

2 在英国，所有儿童都在指定的专科主要治疗中心（PTC）接受治疗，包括曼彻斯特皇家儿童医院（RMCH），以实现临床治疗和随访的标准化。3 曼彻斯特皇家儿童医院每年接诊来自该地区的约 120 名新恶性疾病患者，他们都需要接受一系列治疗，包括化疗、放疗、质子束疗法、干细胞移植和外科手术治疗。英国皇家外科学院建议，所有被诊断患有癌症的儿童在开始治疗前都应获得牙科护理，包括在确诊时进行全面的初步评估并拍摄X光片。口腔健康状况不佳会对肿瘤治疗产生不利影响，增加发病风险和住院时间。3 此外，癌症根治性治疗后的长期口腔并发症将来可能需要口腔康复方面的专科护理。在对一名患有严重蛀牙的接受癌症治疗的儿童进行紧急全身麻醉手术后，我们发现 RMCH 医院并非所有新诊断的肿瘤患者在确诊时都接受了基线牙科评估。对上个月的分析显示，有多名疼痛患者紧急前往病房进行牙科评估，而这些患者在开始接受癌症治疗之前并不认识该部门，也没有见过牙科医生进行评估。这突显出临床上需要改善对这部分患者的牙科护理，从而推动了采用 "计划-实施-研究"（Plan-Do-Study Act，PDSA）模式开展的质量改进项目。在第 3 个周期中，90%（n = 36）的患儿被转诊，这一进步得益于将直接电子转诊整合到新的全信托电子记录系统（Epic™）中。在第二周期之后，我们实施了一套交叉核对系统，由肿瘤科团队每月提供一份新诊断患者的数字名单。这使 DHU 能够对患者进行核对，找出那些被遗漏的患者，并强调那些需要转诊的患者。此后，我们与肿瘤科团队密切合作，宣传口腔健康基线预防和评估的重要性，以改善这一人群的口腔健康状况。第一周期是在 COVID-19 大流行初期进行的，由于临床工作人员的能力和可用性降低，影响了转诊分流的数量。因此，最初接受牙科评估的转诊比例并不理想。接下来的周期显示，转诊儿童中被分流并获得牙科评估预约的比例有所增加，回顾性数据分别为 90%（n = 26）和 94%（n = 34）。由于每个周期的儿童人数较少，因此在绝对值变化相对较小的情况下，百分比变化却很大。因此，尽管这是一种最佳做法，但要 100%实现既定目标仍具有挑战性。在为期 3 年的项目中，转诊到 DHU 的儿童中约有四分之一有积极的治疗需求，其中三分之一的儿童需要牙科全身麻醉。通常情况下，口腔健康团队与 PTC 是分开的，进一步开展跨医疗学科的合作项目有助于进一步整合患者护理，让口腔回归身体。随着肿瘤团队转诊到口腔科的病人越来越多，口腔科正在努力确保 "迷你口腔护理计划 "得到有效利用。迷你口腔护理计划 "的原则将有助于加强各医疗部门的口腔健康宣传，确保为患者提供全面的护理，并确保在需要时转介适当的牙科人员进行基线评估。我们部门的目标是将口腔健康筛查扩展到其他医疗专科。

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引用次数: 0

Virtual clinics in paediatric dentistry 儿童牙科虚拟诊所。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13245

