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Sadeq HS, Atwan AS, Alhilfi SR. Ensuring Adherence to 2023 National Institute of Excellence (Nice) Guidelines for CT Scans in Head Injury Cases in a Teaching Hospital in Basra, Iraq: A Clinical Audit. Cureus 2024; 16:e67282. [PMID: 39165623 PMCID: PMC11334224 DOI: 10.7759/cureus.67282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 08/22/2024] Open
Abstract
Objective The objective of this audit was to find out whether brain CT scans performed on patients with head trauma in Basra Teaching Hospital (BTH) adhere to the 2023 National Institute of Excellence (NICE) guidance for head injury (NG232) and whether we can improve this with selected interventions. Methodology We performed a clinical audit in two cycles; in the first cycle, we collected data retrospectively over a month in February 2024. The data was sourced from the imaging request forms and patient records at BTH. We then analyzed the data and implemented four key interventions to improve the outcome. After that, we performed our second audit cycle over an additional 30-day period during April 2024. Results Cycle One involved 59 patients, while Cycle Two involved 46. There was a significant decrease in scans requested outside of the NICE guidance, from 59.3% in Cycle One to 17.4% in Cycle Two (p<0.05). We also noticed a significant increase in the one-hour indication scans, from 32% in Cycle One to 65.2% in Cycle Two (p<0.05). Conclusion Our study findings reveal that by following some simple interventions, we significantly improved the adherence of our emergency department to the 2023 NICE guidelines for head CT following head trauma.
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Affiliation(s)
- Hussein S Sadeq
- Department of Radiology, Basra Teaching Hospital, Basra, IRQ
| | - Ahmed S Atwan
- Department of Radiology, Basra Teaching Hospital, Basra, IRQ
| | - Sarmad R Alhilfi
- Department of Surgery, College of Medicine, University of Basra, Basra, IRQ
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2
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Lam XY, Ren J, Yeung AWK, Lin Y. The 100 Most-Cited Randomised Controlled Trials in Orthodontics: A Bibliometric Study. Int Dent J 2024; 74:868-875. [PMID: 38242809 PMCID: PMC11287139 DOI: 10.1016/j.identj.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION AND AIM Randomised controlled trials (RCTs) are recognised as the highest level of original evidence and provide essential evidence for dentists to practice evidence-based dentistry. By analysing the top 100 most-cited RCT reports in orthodontics, this study aimed to determine popular research topics, key authors, countries, journals, and their impacts. METHODS A comprehensive search was performed in the Web of Science (WoS) electronic database to identify the top 100 most-cited RCT reports in orthodontics. Publication and citation data were retrieved and further analysed and visualised using R Biblioshiny. The primary themes of the 100 articles were also determined. Additionally, the correlation between number of years since publication and citation counts was examined. RESULTS The top 100 most-cited RCT reports were published between 1992 and 2018, contributed by 419 authors across 22 journals, with an average citation count of 93.48. The US led with the highest number of publications (28) and citations (2552), followed by the UK (22 and 2061) and Australia (8 and 912). Notably, 20 of the top 24 authors with at least 4 publications are from the UK. The primary focus areas of the articles included early Class II treatment (n = 14), obstructive sleep apnoea (n = 14), demineralisation (n = 12), and pain and quality of life (n = 12). Besides, a positive correlation was found between the number of years since publication and citation counts (P < .001). CONCLUSIONS The top 100 most-cited RCT reports in orthodontics encompass a wide range of topics with varying focus areas across different time periods. This analysis recognises the contributions of scholars and offers valuable insights into the research trends within the field of orthodontics.
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Affiliation(s)
- Xiang Yao Lam
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China
| | - Jianhan Ren
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China
| | - Andy Wai Kan Yeung
- Division of Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China
| | - Yifan Lin
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, China.
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Borgstrom E, Jordan J, Ledger US, Henry C. Small Steps, Big Vision: using multi-stage qualitative research to develop a grab-and-go guide to support utilisation of the Ambitions for Palliative and End of Life Care framework. BMC Palliat Care 2024; 23:151. [PMID: 38877509 PMCID: PMC11179334 DOI: 10.1186/s12904-024-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/22/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The Ambitions for Palliative and End of Life Care is a national framework for local action in England co-produced by over 30 partners; little research has been conducted on how the Framework is received and used. This study sought to examine and support how people understand, interpret, and implement the Framework. METHODS A multi-stage qualitative methodology involving four stages of data collection: (1) case study interviews, (2) focus groups, (3) interactive workshops, and (4) Evidence Cafés. From initial interviews, ongoing thematic data analysis informed the design and focus of subsequent stages as part of a process of knowledge transfer. RESULTS A practical resource to support service provision and development was produced; a grab-and-go guide called "Small Steps, Big Visions". It focuses on the eight foundations in the Ambitions Framework, with additional guidance on collaboration and partnership working, and sharing learning. Each foundation is presented with a 'what' (definition), 'ask' (prompt questions), and 'examples in action' (drawn from case studies). CONCLUSIONS Research can contribute to policy implementation to advance palliative and end of life care. The engagement and input of those responsible for implementation is key.
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Affiliation(s)
- Erica Borgstrom
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK.
| | - Joanne Jordan
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Una St Ledger
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Claire Henry
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
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Song JW, Frame MY, Sellers RT, Klahn C, Fitzgerald K, Pomponio B, Schnall MD, Kasner SE, Loevner LA. Implementation of a Clinical Vessel Wall MR Imaging Program at an Academic Medical Center. AJNR Am J Neuroradiol 2024; 45:554-561. [PMID: 38514091 PMCID: PMC11288535 DOI: 10.3174/ajnr.a8191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/12/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND PURPOSE The slow adoption of new advanced imaging techniques into clinical practice has been a long-standing challenge. Principles of implementation science and the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework were used to build a clinical vessel wall imaging program at an academic medical center. MATERIALS AND METHODS Six phases for implementing a clinical vessel wall MR imaging program were contextualized to the RE-AIM framework. Surveys were designed and distributed to MR imaging technologists and clinicians. Effectiveness was measured by surveying the perceived diagnostic value of vessel wall imaging among MR imaging technologists and clinicians, trends in case volumes in the clinical vessel wall imaging examination, and the number of coauthored vessel wall imaging-focused publications and abstracts. Adoption and implementation were measured by surveying stakeholders about workflow. Maintenance was measured by surveying MR imaging technologists on the value of teaching materials and online tip sheets. The Integration dimension was measured by the number of submitted research grants incorporating vessel wall imaging protocols. Feedback during the implementation phases and solicited through the survey is qualitatively summarized. Quantitative results are reported using descriptive statistics. RESULTS Six phases of the RE-AIM framework focused on the following: 1) determining patient and disease representation, 2) matching resource availability and patient access, 3) establishing vessel MR wall imaging (VWI) expertise, 4) forming interdisciplinary teams, 5) iteratively refining workflow, and 6) integrating for maintenance and scale. Survey response rates were 48.3% (MR imaging technologists) and 71.4% (clinicians). Survey results showed that 90% of the MR imaging technologists agreed that they understood how vessel wall MR imaging adds diagnostic value to patient care. Most clinicians (91.3%) reported that vessel wall MR imaging results changed their diagnostic confidence or patient management. Case volumes of clinical vessel wall MR imaging performed from 2019 to 2022 rose from 22 to 205 examinations. Workflow challenges reported by MR imaging technologists included protocoling examinations and scan length. Feedback from ordering clinicians included the need for education about VWI indications, limitations, and availability. During the 3-year implementation period of the program, the interdisciplinary teams coauthored 27 publications and abstracts and submitted 13 research grants. CONCLUSIONS Implementation of a clinical imaging program can be successful using the principles of the RE-AIM framework. Through iterative processes and the support of interdisciplinary teams, a vessel wall MR imaging program can be integrated through a dedicated clinical pipeline, add diagnostic value, support educational and research missions at an academic medical center, and become a center for excellence.
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Affiliation(s)
- Jae W Song
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Megan Y Frame
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rob T Sellers
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Connie Klahn
- Department of Radiology, (C.K.), Penn Presbyterian Hospital, Philadelphia, Pennsylvania
| | - Kevin Fitzgerald
- Department of Radiology (K.F.), Penn Radnor, Philadelphia, Pennsylvania
| | - Bridget Pomponio
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott E Kasner
- Department of Neurology (S.E.K.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurie A Loevner
- From the Department of Radiology (J.W.S., M.Y.F., R.T.S., B.P., M.D.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Alsoghier A, Ali K. Self-perceived preparedness of new dental graduates from a Middle Eastern university. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:559-566. [PMID: 38098132 DOI: 10.1111/eje.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/20/2023] [Accepted: 11/12/2023] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Preparedness for independent clinical practice is a core goal of undergraduate dental education. The aim of this study was to evaluate the self-reported preparedness for the dental practice among new dental graduates from a University in the Middle East. METHODS Following ethics approval, a purposive sampling techniques were used to invite newly qualified dental graduates at a Middle Eastern University. A validated research instrument, namely the Dental Undergraduate Preparedness Assessment Scale (DU-PAS), was used to evaluate the self-perceived preparedness of the participants. Data collection was undertaken online using Google Forms and data were analysed to compute the descriptive statistics, reliability and demographic differences among the participants. RESULTS A total of 82 participants provided their response yielding a response rate of 68%. The participants included 49 males and 33 females. The overall reliability of DU-PAS was excellent. (α = 0.93). The participants included less than 40% of participants were able independently to prescribe medications, assess orthodontics needs and perform endodontic treatment on multirooted teeth. In addition, more than 65% indicated low confidence in evaluating new dental materials and products, interpreting new research findings and behavioural management of children. CONCLUSION The present findings identified strengths and weaknesses of new dental graduates from a Middle Eastern university. The participants were confident in basic clinical skills but lower confidence was reported for complex dental procedures. The findings highlight the learning needs of new dental graduates and can serve to inform the undergraduate curriculum to enhance the preparedness of future cohorts of dental graduates.
