Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of d... more Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of daily life. 1 In the United Kingdom (UK), this resulted in unprecedented and widespread pressures on both secondary and primary healthcare, along with considerable socioeconomic disruption. At the beginning of March 2020, The Economist article 'Is it ready? Britain's NHS is well suited to dealing with crises' commented: 'by International comparisons Britain was among the best prepared countries for a pandemic, thanks to its testing infrastructure and contingency planning'. However, it also pointed out that the NHS was a 'relative weak point'. 2 Ten years ago, the UK received a 'highly satisfactory rating' for its handling of the swine flu pandemic. Over a period of one year of the pandemic, 800,000 people were infected. Of these, 26,000 needed hospitalisation and 342 died in England. 3 For COVID-19, the current figures from 15 February-31 May 2020 are 274,762 cases and 38,489 deaths, with worldwide figures reaching 6.2 million confirmed cases and 371,764 deaths. 4 The National Risk Register rates a pandemic as the highest risk for the country. 5 The expectation was that NHS England's Emergency Preparedness, Resilience and Response framework would be actioned and that a level 4 alert would signal national control of the service. 6 However, this did not consider several factors, including the decrease in number of primary care general medical practices, the number of vacancies in the NHS and added burden of large numbers of highly trained staff leaving, and the intensive care facilities' ability to cope with the increased demand. In addition, the pandemic occurred during the normally expected flu season. Many would argue that the most important factor is the persistent chronic underfunding of the NHS in the last ten years. Throughout the pandemic, the NHS looked to alternative means of staffing hospitals. The healthcare system came under an inordinate amount of pressure as illness and self-isolation of frontline staff led to reduced numbers of healthcare workers available to their Trusts. Redeployment of staff was required to cover these shortages. At the same time, general dental practices ceased treatment of both routine and urgent patients. 7 The process released a large group of highly trained healthcare staff with transferable medical skills who could participate in delivering essential healthcare. This paper aims to investigate whether the dental team-dentists and dental care professionals (DCPs)-can be effectively redeployed when the healthcare system is under pressure during national emergencies. This does not preclude the important issue that dentistry is an essential branch of the Provides dental, medical and wider healthcare systems with a clearer understanding of the medical competencies gained by the dental team during undergraduate and specialist training. Shows the commonality between dental and medical education curricula. Utilising the dental team during crises has the advantage of the presence of medical and dental competencies with added benefits of administration, finance and leadership skills.
Dental caries remains a challenge in the improvement of oral health. It is the most common and wi... more Dental caries remains a challenge in the improvement of oral health. It is the most common and widespread biofilm-dependent oral disease, resulting in the destruction of tooth structure by the acidic attack from cariogenic bacteria. The tooth is a heavily mineralised tissue, and both enamel and dentine can undergo demineralisation due to trauma or dietary conditions. The adult population worldwide affected by dental caries is enormous and despite significant advances in caries prevention and tooth restoration, treatments continue to pose a substantial burden to healthcare. Biomaterials play a vital role in the restoration of the diseased or damaged tooth structure and, despite providing reasonable outcomes, there are some concerns with clinical performance. Amalgam, the silver grey biomaterial that has been widely used as a restorative material in dentistry, is currently in throes of being phased out, especially with the Minimata convention and treaty being signed by a number of countries (January 2013; http://mercuryconvention.org/Convention/) that aims to control the anthropogenic release of mercury in the environment, which naturally impacts the use of amalgam, where mercury is a component. Thus, the development of alternative restoratives and restoration methods that are inexpensive, can be used under different climatic conditions, withstand storage and allow easy handling, the main prerequisites of dental biomaterials, is important. The potential for using biologically engineered tissue and consequent research to replace damaged tissues has also seen a quantum leap in the last decade. Ongoing research in regenerative treatments in dentistry includes alveolar ridge augmentation, bone tissue engineering and periodontal ligament replacement, and a future aim is bioengineering of the whole tooth. Research towards developing bioengineered teeth is well underway and identification of adult stem cell sources to make this a viable treatment is advancing; however, this topic is not in the scope of this chapter. Whilst research focuses on many different aspects, operative dentistry involves the wide use of restorative biomaterials; thus, the development of smart biomaterials to suit the current climes of minimally invasive dentistry is important. The concept of minimally invasive dentistry primarily promotes preservation of the natural tissue, and, thus, the prevention of disease or the advancement of procedures that allow early detection and interception of its progress with minimal tissue loss are of significance. This chapter presents, in brief, the current state