Alexandra Lyne, Joe Noar

During the COVID-19 pandemic, the National Health Service (NHS) had to adapt and innovate in ways to provide clinical care. A traditional healthcare model, where patients travel to a clinical building for their care, or a clinician travelled to the patients' home, was not possible. Instead, many Trusts established or expanded virtual ways of providing care; the patient and clinician connect remotely, via telephone, video call, or written communication.Beyond the pandemic, virtual clinics and wards have become a routine part of NHS healthcare, with benefits for patients, staff, and the environment.1Dental procedures cannot be carried out virtually, so in this paper we refer to appointments that are for assessment, treatment planning, or review. In the speciality of paediatric dentistry, where patients have rapidly evolving dentitions and undergo rapid change, there is a high need for these types of appointments.The aim of this paper is to highlight different formats of virtual clinics that are relevant to the field of paediatric dentistry, using example cases and quality improvement data from the virtual clinics at the Eastman Dental Hospital.Virtual clinics can take many forms, and the value of different clinic types may depend on the case-mix for each paediatric dentistry service. All virtual clinics can be conducted in a clinical room, in a non-clinical room, or remotely.For any appointment or interaction, appropriate patient documentation will need to be completed, such as clinical notes, letters, requesting follow up appointments, coding, and recording the referral-to-treat outcome. The authors also suggest asking parents to send in patient photographs in advance of a virtual clinic, as this aids the diagnostic value of the appointment.For the sake of simplicity, the term ‘parent’ is used to refer to the adult most likely to accompany the patient and have parental responsibility. This is not the case for every patient, and so the term ‘parent’ should be substituted with the appropriate adult(s) for each child or young person.Virtual working can have benefits for patients, parents, and staff. They are also associated with less costs both financially and environmentally. Admittedly, except for A&G, they require a similar amount of time as face-to-face appointments.When planning a virtual clinic, a clear standard operating procedure should be written, and all stakeholders included to identify the important issues to be managed. This could include personnel, funding, administrative support, as well as the physical location and hardware required to run the virtual service. Each part of the pathway should be assessed from referrer to clinician to hospital capacity. The virtual service must fit in with the existing clinical service, recognising the clinical and administrative time needed.Once this is in place, then clear guidance should be produced so that

在 COVID-19 大流行期间，国家医疗服务系统（NHS）不得不调整和创新提供临床护理的方式。传统的医疗保健模式，即病人前往临床大楼接受治疗，或临床医生前往病人家中，是不可能实现的。相反，许多信托机构建立或扩大了提供医疗服务的虚拟方式；病人和临床医生通过电话、视频通话或书面交流进行远程联系。除了大流行病之外，虚拟诊所和病房已经成为英国国家医疗服务体系医疗服务的常规部分，对病人、员工和环境都有好处。在儿童牙科这一专业领域，患者的牙齿状况发展迅速，变化也很快，因此非常需要这些类型的预约。本文旨在利用伊士曼牙科医院虚拟诊所的案例和质量改进数据，重点介绍与儿童牙科领域相关的虚拟诊所的不同形式。虚拟诊所可以有多种形式，不同诊所类型的价值可能取决于每个儿童牙科服务的病例组合。所有虚拟诊所都可以在临床诊室、非临床诊室或远程进行。对于任何预约或互动，都需要完成适当的患者文件记录，如临床笔记、信件、要求后续预约、编码和记录转诊到治疗的结果。作者还建议请家长在虚拟门诊前发送患者照片，因为这有助于提高预约的诊断价值。为简单起见，"家长 "一词指的是最有可能陪伴患者并承担家长责任的成年人。并非每位患者都是如此，因此 "家长 "一词应替换为每位儿童或青少年的适当成年人。虚拟工作对病人、家长和员工都有好处，而且在经济和环境方面的成本都较低。诚然，除 A&G 外，虚拟工作所需的时间与面对面预约的时间相近。这可能包括人员、资金、行政支持以及运行虚拟服务所需的物理位置和硬件。应评估从转介人到临床医生再到医院能力的路径的每个部分。虚拟服务必须与现有的临床服务相适应，并认识到所需的临床和行政时间。一旦准备就绪，就应制定明确的指南，以便所有利益相关者了解服务的目的、目标、限制和成果。与提供面对面门诊需要训练有素的护理人员一样，准备、预约和处理虚拟门诊也需要训练有素的行政人员。这需要所有利益相关者的参与，并对所有相关人员进行培训。以下是任何考虑采用虚拟工作方式的儿童牙科服务的一些主要注意事项。就虚拟诊所而言，与任何类型的服务设计或开发一样，质量改进方法的设计应旨在评估虚拟诊所的成功，并推动变革。表 2 展示了虚拟诊所可采用的一些有用的质量改进工具和成果。如果规划得当，虚拟诊所可以使患者、家属、员工、成本和环境受益。虚拟诊所有许多不同的形式，与任何新兴服务一样，可以通过质量改进方法对其进行评估和改进。

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引用次数: 0

From the editor 编辑的话

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

International journal of paediatric dentistry

Pub Date : 2024-09-05 DOI: 10.1111/ipd.13244

I am pleased to share with you this 4th edition of the BSPD Quality Improvement Briefing, which includes a collection of novel quality improvement projects in paediatric dentistry. This year's invited article on ‘Virtual clinics in paediatric dentistry’ has been authored by two leading innovators and experts in the area: Alexendra Lyne and Joe Noar. This excellent paper will provide a practical guide to setting up virtual clinics and advise on the use of quality improvement projects to continuously improve the standard of patient care in this format.

