Merlin Park University Hospital

Interproximal enamel reduction (IER) is a common orthodontic procedure used to correct tooth-size discrepancies, create space, and reduce black triangles. Although several studies have examined the effects of IER on enamel roughness, caries risk, and periodontal health, none have investigated patient-reported pain associated with different IER techniques. As pain is a key patient-reported outcome, understanding how it varies between manual and motor-driven techniques can help clinicians improve patient comfort, refine treatment planning, and enhance informed consent discussions. The primary objective was to compare pain experienced during IER using manual abrasive strips versus motor-driven abrasive strips in patients undergoing orthodontic treatment at Royal Surrey County Hospital NHS Foundation Trust. There is no significant difference in patient-reported pain between manual and motor-driven IER methods in the lower labial segment. This prospective, randomised, crossover clinical trial used visual analogue scale (VAS) questionnaires to measure pain. In accordance with a power calculation based on detecting a 10 mm difference in VAS scores as statistically significant, a total of 68 subjects were required. A total of 34 participants (due to the crossover design) aged 16 years or older were recruited. Participants were randomly assigned via concealed allocation into two groups. Group A underwent manual IER first, followed by motor-driven IER after a 6-week washout period; Group B underwent the reverse sequence. Due to the practical nature of the interventions, blinding of participants and operators was not possible. Randomisation, data measurement, and statistical analysis were conducted by clinicians blinded to allocation. Participants recorded their pain levels on a VAS immediately before and after each IER session. The difference in pre- and post-procedure scores represented the pain outcome. Two independent, blinded assessors measured VAS scores to ensure inter- and intra-rater reliability. Inclusion criteria required participants to be, over 16 years old and undergoing fixed appliance therapy involving IER. Exclusion criteria included systemic health conditions, chronic pain disorders, or previous hypersensitivity to IER procedures. All 34 participants completed the study, with no dropouts or adverse events. The mean increase in VAS pain score following manual IER was 18.5 mm (SD 16.6; 95% CI 15.6-21.3), compared with 15.6 mm (SD 16.0; 95% CI 12.9-18.3) for motor-driven IER. The mean difference in pain between techniques was 2.9 mm (SD 2.0; 95% CI -1.0 to 6.8), which was not statistically significant. No significant effects were observed for intervention order, age, or gender. Inter- and intra-rater agreement for VAS scoring was excellent (ICC = 1.00 for both). No participant reported harm, discomfort, or undue stress during participation. No significant difference in pain was found between manual and motor-driven IER techniques in orthodontic patients. Therefore, the choice of technique should be based on operator preference, efficiency, and patient comfort rather than pain expectations. Further research could explore other patient-reported outcomes, including treatment duration, anxiety, and perceived ease of procedure. ClinicalTrials.gov: NCT02455700.

ABSTRACTIntroductionThe growing prevalence of chronic kidney disease has led to an increased demand for kidney replacement therapies. Although a kidney transplant is the preferred treatment for patients, many patients require dialysis temporarily before receiving a transplant or are unsuitable transplant candidates requiring long‐term dialysis. Home hemodialysis (home HD) is cost‐effective and associated with improved patient outcomes; however, its adoption remains low. There is a need to understand the factors that may support or hinder the use of home HD. Accordingly, a systematic review of the qualitative literature was conducted to identify barriers and facilitators to home HD for patients, their carers/family, and healthcare professionals.MethodsThis systematic review was carried out following ENTREQ guidelines. Electronic searches were conducted on Medline (OVID), EMBASE, CINAHL (EBSCO), and PsycINFO. The COM‐B and Theoretical Domains Framework (TDF) were used to collate the barriers and enablers identified within the papers through deductive content analysis.ResultsThirteen studies met the inclusion criteria. Within the capability component of the COM‐B model, lack of knowledge of home HD was identified as a barrier by healthcare professionals and patients. Within the opportunity component, the suitability of patients' homes (e.g., home modifications) and the healthcare system was identified as barriers to home HD. Fostering an environment of support and community was seen as a facilitator of home HD. Within the motivation component of the model, a lack of confidence and reluctance of patients to burden their family members with the responsibility of treatment were perceived as barriers. Improvements in the quality of life for the person receiving home HD were regarded as a motivator.ConclusionTo encourage widespread home HD use, understanding its barriers and facilitators for patients and the healthcare system is key to developing and implementing effective interventions to increase uptake.