of the art of direct restorative biomaterials and their role and future in the field of dentistry. Modern dental practice is highly reliant on the selection of appropriate materials for optimum function and benefit to the patient. Dentistry, perhaps, has the unique distinction of using the widest variety of materials, ranging from polymers, metals, ceramics, inorganic salts to composite materials. So far, aesthetics of restorative materials and their ability to perform in the harsh oral environment without undergoing changes in dimension and stability has been the major focus of materials used in dentistry. Despite advances in tissue engineering and regeneration in the field of regenerative medicine, this concept has found relatively limited application for enamel and dentine due to their limited ability to remodel, but research related to biomimetic approaches for the modification of dentine is a significant step.
British Journal of Oral & Maxillofacial Surgery, Dec 1, 2021
The multidisciplinary team (MDT) is key to the management and decision-making process for head an... more The multidisciplinary team (MDT) is key to the management and decision-making process for head and neck cancer. The sudden shift to virtual meetings due to the COVID-19 pandemic has been arguably the most dramatic change since inception of the MDT, and we know of no studies that have evaluated the head and neck MDT since this change in working. A preliminary questionnaire was designed and trialled, based on guidance on MDT qualities and measurable outcomes as per published national guidelines. A questionnaire was then distributed to all head and neck MDTs in the UK. We obtained 97 individual responses, from 27 units. Our results indicated that most clinicians (70.1%) felt that decision making was unchanged. Most (84.5%) also felt that technology resources were satisfactory and that some aspects of communication (viewing of images and slides) were as good or improved (76.3%). However, there were notable deficiencies with remote working. In particular, the majority of respondents perceived that engagement (43.9%), teamworking (69.1%), and training (47.7%) were worse since they moved to remote meetings. Our study suggests mixed opinions of virtual meetings. Our results demonstrate that despite remote working, head and neck MDT participants feel that they have largely been able to perform in most indicators. However, we should consider solutions to the perceived deficiencies in engagement, training, teamworking, and communication. To our knowledge, this is the first study to evaluate virtual head and neck MDT meetings, and the largest study of virtual MDTs and remote working within healthcare.
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of d... more Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of daily life. 1 In the United Kingdom (UK), this resulted in unprecedented and widespread pressures on both secondary and primary healthcare, along with considerable socioeconomic disruption. At the beginning of March 2020, The Economist article 'Is it ready? Britain's NHS is well suited to dealing with crises' commented: 'by International comparisons Britain was among the best prepared countries for a pandemic, thanks to its testing infrastructure and contingency planning'. However, it also pointed out that the NHS was a 'relative weak point'. 2 Ten years ago, the UK received a 'highly satisfactory rating' for its handling of the swine flu pandemic. Over a period of one year of the pandemic, 800,000 people were infected. Of these, 26,000 needed hospitalisation and 342 died in England. 3 For COVID-19, the current figures from 15 February-31 May 2020 are 274,762 cases and 38,489 deaths, with worldwide figures reaching 6.2 million confirmed cases and 371,764 deaths. 4 The National Risk Register rates a pandemic as the highest risk for the country. 5 The expectation was that NHS England's Emergency Preparedness, Resilience and Response framework would be actioned and that a level 4 alert would signal national control of the service. 6 However, this did not consider several factors, including the decrease in number of primary care general medical practices, the number of vacancies in the NHS and added burden of large numbers of highly trained staff leaving, and the intensive care facilities' ability to cope with the increased demand. In addition, the pandemic occurred during the normally expected flu season. Many would argue that the most important factor is the persistent chronic underfunding of the NHS in the last ten years. Throughout the pandemic, the NHS looked to alternative means of staffing hospitals. The healthcare system came under an inordinate amount of pressure as illness and self-isolation of frontline staff led to reduced numbers of healthcare workers available to their Trusts. Redeployment of staff was required to cover these shortages. At the same time, general dental practices ceased treatment of both routine and urgent patients. 7 The process released a large group of highly trained healthcare staff with transferable medical skills who could participate in delivering essential healthcare. This paper aims to investigate whether the dental team-dentists and dental care professionals (DCPs)-can be effectively redeployed when the healthcare system is under pressure during national emergencies. This does not preclude the important issue that dentistry is an essential branch of the Provides dental, medical and wider healthcare systems with a clearer understanding of the medical competencies gained by the dental team during undergraduate and specialist training. Shows the commonality between dental and medical education curricula. Utilising the dental team during crises has the advantage of the presence of medical and dental competencies with added benefits of administration, finance and leadership skills.
