from an empty review to a full trial: not a painful...
TRANSCRIPT
From an empty review to a full trial:
not a painful extraction
Hannah Jones1,2, Clive E Adams2, Jayne Simpson1, Graeme Tosh3,
Andrew Clifton4, Waqqas Khokhar5, Patrick Callaghan6, Peter Liddle7
If you would like more information about the dental trial please contact: Hannah Jones, The Sir Colin Campbell Building B7, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU. Tel: 0115 82 31267 Email: [email protected] Website: http://www.clahrc-ndl.nihr.ac.uk
Cochrane Review: Oral health advice for people with serious
mental illness
Trial: The three shires early intervention dental trial: A real
world cluster randomised controlled trial (ISRCTN63382258)
TABLE 1. TRIAL DESIGN
Design Cluster Randomised Controlled Trial
Setting Early Intervention in Psychosis teams in Nottinghamshire,
Derbyshire and Lincolnshire
Duration 12 months
Participants Early Intervention for Psychosis Teams, all care coordinators and all
service users in teams
Intervention Staff dental awareness training + dental checklist for service users
vs. standard care
Outcomes Registered with a dentist, visited a dentists within the last year,
routine check up within last year, owning a toothbrush, cleaning teeth
twice a day
BACKGROUND
People with serious mental illness are more likely to experience oral disease and
have greater oral treatment needs than the general population.
Oral health has never been seen as a priority in people suffering with serious
mental illness.
Poor oral health has a serious impact on quality of life, everyday functioning, social
inclusion and self-esteem.
The search identified 2382 references (from 1558 studies).
Only one study was suitable for further examination.
This was excluded as it did not fulfil the review's criteria.
All relevant randomised clinical trials.
Cochrane Schizophrenia Group Trials Register (October 2009).
To assess the effects of oral health advice in reducing morbidity in people with
serious mental illness.
OBJECTIVES
SEARCH METHODS
SELECTION CRITERIA
RESULTS
CONCLUSIONS
FURTHER RESEARCH
Trials were possible but none had been undertaken.
We have been supported by NIHR Collaborations for Leadership in Applied Health
Research and Care (CLAHRC) – Nottinghamshire, Derbyshire, Lincolnshire to
design and conduct a relevant study.
Current guidance to give advice on oral health to people with serious mental
illness is not based on best possible evidence.
Further research is indicated.
FIGURE 1. TRIAL PROCESS
EIP teams in Nottinghamshire, Derbyshire
and Lincolnshire
(N=10; n=1037)
Randomisation
(block, cluster by shire)
Dental Intervention
(N=5)
Dental Awareness Training +
Modified Oral Health
Checklist
12 month follow up
Modified Oral Health
Checklist
Oral Impacts on Daily
Performance +
Detailed dental data (random
sample of service users from
all teams n=50)
Standard Care
(N=5)
Continue with treatment as
usual for 12 months
12 month follow up
Dental Awareness Training +
Modified Oral Health
Checklist
Oral Impacts on Daily
Performance +
Detailed dental data (random
sample of service users from
all teams n=50)
All EIP teams in Nottinghamshire, Derbyshire and
Lincolnshire have been invited to be involved in the trial.
Half will be allocated to receive the intervention and
half will be allocated to the control
Intervention teams will receive a one-off 30-minute
dental awareness training session and be asked to use
the checklist (see illustration) at the start of the trial and
again 12 months later.
Control teams will continue to deliver standard care
for 12 months and then will also receive the dental
awareness training session and will be asked to use the
checklist.
We acknowledge the support of the National Institute for Health Research, through the Mental Health Research Network.
This poster presents independent research commissioned by the National Institute for Health research (NIHR). The views expressed
in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Hannah Jones is completing a PhD at the University of Nottingham, funded by CLAHRC-NDL, supervised by Professor Clive Adams,
that is based on the Dental Trial.
ACKNOWLEDGEMENTS
PROGRESS
In February 2012 the 10 early intervention in psychosis teams caring for a total of
1037 people were randomised.
Khokhar WA, Clifton A, Jones H, Tosh G. Oral health advice for people with serious mental illness. Cochrane Database of Systematic
Reviews 2011;(11). [DOI: 10.1002/14651858.CD008802.pub2; Other: CD008802]
British Society for Disability and Oral Health (BSDH). Oral health care for people with mental health problems guideline and
recommendations. Report of BSDH Working Group 2000.
Stiefel DJ, Truelove EL, Menard TW, Anderson VK, Doyle PE, Mandel LS. A comparison of the oral health of persons with and
without chronic mental illness in community settings. Special Care in Dentistry 1990;10(1):6-12.
REFERENCES
1CLAHRC-NDL, University of Nottingham. 2Cochrane Schizophrenia Group, University of Nottingham. 3General Adult
Psychiatry, East Midlands Workforce Deanery. 4School of Health, Community & Education Studies, Northumbria University. 5Bradgate Mental Health Unit, Leicestershire Partnership Trust, Leicester, UK. 6School of Nursing, Midwifery & Physiotherapy,
University of Nottingham. 7School of Community Health Sciences, University of Nottingham.
OBJECTIVES
To see whether staff dental awareness training + a simple one page dental checklist
can improve the oral health of people with a serious mental illness in
Nottinghamshire Derbyshire and Lincolnshire Early Intervention for Psychosis (EIP)
teams by 1 year.
METHODS
The intervention and methods were designed after considerable consultation with all
relevant stakeholders – clinicians, managers, commissioners and service users.