1506 Theatre and The Environmental Impact: If You Don’t Measure It Can’t Be Managed

Introduction The environmental impact of healthcare is estimated to be 5% of the total global impact and up to 10% in certain countries. The Green Healthcare programme in Ireland has published aims on its website to recycle 70% of the packaging waste and reduce waste sent to landfill by 10% by 2035. Currently the national average of recycled waste from hospitals is 11% Method We commenced a waste analysis project to assess the carbon footprint of our theatres. We measured the amount of waste which could potentially be recycled and preformed an economic analysis on this data to calculate projected cost benefit. Pilot analysis split waste into three categories – recyclable, landfill, and healthcare risk. Cases included ranged from minor to major complex including robotic procedures. Results Waste destined for the incinerator was excluded Pilot data showed that recyclable waste per case ranged from 400g to 2kg. which represents up to 50% of waste that would have otherwise been destined for landfill Conclusions Significant environmental and monetary savings are possible and recycling in theatre has been shown to be feasible in other hospitals. This does however require engagement from all staff and hospital administration. Further analysis is required to quantify the monetary cost to introduce a recycling programme and to determine optimum pathways for waste disposal in the theatre setting.

The effect of the SIMS Programme versus existing preschool oral healthcare programme on oral hygiene level of preschool children: study protocol for a cluster randomised controlled trial

Background Despite the implementation of the preschool oral healthcare programme (POHP) for 5–6-year-old children over the past 3 decades in Malaysia, dental plaque and caries levels in this age group remain high. Among the child-level attributable factors are unhealthy self-care behaviours (poor oral hygiene and high sugary diet). In order to improve the children’s oral health, an improved programme called the ‘Senyuman Indah Milik Semua’ Programme (SIMSP) or ‘Beautiful Smile for All’ programme is introduced. In this programme, a triad of dental hygienist-teacher-parent works together to improve children’s oral hygiene levels compared with the existing POHP that involves dental hygienists only. The aim of this study is to compare the effect of the SIMSP versus the existing POHP on oral hygiene levels of 5–6-year-old children in the Kampar district, Perak state, Malaysia. Methods This study is a pragmatic, cluster-randomised, parallel-group, matched pair, controlled trial with blinded outcome assessment. Randomisation is performed using a computer-generated table with a 1:1 allocation comparing the SIMSP and the POHP involving 28 preschools in the Kampar district, Perak, Malaysia. The intervention consists of preschool visits by a group of dental therapists, in-class oral health lessons and daily toothbrushing conducted by class teacher, child home toothbrushing supervised by parents, and infographic oral health messages to parents. The control consists of the existing POHP that involves preschool visits by a group of dental therapists only. The trial lasts for 6 months. Primary outcome variable is the mean plaque score change after 6 months. To determine the feasibility of the SIMSP, a process evaluation will be conducted using the perspectives of dental therapists, teachers, and parents on the appropriateness, effectiveness, facilitators, and barriers to the SIMSP implementation as well as an audit trail to assess the trial intervention. Discussion Cluster randomisation may lead to a random effect and cluster selection bias. These factors will be accounted for when analysing the data and interpreting the outcomes. The effectiveness of the SIMSP will be evaluated by comparing the results with those of the POHP. Trial registration ClinicalTrials.gov NCT04339647. Registered on 5 April 2020 – Retrospectively registered.

Facilitators and Barriers to the Implementation of Preschool Oral Healthcare Programme in Malaysia from the Perspective of Dental Therapists: A Qualitative Study

The Preschool Oral Healthcare Programme (POHP) was introduced in Malaysia by the Ministry of Health in 1984 to provide oral healthcare for 5–6-year-old children. Most of its evaluations were directed towards assessing children’s oral health status. Little emphasis has been placed on assessing the programme feasibility from the perspectives of the oral health personnel. The objective of the study was to explore the facilitators and barriers to the implementation of the POHP using the perspectives of dental therapists (DT) in Selangor state, Malaysia. This study took a qualitative approach using focus group discussion (FGD) as the data collection method. The data were transcribed verbatim followed by thematic analysis using NVivo 12 Pro version software. A total of 13 FGDs had been conducted involving 114 DT. The main facilitators were good dental teamwork, assistance from schools and teachers, sufficient training of DT, adequate support from dental administration, and good cooperation from the children. The main barriers were lack of financial support, manpower, time, inadequate support from preschools and children, language barrier, and accessibility to sugary food and drinks at schools. The study provided important insights regarding the POHP that would be useful for programme improvement through policy changes, workforce training, and enhanced school participation.