Dental caries remains a challenge in the improvement of oral health. It is the most common and wi... more Dental caries remains a challenge in the improvement of oral health. It is the most common and widespread biofilm-dependent oral disease, resulting in the destruction of tooth structure by the acidic attack from cariogenic bacteria. The tooth is a heavily mineralised tissue, and both enamel and dentine can undergo demineralisation due to trauma or dietary conditions. The adult population worldwide affected by dental caries is enormous and despite significant advances in caries prevention and tooth restoration, treatments continue to pose a substantial burden to healthcare. Biomaterials play a vital role in the restoration of the diseased or damaged tooth structure and, despite providing reasonable outcomes, there are some concerns with clinical performance. Amalgam, the silver grey biomaterial that has been widely used as a restorative material in dentistry, is currently in throes of being phased out, especially with the Minimata convention and treaty being signed by a number of cou...
Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of d... more Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of daily life. 1 In the United Kingdom (UK), this resulted in unprecedented and widespread pressures on both secondary and primary healthcare, along with considerable socioeconomic disruption. At the beginning of March 2020, The Economist article 'Is it ready? Britain's NHS is well suited to dealing with crises' commented: 'by International comparisons Britain was among the best prepared countries for a pandemic, thanks to its testing infrastructure and contingency planning'. However, it also pointed out that the NHS was a 'relative weak point'. 2 Ten years ago, the UK received a 'highly satisfactory rating' for its handling of the swine flu pandemic. Over a period of one year of the pandemic, 800,000 people were infected. Of these, 26,000 needed hospitalisation and 342 died in England. 3 For COVID-19, the current figures from 15 February-31 May 2020 are 274,762 cases and 38,489 deaths, with worldwide figures reaching 6.2 million confirmed cases and 371,764 deaths. 4 The National Risk Register rates a pandemic as the highest risk for the country. 5 The expectation was that NHS England's Emergency Preparedness, Resilience and Response framework would be actioned and that a level 4 alert would signal national control of the service. 6 However, this did not consider several factors, including the decrease in number of primary care general medical practices, the number of vacancies in the NHS and added burden of large numbers of highly trained staff leaving, and the intensive care facilities' ability to cope with the increased demand. In addition, the pandemic occurred during the normally expected flu season. Many would argue that the most important factor is the persistent chronic underfunding of the NHS in the last ten years. Throughout the pandemic, the NHS looked to alternative means of staffing hospitals. The healthcare system came under an inordinate amount of pressure as illness and self-isolation of frontline staff led to reduced numbers of healthcare workers available to their Trusts. Redeployment of staff was required to cover these shortages. At the same time, general dental practices ceased treatment of both routine and urgent patients. 7 The process released a large group of highly trained healthcare staff with transferable medical skills who could participate in delivering essential healthcare. This paper aims to investigate whether the dental team-dentists and dental care professionals (DCPs)-can be effectively redeployed when the healthcare system is under pressure during national emergencies. This does not preclude the important issue that dentistry is an essential branch of the Provides dental, medical and wider healthcare systems with a clearer understanding of the medical competencies gained by the dental team during undergraduate and specialist training. Shows the commonality between dental and medical education curricula. Utilising the dental team during crises has the advantage of the presence of medical and dental competencies with added benefits of administration, finance and leadership skills.