Background: Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequent THA. Methods: MEDLINE, EMBASE and Scopus databases were searched from the date of inception until February 2024. All studies comparing outcomes following THA in individuals with (PS) and without prior surgery (NPS) of the femur or pelvis were included. Data on operative time, blood loss, intra- and post-operative complications, functional outcomes, and implant survivorship were extracted. Results: 16 studies, comprising 2576 patients were included (PS = 939, NPS = 1637). The PS group was associated with significantly longer operative time [MD: 8.1, 95% CI: 4.6–11.6], significantly greater blood loss [MD: 167.8, 95% CI: 135.6–200.0], and a higher risk of intra-operative peri-prosthetic fracture [RR: 1.9, 95% CI: 1.2–3.0], specifically, with prior femoral osteotomy. There were no differences in terms of risks of dislocation [RR: 1.8, 95% CI: 1.0–3.2], implant loosening [RR: 1.0, 95% CI: 0.7–1.5], or revision surgery [RR: 1.3, 95% CI: 1.0–1.7] between the two groups. The PS group was associated with significantly poorer improvements in functional outcome [MD: −5.6, 95% CI: −7.6–(−3.5)], specifically, with prior acetabular osteotomy. Implant survivorship in the two groups was comparable after one year [HR: 1.9, 95% CI: 0.6–6.2] but significantly inferior in the PS group after five years [HR: 2.5, 95% CI: 1.4–4.7], specifically, with prior femoral osteotomy. Conclusion: Joint-preserving hip operations are associated with greater intra-operative challenges and complications. In subsequent joint arthroplasty, prior acetabular procedures affect functional outcomes while prior femoral procedures influence implant survivorship. Hip pain due to the morphological sequelae of pediatric hip pathology can be debilitating at a young age. Surgical decision-making at that time needs to consider the survivorship of a THA implanted at that young age against the consequences of hip preservation surgery on further THA.

BackgroundAlcohol is a leading cause of morbidity and mortality worldwide. Adolescence is when alcohol use typically begins. Harmful patterns of alcohol consumption, such as binge drinking, may emerge during adolescence and become established. This study aimed to examine potential risk and protective factors for binge drinking among 15–16-year-old adolescents in the West of Ireland.MethodsThis was a cross-sectional secondary analysis of 4473 participants from the Planet Youth 2020 Survey. The outcome was ever binge drinking, defined as ever consumption of five or more drinks in a two-hour period or less. Independent variables were selected a priori following review of peer-reviewed literature and were grouped as individual, parents and family, peer group, school, leisure time and local community factors. Statistical analysis was completed using SPSS version 27. Differences in medians and means for continuous variables were examined using the Mann–Whitney U test and Independent Samples t-test respectively. Multivariable logistic regression was used to examine independent associations between potential risk and protective factors and ever binge drinking. A p-value of < 0.05 was deemed statistically significant.ResultsThe prevalence of ever binge drinking was 34.1%. Self-rated ‘bad/very bad’ mental health (adjusted Odds Ratio (aOR) 1.61, 95% CI 1.26–2.06, p < 0.001), current cigarette use (aOR 4.06, 95% CI 3.01–5.47, p < 0.001) and current cannabis use (aOR 2.79, 95% CI 1.80–4.31, p < 0.001) increased odds of ever binge drinking.Parental supervision (aOR 0.80, 95% CI 0.73–0.88, p < 0.001) and negative parental reaction to adolescent drunkenness (aOR 0.51, 95% CI 0.42–0.61, p < 0.001) reduced odds of ever binge drinking. Getting alcohol from parents increased odds of ever binge drinking (aOR 1.79, 95% CI 1.42–2.25, p < 0.001).Adolescents with friends who drink alcohol had almost five times higher odds of ever binge drinking (aOR 4.59, 95% CI 2.65–7.94, p < 0.001). Participating in team/club sports also increased odds of ever binge drinking (aOR 1.30, 95% CI 1.07–1.57, p = 0.008 for 1–4 times/week, aOR 1.52, 95% CI 1.07–2.16, p = 0.020 for ≥ 5 times/week).ConclusionThis study identifies individual and social environment factors associated with adolescent binge drinking in the West of Ireland. This can inform intersectoral action to protect adolescents from alcohol-related harm.

