Oral piercings and orthodontic treatment: A questionnaire-based national survey

Objective: To obtain opinions from orthodontic colleagues nationally on how they currently manage orthodontic patients with oral piercings. The secondary objectives were to assimilate the national opinions from the survey and attempt to generate educational material as an advice sheet and a patient information leaflet for the professionals and the patients respectively for the British Orthodontic Society (BOS). Design: Cross-sectional survey. Setting: Primary and secondary care orthodontic providers. Participants: Members of the BOS. Methods: An electronic questionnaire was developed and circulated to members of the BOS to obtain their opinions on the effects of oral piercings on their patients’ orthodontic treatment ‘journey’. In addition, the need for the development of informative material around the management of orthodontic treatment and appliances in patients with oral piercings was explored. Results: A total of 110 responses were received. However, only 88 respondents out of 110 attempted all the questions within the survey. There were 22 respondents who attempted it partially. We did include these partial responses well while analysing the results, since many of these offered personalised comments in the free-text boxes within the survey. Conclusion: The most common general complications associated with oral piercings were inflammation of the surrounding tissue and enamel/dentine wear. Moreover, orthodontic complications, reported commonly, were inadequate oral hygiene maintenance, entanglement with the orthodontic appliance causing damage and interference with retainers. Most respondents expressed the need for the development of a web-based patient information leaflet and an advice sheet as educational tool, both of which have been proposed to and agreed by the BOS before submission of this publication.

Empowering Patients to Self-Manage Common Infections: Qualitative Study Informing the Development of an Evidence-Based Patient Information Leaflet

Common self-limiting infections can be self-managed by patients, potentially reducing consultations and unnecessary antibiotic use. This qualitative study informed by the Theoretical Domains Framework (TDF) aimed to explore healthcare professionals’ (HCPs) and patients’ needs on provision of self-care and safety-netting advice for common infections. Twenty-seven patients and seven HCPs participated in semi-structured focus groups (FGs) and interviews. An information leaflet was iteratively developed and reviewed by participants in interviews and FGs, and an additional 5 HCPs, and 25 patients (identifying from minority ethnic groups) via online questionnaires. Qualitative data were analysed thematically, double-coded, and mapped to the TDF. Participants required information on symptom duration, safety netting, self-care, and antibiotics. Patients felt confident to self-care and were averse to consulting with HCPs unnecessarily but struggled to assess symptom severity. Patients reported seeking help for children or elderly dependents earlier. HCPs’ concerns included patients’ attitudes and a lack of available monitoring of advice given to patients. Participants believed community pharmacy should be the first place that patients seek advice on common infections. The patient information leaflet on common infections should be used in primary care and community pharmacy to support patients to self-manage symptoms and determine when further help is required.

703 The Impact of Introducing A Patient Information Leaflet on Patient Experience of Safety Netting for Cauda Equina Syndrome at Lister Hospital

Introduction Cauda Equina Syndrome (CES) is a medical emergency. Patients with symptoms should seek medical attention immediately to prevent long-term neurological consequences. At our hospital, patients with back pain due to prolapsed vertebral discs are discharged with verbal advice about red-flag signs of CES. Studies have shown that patients retain only around half the information discussed in verbal consultations. Practice suggests that verbal advice combined with a patient information leaflet (PIL) allows for better safety-netting. Method In this study, we designed a new PIL reflecting latest British Association of Spinal Surgeons guidance. We then examined its impact on patient understanding and safety-netting of CES. Fifty patients who attended the Lister Hospital back pain service between September 2019 and August 2020 were randomly selected. Patients received a copy of the new PIL and were asked to complete a short questionnaire. Results Out of 26 respondents, over 86% (vs 59%) agreed/strongly agreed that the PIL helped them understand the red-flag signs of CES better. Furthermore, 81% said they felt better informed about CES than at the point of discharge from hospital. Conclusions This shows that the use of an effective way of educating patients about the red-flag signs of a medical emergency like CES.

Possible Causes of and Measures to Minimise Risks of Abscesses Following DTP Vaccination

Registration and analysis of adverse events following immunisation (AEFIs) allow for objective assessment and systematisation of AEFI causes, and promotion of vaccination safety. Development of abscesses after DTP vaccination is a fairly common AEFI, however, they are not included in the “Side effects” part of the patient information leaflet of the vaccine. The aim of the study was to analyse reasons for abscess development after DTP vaccination and to elaborate recommendations on enhancing the vaccine safety. The review of literature data, solicited reports on AEFIs, and AEFI investigation reports submitted to the Scientific Centre for Expert Evaluation of Medicinal Products during 2014–2018 suggests that abscesses associated with DTP vaccination may be caused by the vaccine reactogenicity, quality defects arising during production or distribution, and vaccine administration errors by healthcare personnel. Lack of information in the documents submitted by medical institutions does not allow to rule out any of the identified reasons. The minimisation of risks of abscesses requires quality control of DTP vaccines, maintenance of the cold chain during transportation and storage, and compliance with aseptic regulations during administration. Additional pharmacovigilance measures will also help enhance vaccination safety: improvement and standardisation of data collection during investigation of abscess development in the post-vaccination period, obligatory inclusion of data on the thickness of children’s subcutaneous adipose tissue (weight, body mass index) and the length of the needle used for vaccination in AEFI investigation reports. It is advisable to add information on abscess risk in the “Side effects” part of the patient information leaflet of the DTP vaccine, and to update the “Dosage regimen and administration route” and “Precautions” parts in order to minimise the risk. Personnel of healthcare facilities performing vaccination should be made aware of the importance of providing detailed data on AEFIs for subsequent objective analysis.