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Affiliation(s)
| | - Kamran Ali
- College of Dental Medicine QU Health, Qatar University, Doha, Qatar
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Baig Z, Lawrence D, Ganhewa M, Cirillo N. Accuracy of Treatment Recommendations by Pragmatic Evidence Search and Artificial Intelligence: An Exploratory Study. Diagnostics (Basel) 2024; 14:527. [PMID: 38472998 DOI: 10.3390/diagnostics14050527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
There is extensive literature emerging in the field of dentistry with the aim to optimize clinical practice. Evidence-based guidelines (EBGs) are designed to collate diagnostic criteria and clinical treatment for a range of conditions based on high-quality evidence. Recently, advancements in Artificial Intelligence (AI) have instigated further queries into its applicability and integration into dentistry. Hence, the aim of this study was to develop a model that can be used to assess the accuracy of treatment recommendations for dental conditions generated by individual clinicians and the outcomes of AI outputs. For this pilot study, a Delphi panel of six experts led by CoTreat AI provided the definition and developed evidence-based recommendations for subgingival and supragingival calculus. For the rapid review-a pragmatic approach that aims to rapidly assess the evidence base using a systematic methodology-the Ovid Medline database was searched for subgingival and supragingival calculus. Studies were selected and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and this study complied with the minimum requirements for completing a restricted systematic review. Treatment recommendations were also searched for these same conditions in ChatGPT (version 3.5 and 4) and Bard (now Gemini). Adherence to the recommendations of the standard was assessed using qualitative content analysis and agreement scores for interrater reliability. Treatment recommendations by AI programs generally aligned with the current literature, with an agreement of up to 75%, although data sources were not provided by these tools, except for Bard. The clinician's rapid review results suggested several procedures that may increase the likelihood of overtreatment, as did GPT4. In terms of overall accuracy, GPT4 outperformed all other tools, including rapid review (Cohen's kappa 0.42 vs. 0.28). In summary, this study provides preliminary observations for the suitability of different evidence-generating methods to inform clinical dental practice.
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Affiliation(s)
- Zunaira Baig
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
| | | | | | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia
- CoTreat Pty Ltd., Melbourne, VIC 3000, Australia
- School of Dentistry, University of Jordan, Amman 11733, Jordan
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Al-Yaseen W, Nanjappa S, Jindal-Snape D, Innes N. New dental graduates transition into UK professional practice; a longitudinal study of changes in perceptions and behaviours through the lens of evidence-based dentistry. BMC MEDICAL EDUCATION 2024; 24:195. [PMID: 38408982 PMCID: PMC10895742 DOI: 10.1186/s12909-024-05182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND This longitudinal study using qualitative methodology aims to investigate the perceptions, and implementation, of evidence-based guidelines into practice among new dental graduates (NDGs) during their transition from university into professional practice, by identifying factors that influence the adoption of evidence-based practice (EBP) in dental practice. METHODS The study invited NDGs from one UK dental school (N = 66) and employed longitudinal, multiple qualitative methodologies for data collection, throughout the participants' Vocational Dental Training (VDT) year. Initial interviews (Interview 1) conducted upon graduation and follow-up interviews (Interview 2) carried out between six and nine months into professional practice were combined with participants longitudinal audio diaries (LADs) recorded between the interviews. THE STUDY RESULTS A total of 12 NDGs agreed to participate. For Interview 1, twelve participants were interviewed, seven of whom agreed to participate in Interview 2 and six recorded the LADs. Interview 1 exposed diverse views among NDGs about EBP, acknowledging its significance but facing obstacles in implementation due to time and financial constraints. They intended to use evidence selectively, often aligning with trainers' or NHS treatment options, while hesitating to fully embrace EBP in a busy dental practice. During VDT, LAD entries showed initial enthusiasm for EBP, but integrating evidence-based guidelines within the NHS system led to pragmatic treatment decisions, balancing gold-standard and cost-effective options. Over time, NDGs became more comfortable with alternative treatments, considering patients' financial constraints, yet they expressed frustration with external pressures limiting their clinical decision-making autonomy. In Interview 2, after six to nine months in practice, NDGs exhibited mixed attitudes towards EBP. Some actively used dental guidelines like SDCEP, others associated EBP with hi-tech or expensive materials, while others would thought to rely on colleagues' recommendations. None consistently sought direct evidence for treatment decisions. CONCLUSION NDGs' attitudes towards EBP changed and became more negative over their first year in professional practice, leading to challenges in their applying it. It questions the assumption that teaching EBP during undergraduate education ensures its implementation. Further understanding the influences on the development of attitudinal challenges will help to devise effective strategies for fostering lifelong learning and supporting evidence-based practice in dentistry.
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Affiliation(s)
- Waraf Al-Yaseen
- School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Heath Park, CF14 4XY, Cardiff, UK.
| | - Sucharita Nanjappa
- School of Dentistry, University of Dundee, Park Place, DD1 4HR, Dundee, UK
| | - Divya Jindal-Snape
- School of Humanities, Social Sciences and Law, University of Dundee, Old Medical School, DD1 4HN, Dundee, UK
| | - Nicola Innes
- School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Heath Park, CF14 4XY, Cardiff, UK
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Chitha N, Ntsele N, Mabunda SA, Funani I, Swartbooi B, Mnyaka O, Thabede J, Tshabalala R, Pulido-Estrada GA, Nomatshila S, Chitha W. Exploring the Information Sources Consulted by Doctors at the Point of Care in Four Selected South African Referral Hospitals. Healthcare (Basel) 2023; 12:8. [PMID: 38200915 PMCID: PMC10778943 DOI: 10.3390/healthcare12010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To provide an understanding of the clinical information sources consulted by teaching or referral hospital-based doctors in four South African provinces. METHODS A quantitative cross-sectional survey design was used. To identify provinces, hospitals, and participants, simple random sampling was adopted. This study targeted a total of 276 doctors from all the four hospitals working across different departments within the hospitals. This study was conducted in four selected South African public referral/teaching hospitals in four different provinces, namely Nelson Mandela Academic Hospital in the Eastern Cape province; Witbank Hospital in Mpumalanga province; Robert Mangaliso Sobukwe Hospital in Northern Cape province and lastly, Pietersburg Hospital in Limpopo province. RESULTS Overall, 221 doctors were surveyed. Doctors relied more on colleagues as formal and informal sources of information. They seldomly relied on newspapers, reference, and library books, or used hospital computers to access the internet. They seldomly attended training workshops organised by the district or provincial office. Protocols and clinical guidelines which are kept in the hospitals and easily accessible were often (27.9%) or always (51.1%) used. CONCLUSIONS Teaching hospitals need to strengthen information resources to ensure that even when colleagues are used as an information source, they are an accessible means to validate the correctness of the information provided.
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Affiliation(s)
- Nombulelo Chitha
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | - Nkanyiso Ntsele
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | - Sikhumbuzo A. Mabunda
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - Itumeleng Funani
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | - Buyiswa Swartbooi
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | - Onke Mnyaka
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | - Jahman Thabede
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | - Ruth Tshabalala
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
| | | | - Sibusiso Nomatshila
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Wezile Chitha
- Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg 2050, South Africa (B.S.); (O.M.); (J.T.)
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
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Molena KF, Prado VDO, Paulo AC, Dantas RVF, Curi Júnior A, Pedroso GL, Furtado TCS, Flores-Mir C, Sanglard LF, Feres MFN. Knowledge changes after applying evidence-based dentistry educational interventions to dental students: A systematic review. J Dent Educ 2023; 87:1321-1369. [PMID: 37414522 DOI: 10.1002/jdd.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To critically evaluate the evidence on knowledge changes observed after the application of evidence-based dentistry (EBD) educational interventions to dental students. METHODS We included studies that assessed EBD knowledge after applying educational interventions to undergraduates. Studies that evaluated post-graduate students or professionals, that exclusively described educational interventions, programs, or the application of curriculum revisions were excluded. Electronic databases (PubMed, Embase, Scopus, and Web of Science), unpublished gray literature, and manual searches were performed. Data concerning "perceived" and "actual knowledge" was extracted. The quality of the studies was appraised according to the Mixed Methods Appraisal Tool. RESULTS The 21 selected studies enrolled students at different stages, and the intervention formats were diverse. The educational interventions could be categorized into three modalities, that is, regular, EBD-focused disciplines or courses, and other educational interventions including one or more of the EBD principles, methods, and/or practices. Despite the format, knowledge was generally improved after the implementation of educational interventions. Overall, perceived and actual levels of knowledge increased considering EBD general concepts, principles, and/or practices, and concerning the "acquire" and "appraise" skills. Among the selected studies, two were randomized controlled trials, while most were non-randomized or descriptive studies. CONCLUSIONS EBD-related educational interventions seem to improve dental students' perceived and actual knowledge, according to literature with a high risk of bias. Therefore, more complete, methodologically rigorous, and longer-term studies are still recommended to confirm and expand the current knowledge.
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Affiliation(s)
- Kelly Fernanda Molena
- Department of Pediatric Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Viviane de Oliveira Prado
- Department of Pediatric Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Alana Cândido Paulo
- Department of Pediatric Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Airton Curi Júnior
- Department of Pediatric Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Gabriela Leite Pedroso
- Department of Pediatric Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Taissa Cassia Souza Furtado
- Department of Pediatric Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Carlos Flores-Mir
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Luciana Faria Sanglard
- Department of Clinical Dentistry, School of Dentistry, Federal University of Espirito Santo, Vitoria, Brazil
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Abt E, Weyant RJ, Frantsve-Hawley J, Carrasco-Labra A. The potential harm of not following clinical practice guideline recommendations. J Am Dent Assoc 2023:S0002-8177(23)00276-3. [PMID: 37367711 DOI: 10.1016/j.adaj.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) provide recommendations for clinicians on the basis of best evidence. CPGs are often not followed because of numerous barriers, including lack of awareness, inability to understand recommendations, and problems with implementation. CASE DESCRIPTION A case report is presented in which treatment of a patient's incipient caries lesions may not have followed a CPG available to practitioners, recommending conservative nonrestorative medical interventions. The resulting treatment led to pain and the need for endodontic therapy and full-coverage restoration. PRACTICAL IMPLICATIONS This case represents possible mismanagement leading to undue pain and additional costs that could have been avoided by being aware of, and following, the recommendations from CPGs.