RT-PCR tests based on RNA extraction from nasopharyngeal swabs (NPS) are promoted as the "gold standard" for SARS-CoV-2 detection. However, the use of saliva samples offers noninvasive self-collection more suitable for high-throughput testing. This study evaluated performance of the TaqPath COVID-19 Fast PCR Combo kit 2.0 assay for detection of SARS-CoV-2 in raw saliva relative to a lab-developed direct RT-PCR test (SalivaDirect-based PCR, SDB-PCR) and an RT-PCR test based on RNA extraction from NPS. Saliva and NPS samples were collected from symptomatic and asymptomatic individuals (N = 615). Saliva samples were tested for SARS-CoV-2 using the TaqPath COVID-19 Fast PCR Combo kit 2.0 and the SDB-PCR, while NPS samples were tested by RT-PCR in RNA extracts according to the Irish national testing system. TaqPath COVID-19 Fast PCR Combo kit 2.0 detected SARS-CoV-2 in 52 saliva samples, of which 51 were also positive with the SDB-PCR. Compared to the NPS "gold standard" biospecimen method, 49 samples displayed concordant results, while three samples (35<Ct<37) were positive on raw saliva. Among the negative samples, 10 discordant cases were found with the TaqPath COVID-19 Fast PCR Combo kit 2.0 (PPA-83.05%; NPA-99.44%), compared to the RNA extraction-based NPS method, performing similarly to the SDB-PCR (PPA-84.75%; NPA-99.63%). The direct RT-PCR testing of saliva samples shows high concordance with the NPS extraction-based method for SARS-CoV-2 detection, and therefore provides a cost-effective and highly scalable system for high-throughput COVID-19 rapid-testing. IMPORTANCE The scale of the COVID-19 pandemic highlighted the need for viral diagnostic systems that are accurate and could be deployed at large population scales. Large-scale diagnostic or surveillance testing of large numbers of people requires collection of infected biological samples that is easy and rapid. Here, we demonstrate that raw saliva samples can be easily collected and tested by RT-PCR assays. Indeed, we find that direct testing of raw saliva by two different RT-PCR assays is as accurate (if not more accurate) than nasal swab-based RT-PCR testing. We present a cost-effective and highly scalable system for high-throughput COVID-19 rapid-testing.

BackgroundPsychosis, even in its early stages, is associated with significant disability, causing it to be ranked ahead of paraplegia and blindness in those aged 18–35 in terms of years lived with disability. Current pharmacological and psychological interventions intervention have focused primarily on the reduction of positive symptoms (hallucinations and delusions), with little benefit to domains of psychosis such as cognitive difficulties and social and occupational functioning.Methods/designThe CReSt-R intervention trial is a single center, pilot randomised controlled study based at the National University of Ireland (NUI), Galway. The trial will recruit participants from four clinical sites with assessment and intervention completed by the primary NUI Galway team. The trial will explore the feasibility, acceptability, and effectiveness of a novel psychosocial intervention for early psychosis based on a combined cognitive remediation training and cognitive behavioural therapy approach focused on social recovery. Participants, aged 16–35 within the first 5 years of a diagnosed psychotic disorder, will be recruited from the Children and Adolescent Mental Health Service and the Adult Mental Health Services in the region.DiscussionCognitive remediation training (for improving cognition) and social recovery focused cognitive behavioural therapy, have both separately demonstrated effectiveness. This trial will evaluate the feasibility, acceptability, and explore the efficacy of a treatment approach that combines both approaches as part of an integrated, multicomponent intervention.Trial registrationCognitive Remediation & Social Recovery in Early Psychosis (CReSt-R): ClincialTrials.gov Identifier NCT04273685. Trial registered Feb 18th, 2020. Last updated April 14th, 2021.

BackgroundRandomised trials are considered the gold standard in providing robust evidence on the effectiveness of interventions. However, there are relatively few initiatives to help increase public understanding of what randomised trials are and why they are important. This limits the overall acceptance of and public participation in clinical trials. The People’s Trial aims to help the public learn about randomised trials, to understand why they matter, and to be better equipped to think critically about health claims by actively involving them in all aspects of trial design. This was done by involving the public in the design, conduct, and dissemination of a randomised trial.MethodsUsing a reflexive approach, we describe the processes of development, conduct, and dissemination of The People’s Trial.ResultsOver 3000 members of the public, from 72 countries, participated in The People’s Trial. Through a series of online surveys, the public designed a trial called The Reading Trial. They chose the question the trial would try to answer and decided the components of the trial question. In December 2019, 991 participants were recruited to a trial to answer the question identified and prioritised by the public, i.e. ‘Does reading a book in bed make a difference to sleep in comparison with not reading a book in bed?’ We report the processes of The People’s Trial in seven phases, paralleling the steps of a randomised trial, i.e. question identification and prioritisation, recruitment, randomisation, trial conduct, data analysis, and sharing of findings. We describe the decisions we made, the processes we used, the challenges we encountered, and the lessons we learned.ConclusionThe People’s Trial involved the public successfully in the design, conduct, and dissemination of a randomised trial demonstrating the potential for such initiatives to help the public learn about randomised trials, to understand why they matter, and to be better equipped to think critically about health claims.Trial registrationClinicalTrials.govNCT04185818. Registered on 4 December 2019

