In Australia, dental caries are observed in almost half of children starting school. Oral health ... more In Australia, dental caries are observed in almost half of children starting school. Oral health promotion programs are being implemented in early childhood education and care (ECEC) settings to promote oral health. This study examined children's perceptions of one such program, the Bright Smiles Bright Futures (BSBF) program in ECEC settings in New South Wales, Australia. Data were collected using focus group discussions from 15 children aged 3-5 years, transcribed verbatim, and analysed through inductive thematic analysis. Three themes were identified as follows: (i) oral health knowledge of children, (ii) oral hygiene practices routine and skills development, and (iii) evaluation of the oral health promotion kit and opportunities for improvement. Children's perspectives highlight the BSBF program's success in communicating key messages to promote oral health. The integration of family-centric approaches, acknowledgement of children's preferences, and the use of interactive tools collectively enhance the overall effectiveness of the oral health promotion program.
International Journal of Environmental Research and Public Health, Oct 3, 2021
The aims of this systematic review were to critically appraise the quality of the crosscultural a... more The aims of this systematic review were to critically appraise the quality of the crosscultural adaptation and the psychometric properties of the translated versions of oral health literacy assessment tools. CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), and ProQuest Dissertation and Thesis were searched systematically. Studies focusing on cross-cultural adaptation and psychometric properties of oral health literacy tools were included. The methodological quality of included studies was assessed according to the COSMIN Risk of Bias checklist. Sixteen oral health literacy instruments in 11 different languages were included in this systematic review. However, only seven instruments met the criteria for an accurate cross-cultural adaptation process, while the remaining tools failed to meet at least one criterion for suitable quality of cross-cultural adaptation process. None of the studies evaluated all the aspects of psychometric properties. Most of the studies reported internal consistency, reliability, structural validity, and construct validity. Despite adequate ratings for some reported psychometric properties, the methodological quality of studies on translated versions of oral health literacy tools was mostly doubtful to inadequate. Researchers and clinicians should follow standard guidelines for cross-cultural adaptation and assess all aspects of psychometric properties for using oral health literacy tools in cross-cultural settings.
Background: Untreated dental caries negatively impacts a child's quality of life including overal... more Background: Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods: Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and Psy-cINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results: A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.
Background Untreated dental caries negatively impacts a child's quality of life including ove... more Background Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing program...
Methodologic Quality of Guidelines for Training or Competence Processes for Basic Point-of-Care Echocardiography in Critical Care
Chest, 2021
BACKGROUND The formulation of expert-opinion guidelines has several sources of bias that may adve... more BACKGROUND The formulation of expert-opinion guidelines has several sources of bias that may adversely affect their quality. To minimize bias, guideline creators must employ rigorous methodology. There has been no appraisal of the methodological quality of basic critical care echocardiography (BCCE) training/education guidelines. RESEARCH QUESTION What is the methodological quality of expert guidelines/recommendations on BCCE training? STUDY DESIGN and Methods: The review was performed by a multidisciplinary team including intensive care specialists, hospital scientist, trainee, nurse sonographer and public health expert. Four databases (PubMed, OVID-Embase, Web of Science, Google Scholar) were searched on 31/07/2020 to identify guidelines on BCCE training/education. Every guideline was subjectively assessed for the degree of detail of the recommendations, and objectively assessed using the AGREE-II critical appraisal tool for clinical practice guidelines to generate a scaled domain score. Scores >75%, in every domain was the cut-off for guidelines to be used without modifications. RESULTS From 4288 abstracts screened, 24 guidelines met the inclusion criteria. Very few guidelines made clear recommendations regarding introductory courses - physics (n=6; 25%), instrumentation (n=5; 20.8%), image-acquisition theory (n= 6, 25%), course curriculum (n=5, 20.8%), pre/post-course tests (n=1; 4.2%), minimum course duration (n=6, 25%), or trainer-qualifications (n= 5, 20.8%). Very few provided clear recommendations for longitudinal competence programs - clinically indicated scans (n=8, 33.3%), logbook (n= 14; 58.3%), image-storage (n= 9, 37.5%), formative assessment (n=6; 25%), minimum scan numbers (n= 14, 58.3%), image-acquisition competence (n=3, 12.5%), image-interpretation competence (n=2, 8.3%) and credentialling/certification (n=3, 12.5%). Five guidelines (20.8%) attained a scaled overall AGREE-II score >75%. One guideline (4.2%) attained scores of >75% in every domain.