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Randall CL. Dissemination and implementation research for oral and craniofacial health: Background, a review of literature and future directions. Community Dent Oral Epidemiol 2023; 51:119-132. [PMID: 36744988 PMCID: PMC10364974 DOI: 10.1111/cdoe.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 02/07/2023]
Abstract
Oral conditions are highly prevalent globally and have profound consequence on individuals and communities. Clinical (e.g. dental treatments, behavioural counselling) and non-clinical (e.g. community-based programming, water fluoridation, oral health policy) evidence-based interventions have been identified, recommended and applied at the clinic, community and policy levels. Still, the burden of oral conditions persists, with inequitable distribution across populations. A major driver of this lack of progress is poor translation of research findings, which results in an evidence-to-practice gap. Dissemination and implementation science (DIS) has emerged to address this gap. A relatively new field, application of DIS represents an important avenue for achieving good dental, oral and craniofacial health for all. The goal of this introductory article is to provide a brief background on DIS relevant to researchers in dentistry and oral health. The problem of knowledge translation, basic concepts and terminology in DIS, and approaches to doing dissemination and implementation research-including implementation strategies, key outcomes, and implementation theories, models and frameworks-are discussed. Additionally, the article reviews literature applying DIS to dentistry and oral health. Results of published studies and their implications for the field are presented. Drawing on the literature review and contemporary thinking in DIS, current gaps, opportunities and future directions are discussed. Resources for understanding and applying DIS are provided throughout. This article serves as a primer on DIS for dental and oral health researchers of all types working across a range of contexts; it also serves as a call to action for increased application of DIS to address the burden of oral conditions globally.
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Affiliation(s)
- Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
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Rath A, Wong Li Zheng M, Hesarghatta Ramamurthy P, Sidhu P, Pannuti CM, Fernandes B, Termizi Bin Zamzuri A. Evidence-based dentistry: Knowledge, Practice, Confidence and Attitude amongst Malaysian dental undergraduate students: A Multi-institutional study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:9-18. [PMID: 35023265 DOI: 10.1111/eje.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/19/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Evidence-based dental practice provides patient-centred, compatible and efficient interventions and forms the basis for health profession education. So far, there is a paucity of data about Malaysian undergraduate dental education and the role of evidence-based dentistry in it. The current research aimed to study the level of knowledge, attitude, practice and confidence of dental undergraduate students in Malaysia towards evidence-based dental practice. METHODS This cross-sectional study included final-year undergraduate dental students (N = 645) who completed a pre-tested self-administered questionnaire that analysed the domains of perceived knowledge, practice, critical appraisal and attitude towards evidence-based dentistry. We further explored the association between these domains with the type of curriculum, sex, prior research experience and EBD training. RESULTS A total of (n = 526) students participated (response rate of 81.55%). About 92% knew about evidence-based dentistry. Whilst 58% had undergone formal training in evidence-based dentistry, 90% of the respondents showed an overall positive attitude towards evidence-based dentistry. However, only 45% of them practised it most of the time. Schools with an integrated curriculum showed more willingness and practised evidence-based dentistry more frequently (p < 0.001). More than 50% of the participants rated their confidence in appraisal as moderate. CONCLUSION Our findings revealed that Malaysian dental undergraduate students who are well aware of evidence-based dentistry displayed a positive attitude towards it. The type of dental curriculum had a significant association with practice and attitude towards evidence-based dental knowledge and practice.
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Affiliation(s)
- Avita Rath
- Faculty of Dentistry, SEGi University, Selangor, Malaysia
| | | | | | - Preena Sidhu
- Faculty of Dentistry, IMU University, Kuala Lumpur, Malaysia
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Asgari I, Farahmand H, Ahmady A, Zahed M. Attitude of dental students toward evidence-based dentistry in Iran: A systematic review. Dent Res J (Isfahan) 2023; 20:30. [PMID: 36960014 PMCID: PMC10028577 DOI: 10.4103/1735-3327.369632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 09/19/2022] [Accepted: 12/19/2022] [Indexed: 03/25/2023] Open
Abstract
Background Dentistry practice has become more complex and challenging in the recent years. The clinical decision-making process has experienced many problems due to changing socioeconomic patterns, knowledgeable patients, rapid technological advances, and information explosion. The present study reviewed the status of the attitude toward evidence-based dentistry (EBD) among dental students of Iran Universities. The effect of the educational intervention was also assessed. Materials and Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. Search strategy was developed by Medical Subject Headings terms and keywords surfing electronic available databases including Medline/PubMed and Google Scholar and local databases such as Scientific Information Database (SID) and Magiran. Two reviewers read the abstracts of all eligible papers and excluded the duplicates. They extracted the information of the full-text of the studies included in the review and assessed the quality by Joanna Briggs Institute critical appraisal checklist. Results Ten studies including 8 cross-sectional and 2 interventional studies met the criteria. The assessment of the attitude of 937 dental students from a different region of the country toward EBD showed moderate to acceptable status using 3 different tools. In regard to educational interventions, 2 studies were successful to improve their attitude. Conclusion Although the researchers presented good scores on the attitude questionnaires, the quality of the study tools, the eligible criteria for recruiting the participants and the method of evaluating the construct of attitude should be investigated in future studies.
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Affiliation(s)
- Imaneh Asgari
- Department of Oral Public Health, Dental Material Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
| | - Hanieh Farahmand
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ahmady
- Department of Oral Public Health, Student Research Committee, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
| | - Maryam Zahed
- Department of Oral and Maxillofacial Medicine, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Address for correspondence: Dr. Maryam Zahed, Department of Oral and Maxillofacial Medicine, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail:
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van der Windt M, Schoenmakers S, van der Kleij RM, van Rossem L, Steegers-Theunissen RP. Implementation of effective blended periconception lifestyle care in a tertiary hospital in the Netherlands: a cross-sectional study on determinants and patient satisfaction. BMJ Open 2022; 12:e061088. [PMID: 36523223 PMCID: PMC9748931 DOI: 10.1136/bmjopen-2022-061088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify implementation determinants of blended periconception lifestyle care, and to evaluate patient satisfaction. DESIGN Cross-sectional study. SETTING The outpatient clinic of the department of Obstetrics and Gynaecology of the Erasmus MC. PARTICIPANTS Implementation part: counsellors providing blended periconception lifestyle care. Patient satisfaction part: women who received blended periconception lifestyle care. METHODS Blended periconception lifestyle care, including face-to-face counselling and 26 weeks of lifestyle coaching via the online platform 'Smarter Pregnancy', was implemented between June-December 2018. The Measurement Instrument for Determinants of Innovations questionnaire was used as input for the consolidated framework for implementation research to assess determinants of implementation. To evaluate patient satisfaction, patients receiving lifestyle care filled out an evaluation questionnaire, including questions on the needs for lifestyle counselling, information provision during counselling, and motivation and lifestyle change after counselling. PRIMARY AND SECONDARY OUTCOME MEASURES Identification of implementation determinants and the level of patient satisfaction. RESULTS Facilitators were reported in the implementation domains 'characteristics of the intervention' and 'characteristics of the individuals'. Barriers were in the implementation domains 'inner setting' and 'implementation process'. Regarding patient satisfaction on nutrition counselling, 31% of the respondents wanted information prior to the counselling session, 22% received new information after consultation, 51% got motivated to change and 40% changed their nutritional behaviour. CONCLUSIONS A considerable number of patients improved lifestyle after counselling, although, a relatively small number wanted lifestyle counselling prior to consultation.This study underlines the importance of implementation science and the information it provides for improving the implementation process.
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Affiliation(s)
- Melissa van der Windt
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Rianne Mjj van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lenie van Rossem
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Régine Pm Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
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Feres MFN, Ruiz-Rodrigues L, Prado VDO, Vicioni-Marques F, Feres M, Nelson-Filho P, Flores-Mir C. Dentists' attitudes and practices toward evidence-based dentistry: a systematic review. JBI Evid Implement 2022; 22:02205615-990000000-00019. [PMID: 36378117 DOI: 10.1097/xeb.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS Considering that attitudes toward evidence-based dentistry (EBD) may predict implementation behaviors, the objective of this systematic review was to synthesize and evaluate the existing evidence related to dentists' attitudes and practices toward EBD. METHODS We included primary studies that collected information from interviews, questionnaires, or conversation sessions with dentists. The following sources were searched: Cochrane Central Register of Controlled Trials, Embase, PubMed, Scopus, and Web of Science, in addition to gray literature. The included studies were appraised according to the assessment tools recommended by the Joanna Briggs Institute for qualitative and quantitative observational studies. Descriptive data were collected in standardized tables and descriptively synthesized. RESULTS The selection process resulted in 36 included studies. Dentists share positive opinions about EBD and predominantly report willingness to learn or adopt these practices. Despite high methodological risks and significant heterogeneity, the results collected in this review indicated that scientific journals, clinical practice guidelines, and trusted colleagues are generally perceived as influential and useful by dentists, who highly consulted these information sources. CONCLUSION Despite supportive reported attitudes toward EBD, very low certainty exists about actual EBD-related practices.
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Affiliation(s)
| | - Larissa Ruiz-Rodrigues
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Viviane de Oliveira Prado
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fernanda Vicioni-Marques
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
- The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Frantsve-Hawley J, Abt E, Carrasco-Labra A, Dawson T, Michaels M, Pahlke S, Rindal DB, Spallek H, Weyant RJ. Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice. J Am Dent Assoc 2022; 153:1041-1052. [PMID: 36127176 DOI: 10.1016/j.adaj.2022.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice. RESULTS This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines). PRACTICAL IMPLICATIONS Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.