Dental caries remains a challenge in the improvement of oral health. It is the most common and wi... more Dental caries remains a challenge in the improvement of oral health. It is the most common and widespread biofilm-dependent oral disease, resulting in the destruction of tooth structure by the acidic attack from cariogenic bacteria. The tooth is a heavily mineralised tissue, and both enamel and dentine can undergo demineralisation due to trauma or dietary conditions. The adult population worldwide affected by dental caries is enormous and despite significant advances in caries prevention and tooth restoration, treatments continue to pose a substantial burden to healthcare. Biomaterials play a vital role in the restoration of the diseased or damaged tooth structure and, despite providing reasonable outcomes, there are some concerns with clinical performance. Amalgam, the silver grey biomaterial that has been widely used as a restorative material in dentistry, is currently in throes of being phased out, especially with the Minimata convention and treaty being signed by a number of countries (January 2013; http://mercuryconvention.org/Convention/) that aims to control the anthropogenic release of mercury in the environment, which naturally impacts the use of amalgam, where mercury is a component. Thus, the development of alternative restoratives and restoration methods that are inexpensive, can be used under different climatic conditions, withstand storage and allow easy handling, the main prerequisites of dental biomaterials, is important. The potential for using biologically engineered tissue and consequent research to replace damaged tissues has also seen a quantum leap in the last decade. Ongoing research in regenerative treatments in dentistry includes alveolar ridge augmentation, bone tissue engineering and periodontal ligament replacement, and a future aim is bioengineering of the whole tooth. Research towards developing bioengineered teeth is well underway and identification of adult stem cell sources to make this a viable treatment is advancing; however, this topic is not in the scope of this chapter. Whilst research focuses on many different aspects, operative dentistry involves the wide use of restorative biomaterials; thus, the development of smart biomaterials to suit the current climes of minimally invasive dentistry is important. The concept of minimally invasive dentistry primarily promotes preservation of the natural tissue, and, thus, the prevention of disease or the advancement of procedures that allow early detection and interception of its progress with minimal tissue loss are of significance. This chapter presents, in brief, the current state of the art of direct restorative biomaterials and their role and future in the field of dentistry. Modern dental practice is highly reliant on the selection of appropriate materials for optimum function and benefit to the patient. Dentistry, perhaps, has the unique distinction of using the widest variety of materials, ranging from polymers, metals, ceramics, inorganic salts to composite materials. So far, aesthetics of restorative materials and their ability to perform in the harsh oral environment without undergoing changes in dimension and stability has been the major focus of materials used in dentistry. Despite advances in tissue engineering and regeneration in the field of regenerative medicine, this concept has found relatively limited application for enamel and dentine due to their limited ability to remodel, but research related to biomimetic approaches for the modification of dentine is a significant step.
British Journal of Oral & Maxillofacial Surgery, Dec 1, 2021
The multidisciplinary team (MDT) is key to the management and decision-making process for head an... more The multidisciplinary team (MDT) is key to the management and decision-making process for head and neck cancer. The sudden shift to virtual meetings due to the COVID-19 pandemic has been arguably the most dramatic change since inception of the MDT, and we know of no studies that have evaluated the head and neck MDT since this change in working. A preliminary questionnaire was designed and trialled, based on guidance on MDT qualities and measurable outcomes as per published national guidelines. A questionnaire was then distributed to all head and neck MDTs in the UK. We obtained 97 individual responses, from 27 units. Our results indicated that most clinicians (70.1%) felt that decision making was unchanged. Most (84.5%) also felt that technology resources were satisfactory and that some aspects of communication (viewing of images and slides) were as good or improved (76.3%). However, there were notable deficiencies with remote working. In particular, the majority of respondents perceived that engagement (43.9%), teamworking (69.1%), and training (47.7%) were worse since they moved to remote meetings. Our study suggests mixed opinions of virtual meetings. Our results demonstrate that despite remote working, head and neck MDT participants feel that they have largely been able to perform in most indicators. However, we should consider solutions to the perceived deficiencies in engagement, training, teamworking, and communication. To our knowledge, this is the first study to evaluate virtual head and neck MDT meetings, and the largest study of virtual MDTs and remote working within healthcare.