International Journal of Environmental Research and Public Health, 2021
The purpose of this study was to learn about mothers’ experiences with food choices for their pre... more The purpose of this study was to learn about mothers’ experiences with food choices for their pre-school children in underprivileged communities in Greater Western Sydney (GWS). A total of 20 mother-child dyads living in GWS were recruited to a qualitative study from an ongoing birth cohort study. Participants’ houses were visited for semi-structured interviews, which were recorded, transcribed verbatim, and analysed thematically. The interviews yielded five main themes: (i) food choices, nutrition, and health; (ii) accessibility and availability of foods (iii) buying time for parents; (iv) child’s age and their preference on food choices; (v) conditioning certain behaviours by family and cultural factors. Nutrition literacy, child’s preferences, unhealthy food intake by family members, child’s demand, advertising and availability of harmful foods, and time constraints were all mentioned as hurdles to mothers making appropriate meal choices for their children. However, some identifi...
Australia/New Zealand) * Competence in point-of-care ultrasound (PoCUS) is widely recommended by ... more Australia/New Zealand) * Competence in point-of-care ultrasound (PoCUS) is widely recommended by several critical care societies. Despite numerous introductory short courses, very few doctors attain PoCUS competence because of the challenges in establishing longitudinal competence programs. RESEARCH QUESTION: To evaluate the methodologic quality of the literature on basic PoCUS competence processes in critical care. A systematic review to identify manuscripts meeting predefined inclusion criteria was performed using three medical databases (PubMed, OVID Embase, and Web of Science); using extra references from original articles, review articles, and expert panel guidelines; and by directly contacting authors for further information if required. The objectives, domains, and inclusion and exclusion criteria of the review were determined during discussions between experienced PoCUS educators. Data extraction and analyses were performed independently by three reviewers. RESULTS: Of the 5,408 abstracts extracted, 42 met the inclusion criteria for longitudinal PoCUS competence. Each study was described along four broad categories: general information, study design, and trainee characteristics; description of introductory course; description of longitudinal competence program; and grading of overall methodologic quality on a 4-point Likert scale. Thirty-nine studies (92.9%) were from a single center. Most studies lacked important details on study methodology such as prior ultrasound experience, pre-and postcourse tests, models for hands-on sessions, ratio of instructors to trainees, competence assessment criteria, number of scans performed by individual trainees, and formative and summative assessments. The studies were rated as follows: poor ¼ 19 (45.2%), average ¼ 15 (35.7%), good ¼ 4 (9.5%), and excellent ¼ 4 (9.5%). INTERPRETATION: Ther is very little high-quality evidence on PoCUS competence. To help frame policy guidelines to improve PoCUS education, there is a need for well-designed longitudinal studies on PoCUS competence.
In 2014, basic critical care echocardiography (BCCE) competence became a mandatory requirement fo... more In 2014, basic critical care echocardiography (BCCE) competence became a mandatory requirement for trainees registered with the College of Intensive Care Medicine (CICM). To determine the proportion of CICM intensive care units (ICUs) that conduct a BCCE competence program and to learn about the barriers/challenges and successful strategies, we conducted a survey of intensivists working in ICUs accredited by CICM for basic/advanced training in Australia, New Zealand, Hong Kong, Singapore, Ireland and India. Following consultations with content experts and a trial phase to improve clarity and minimise ambiguity, an 11-point questionnaire survey was sent to one intensivist from every CICM-accredited ICU by several methods. Participation was voluntary. Consent was implied. No incentives were offered. Results are reported as numbers and percentages. Of the 104 ICUs surveyed, 99 (95.1%) responded, with 75 (75.8%) having no BCCE teaching whatsoever. In the remaining 24 (24.2%) ICUs, the t...
Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical ca... more Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. Design: Web-based survey. Setting: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. Subjects: Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. Interventions: Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultra...