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kadri G, Enejjari Z, Bouziane A. Knowledge, attitudes and practices towards Evidence-Based-Dentistry regarding dental practitioner: A cross-sectional study. Ann Med Surg (Lond) 2022; 81:104289. [PMID: 36147137 PMCID: PMC9486421 DOI: 10.1016/j.amsu.2022.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Dental practice experienced two important evolutions: the development of the concept of evidence-based dentistry (EBD) and the changes in the relationship between dentists and patients. Thus, the practitioner is invited nowadays to give a treatment that reflects the best available evidence. The purpose of this study is to explore knowledge, attitudes, and practices of dentists toward the concept of EBD. Methods This is a cross sectional study that was conducted among dentists in public and private sector in Morocco. A self-administered questionnaire with 27 questions was delivered to practitioners. The comparison was carried out using the Khi2 test or Fisher's exact test, t-test or the Mann-Whitney. Logistic regression was performed to assess factors associated with the application of EBD. Linear regression was also performed to identify factors that impact knowledge, attitude and practice score. Results A total of 209 responses was received. 58% of the participants were in the private sector, and 32.7% were academics. The main reported obstacles were the lack of time 44% and lack of training on critical appraisal 60.3%. Knowledge of PICO question formulation and previous EBD training was significantly related to the implementation of EBD in multivariate analysis in logistic regression (OR = 8.163- CI95%: 2.095–31.80 and OR = 12.79- CI95%: 2.868–57 respectively). The total score of surveyed dentists was affected by the knowledge of PICO question formulation and the knowledge of relevant information sources (PubMed/Medline, the Cochrane library) (β = 3.04- CI95%: 0.411–5.66, β = 6.29- CI95%: 2.92–9.66 and β = 8.35- CI95%: 5.89–10.81 respectively). Conclusion Based on the findings of this study, application of EBD was associated with knowledge of PICO question formulation and previous EBD training. The lack of time was the most common obstacles identified by the participants applying EBD. Therefore, EBD educational programs should be developed for dental practitioners to enhance their knowledge and skills. Application of EBD was associated with knowledge of PICO question formulation, previous EBD training and the knowledge of relevant information sources (PubMed/Medline and the Cochrane library). The lack of time was the most common obstacles identified by the participants applying EBD. EBD educational programs should be developed for dental practitioners to enhance their knowledge and skills.
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Affiliation(s)
- Ghita kadri
- Department of Periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, Morocco
- Corresponding author. Department of periodontology, BP 6212, Madinat Al Irfane, Rabat, Morocco.
| | - Zahra Enejjari
- Faculty of Dental Medicine, Mohammed V University in Rabat, Morocco
| | - Amal Bouziane
- Department of Periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, Morocco
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Mohammed V University in Rabat, Morocco
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Craniofacial Sleep Medicine: The Important Role of Dental Providers in Detecting and Treating Sleep Disordered Breathing in Children. CHILDREN 2022; 9:children9071057. [PMID: 35884041 PMCID: PMC9323037 DOI: 10.3390/children9071057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.
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Finkelstein S, Kanee L, Behroozian T, Wolf JR, van den Hurk C, Chow E, Bonomo P. Comparison of clinical practice guidelines on radiation dermatitis: a narrative review. Support Care Cancer 2022. [PMID: 35067732 DOI: 10.1007/s00-022-06829-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10 years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). METHODS Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. RESULTS Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. CONCLUSIONS Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.
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Affiliation(s)
| | | | | | | | | | - Edward Chow
- University of Toronto, Toronto, ON, Canada.
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Comparison of clinical practice guidelines on radiation dermatitis: a narrative review. Support Care Cancer 2022; 30:4663-4674. [PMID: 35067732 DOI: 10.1007/s00520-022-06829-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10 years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). METHODS Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. RESULTS Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. CONCLUSIONS Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.
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Bangar S, Neumann A, White JM, Yansane A, Johnson TR, Olson GW, Kumar SV, Kookal KK, Kim A, Obadan-Udoh E, Mertz E, Simmons K, Mullins J, Brandon R, Walji MF, Kalenderian E. Caries Risk Documentation And Prevention: eMeasures For Dental Electronic Health Records. Appl Clin Inform 2022; 13:80-90. [PMID: 35045582 PMCID: PMC8769809 DOI: 10.1055/s-0041-1740920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Longitudinal patient level data available in the electronic health record (EHR) allows for the development, implementation, and validations of dental quality measures (eMeasures). OBJECTIVE We report the feasibility and validity of implementing two eMeasures. The eMeasures determined the proportion of patients receiving a caries risk assessment (eCRA) and corresponding appropriate risk-based preventative treatments for patients at elevated risk of caries (appropriateness of care [eAoC]) in two academic institutions and one accountable care organization, in the 2019 reporting year. METHODS Both eMeasures define the numerator and denominator beginning at the patient level, populations' specifications, and validated the automated queries. For eCRA, patients who completed a comprehensive or periodic oral evaluation formed the denominator, and patients of any age who received a CRA formed the numerator. The eAoC evaluated the proportion of patients at elevated caries risk who received the corresponding appropriate risk-based preventative treatments. RESULTS EHR automated queries identified in three sites 269,536 patients who met the inclusion criteria for receiving a CRA. The overall proportion of patients who received a CRA was 94.4% (eCRA). In eAoC, patients at elevated caries risk levels (moderate, high, or extreme) received fluoride preventive treatment ranging from 56 to 93.8%. For patients at high and extreme risk, antimicrobials were prescribed more frequently site 3 (80.6%) than sites 2 (16.7%) and 1 (2.9%). CONCLUSION Patient-level data available in the EHRs can be used to implement process-of-care dental eCRA and AoC, eAoC measures identify gaps in clinical practice. EHR-based measures can be useful in improving delivery of evidence-based preventative treatments to reduce risk, prevent tooth decay, and improve oral health.
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Affiliation(s)
- Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Ana Neumann
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Todd R. Johnson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Gregory W. Olson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Shwetha V. Kumar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Krishna K. Kookal
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Aram Kim
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
| | - Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Elizabeth Mertz
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | | | - Joanna Mullins
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Ryan Brandon
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, South Africa
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Gupta B, Li D, Dong P, Acri MC. From intention to action: A systematic literature review of provider behaviour change-focused interventions in physical health and behavioural health settings. J Eval Clin Pract 2021; 27:1429-1445. [PMID: 33565177 DOI: 10.1111/jep.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES It is clear there are significant delays in the uptake of best practices as part of routine care in the healthcare system, yet there is conflicting evidence on how to specifically align provider behaviour with best practices. METHOD We conducted a review of interventions utilized to change any aspect of provider behaviour. To extend prior research, studies were included in the present review if they had an active intervention targeting behaviour change of providers in health or behavioural-health settings and were published between 2001 and 2020. RESULTS Of 1547 studies, 44 met inclusion criteria. Of 44 studies identified, 28 studies utilized contextually relevant interventions (eg, tailored to a specific provider population). Twenty six interventions with a contextually relevant approach resulted in provider behaviour change. CONCLUSIONS Findings are promising for encouraging provider behaviour change when interventions are tailored to be contextually relevant, as both single-component and multifaceted interventions were successful when they were contextually relevant. It is critical to conduct additional research to ensure that providers sustain behaviour changes over a long-term beyond an intervention's implementation and evaluation period.
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Affiliation(s)
- Brinda Gupta
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dongze Li
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Peiyu Dong
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary C Acri
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
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Leveraging Clinical Decision Support and Integrated Medical-Dental Electronic Health Records to Implementing Precision in Oral Cancer Risk Assessment and Preventive Intervention. J Pers Med 2021; 11:jpm11090832. [PMID: 34575609 PMCID: PMC8470765 DOI: 10.3390/jpm11090832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Precision medicine is focused on serving the unique needs of individuals. Oral and oropharyngeal cancer risk assessment identifies individual risk factors while providing support to reduce risk. The objective is to examine potential current and future strategies to broadly implement evidence-based oral and oropharyngeal cancer risk assessment and screening in dental practices throughout the United States. METHODS Feasible and effective oral cancer risk assessment and risk reduction strategies, ripe for implementation in dental practice, were identified in the published literature. RESULTS The Screening, Brief Intervention, Referral for Treatment (SBIRT) model is a feasible approach to assessing individual oral cancer risk and providing risk reducing interventions in the dental setting. HPV is a more recently identified risk factor that dentistry is well positioned to address. Evidence supporting the utilization of specific risk assessment tools and risk reduction strategies is summarized and future opportunities discussed. DISCUSSION Current knowledge of risk factors for oral and oropharyngeal cancers support the recommendation for dental providers to routinely assess all patients for risk factors, educate them about their personal level of cancer risk, and recommend actions to reduce relevant risk factors. Individuals ages 9-26 should be asked about their HPV vaccination status, educated about HPV and oropharyngeal cancer and receive a recommendation to get the HPV vaccination.
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Rostamnia L, Ghanbari V, Shabani F, Farahani A, Dehghan-Nayeri N. Evidence-Based Practice for Cardiac Intensive Care Unit Nurses: An Educational Intervention Study. J Contin Educ Nurs 2021; 51:167-173. [PMID: 32232492 DOI: 10.3928/00220124-20200317-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study examined the effectiveness of two educational methods on nurses' skills and commitment to implementing evidence-based practice (EBP). METHOD Ninety nurses were randomly assigned to three groups. Participants in the workshop group took part in a 2-day training course, participants in the multimedia group received educational content through video, and participants in the control group did not receive any training content. The nurses' skills and commitment to implement EBP were assessed at baseline and 1 month after the teaching sessions. RESULTS The EBP skills of nurses in the intervention groups were significantly enhanced compared with nurses in the control group (p < .05). Mean scores in the multimedia group were slightly better than in the workshop group; however, this difference was not statistically significant. Commitment to EBP implementation did not change significantly over time among the groups (p > .05). CONCLUSION Different methods of training can be useful in improving nurses' EBP skills; however, the participants' commitment to implement EBP did not change considerably. Because of its cost effectiveness, the multimedia method should be considered for use in nurse training. [J Contin Educ Nurs. 2020;51(4):167-173.].