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of d... more Background The coronavirus (COVID-19) pandemic caused a national crisis affecting every part of daily life. 1 In the United Kingdom (UK), this resulted in unprecedented and widespread pressures on both secondary and primary healthcare, along with considerable socioeconomic disruption. At the beginning of March 2020, The Economist article 'Is it ready? Britain's NHS is well suited to dealing with crises' commented: 'by International comparisons Britain was among the best prepared countries for a pandemic, thanks to its testing infrastructure and contingency planning'. However, it also pointed out that the NHS was a 'relative weak point'. 2 Ten years ago, the UK received a 'highly satisfactory rating' for its handling of the swine flu pandemic. Over a period of one year of the pandemic, 800,000 people were infected. Of these, 26,000 needed hospitalisation and 342 died in England. 3 For COVID-19, the current figures from 15 February-31 May 2020 are 274,762 cases and 38,489 deaths, with worldwide figures reaching 6.2 million confirmed cases and 371,764 deaths. 4 The National Risk Register rates a pandemic as the highest risk for the country. 5 The expectation was that NHS England's Emergency Preparedness, Resilience and Response framework would be actioned and that a level 4 alert would signal national control of the service. 6 However, this did not consider several factors, including the decrease in number of primary care general medical practices, the number of vacancies in the NHS and added burden of large numbers of highly trained staff leaving, and the intensive care facilities' ability to cope with the increased demand. In addition, the pandemic occurred during the normally expected flu season. Many would argue that the most important factor is the persistent chronic underfunding of the NHS in the last ten years. Throughout the pandemic, the NHS looked to alternative means of staffing hospitals. The healthcare system came under an inordinate amount of pressure as illness and self-isolation of frontline staff led to reduced numbers of healthcare workers available to their Trusts. Redeployment of staff was required to cover these shortages. At the same time, general dental practices ceased treatment of both routine and urgent patients. 7 The process released a large group of highly trained healthcare staff with transferable medical skills who could participate in delivering essential healthcare. This paper aims to investigate whether the dental team-dentists and dental care professionals (DCPs)-can be effectively redeployed when the healthcare system is under pressure during national emergencies. This does not preclude the important issue that dentistry is an essential branch of the Provides dental, medical and wider healthcare systems with a clearer understanding of the medical competencies gained by the dental team during undergraduate and specialist training. Shows the commonality between dental and medical education curricula. Utilising the dental team during crises has the advantage of the presence of medical and dental competencies with added benefits of administration, finance and leadership skills.
Dental caries remains a challenge in the improvement of oral health. It is the most common and wi... more Dental caries remains a challenge in the improvement of oral health. It is the most common and widespread biofilm-dependent oral disease, resulting in the destruction of tooth structure by the acidic attack from cariogenic bacteria. The tooth is a heavily mineralised tissue, and both enamel and dentine can undergo demineralisation due to trauma or dietary conditions. The adult population worldwide affected by dental caries is enormous and despite significant advances in caries prevention and tooth restoration, treatments continue to pose a substantial burden to healthcare. Biomaterials play a vital role in the restoration of the diseased or damaged tooth structure and, despite providing reasonable outcomes, there are some concerns with clinical performance. Amalgam, the silver grey biomaterial that has been widely used as a restorative material in dentistry, is currently in throes of being phased out, especially with the Minimata convention and treaty being signed by a number of cou...
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Papers by Simran Chana