Tony Ireland

A review of outcome measures used in cleft care

This article provides a summary of the main outcome measures currently available and in use within modern cleft care. The fact that there are such a diverse range, including surgical, orthodontic, dental, speech and patient satisfaction measures, is a reflection of the complex, multidisciplinary and longitudinal nature of the care provided. The use of such measures of outcome is essential in the auditing and drive for continued improvements in the standards of care for patients affected with cleft lip and palate.

Using service rationalisation to build a research network: lessons from the centralisation of UK services for children with cleft lip and palate

In the UK around a thousand children are born annually with a cleft lip and/or palate that requires treatment. In the last decade services have been centralised in the UK reducing the 57 centres operating on these children in 1998, down to 11 centres or managed clinical networks in 2011. While the rationale for centralisation was to improve the standard of care (and in so doing the outcome) for children born with cleft lip and/or palate, research was central to this process. We illustrate how research informed and shaped this service rationalisation and how it facilitated the emergence of a research culture within the newly configured teams. We also describe how these changes in service provision were linked to the development of a national research strategy and to the identification of the resources necessary to support this strategy.

Approaching Parents to Take Part in a Cleft Gene Bank: A Qualitative Pilot Study

Objective A gene bank, comprising genetic material and environmental and family history data, is being established in the United Kingdom to improve the understanding of the etiology of orofacial clefting (OFC). This study aimed to identify factors that might contribute to participation in a cleft gene bank and what issues need to be considered in approaching parents to be included. Design A qualitative approach was adopted, using focus groups and interviews. Transcripts of audio recordings were analyzed using inductive thematic analysis. Participants A UK cleft center invited 100 families of children born with OFC to participate. Inclusion criteria included any parent of a child aged between 6 months and 16 years willing to take part. Sixteen parents participated. Results Participants were generally motivated to take part in a cleft gene bank because they value the discovery of new knowledge of the etiology of OFC. They wanted reassurance about the purpose and integrity of the project. Many conveyed shock at the diagnosis of cleft and offered mixed accounts of experiences with health care professionals. They suggested an individualized approach from a trustworthy and sensitive professional when being invited to join the gene bank, avoiding difficult times associated with new-baby challenges and issues related to the cleft. Conclusions This pilot study indicates that parents of children born with OFC would be supportive of developing a cleft gene bank, but sensitive issues need to be considered.

An evaluation of the effects of a web-based modular teaching programme, housed within a virtual learning environment on orthodontic training for specialist registrars.

Objectives A new modular teaching programme, housed within a virtual learning environment (VLE) was introduced in Bristol in 2004 to complement the academic training of orthodontic postgraduates. The aims of this study were to evaluate whether its introduction had reduced travel commitments for trainees, reduced demands on academic staff and whether it had any effect on teaching and learning. Design An investigative mixed methods study designed to collect and analyse verbal and written data. Setting The South West Region of the UK s ubjects and methods: s emi-structured interviews and focus groups with nine trainees and 14 trainers were taped and transcribed. Written data were coded and analysed thematically. The qualitative data from interviews and focus groups were complemented with written data from trainee diaries and a limited amount of quantitative data collected from the VLE. Conclusions Travel commitments for trainees have reduced as a result of introducing the web-based resource, but not as expected. Demands on academic staff have not reduced but have changed. The resource has had positive effects on postgraduate orthodontic teaching and learning. Important themes of interest emerging from the data are improvements in the flexibility and efficiency of learning and the value of the resource as a repository of information and in the organiz ation of teaching and learning. Despite the popularity of this web based learning resource, trainees continue to value the opportunity to interact face to face with their teachers and peers and are prepared to travel for organiz ed teaching sessions.

Bilateral Transverse Mandibular Second Molars: A Case Report

Impaction of mandibular second permanent molars is a rare occurrence, with prevalence rates reported to be between 0.65% and 2.0%. In the absence of systemic conditions, impactions are usually unilateral. There appears to be no consensus as to the optimal treatment for impacted mandibular second molars and treatment plans will be based upon the individual case. Treatment may involve orthodontics and/or various surgical techniques, and early diagnosis is important. This paper presents an unusual case of bilateral transverse impaction of both mandibular second and third molars that was diagnosed at 18 years of age. All impacted molars were extracted.

