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Funder: Victorian Cancer Agency, Funder: NIHR Manchester Biomedical Research Centre, Funder: Cancer Research UK, Funder: Cancer Council Tasmania, Funder: Instituto de Salud Carlos III, Funder: Cancer Australia, Funder: NIHR Oxford Biomedical Research Centre, Funder: Fundación Científica de la Asociación Española Contra el Cáncer, Funder: Cancer Council South Australia, Funder: Swedish Cancer Society, Funder: NIHR Cambridge Biomedical Research Centre, Funder: Institut Català de la Salut, Funder: Cancer Council Victoria, Funder: Prostate Cancer Foundation of Australia, Funder: National Institutes of Health, BACKGROUND: Lynch syndrome is a rare familial cancer syndrome caused by pathogenic variants in the mismatch repair genes MLH1, MSH2, MSH6, or PMS2, that cause predisposition to various cancers, predominantly colorectal and endometrial cancer. Data are emerging that pathogenic variants in mismatch repair genes increase the risk of early-onset aggressive prostate cancer. The IMPACT study is prospectively assessing prostate-specific antigen (PSA) screening in men with germline mismatch repair pathogenic variants. Here, we report the usefulness of PSA screening, prostate cancer incidence, and tumour characteristics after the first screening round in men with and without these germline pathogenic variants. METHODS: The IMPACT study is an international, prospective study. Men aged 40-69 years without a previous prostate cancer diagnosis and with a known germline pathogenic variant in the MLH1, MSH2, or MSH6 gene, and age-matched male controls who tested negative for a familial pathogenic variant in these genes were recruited from 34 genetic and urology clinics in eight countries, and underwent a baseline PSA screening. Men who had a PSA level higher than 3·0 ng/mL were offered a transrectal, ultrasound-guided, prostate biopsy and a histopathological analysis was done. All participants are undergoing a minimum of 5 years' annual screening. The primary endpoint was to determine the incidence, stage, and pathology of screening-detected prostate cancer in carriers of pathogenic variants compared with non-carrier controls. We used Fisher's exact test to compare the number of cases, cancer incidence, and positive predictive values of the PSA cutoff and biopsy between carriers and non-carriers and the differences between disease types (ie, cancer vs no cancer, clinically significant cancer vs no cancer). We assessed screening outcomes and tumour characteristics by pathogenic variant status. Here we present results from the first round of PSA screening in the IMPACT study. This study is registered with ClinicalTrials.gov, NCT00261456, and is now closed to accrual. FINDINGS: Between Sept 28, 2012, and March 1, 2020, 828 men were recruited (644 carriers of mismatch repair pathogenic variants [204 carriers of MLH1, 305 carriers of MSH2, and 135 carriers of MSH6] and 184 non-carrier controls [65 non-carriers of MLH1, 76 non-carriers of MSH2, and 43 non-carriers of MSH6]), and in order to boost the sample size for the non-carrier control groups, we randomly selected 134 non-carriers from the BRCA1 and BRCA2 cohort of the IMPACT study, who were included in all three non-carrier cohorts. Men were predominantly of European ancestry (899 [93%] of 953 with available data), with a mean age of 52·8 years (SD 8·3). Within the first screening round, 56 (6%) men had a PSA concentration of more than 3·0 ng/mL and 35 (4%) biopsies were done. The overall incidence of prostate cancer was 1·9% (18 of 962; 95% CI 1·1-2·9). The incidence among MSH2 carriers was 4·3% (13 of 305; 95% CI 2·3-7·2), MSH2 non-carrier controls was 0·5% (one of 210; 0·0-2·6), MSH6 carriers was 3·0% (four of 135; 0·8-7·4), and none were detected among the MLH1 carriers, MLH1 non-carrier controls, and MSH6 non-carrier controls. Prostate cancer incidence, using a PSA threshold of higher than 3·0 ng/mL, was higher in MSH2 carriers than in MSH2 non-carrier controls (4·3% vs 0·5%; p=0·011) and MSH6 carriers than MSH6 non-carrier controls (3·0% vs 0%; p=0·034). The overall positive predictive value of biopsy using a PSA threshold of 3·0 ng/mL was 51·4% (95% CI 34·0-68·6), and the overall positive predictive value of a PSA threshold of 3·0 ng/mL was 32·1% (20·3-46·0). INTERPRETATION: After the first screening round, carriers of MSH2 and MSH6 pathogenic variants had a higher incidence of prostate cancer compared with age-matched non-carrier controls. These findings support the use of targeted PSA screening in these men to identify those with clinically significant prostate cancer. Further annual screening rounds will need to confirm these findings. FUNDING: Cancer Research UK, The Ronald and Rita McAulay Foundation, the National Institute for Health Research support to Biomedical Research Centres (The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Oxford; Manchester and the Cambridge Clinical Research Centre), Mr and Mrs Jack Baker, the Cancer Council of Tasmania, Cancer Australia, Prostate Cancer Foundation of Australia, Cancer Council of Victoria, Cancer Council of South Australia, the Victorian Cancer Agency, Cancer Australia, Prostate Cancer Foundation of Australia, Asociación Española Contra el Cáncer (AECC), the Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional (FEDER), the Institut Català de la Salut, Autonomous Government of Catalonia, Fundação para a Ciência e a Tecnologia, National Institutes of Health National Cancer Institute, Swedish Cancer Society, General Hospital in Malmö Foundation for Combating Cancer.