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Ilgunas A, Lövgren A, Fjellman-Wiklund A, Häggman-Henrikson B, Karlsson Wirebring L, Lobbezoo F, Visscher CM, Durham J. Conceptualizing the clinical decision-making process in managing temporomandibular disorders: A qualitative study. Eur J Oral Sci 2021; 129:e12811. [PMID: 34145628 DOI: 10.1111/eos.12811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision-making process in TMD management, and thereby to conceptualize the decision-making process in dentistry. Individual semi-structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision-making process for TMD. The challenges were primarily related to organisational factors and lack of self-confidence. This identifies a need for re-organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self-confidence. The complexity of the decision-making process for TMD makes the study findings applicable in other dental situations.
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Affiliation(s)
- Aurelia Ilgunas
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | | | | | | | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK.,Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
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Oyedokun TB, Abidoye RB, Akinbogun SP. Bridging the gap between real estate research and professional practice in Nigeria. PROPERTY MANAGEMENT 2021. [DOI: 10.1108/pm-12-2020-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeBeyond contributing to literature, research findings are expected to reinforce existing best practices while also serving as a springboard for formulating new and more efficient methods of undertaking economic activities. However, academic research is sometimes divorced from implementation and research findings are not always translated into practice. This study, therefore, assesses the impact of real estate research activities and findings on the practice of real estate surveying and valuation in Nigeria as the largest real estate market in Africa.Design/methodology/approachAn online questionnaire survey was conducted to obtain relevant data from Estate Surveyors and Valuers across the country. The survey questions cover reading of academic papers from the field of real estate and the reasons for doing so; whether they have made any changes to their professional practice based on findings from academic papers; and possible barriers to adoption academic research findings in your practice. Mean score ranking and principal component analysis were employed for data analysis.FindingsOut of a total of 61 participants, only 35 have made a change to their professional practice based on findings from academic papers they have read. “Personal development and enlightenment” ranks first on the list of reasons for reading academic papers among the participants while barriers to the adoption of academic research findings relate mainly to education, dissemination and lack of guidance on how to apply research findings.Practical implicationsThe study demonstrates how findings from real estate research are being applied and identifies possible barriers that must be addressed to improve the level of application and consequently, the value of academic studies.Originality/valueThe study provides evidence on barriers to the adoption of academic research and contributes to the global effort to bridge the gap between academia and practice.
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Leggett H, Csikar J, Vinall-Collier K, Douglas G. Whose Responsibility Is It Anyway? Exploring Barriers to Prevention of Oral Diseases across Europe. JDR Clin Trans Res 2021; 6:96-108. [PMID: 32437634 PMCID: PMC7754828 DOI: 10.1177/2380084420926972] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Dental caries, gum disease, and tooth loss are all preventable conditions. However, many dental care systems remain treatment oriented rather than prevention oriented. This promotes the treatment of oral diseases over preventive treatments and advice. Exploring barriers to prevention and understanding the requirements of a paradigm shift are the first steps toward delivering quality prevention-focused health care. OBJECTIVES To qualitatively explore perceived barriers and facilitators to oral disease prevention from a multistakeholder perspective across 6 European countries. METHODS A total of 58 interviews and 13 focus groups were undertaken involving 149 participants from the United Kingdom, Denmark, Germany, the Netherlands, Ireland, and Hungary. Interviews and focus groups were conducted in each country in its native language between March 2016 and September 2017. Participants were patients (n = 50), dental team members (n = 39), dental policy makers(n = 33), and dental insurers (n = 27). The audio was transcribed, translated, and analyzed via deductive thematic analysis. RESULTS Five broad themes emerged that were both barriers and facilitators: dental regulation, who provides prevention, knowledge and motivation, trust, and person-level factors. Each theme was touched on in all countries; however, cross-country differences were evident surrounding the magnitude of each theme. CONCLUSION Despite the different strengths and weaknesses among the systems, those who deliver, organize, and utilize each system experience similar barriers to prevention. The findings suggest that across all 6 countries, prevention in oral health care is hindered by a complex interplay of factors, with no particular dental health system offering overall greater user satisfaction. Underlying the themes were sentiments of blame, whereby each group appeared to shift responsibility for prevention to other groups. To bring about change, greater teamwork is needed in the commissioning of prevention to engender its increased value by all stakeholders within the dental system. KNOWLEDGE TRANSFER STATEMENT The results from this study provide an initial first step for those interested in exploring and working toward the paradigm shift to preventive focused dentistry. We also hope that these findings will encourage more research exploring the complex relationship among dental stakeholders, with a view to overcoming the barriers. In particular, these findings may be of use to dental public health researchers, dentists, and policy makers concerned with the prevention of oral diseases.
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Affiliation(s)
- H. Leggett
- School of Dentistry, University of Leeds, Leeds, UK
| | - J. Csikar
- School of Dentistry, University of Leeds, Leeds, UK
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Peikert SA, Mittelhamm F, Frisch E, Vach K, Ratka-Krüger P, Woelber JP. Use of digital periodontal data to compare periodontal treatment outcomes in a practice-based research network (PBRN): a proof of concept. BMC Oral Health 2020; 20:297. [PMID: 33115466 PMCID: PMC7594469 DOI: 10.1186/s12903-020-01284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/15/2020] [Indexed: 11/11/2022] Open
Abstract
Background Scientific studies in dentistry are mainly conducted at universities. However, most patients are treated in dental practices, which differ in many ways from treatment at the university. Through the establishment of practice-based research networks, however, it is also possible to examine studies in a real-world setting in dental practices. For this reason the aim of this non-interventional, observational study was to develop and evaluate a digital procedure to access, extract and analyse recorded clinical data in practices to assess periodontal treatment outcomes.
Methods Participating periodontists were former or active postgraduate students of a master’s course in periodontics in Freiburg who routinely used a digital periodontal diagnostic program. All available stored periodontal patient charts were extracted, anonymized and digitally sent to the study centre. Results In this study, data were collected from 6301 patients from 9 different practices. Information such as probing depth (PD), bleeding on probing (BOP), mobility, furcation and gingival attachment for 153,163 teeth at first visit were successfully transferred to the study centre. During the average observational period of 9.77 years, only 2.8% of all teeth were lost. The number of visits was significantly negatively correlated with BOP (p < 0.0001), and the number of BOP-positive sites was significantly correlated with deeper PDs (p < 0.001). Conclusion The presented procedure was able to gather a large amount of practice-based periodontal data, and thus this study may support practice-based research networks. The data indicate that systematic and supportive periodontal therapy is successful on a practice-based level. Trial registration The study was internationally registered on 4 January 2017 in the German Clinical Trials Register (DRKS 00011448). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011448
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Affiliation(s)
- Stefanie Anna Peikert
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | | | - Eberhard Frisch
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.,, Hofgeismar, Germany
| | - Kirstin Vach
- Department of Medical Biometry and Statistics, University Freiburg Medical Center, Stefan-Meier-Straße 26, 79104, Freiburg im Breisgau, Germany
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Kimiaeimehr F, Hosseini SM, Alimohammadzadeh K, Bahadori M, Maher A. Confirmatory factor analysis model of factors affecting the implementation of clinical guidelines in Iran. Med J Islam Repub Iran 2020; 34:122. [PMID: 33437718 PMCID: PMC7787019 DOI: 10.34171/mjiri.34.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Clinical guidelines refer to a developed scientific statement to help physicians and patients for decision-making about the best care for special clinical conditions, which can be an important document to shape evidence-based medicine. This study aimed to identify factors affecting the implementation of clinical guidelines in Iran to enhance the quality of services. Methods: This descriptive analytical study was performed with combined quantitative-qualitative method in the first half of 2019. The statistical population consisted of 400 health managers and experts who were selected through multistage sampling method in 5 regions of Iran (north, south, center, east, and west). Overall, 20 academic experts were selected from each university. For data collection, a researcher-made questionnaire (n = 400) was used. To measure face and content validity, content validity ratio (CVR) and content validity index (CVI) were used. Also, to determine reliability, test-retest method, with Cronbach's alpha coefficient of 0.934 was used. For data analysis, Lisrel 8.8 and SPSS 24 were used. Finally, fitness indices were used to determine the fitness of the model. Results: Six factors, including organizational (9 components), organizational culture (8 components), the clinical guidelines feature (8 components), insurance (7 components), and trusteeship of the health care system (8 components) were identified as the main dimensions. The economic dimension had the maximum effect on implementing clinical guidelines (0.90), while the clinical guidelines feature (0.63) and organizational culture (0.63) showed the minimum extent of effect on implementing clinical guidelines. Conclusion: Evidently, imposing the mentioned interventions with the ultimate goal of sustainable behavior change in providing health care services requires contribution of all practitioners, presentation of suitable facilities for implementing clinical guidelines based on evidence, time and personnel management, training methodology and planning, developing the necessary infrastructure, supervision, and developing professional and legal motivation.