PP506 Health Technology Reassessment (HTR) Of A Non-Drug Technology: Methods Used By A Regional HTA Unit

IntroductionAn environmental scan conducted by the Canadian Agency for Drugs and Technologies (CADTH-March-2019) revealed that several health technology assessment (HTA) organisations are currently developing standard health technology reassessment (HTR) processes. Here we present methods used to conduct an HTR of a prioritization programme for non-immediate life-threatening urgent surgeries implemented in 2017 at a tertiary referral hospital in (Quebec-Canada). This HTR initiative was conducted by a regional HTA unit to optimize the programme efficiency and resources utilization as well as to motivate change in the clinical community of other hospitals within its healthcare network. Patient and healthcare personnel satisfaction levels towards the programme were also considered.MethodsIn this case study, HTR methods and outputs were elaborated using elements presented in the CADTH environmental scan and relevant publications identified through PubMed and in the grey literature. Documents in English and French, published between January 2002 and March 2019 were considered. Key stakeholders were consulted to identify barriers of the programme implementation to other hospitals in regards to aspects related either to the local medical practice or organizational factors.ResultsThe prioritization process was conducted using the same tool applied for HTA appraisal with the additional criterion that the HTR could facilitate the programme implementation. The research processes used in this HTR included: i) systematic review of the literature, ii) hospital database search (efficacy and resource utilization), iii) perceptions of healthcare teams and patients. HTR outputs consist of specific recommendations on implementation barriers and methods to monitor the impacts of the programme.ConclusionsIn this evolving field, sharing lessons from HTR methods provides information to develop standard adaptable processes to different contexts. Hence, this work applies HTR to a healthcare programme while most of the literature focuses on the HTR processes on drug and interventional medicine disinvestment. These elements represented HTR methods used from prioritization appraisal, research processes for evaluation and outputs used to plan the implementation and finally monitoring from a regional HTA unit. It also showcases that HTR being conducted as a structured evidence-based assessment adds value to a healthcare programme and could also facilitate its implementation.

Introduction to the training exercises

This chapter introduces the handbook spreadsheet training exercises, which are designed to provide hands-on experience in using the methods of distributional cost-effectiveness analysis (DCEA). Seven of the exercises form a cumulative step-by-step sequence relating to nicotine replacement therapy (NRT) in England, which is a classic example of a preventive healthcare programme designed to improve health and reduce health inequality. This allows us to illustrate all the main steps involved in conducting a DCEA using a single common example. There are also two stand-alone exercises relating to other topics in other countries.

A Brief History of Āyurveda

For over two and a half millennia Āyurveda was the mainstream healthcare programme in the Indian subcontinent. However, what was once seen as indispensable, is now often officially described as ‘alternative medicine’. Moreover, there seems to be a lack of proper understanding of the specific culture from which Āyurveda emerged. This is because existing works on the subject have mostly been mere compilations of Āyurvedic practices and focused on classical texts. This book studies the stages of development in the system of Āyurveda and its practice from proto-historic times until British colonization. Using original Pāli and Sanskrit works, archaeological artefacts, as well as oft-neglected medieval epigraphic documents, M. R. Raghava Varier highlights how centuries of privileging Western knowledge has resulted in the sidelining of indigenous learning—a process that accelerated with the advent of colonialism. Further, he makes use of Jain and Buddhist sources to question the assumption that Āyurveda is a purely Hindu or Brahmanical system, thus providing a historiographical frame for conceptually establishing the notion of Āyurveda.

Mouth Care Matters

The British Dental Conference and Dentistry Show 2020 will present an array of educational opportunities, including a presentation on a major national healthcare programme