To the Editor: We were pleased to read and are delighted to acknowledge the Editorial of Cummings and Eastell1 that reviewed the history of pivotal advances in clinical research into bone and mineral disease in connection with the 40th anniversary celebration of the ASBMR. The article provides a succinct review of several key epidemiological, technological, biochemical, and therapeutic advances that, overall, have signaled landmark achievements in our field. The importance of the combined effects of enhanced study design, analysis, and capability coupled with knowledge of how to apply different research methods to most appropriately address relevant research questions over the past 40 years cannot be overemphasized.2-7 It was a daunting task to cover everything and, while the Editorial includes many issues, it omits several key points. These include references to key advances, such as the prevalence and importance of fractures in postmenopausal women relative to other diseases,8 specific delineation of risk factors in postmenopausal women with and without prior fracture,9-11 age-, sex-, and ethnicity-matched normative reference values for bone mineral density,12 and the timing, location, and mechanism of fragility fractures among postmenopausal women in many countries.13 Multiple societies, including the ASBMR, National Osteoporosis Foundation (NOF), International Society for Clinical Densitometry (ISCD), Endocrine Society (ES), American Association of Clinical Endocrinology (AACE), International Osteoporosis Foundation (IOF), European Calcified Tissue Society (ECTS), and Asian Federation of Osteoporosis Societies (AFOS), have embraced the field and expanded our own society, so small and modest in the late 1970s, to one of international stature. Global and regional experts now regularly meet and collaborate in ways that wouldn't have seemed likely when ASBMR began. An example among many of these collaborative societies is the ISCD, which has clarified many issues related to bone densitometry and is dedicated to educating, training, and certifying technologists, clinicians, and scientists around the world. Its multiple internationally respected Position Development Statements and courses14, 15 have, along with ASBMR Task Forces, literally changed the way we think about key and controversial issues. Cummings and Eastell omitted to mention in their section on advances in therapeutics the recently FDA-approved (but EMA-rejected) osteoanabolic agent for postmenopausal osteoporosis, abaloparatide,16 while they prominently discuss romosozumab, a drug that is still in development.17 Although the Editorial focuses upon advances, it omits one of the most important issues that has been brewing over the past decade, namely the increasingly wide gap that has developed between evidence-based guidelines of diagnosis and therapy of osteoporosis and the alarming reduction in adherence to such guidelines.(18–22) Many barriers exist to get educated health care professionals to do what is recommended,23 and many different guidelines exist, some with conflicting recommendations.24 Contemporaneous inclusion of patient education, active engagement, and shared decision-making, in tandem with professionals, will likely reap the greatest benefits.25, 26 Our greatest advancement over the next 40 years will be to develop effective solutions to close this gap and to harmonize guidelines and societies in the field in order to bring best evidence into best practice and universal quality care to the forefront of clinical care everywhere. This would be a deeply satisfying outcome for our field.

The undertreatment of cancer pain remains problematic. This is despite the association of significant human and economic costs. The problem is multifaceted including patient, physician and system barriers. In Ireland, the majority of palliative care, including cancer pain management is delivered by General Practitioners (GPs).

Introduction A study of Irish mental health practitioners (Cleary & Dowling ) identified the need to improve knowledge and attitudes towards recovery. This led to the Advancing Recovery in Ireland Project (ARI) which promoted recovery-orientated services and a need to 'benchmark' progress. There is little evidence regarding the types of educational interventions that maintain positive recovery knowledge and attitudes in providers. Aim The study assessed current knowledge and attitudes to recovery. Methods The methodology of Cleary & Dowling () was replicated. A survey was administered to practitioners (n=337) using the adapted Recovery Knowledge Inventory (RKI) (Cleary & Dowling ). Results No significant differences were found in recovery scores compared to Cleary & Dowling () or by level of experience. Working in dual settings, being a non-nurse, and training was associated with better recovery scores. Significantly more respondents had received training in recovery (40% versus 23%) compared to Cleary & Dowling (). Training appears to be the strongest factor predicting better recovery knowledge. Conclusions There is considerable scope to improve recovery knowledge. Key recommendations include the need for more recovery training, using 'Recovery Champions', introducing peer support workers and developing local policies and protocols to support recovery working.