Objective To investigate factors that might influence inappropriate prescriptions of antibiotics (ABs) by UK-based general dental practitioners (GDPs) in their management of acute dental pain in adults in primary dental care. Methods A questionnaire was circulated via social media to UK-based GDPs. The questionnaire examined GDPs' likelihood of issuing an inappropriate AB in two hypothetical clinical scenarios. Results A total of 205 questionnaires were completed, of which 198 were included for analysis. The resulting data were analysed to try and identify factors that correlated with an increased likelihood of an inappropriate AB prescription being issued for each clinical scenario. The results suggested the following factors as being associated with a statistically greater chance of the survey respondent issuing an inappropriate AB prescription: no postgraduate qualification; received their primary dental qualification from a non-UK university; scheduled appointments of less than 20 minutes; and low confidence in their ability to provide adequate local anaesthesia for the patients in the clinical scenario. Conclusions Four factors were shown to be associated with dentists' stated intention to prescribe ABs for acute dental pain, not in accordance with guidance. These results should guide further research to understand the significance of appropriate AB prescribing on the quality of urgent dental care. While the total number of respondents was too low to enable the results to be generalised, it is hoped that the results may help guide future research. Further studies could focus on these factors to understand more about their impact on the urgent care of adult patients in pain. The impact of the restrictions caused by the response to COVID-19 needs to be considered., Key points Investigates the factors that might influence the inappropriate use of antibiotics in the management of acute dental pain before the COVID-19 pandemic. Involves an online questionnaire-based survey of UK-based GDPs. The survey collected data relating to the likelihood of antibiotics being used in two clinical scenarios.

Aims To investigate the reported use of rubber dam isolation by UK general dental practitioners (GDPs), utilising an internet-mediated (SurveyMonkey) questionnaire reporting the demographic profile of respondents and the attitudes and factors influencing rubber dam use.Methods A piloted questionnaire was distributed to a random sample of GDPs in a private Facebook group, investigating respondent demographics, clinical applications, and attitudes towards and factors influencing rubber dam use. The data were analysed using descriptive statistics along with chi-squared and pairwise Mann-Whitney U tests.Results The response rate was 61%, with 403 valid completed questionnaires. Of these, 218 (54%) were female and 185 (46%) were male, with an age range of 23-72 years. Most of them (248; 62%) worked in mixed practices. The majority agreed that rubber dam aids placement of posterior restorations (311; 78%), provides clearer access (308; 76%), enables a higher clinical standard (355; 89%) and increases restoration longevity (257; 65%). Most agreed that proper isolation for root canal/operative procedures cannot be achieved without rubber dam use (329; 82%). Respondents disagreed with the following statements: root canal therapy completed without rubber dam isolation is as successful as those completed using rubber dam (338; 85%), rubber dam is difficult to apply (292; 73%) and rubber dam is disliked by patients (257; 64%). Respondents agreed that rubber dam use is influenced by clinical setting (259; 64%), procedure (390; 97%), choice of material being placed (382; 95%) and ease of application (337; 84%). Furthermore, 218 (54%) of the respondents expressed an interest in further training in rubber dam use.Conclusions This study provides greater insight into the attitudes and factors influencing rubber dam use, while demonstrating an interest in further training.

Aims To investigate the reported clinical applications of rubber dam isolation by UK general dental practitioners (GDPs) using an internet-mediated approach. Methods The data were collected in 2019, using an online (SurveyMonkey) questionnaire that was distributed to GDPs in a private group on Facebook. The percentages are based on the number of respondents who answered each question. Results The response rate was 61% with 403 valid completed questionnaires. The majority (395; 98%) of respondents reported using rubber dam in clinical practice. Undergraduate training in rubber dam use was received by 382 (98%) respondents, with greater training reported by younger, more recently qualified graduates. The main clinical applications of rubber dam included its use for composite restorations, endodontic treatments and internal bleaching procedures, while for other clinical procedures, the majority of respondents did not use rubber dam. For posterior and anterior composites, 332 (82%) and 298 (74%) respondents, respectively, reported using rubber dam isolation at least rarely. At least 98% (395) of the respondents used rubber dam for endodontic procedures, irrespective of tooth type and position. Over 70% (281) of respondents reported using rubber dam at least rarely for internal bleaching. Rubber dam was used by 99% (392) and 67% (262) of respondents on adults and paediatric patients, respectively. Conclusions The main clinical applications agree with previous reports, but highlight an increase in rubber dam use. This study investigated a wider range of clinical applications compared to previous studies, adding to the literature surrounding rubber dam use., Key points Part two of this study highlights the reported clinical applications of rubber dam by GDPs in the UK. This study identified an increased reported use of rubber dam by GDPs in the study population as well as an increased use with paediatric patients. The main clinical applications using rubber dam isolation included the provision of composite restorations, endodontic and internal bleaching treatments..

Irish Travellers are a minority group exposed to a range of social and health inequalities. Traveller men and women live 9.9 and 11.9 years less, respectively, than men and women in the general population. One of the major causes of death is cardiovascular disease (CVD). Information concerning CVD risk factor assessment in this population is lacking. Our pilot study assesses the point prevalence of diabetes, pre-diabetes and the metabolic syndrome in a sample population of Irish Travellers living along the Irish Atlantic seaboard. To date, 187 Travellers have completed the study. The prevalence of diabetes was found to be 2.7%, pre-diabetes 11.2 % and metabolic syndrome 40% compared with 4.3%, 6.4% and 21.0% respectively in the background population. Targeted screening for glucose abnormalities and traditional CVD risk factors is needed in this minority group. Appropriate culturally sensitive interventions to reduce CVD risk factors are expected to lower morbidity and increase life expectancy.