The aim of this study was to identify factors that affect the dental service delivery in a dental clinic from the context of Papua New Guinean dental providers and to make practical recommendations to improve dental service delivery. This qualitative descriptive study used individual interviews with seven dental providers to identify the factors that were affecting quality dental service delivery in a dental clinic in Papua New Guinea. The factors influencing the quality of dental service fell into three categories and 8 themes. The categories were environmental factors with themes of resources and facilities, leadership and management, partnership development and collaboration; provider-related factors with themes provider competence, provider motivation and satisfaction; and required measures with the themes of a new dental clinic building, renovation of the main clinic area and organizational structure. Quality dental service is achieved when there is a supportive working environment with availability of (new) physical amenities and dental resources, and proper management and organizational structures with supportive visionary leadership. This would encourage teamwork and partnership development internally within the dental team and externally with its stakeholders. Furthermore, it would increase staff motivation and satisfaction internally and partnership development internally within the dental staff and externally with its stakeholders. Consider creating a new dental clinic. Develop a contract between the University and the Hospital to resolve the property ownership issues. Create a clear organizational structure and improve management interaction with clinical staff so that management is supportive. Improve the quality of dental supplies and create an efficient material ordering system. Ensure fairness to staff and respect to procedures are compliantly maintained to encourage teamwork. Reward clinical staff for mentoring and teaching dental students. Create access to continuing professional development for the clinical staff.

BACKGROUND: Bendamustine was approved in China on May 26th, 2019 by the National Medical Product Administration for the treatment of indolent B-cell non-Hodgkin lymphoma (NHL). The current study was the registration trial and the first reported evaluation of the efficacy, safety, and pharmacokinetics of bendamustine in Chinese adult patients with indolent B-cell NHL following relapse after chemotherapy and rituximab treatment. METHODS: This was a prospective, multicenter, open-label, single-arm, phase 3 study (NCT01596621; C18083/3076) with a 2-year follow-up period. Eligible patients received bendamustine hydrochloride 120 mg/m2 infused intravenously on days 1 and 2 of each 21-day treatment cycle for at least six planned cycles (and up to eight cycles). The primary endpoint was the overall response rate (ORR); and secondary endpoints were duration of response (DoR), progression-free survival (PFS), safety, and pharmacokinetics. Patients were classified according to their best overall response after initiation of therapy. Proportions of patients in each response category (complete response [CR], partial response [PR], stable disease, or progressive disease) were summarized along with a two-sided binomial exact 95% confidence intervals (CIs) for the ORR. RESULTS: A total of 102 patients were enrolled from 20 centers between August 6th, 2012, and June 18th, 2015. At the time of the primary analysis, the ORR was 73% (95% CI: 63%-81%) per Independent Review Committee (IRC) including 19% CR and 54% PR. With the follow-up period, the median DoR was 16.2 months by IRC and 13.4 months by investigator assessment; the median PFS was 18.6 months and 15.3 months, respectively. The most common non-hematologic adverse events (AEs) were gastrointestinal toxicity, pyrexia, and rash. Grade 3/4 neutropenia was reported in 76% of patients. Serious AEs were reported in 29 patients and five patients died during the study. Pharmacokinetic analysis indicated that the characteristics of bendamustine and its metabolites M3 and M4 were generally consistent with those reported for other ethnicities. CONCLUSION: Bendamustine is an active and effective therapy in Chinese patients with relapsed, indolent B-cell NHL, with a comparable risk/benefit relationship to that reported in North American patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, No. NCT01596621; https://clinicaltrials.gov/ct2/show/NCT01596621.
Adult ; Antineoplastic Combined Chemotherapy Protocols ; Bendamustine Hydrochloride/therapeutic use* ; China ; Humans ; Lymphoma, Non-Hodgkin/drug therapy* ; Neoplasm Recurrence, Local/drug therapy* ; Prospective Studies ; Rituximab/therapeutic use*