An Ingested Orthodontic Wire Fragment: A Case Report

Accidental ingestion or inhalation of foreign bodies has been widely documented, including incidents which occur whilst undertaking dental treatment. Most ingested objects pass through the gastrointestinal tract (GIT) spontaneously, but approximately 10%–20% need to be removed endoscopically and 1% require surgery. This case reports a complication arising from the accidental loss of an archwire fragment during maxillary archwire placement. It describes the immediate and subsequent management, including the use of radiographs to track the passage of the fragment through the gastro-intestinal tract. This case stresses the vigilance that dentists must take to prevent inhalation or ingestion of foreign bodies and the consequences of time-delays when management decisions are needed.

Furthering orthodontic research

One of the charitable aims of the British Orthodontic Society has been to promote and sponsor research in order to answer questions of relevance to orthodontics and orthodontists. For the past 14 years, the vehicle for this has been the British Orthodontic Society Foundation (BOSF) and since its inception in 2000, the BOSF has funded 23 research projects, of which 17 have reached completion and 6 are still ongoing. These projects have ranged from bench-top basic science to large multicentre randomised trials and have been awarded to both young orthodontic researchers and more experienced academics alike. A total of £633,400 has so far been awarded; so what have we got to show for all of this money you may well ask? Well the good news is that in total, from the 17 completed projects there have been 2 successful PhDs; 1 MPhil; 27 research papers and 1 abstract published. In addition, the BOSF funded the initial development of the National Orthodontic Virtual Learning Environment (VLE), which is now available with content for Specialist Registrar, Post-CCST FTTA and DWSI trainees, and we know has been used by many of you during your training. Therefore this funding has not only added to the evidence-base in orthodontics, but it has supported and continues to support the education and training of the future providers of orthodontics. It is perhaps worth looking at all of this in a little more detail. Since 2000, there have been awards made in all but three years, with an average value of £24,400 per award and ranging from just £260 up to £97,400. In any one of the 10 years in which awards have been made, the total value of all the awards has ranged from £12,000 to £130,000. Up to 12 applications are made for funding in each round, with 1 in 5 projects being successful in receiving an award. In all cases, the calls for funding have been open, meaning that the research has been investigator-devised and led. Where does all this the money come from? The BOSF receives approximately £41,000 per year and it comes from a variety of sources. Of the 1943 BOS members, approximately 5% (just 98 members) donate in the form of a monthly standing order (ranging from £10 to £100 per month) providing a total of £12800 per year. The concept of a regular standing order comes from the idea of donating the equivalent of one case fee over a period of four years. In reality, the members who donate through this route have been far more generous than this. Once the standing order has been set up, many are content to continue to donate each month for many years and we are very grateful for this. Unfortunately, the number of regular donors is declining. The remainder of the funding comes via the generosity of course organisers donating part of their course fee, donations for mail shots run through the BOS office, from speakers at meetings donating their speaker fees and donations made by individuals undertaking charitable challenges, such as sponsored walks or cycle rides. It can be seen that although the total value of the awards in any one year might appear high; in reality, this is not the case, particularly in an age where even single grant awards in the low hundreds of thousands are not considered to be large in academic circles. Nevertheless, in an era where dentistry, let alone orthodontics, has to compete for funding with the likes of medicine and other scientific disciplines, the BOSF is a vital source of funding for UK orthodontic research from which we, as members of the BOS, have all benefitted, and will continue to benefit, either as trainees or practising clinicians. What for the future? The BOS has undergone a reorganisation in structure during the past year and we now have a BOS Research Directorate, headed by the editor of this Journal, Martyn Cobourne. The BOSF comes under the remit of this directorate and has undergone some smaller changes. For much of the past 10 years Rye Mattick as BOSF Director has very successfully run the BOSF, almost single handedly, with support from Kevin O’Brien as scientific advisor. In the new restructured era we now have a BOSF Director, treasurer and secretary, with a scientific advisor and hopefully soon, a primary care member to share the load. We have recently issued a BOSF funding call for awards up to the value of £25000 for any single award, and as in previous years, this is an open call to researchers. Another new development this year within the Research Directorate is that the BOS has also put out a research call. In this case it is themed, with a maximum of £50,000 to be made available for any one award. Being themed, it is designed to address more immediate and pressing EDITORIAL Journal of Orthodontics, Vol. 41, 2014, 1–2