Once again, I am grateful to the many authors who submitted papers on a range of topics demonstrating their commitment to quality improvement. My heartfelt thanks to all our reviewers who kindly provided their time and expertise to deliver a comprehensive peer review for the papers submitted: Clarissa Dale, Carly Dixon, Chris Donnell, Maryam Ezzeldin, Julia Hurry, Clare Hutchison, Shrita Lakhani, Jessica Large, Emma Morgan, Rachel Osborne, Charlotte Schofield, Jessica Talbot, Laura Timms, Chris Wallace and Scott Wright.

I am thankful to my deputy editor Armaana Ahmad and assistant editor Claudia Heggie for their continued enthusiasm, support and commitment; producing this publication is truly a team effort. As my term as the editor if the Quality Improvement Briefing now comes to an end, I wish Armaana every success as she takes on this role. I am confident that the publication will continue to flourish and develop under her leadership in the coming years.

I hope you find enjoyment and value in reading this edition of the Quality Improvement Briefing.

IN THIS ISSUE

1. Virtual clinics in paediatric dentistry

Alexandra Lyne & Joe Noar

2. Oral health assessment of newly diagnosed oncology patients—Who are we missing?

L. Roocroft, C. Dixon, A. Shepherd & C. Hood

3. Improving dental trauma management in primary care: A team-based approach

V. Stevens

4. Dental screening pathway for paediatric nephrology patients: A service development and evaluation

C. K. Wallace & V. Hind

5. Development of a virtual orthodontic advice pathway in a community dental service

J. Zhao, D. Rosentha, J. Tomson, H. Patel & A. Ahmad

Editor: Cheryl Somani

Deputy Editor: Armaana Ahmad

Assistant Editor: Claudia Heggie

我很高兴与大家分享第四期《BSPD 质量改进简报》，其中包括一系列新颖的儿童牙科质量改进项目。今年的特邀文章 "儿童牙科虚拟诊所 "由该领域的两位领先创新者和专家撰写：Alexendra Lyne 和 Joe Noar。这篇优秀论文将为建立虚拟诊所提供实用指南，并就如何利用质量改进项目来不断提高这种形式的患者护理水平提出建议。我再次感谢许多作者提交了各种主题的论文，这表明了他们对质量改进的承诺。我衷心感谢所有审稿人，他们付出了宝贵的时间和专业知识，对所提交的论文进行了全面的同行评审：Clarissa Dale、Carly Dixon、Chris Donnell、Maryam Ezzeldin、Julia Hurry、Clare Hutchison、Shrita Lakhani、Jessica Large、Emma Morgan、Rachel Osborne、Charlotte Schofield、Jessica Talbot、Laura Timms、Chris Wallace 和 Scott Wright。我非常感谢我的副主编阿尔马纳-艾哈迈德（Armaana Ahmad）和助理编辑克劳迪娅-赫吉（Claudia Heggie），感谢他们一如既往的热情、支持和奉献；出版这本刊物确实是一个团队的努力。我作为《质量改进简报》编辑的任期即将结束，我祝愿阿尔玛娜在担任这一职务时一切顺利。我相信，在她的领导下，本刊物在未来几年将继续蓬勃发展。本期内容 1.儿童牙科的虚拟诊所 Alexandra Lyne & Joe Noar 2.新诊断肿瘤患者的口腔健康评估--我们漏掉了谁？ L. Roocroft, C. Dixon, A. Shepherd & C. Hood 3.改善初级保健中的牙科创伤管理：以团队为基础的方法 V. Stevens 4.儿科肾病患者的牙科筛查路径：C. K. Wallace & V. Hind 5.在社区牙科服务中开发虚拟正畸建议路径 J. Zhao, D. Rosentha, J. Tomson, H. Patel & A. Ahmad Editor：Cheryl SomaniDeputy Editor：副主编：Armaana Ahmad 助理编辑：Claudia Heggie克劳迪娅-赫吉

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引用次数: 0