Supplemental material, sj-pdf-1-aic-10.1177_0310057X20911663 for Basic echocardiography competenc... more Supplemental material, sj-pdf-1-aic-10.1177_0310057X20911663 for Basic echocardiography competence program in intensive care units: A multinational survey of intensive care units accredited by the College of Intensive Care Medicine by Arvind Rajamani, Sebastian Knudsen, Kerrianne Ngoc Bich Ha Huynh, Stephen Huang, Wai-Tat Wong, Iris Ting, Anthony S McLean, Johnson Chi Wa Ng, Jinal Parmar, Moushumi Salvi, Kollengode Ramanathan and On behalf of the SPARTAN Collaborative (Small Projects, Audits, Research Trials – Australia/New Zealand) in Anaesthesia and Intensive Care
In Australia, dental caries are observed in almost half of children starting school. Oral health ... more In Australia, dental caries are observed in almost half of children starting school. Oral health promotion programs are being implemented in early childhood education and care (ECEC) settings to promote oral health. This study examined children's perceptions of one such program, the Bright Smiles Bright Futures (BSBF) program in ECEC settings in New South Wales, Australia. Data were collected using focus group discussions from 15 children aged 3-5 years, transcribed verbatim, and analysed through inductive thematic analysis. Three themes were identified as follows: (i) oral health knowledge of children, (ii) oral hygiene practices routine and skills development, and (iii) evaluation of the oral health promotion kit and opportunities for improvement. Children's perspectives highlight the BSBF program's success in communicating key messages to promote oral health. The integration of family-centric approaches, acknowledgement of children's preferences, and the use of interactive tools collectively enhance the overall effectiveness of the oral health promotion program.
International Journal of Environmental Research and Public Health, Oct 3, 2021
The aims of this systematic review were to critically appraise the quality of the crosscultural a... more The aims of this systematic review were to critically appraise the quality of the crosscultural adaptation and the psychometric properties of the translated versions of oral health literacy assessment tools. CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), and ProQuest Dissertation and Thesis were searched systematically. Studies focusing on cross-cultural adaptation and psychometric properties of oral health literacy tools were included. The methodological quality of included studies was assessed according to the COSMIN Risk of Bias checklist. Sixteen oral health literacy instruments in 11 different languages were included in this systematic review. However, only seven instruments met the criteria for an accurate cross-cultural adaptation process, while the remaining tools failed to meet at least one criterion for suitable quality of cross-cultural adaptation process. None of the studies evaluated all the aspects of psychometric properties. Most of the studies reported internal consistency, reliability, structural validity, and construct validity. Despite adequate ratings for some reported psychometric properties, the methodological quality of studies on translated versions of oral health literacy tools was mostly doubtful to inadequate. Researchers and clinicians should follow standard guidelines for cross-cultural adaptation and assess all aspects of psychometric properties for using oral health literacy tools in cross-cultural settings.
Background: Untreated dental caries negatively impacts a child's quality of life including overal... more Background: Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods: Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and Psy-cINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results: A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.
Background Untreated dental caries negatively impacts a child's quality of life including ove... more Background Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing program...
Methodologic Quality of Guidelines for Training or Competence Processes for Basic Point-of-Care Echocardiography in Critical Care
Chest, 2021
BACKGROUND The formulation of expert-opinion guidelines has several sources of bias that may adve... more BACKGROUND The formulation of expert-opinion guidelines has several sources of bias that may adversely affect their quality. To minimize bias, guideline creators must employ rigorous methodology. There has been no appraisal of the methodological quality of basic critical care echocardiography (BCCE) training/education guidelines. RESEARCH QUESTION What is the methodological quality of expert guidelines/recommendations on BCCE training? STUDY DESIGN and Methods: The review was performed by a multidisciplinary team including intensive care specialists, hospital scientist, trainee, nurse sonographer and public health expert. Four databases (PubMed, OVID-Embase, Web of Science, Google Scholar) were searched on 31/07/2020 to identify guidelines on BCCE training/education. Every guideline was subjectively assessed for the degree of detail of the recommendations, and objectively assessed using the AGREE-II critical appraisal tool for clinical practice guidelines to generate a scaled domain score. Scores >75%, in every domain was the cut-off for guidelines to be used without modifications. RESULTS From 4288 abstracts screened, 24 guidelines met the inclusion criteria. Very few guidelines made clear recommendations regarding introductory courses - physics (n=6; 25%), instrumentation (n=5; 20.8%), image-acquisition theory (n= 6, 25%), course curriculum (n=5, 20.8%), pre/post-course tests (n=1; 4.2%), minimum course duration (n=6, 25%), or trainer-qualifications (n= 5, 20.8%). Very few provided clear recommendations for longitudinal competence programs - clinically indicated scans (n=8, 33.3%), logbook (n= 14; 58.3%), image-storage (n= 9, 37.5%), formative assessment (n=6; 25%), minimum scan numbers (n= 14, 58.3%), image-acquisition competence (n=3, 12.5%), image-interpretation competence (n=2, 8.3%) and credentialling/certification (n=3, 12.5%). Five guidelines (20.8%) attained a scaled overall AGREE-II score >75%. One guideline (4.2%) attained scores of >75% in every domain.