Are proton pump inhibitors close or distant relatives? (Lecture)

Proton pump inhibitors (PPIs) are drugs that block H+-K+-ATPase on the apical membrane of the gastric parietal cells. Due to this pharmacological effect, it is possible to achieve inhibition of hydrochloric acid and its secretion formation. To date, 6 PPIs (under an international nonproprietary name) have been registered in the Russian Federation. PPIs, having proven efficacy and safety in many clinical studies, have several patterns reflected in their patient information leaflet. The attending physician should pay attention to these patterns before starting PPIs therapy. The author considers the characteristics of pharmacokinetics, pharmacodynamics of various PPIs, as well as the issues concerning efficacy and safety of use. The lecture also discusses the adverse events of PPIs, including rare ones, such as mental disorders (hallucinations), bronchospasm, subacute cutaneous lupus erythematosus. The author focuses on the metabolism peculiarities of various PPIs and the possibility of adverse drug interactions. It is especially important to consider the PPIs administration in the treatment of elderly and senile patients, patients with liver failure, during the eradication of Helicobacter pylori. KEYWORDS: proton pump inhibitors, patient information leaflet, adverse events, eradication, Helicobacter pylori. FOR CITATION: Plyusnin S.V. Are proton pump inhibitors close or distant relatives? (Lecture). Russian Medical Inquiry. 2021;5(6):398– 403 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-398-403.

A cross sectional study into the use of YouTube™ as a source of patient education in orthodontic treatment risks

Introduction: To investigate the quality of information offered by videos on YouTube™ for those individuals seeking information regarding risks associated with orthodontic treatment. The quality of information was compared the British Orthodontic Society (BOS) patient information leaflet ‘Orthodontic treatment- what are the risks’. Materials and Method: YouTube™ was searched systematically for videos on orthodontic treatment risks using the terms ‘orthodontic risks’ and ‘braces risks’. Videos were selected based on a strict inclusion and exclusion criteria and demographics recorded. Completeness was assessed using a 8-point score based on the BOS patient information leaflet ‘Orthodontic treatment- what are the risks’. Descriptive statistics and statistical analysis using correlation tests were generated. Result: 19.2% videos met the specified criteria with 80.8% videos excluded. Videos varied in regards to completeness with the mean completeness score of 3 and only 13% meeting all criteria. The risk of pain and discomfort was most commonly included orthodontic risk 61%. No statistical significance was found for completeness of the video with viewers interaction (R = 0.2665, P=0.219897) viewing rate (R=0.1138, P=0.617326) or length of video (R=0.0062, P= 0.977601). Conclusion: YouTube™ generally hosts videos with low completeness with regards to orthodontic treatment risks. Therefore, orthodontists should be aware of this resource and caution patients regarding the comprehensiveness of information. In addition to the potentially misleading content which is avail-able within YouTube™ videos

The role of clinical pharmacist in enhancing the health-related quality of life in patients with pulmonary tuberculosis

Tuberculosis (TB) is potentially airborne severe infectious disease which requires long term treatment. It considerably affects the physical and mental health quality of the patient’s life. Appropriate patient counselling with the help of Patient Information Leaflet will help to improve the patient’s quality of life and overall treatment outcome. To enhance the health related quality of life in pulmonary tuberculosis patients by providing patient counselling with the aid of patient information leaflet. An interventional study was carried out for six months in 80 patients diagnosed with pulmonary tuberculosis from the OP & IP of Tuberculosis and Chest Department of a medical college hospital. The HRQoL was assessed using the SF-36 questionnaire. Appropriate patient counselling was provided with the help of Patient Information Leaflet. In our study, a total of 80 patients were enrolled, out of which 49[61%] were Out-patients, and 31[39%] were In-patients. All the 8 sub domains of the SF-36 survey show statistical significance with improvement in 2nd Visit (after counselling) when compared with the baseline visit. The demographic variables like smoking, low socioeconomic status, allergies, family history show statistically significant association with overall HRQoL. The HRQOL of the pulmonary tuberculosis patients were initially low before the start of Anti-TB therapy, after providing proper patient counselling using patient information leaflet the HRQoL scores were found to be increased on the subsequent re-visits, which implies the need of proper patient counselling and follow-up in PTB for the better quality of life.