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Affiliation(s)
- Farzaneh Kimiaeimehr
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Khalil Alimohammadzadeh
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
- Health Economics Policy Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Maher
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
- Department of Health Policy, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Asefa A, Morgan A, Gebremedhin S, Tekle E, Abebe S, Magge H, Kermode M. Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals. BMJ Open 2020; 10:e038871. [PMID: 32883738 PMCID: PMC7473661 DOI: 10.1136/bmjopen-2020-038871] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES There is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention. DESIGN A pre-post study design was undertaken to quantify changes in women's experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention. INTERVENTION A respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement. OUTCOME MEASURES A 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods. RESULTS The number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth. CONCLUSIONS Women reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Samson Gebremedhin
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Tekle
- Maternal and Child Health Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hema Magge
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
- Division of Global Health Equity, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Frantsve-Hawley J, Kumar SS, Rindal DB, Weyant RJ. Implementation science and periodontal practice: Translation of evidence into periodontology. Periodontol 2000 2020; 84:188-201. [PMID: 32844415 DOI: 10.1111/prd.12336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The advent of evidence-based practice in the 1990s led to the development of processes and resources to support the use of high-quality research in the provision of health care. As the evidence-based approach to health care continues to evolve, it has become apparent that mere creation and access to scientific knowledge is not sufficient to facilitate its routine adoption in health care. Throughout any health care system, there are inherent barriers preventing the adoption and routine use of new evidence in patient care. These barriers include provider-level factors, such as knowledge and access to new evidence, as well as each provider's attitudes and beliefs around adopting and applying the evidence with their patients. Importantly, there are also health care system-level barriers that, even among willing providers, prevent the easy adoption of new evidence and routine application in patient care. In addition to barriers, there are facilitators that help promote adoption of evidence into practice. Understanding and addressing barriers and facilitators to promote adoption of evidence into practice has led to the growth of a new field known as implementation science. Successful application of implementation science in all areas of health care, including periodontology, will help bridge the gap between what are known from clinical research to be effective treatments and what treatments should be applied routinely in clinical practice. This article reviews key concepts in implementation science and how its application in periodontology can facilitate the translation of high-quality evidence into routine periodontal practice and improved patient outcomes.
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Affiliation(s)
- Julie Frantsve-Hawley
- University of Illinois at Chicago College of Dentistry, Illinois, USA.,DentaQuest Partnership for Oral Health Advancement, Boston, MA, USA
| | - Satish S Kumar
- Arizona School of Dentistry and Oral Health (ASDOH), A.T. Still University, Arizona, USA
| | - D Brad Rindal
- HealthPartners Institute, Bloomington, Minnesota, USA
| | - Robert J Weyant
- Department of Dental Public Health, University of Pittsburgh, Pennsylvania, USA
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Johnson KS, Schmidt AM, Bader JD, Spallek H, Rindal DB, Enstad CJ, Fricton JR, Asche SE, Kane SM, Thirumalai V, Godlevsky OV, Johnson NJ, Acharya A, Rush WA. Dental Decision Simulation (DDSim): Development of a virtual training environment. J Dent Educ 2020; 84:1284-1293. [PMID: 32702778 DOI: 10.1002/jdd.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE Case-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence. This simulated EDR provides case-based information in support of a set of defined evidence-based learning objectives. METHODS The development of this complex simulation model required coordinated efforts to create several components: identify behavior changes, case authoring mechanism, create virtual patient visits, require users to make treatment plan decisions related to learning objectives, and a feedback mechanism to help users recognize departures from those learning objectives. This simulation was evaluated in a 2-arm, clinic-randomized, controlled pilot study examining the extent to which DDSim changed dentists' planned treatment to conform to evidence-based treatment guidelines relative to change in dentists not exposed to DDSim. Outcomes were measured by comparing preintervention and postintervention patient EDR treatment data. RESULTS Changes in behavior over time did not favor intervention or control clinics. CONCLUSION DDSim provides a standardized learning platform that cannot be achieved through the use of live patients. Both live patients and case-based simulations can be used to transfer knowledge and skill development. DDSim offers the advantage of providing a platform for developing treatment planning skills in a low-risk environment. However, further research examining behavior change is needed.
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Affiliation(s)
| | | | - James D Bader
- Department of Operative Dentistry, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Heiko Spallek
- Dean, University of Sydney School of Dentistry, Sydney, Australia
| | - D Brad Rindal
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | | | | | | | - Sheryl M Kane
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | | | | | - Neil J Johnson
- HealthPartners Institute, Minneapolis, Minnesota, USA.,Centennial Lakes Dental Group, Minneapolis, Minnesota, USA
| | - Amit Acharya
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Vahedi NB, Ramazan-Yousif L, Andersen TS, Jensen HI. Implementation of Neurally Adjusted Ventilatory Assist (NAVA): Patient characteristics and staff experiences. J Healthc Qual Res 2020; 35:253-260. [PMID: 32536580 DOI: 10.1016/j.jhqr.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study was to describe the implementation of Neurally Adjusted Ventilatory Assist (NAVA) by characteristics of patients receiving NAVA and by staff-experienced opportunities and barriers. METHODS Design. A retrospective review of hospital records of mechanically ventilated patients over two time periods after implementation, as well as a questionnaire survey and interviews with staff. SETTING A secondary Danish ICU. PARTICIPANTS ICU patients, nurses, and intensivists. INTERVENTION Implementation of NAVA, which included theoretical education, bedside training, and frequent updates. MAIN OUTCOME MEASURE Evaluation of NAVA implementation measured by characteristics of patients receiving NAVA and staff experiences with NAVA. RESULTS A total of 311 patients were included. Hereof 43 (27%) and 68 (44%) patients, respectively, had recieved NAVA. The patients receiving NAVA had higher severity scores and more hours on ventilators. A total of 35 nurses (76%) and 16 physicians (64%) completed the questionnaire. Most clinicians found, to a high (43%) or very high (41%) degree, that NAVA was an effective therapy option. Furthermore, 77% did not experience any barriers regarding NAVA therapy. The main advantages experienced with NAVA were increased patient comfort, respiratory synchrony with the ventilator, and improved opportunities for monitoring patient respiratory performance. The main disadvantage was the need for additional theoretical and practical knowledge. CONCLUSION Despite staff experience of NAVA as a beneficial treatment option, more than half of the patients did not receive NAVA treatment two years after the start of its implementation. Implementation of a therapy which is substantially different to earlier practices is complicated.
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Affiliation(s)
- N B Vahedi
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark.
| | - L Ramazan-Yousif
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark
| | - T S Andersen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark
| | - H I Jensen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000 Odense, Denmark
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Neuppmann Feres MF, Roscoe MG, Job SA, Mamani JB, Canto GDL, Flores-Mir C. Barriers involved in the application of evidence-based dentistry principles: A systematic review. J Am Dent Assoc 2020; 151:16-25.e16. [PMID: 31902396 DOI: 10.1016/j.adaj.2019.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The authors' objective in this systematic review was to investigate the barriers involved in the application of evidence-based dentistry principles, as reported by dentists. The authors registered the protocol in the PROSPERO database. TYPES OF STUDIES REVIEWED Eligible studies included qualitative and quantitative approaches, constituting information about barriers, collected through interviews, questionnaires, or conversation sessions. The authors searched databases and reference lists of preselected studies. After the selection process, the authors evaluated the included studies for potential risk of bias and collected either qualitative or quantitative data. RESULTS After the selection process, the authors included 35 studies, of which 16 were reported in this article. The authors synthesized and classified the barriers in 4 categories: self-related, evidence-related, context-related, and patient-related barriers. Shortage of time and financial constraints were the barriers most frequently studied. However, the quantification of these barriers, as well as others, was not possible because of the variability of the results and methodological issues of the included studies. CONCLUSIONS AND PRACTICAL IMPLICATIONS The authors suggest the development of valid questionnaires and their use in representative samples to quantify the effects of specific barriers. The authors encourage practitioners to participate in educational programs focused on training in evidence-based dentistry abilities, in addition to seeking accessible and synthesized formats of reliable scientific knowledge.
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Finkelstein J, Zhang F, Levitin SA, Cappelli D. Using big data to promote precision oral health in the context of a learning healthcare system. J Public Health Dent 2020; 80 Suppl 1:S43-S58. [PMID: 31905246 PMCID: PMC7078874 DOI: 10.1111/jphd.12354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
There has been a call for evidence-based oral healthcare guidelines, to improve precision dentistry and oral healthcare delivery. The main challenges to this goal are the current lack of up-to-date evidence, the limited integrative analytical data sets, and the slow translations to routine care delivery. Overcoming these issues requires knowledge discovery pipelines based on big data and health analytics, intelligent integrative informatics approaches, and learning health systems. This article examines how this can be accomplished by utilizing big data. These data can be gathered from four major streams: patients, clinical data, biological data, and normative data sets. All these must then be uniformly combined for analysis and modelling and the meaningful findings can be implemented clinically. By executing data capture cycles and integrating the subsequent findings, practitioners are able to improve public oral health and care delivery.
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Affiliation(s)
- Joseph Finkelstein
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Frederick Zhang
- Center for Bioinformatics and Data Analytics in Oral HealthCollege of Dental Medicine, Columbia UniversityNew YorkNYUSA
| | - Seth A. Levitin
- Center for Bioinformatics and Data Analytics in Oral HealthCollege of Dental Medicine, Columbia UniversityNew YorkNYUSA
| | - David Cappelli
- Department of Biomedical SciencesSchool of Dental Medicine, University of NevadaLas VegasNVUSA
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Predel HG, Graas F, Rudinger G, Randerath O. Management of arterial hypertension: Transfer from clinical guidelines into daily practice - Results of a survey in German practitioners offices. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:34. [PMID: 32318602 PMCID: PMC7161658 DOI: 10.4103/jehp.jehp_426_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/02/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The principal objective of clinical guidelines is to improve the quality of medical care. However, standardized evaluation of the adoption into daily practice is missing. The aim of our study was to investigate the implementation of guideline recommendations on the management of arterial hypertension (AH) in German general practitioner's (GPs) offices. METHODS A questionnaire focusing on the implementation of the German guidelines for the management of AH was developed and prospectively rolled out in 3.200 GPs and field-based specialists in internal medicine in Germany. Data were interpreted in an explorative way. RESULTS Data from 689 German physicians that participated in the survey were analyzed. Effectiveness of lifestyle changes in the management of AH was rated as very high or high in 36.6%. When lifestyle changes only will not normalize blood pressure (BP), medical treatment will be initiated after 2-6 months by majority of physicians. Decision for mono- or combination therapy was driven by BP and patient's risk profile. Choice for a specific antihypertensive substance was based on the recommendations of scientific guidelines in the majority of GPs. CONCLUSIONS Medication treatment algorithms recommended in 2015 by German guidelines are well accepted by GPs. Lifestyle changes are voted by only slightly more than one-third as a reasonable tool for the management of AH in the setting of the medical office. This might reflect a lack of certified medical education regarding this topic. Our study was not designed to register the time from publication of guidelines to practical implementation.