International Journal of Environmental Research and Public Health, 2021
The purpose of this study was to learn about mothers’ experiences with food choices for their pre... more The purpose of this study was to learn about mothers’ experiences with food choices for their pre-school children in underprivileged communities in Greater Western Sydney (GWS). A total of 20 mother-child dyads living in GWS were recruited to a qualitative study from an ongoing birth cohort study. Participants’ houses were visited for semi-structured interviews, which were recorded, transcribed verbatim, and analysed thematically. The interviews yielded five main themes: (i) food choices, nutrition, and health; (ii) accessibility and availability of foods (iii) buying time for parents; (iv) child’s age and their preference on food choices; (v) conditioning certain behaviours by family and cultural factors. Nutrition literacy, child’s preferences, unhealthy food intake by family members, child’s demand, advertising and availability of harmful foods, and time constraints were all mentioned as hurdles to mothers making appropriate meal choices for their children. However, some identifi...
Australia/New Zealand) * Competence in point-of-care ultrasound (PoCUS) is widely recommended by ... more Australia/New Zealand) * Competence in point-of-care ultrasound (PoCUS) is widely recommended by several critical care societies. Despite numerous introductory short courses, very few doctors attain PoCUS competence because of the challenges in establishing longitudinal competence programs. RESEARCH QUESTION: To evaluate the methodologic quality of the literature on basic PoCUS competence processes in critical care. A systematic review to identify manuscripts meeting predefined inclusion criteria was performed using three medical databases (PubMed, OVID Embase, and Web of Science); using extra references from original articles, review articles, and expert panel guidelines; and by directly contacting authors for further information if required. The objectives, domains, and inclusion and exclusion criteria of the review were determined during discussions between experienced PoCUS educators. Data extraction and analyses were performed independently by three reviewers. RESULTS: Of the 5,408 abstracts extracted, 42 met the inclusion criteria for longitudinal PoCUS competence. Each study was described along four broad categories: general information, study design, and trainee characteristics; description of introductory course; description of longitudinal competence program; and grading of overall methodologic quality on a 4-point Likert scale. Thirty-nine studies (92.9%) were from a single center. Most studies lacked important details on study methodology such as prior ultrasound experience, pre-and postcourse tests, models for hands-on sessions, ratio of instructors to trainees, competence assessment criteria, number of scans performed by individual trainees, and formative and summative assessments. The studies were rated as follows: poor ¼ 19 (45.2%), average ¼ 15 (35.7%), good ¼ 4 (9.5%), and excellent ¼ 4 (9.5%). INTERPRETATION: Ther is very little high-quality evidence on PoCUS competence. To help frame policy guidelines to improve PoCUS education, there is a need for well-designed longitudinal studies on PoCUS competence.
In 2014, basic critical care echocardiography (BCCE) competence became a mandatory requirement fo... more In 2014, basic critical care echocardiography (BCCE) competence became a mandatory requirement for trainees registered with the College of Intensive Care Medicine (CICM). To determine the proportion of CICM intensive care units (ICUs) that conduct a BCCE competence program and to learn about the barriers/challenges and successful strategies, we conducted a survey of intensivists working in ICUs accredited by CICM for basic/advanced training in Australia, New Zealand, Hong Kong, Singapore, Ireland and India. Following consultations with content experts and a trial phase to improve clarity and minimise ambiguity, an 11-point questionnaire survey was sent to one intensivist from every CICM-accredited ICU by several methods. Participation was voluntary. Consent was implied. No incentives were offered. Results are reported as numbers and percentages. Of the 104 ICUs surveyed, 99 (95.1%) responded, with 75 (75.8%) having no BCCE teaching whatsoever. In the remaining 24 (24.2%) ICUs, the t...
Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical ca... more Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. Design: Web-based survey. Setting: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. Subjects: Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. Interventions: Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultra...
Supplemental material, sj-pdf-1-aic-10.1177_0310057X20911663 for Basic echocardiography competenc... more Supplemental material, sj-pdf-1-aic-10.1177_0310057X20911663 for Basic echocardiography competence program in intensive care units: A multinational survey of intensive care units accredited by the College of Intensive Care Medicine by Arvind Rajamani, Sebastian Knudsen, Kerrianne Ngoc Bich Ha Huynh, Stephen Huang, Wai-Tat Wong, Iris Ting, Anthony S McLean, Johnson Chi Wa Ng, Jinal Parmar, Moushumi Salvi, Kollengode Ramanathan and On behalf of the SPARTAN Collaborative (Small Projects, Audits, Research Trials – Australia/New Zealand) in Anaesthesia and Intensive Care
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