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Affiliation(s)
- Hans-Georg Predel
- Institute of Cardiology and Sports Medicine, German Sport University, Cologne, Germany
| | - Fabian Graas
- Uzbonn GmbH – Gesellschaft für Empirische Sozialforschung und Evaluation, Bonn, Germany
| | - Georg Rudinger
- Uzbonn GmbH – Gesellschaft für Empirische Sozialforschung und Evaluation, Bonn, Germany
| | - Olaf Randerath
- Medical Affairs, Apontis Pharma Gmbh and Co. KG, Monheim, Germany
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Gruß I, Pihlstrom DJ, Kaplan CD, Yosuf N, Fellows JL, Guerrero EG, Polk DE. Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice. JDR Clin Trans Res 2020; 6:87-95. [PMID: 32040925 DOI: 10.1177/2380084420903999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This evaluation captures the perspectives of multiple stakeholders within a salaried dental care delivery organization (dentists, dental assistants, dental hygienists, and dental management) on the implementation of a pit-and-fissure sealant guideline in the Kaiser Permanente Dental Program. Also assessed is the role of formal processes and structures in providing a framework for guideline implementation. METHODS We collected qualitative data through field observations, stakeholder interviews (n = 6), and focus groups (30 participants in 5 focus groups). Field observation notes captured summaries of conversations and other activities. Interviews and focus groups were recorded and transcribed. We analyzed transcripts and field notes using a template analysis with NVivo 12 software to identify themes related to the existing implementation process of clinical guidelines and stakeholder perspectives on the strengths and weaknesses of this process. RESULTS Stakeholders perceived 2 main barriers for achieving implementation of the pit-and-fissure sealant guideline: 1) shortcomings in the implementation infrastructure resulting in lack of clarity about the roles and responsibilities in the guideline implementation process and lack of effective mechanisms to disseminate guideline content and 2) resource constraints, such as limited human, space, and material resources. Perceived opportunities for the dissemination and implementation of guidelines included recognition of the importance of guidelines in dental practice and well-functioning workflows within dental specialties. CONCLUSION Our research points to the importance of developing and maintaining an infrastructure to ensure standardized, predictable mechanisms for implementation of guidelines and thereby promoting practice change. While addressing resource constraints may not be possible in all circumstances, an important step for improving guideline implementation-wherever feasible-would be the development of a robust implementation infrastructure that captures and delineates roles and responsibilities of different clinical actors in the guideline implementation process. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by health care leadership and administrators to understand possible reasons for a lack of guideline implementation and provide suggestions for establishing sustainable infrastructure to promote the adoption of clinical guidelines in salaried dental clinics.
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Affiliation(s)
- I Gruß
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - C D Kaplan
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - N Yosuf
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - J L Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - E G Guerrero
- I-Lead Institute-Research to End Healthcare Disparities Corp, Santa Monica, CA, USA
| | - D E Polk
- University of Pittsburgh, Pitt Dental Medicine, Pittsburgh, PA, USA
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Villarosa AR, Maneze D, Ramjan LM, Srinivas R, Camilleri M, George A. The effectiveness of guideline implementation strategies in the dental setting: a systematic review. Implement Sci 2019; 14:106. [PMID: 31847876 PMCID: PMC6918615 DOI: 10.1186/s13012-019-0954-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/25/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Guideline implementation has been an ongoing challenge in the dental practice setting. Despite this, there are no reviews summarising the existing evidence regarding effective guideline implementation strategies in this setting. In order to address this, this systematic review examines the effectiveness of guideline implementation strategies in the dental practice setting. METHODS A systematic search was undertaken according to the PRISMA statement across nine electronic databases, targeting randomised controlled trials and quasi-experimental studies which evaluated the effectiveness of guideline implementation strategies in improving guideline adherence in the dental setting. All records were independently examined for relevance and appraised for study quality by two authors, with consensus achieved by a third author. Data were extracted from included studies using a standardised data extraction pro forma. RESULTS A total of 15 records were eligible for inclusion in this review, which focused on the effects of audit and feedback, reminders, education, patient-mediated interventions, pay for performance and multifaceted interventions. Although there were some conflicting evidence, studies within each category of implementation strategy indicated a positive effect on guideline adherence. CONCLUSIONS This study has identified education, reminders and multifaceted interventions as effective implementation strategies for the dental practice setting. Although this is similar to research findings from other health sectors, there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting. These findings can inform policy makers, professional associations, colleges and organisations in the future adoption of clinical guidelines in the dental practice setting. TRIAL REGISTRATION This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration ID CRD42018093023.
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Affiliation(s)
- Amy R Villarosa
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, 1871, Australia. .,Western Sydney University, Penrith, 2751, Australia. .,South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia. .,Ingham Institute for Applied Medical Research, Liverpool, 1871, Australia.
| | - Della Maneze
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, 1871, Australia.,Western Sydney University, Penrith, 2751, Australia.,South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool, 1871, Australia
| | - Lucie M Ramjan
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, 1871, Australia.,Western Sydney University, Penrith, 2751, Australia.,Ingham Institute for Applied Medical Research, Liverpool, 1871, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, 2751, Australia
| | - Ravi Srinivas
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, 1871, Australia.,Western Sydney University, Penrith, 2751, Australia.,South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool, 1871, Australia.,University of Sydney, Camperdown, 2050, Australia
| | - Michelle Camilleri
- South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), Liverpool, 1871, Australia.,Western Sydney University, Penrith, 2751, Australia.,South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool, 1871, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, 2751, Australia.,University of Sydney, Camperdown, 2050, Australia
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Maharaj SS, White TL, Kaka B. How are children with cerebral palsy managed in public hospitals of KwaZulu-Natal, South Africa? Physiother Theory Pract 2019; 37:1235-1243. [PMID: 31686566 DOI: 10.1080/09593985.2019.1686791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Medical advances have resulted in the survival of infants who are born prematurely. This makes them at risk of developing neurological manifestations and increases the incidence of children diagnosed with cerebral palsy (CP). Physiotherapy plays an important role in the management of children with CP. However, in KwaZulu-Natal (KZN) there are challenges for rehabilitation of children presenting with CP due to limited equipment, assistive devices and shortage of health care professionals. The aim of this study was to determine the current physiotherapy management for children presenting with CP in public hospitals of KZNMethods: One hundred and fifty-two physiotherapists were recruited using convenience sampling from different levels of public hospitals in KZN. The design was a cross-sectional study using a survey with a self-designed questionnaire to review current physiotherapy management of CP. The data was analyzed and presented by means of descriptive statisticsResults: Seventy-two participants completed the study indicating a 47.4% response rate with an age range of 31 to 40 years. Thirty-five (48.6%) of participants treated one to ten children with CP each month. Twenty-five (34.7%) used outcome measures to evaluate their CP management. This study showed the most common treatment techniques used by physiotherapists were: postural stabilizing activities - 68 (94.4%); respiratory care - 67 (92.9%); and positioning - 67 (92.9%)Conclusion: Despite challenges by physiotherapists in KZN, the overall management of children with CP was holistic and favorable. The most common treatment approach was postural stabilizing activities with children with CP receiving treatment once a month for 30 minutes.
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Affiliation(s)
- Sonill S Maharaj
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Tracey-Lee White
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bashir Kaka
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Pediatric Physical Therapists' Use of the Congenital Muscular Torticollis Clinical Practice Guidelines: A Qualitative Implementation Study. Pediatr Phys Ther 2019; 31:331-336. [PMID: 31568376 DOI: 10.1097/pep.0000000000000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study is a follow-up to the quantitative survey to examine the perceptions of pediatric physical therapists (PTs) on the application of the 2013 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). METHOD Qualitative semi-structured telephone interviews were completed. Interview questions focused on how the guidelines influenced practice, facilitators and barriers to implementation, and knowledge translation activities. RESULTS Thirteen pediatric PTs from a variety of practice settings participated. Positive perceptions about the CMT CPG included the use of flow charts, synthesized literature in one place, and validation of examination and intervention approaches. Negative perceptions included its length and that approaches without published evidence were not addressed. Three major themes were identified: knowledge and evidence for practice, education of clinicians, and the CPG structure and components that influenced practice. CONCLUSIONS The CMT CPG provided a number of benefits. Recommendations for future enhancement and development are provided.
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Tessema GA, Gomersall JS, Laurence CO, Mahmood MA. Healthcare providers' perspectives on use of the national guideline for family planning services in Amhara Region, Ethiopia: a qualitative study. BMJ Open 2019; 9:e023403. [PMID: 30787080 PMCID: PMC6398659 DOI: 10.1136/bmjopen-2018-023403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore healthcare providers' views on barriers to and facilitators of use of the national family planning (FP) guideline for FP services in Amhara Region, Ethiopia. DESIGN Qualitative study. SETTING Nine health facilities including two hospitals, five health centres and two health posts in Amhara Region, Northwest Ethiopia. PARTICIPANTS Twenty-one healthcare providers working in the provision of FP services in Amhara Region. PRIMARY AND SECONDARY OUTCOME MEASURES Semistructured interviews were conducted to understand healthcare providers' views on barriers to and facilitators of the FP guideline use in the selected FP services. RESULTS While the healthcare providers' views point to a few facilitators that promote use of the guideline, more barriers were identified. The barriers included: lack of knowledge about the guideline's existence, purpose and quality, healthcare providers' personal religious beliefs, reliance on prior knowledge and tradition rather than protocols and guidelines, lack of availability or insufficient access to the guideline and inadequate training on how to use the guideline. Facilitators for the guideline use were ready access to the guideline, convenience and ease of implementation and incentives. CONCLUSIONS While development of the guideline is an important initiative by the Ethiopian government for improving quality of care in FP services, continued use of this resource by all healthcare providers requires planning to promote facilitating factors and address barriers to use of the FP guideline. Training that includes a discussion about healthcare providers' beliefs and traditional practices as well as other factors that reduce guideline use and increasing the sufficient number of guideline copies available at the local level, as well as translation of the guideline into local language are important to support provision of quality care in FP services.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Judith Streak Gomersall
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Caroline O Laurence
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Teshome M, Wolde Z, Gedefaw A, Asefa A. Improving surgical informed consent in obstetric and gynaecologic surgeries in a teaching hospital in Ethiopia: A before and after study. BMJ Open 2019; 9:e023408. [PMID: 30679291 PMCID: PMC6347859 DOI: 10.1136/bmjopen-2018-023408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Even though surgical informed consent (SIC) has marked benefits, in many settings the information is not provided appropriately. In Ethiopia, minimal attention is given to SIC. This study assesses whether an intervention designed to improve SIC in obstetric and gynaecologic surgeries is associated with receipt of SIC components. DESIGN Pre-intervention and post-intervention surveys were conducted at Hawassa University Comprehensive Specialized Hospital among women who underwent obstetric or gynaecologic surgeries. The intervention consisted of a 3-day training on standard counselling for surgical procedures offered to health professionals. A total of 457 women were surveyed (230 pre-intervention, 227 post-intervention). An adjusted Poisson regression analysis was used to identify the association between the intervention and the number of SIC components received. RESULTS The majority of participants were 25-34 years of age in both the pre-intervention and post-intervention groups (p=0.66). 45.7% of the pre-intervention and 51.5% of the post-intervention survey participants underwent elective surgery (p=0.21). Additionally, 70.4% of pre-intervention survey participants received counselling immediately before surgery, compared with 62.4% of post-intervention participants (p<0.001). 5.7% of pre-intervention and 6.6% of post-intervention participants reported the belief that SIC consists entirely of signing on a piece of paper (p=0.66). After controlling for effects of potential confounders, the number of SIC components reported by post-intervention survey participants was 16% higher than what is received by pre-intervention ones (adjusted coefficient=1.16 (1.06-1.28)). Having elective versus emergency surgery was not associated with the number of components received by participants in either group (adjusted coefficient=0.98 (0.88-1.09)). CONCLUSION Training on the delivery of standard SIC is associated with receipt of a higher number of standard counselling components. However, there is a need to evaluate whether a one-time intervention leads to sustained improvement. A system-wide study of factors that promote SIC is required.
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Affiliation(s)
- Million Teshome
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zenebe Wolde
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Frantsve-Hawley J, Rindal DB. Translational Research: Bringing Science to the Provider Through Guideline Implementation. Dent Clin North Am 2019; 63:129-144. [PMID: 30447788 DOI: 10.1016/j.cden.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Significant variation exists in health care practice patterns that creates concerns regarding the quality of care delivered. Clinical practice based on high-quality evidence provides a rationale for clinical decision making. Resources, such as evidence-based guidelines, provide that evidence to clinicians and improve patient outcomes by decreasing unwanted variation in clinical practice. Because knowledge dissemination alone is ineffective to translate scientific evidence into clinical practice, the field of implementation science has emerged to facilitate this translation of research into routine clinical practice. This article provides an introduction to implementation science, and its application in dentistry to promote adoption of evidence-based guidelines.
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Affiliation(s)
- Julie Frantsve-Hawley
- Department of Guidelines & Publishing, American College of Chest Physicians, 2595 Patriot Boulevard, Glenview, IL 60026, USA.
| | - D Brad Rindal
- HealthPartners Institute, 3311 East Old Shakopee Road, Bloomington, MN 55425, USA
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Abstract
The motivation for teaching evidence-based practice is that, through the use of high-quality clinically relevant evidence, clinicians will make rationale decision that optimally improve patient health outcomes. Achieving that goal requires clinicians who are able to answer patient care-relevant clinical questions efficiently, which means that they must be able rapidly to retrieve, assess, and apply evidence of direct relevance to their patients. Educational programs designed to accomplish this vary in their effectiveness. This article reviews the evidence on educational approaches that may be beneficial when developing educational programs for both dental students and practicing dentists.
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Affiliation(s)
- Robert J Weyant
- University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, Pittsburgh, PA 15213, USA.
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Ngoc CN, Mehta R, Donovan TE, Ferreira Zandona AG. Teaching Silver Diamine Fluoride in U.S. Dental Schools' Predoctoral Curricula. J Dent Educ 2018; 82:1305-1309. [PMID: 30504468 DOI: 10.21815/jde.018.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 01/28/2023]
Abstract
Silver diamine fluoride (SDF), a low-cost topical agent used in many countries to arrest dental caries, was cleared as a desensitizing agent by the Food & Drug Administration for the U.S. market in 2014. The aim of this study was to survey U.S. dental schools regarding their teaching of SDF. Email invitations were sent to all accredited U.S. predoctoral dental education programs (n=66) in September 2016. Deans, chairs, and selected faculty members were asked to respond or forward the survey-link provided to the appropriate person in their school. Under the assumption that some respondents from the same school were unaware of SDF implementation across departments, multiple responses from the same school were collapsed for analysis. A total of 62 schools (94% response rate) responded to the survey, and 67.7% of them reported that SDF was part of their curricula. There was a wide variation across dental schools' teaching about SDF indications and protocols of application. All but one school consistently agreed on using SDF for arresting caries on primary teeth. Only 18 respondents were able to confirm if there was an existing protocol at their school for the use of SDF. When re-application after initially arresting caries with SDF was taught, 50% of respondents advocated 2×/year re-application. Schools not teaching SDF (n=20) planned on including it in their curricula in the future. These findings suggest that, with the use of SDF increasing rapidly in the U.S. and its adoption in most dental schools, there is a need for the development of standardized evidence-based protocols.
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Affiliation(s)
- Caroline Nguyen Ngoc
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine
| | - Ritu Mehta
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine
| | - Terry E Donovan
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine
| | - Andrea G Ferreira Zandona
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine.
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Moreira NC, Leonardi-Dutra K, Feres MF, Colangelo EA, Balevi B, Matthews D, Flores-Mir C. Impact of Evidence-Based Dentistry Workshops on Educators’ Use of Evidence in Teaching and Practice: A Pilot Study. J Dent Educ 2018; 82:581-590. [DOI: 10.21815/jde.018.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 12/10/2017] [Indexed: 11/20/2022]
Affiliation(s)
| | | | | | | | - Ben Balevi
- Faculty of Medicine; University of British Columbia; Canada
| | - Debora Matthews
- Academic Affairs, Faculty of Dentistry; Dalhousie University; Canada
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Polk DE, Weyant RJ, Shah NH, Fellows JL, Pihlstrom DJ, Frantsve-Hawley J. Barriers to sealant guideline implementation within a multi-site managed care dental practice. BMC Oral Health 2018; 18:17. [PMID: 29394921 PMCID: PMC5797385 DOI: 10.1186/s12903-018-0480-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background The purpose of this study was to identify barriers frequently endorsed by dentists in a large, multi-site dental practice to implementing the American Dental Association’s recommendation for sealing noncavitated occlusal carious lesions as established in their 2016 pit-and-fissure sealant clinical practice guideline. Although previous research has identified barriers to using sealants perceived by dentists in private practice, barriers frequently endorsed by dentists in large, multi-site dental practices have yet to be identified. Identifying barriers for these dentists is important, because it is expected that in the future, the multi-site group practice configuration will comprise more dental practices. Methods We anonymously surveyed the 110 general and pediatric dentists at a multi-site dental practice in the U.S. The survey assessed potential barriers in three domains: practice environment, prevailing opinion, and knowledge and attitudes. Results were summarized using descriptive statistics. Results The response rate to the survey was 62%. The principal barrier characterizing the practice environment was concern regarding liability; endorsed by 33% of the dentists. Many barriers of prevailing opinion were frequently endorsed. These included misunderstanding the standard of practice (59%), being unaware of the expectations of opinion leaders (56%) including being unaware of the guideline itself (67%), and being unaware of what is currently being taught in dental schools (58%). Finally, barriers of knowledge and attitudes were frequently endorsed. These included having suboptimal skill in applying sealants (23% - 47%) and lacking knowledge regarding the relative efficacy of the different ways to manage noncavitated occlusal carious lesions (50%). Conclusions We identified barriers frequently endorsed by dentists in a large, multi-site dental practice relating to the practice environment, prevailing opinion, and knowledge and attitudes. All the barriers we identified have the potential to be addressed by implementation strategies. Future studies should devise and test implementation strategies to target these barriers. Electronic supplementary material The online version of this article (10.1186/s12903-018-0480-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deborah E Polk
- University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, 381 Salk Hall, Pittsburgh, PA, 15261, USA.
| | - Robert J Weyant
- University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, 347 Salk Hall, Pittsburgh, PA, 15261, USA
| | - Nilesh H Shah
- University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, 389 Salk Hall, Pittsburgh, PA, 15261, USA
| | - Jeffrey L Fellows
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave., Portland, OR, 97227-1110, USA
| | - Daniel J Pihlstrom
- Permanente Dental Associates, 500 NE Multnomah St., Suite 100, Portland, OR, 97232, USA
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O’Donnell PH, Wadhwa N, Danahey K, Borden BA, Lee SM, Hall JP, Klammer C, Hussain S, Siegler M, Sorrentino MJ, Davis AM, Sacro YA, Nanda R, Polonsky TS, Koyner JL, Burnet DL, Lipstreuer K, Rubin DT, Mulcahy C, Strek ME, Harper W, Cifu AS, Polite B, Patrick-Miller L, Yeo KTJ, Leung EKY, Volchenboum SL, Altman RB, Olopade OI, Stadler WM, Meltzer DO, Ratain MJ. Pharmacogenomics-Based Point-of-Care Clinical Decision Support Significantly Alters Drug Prescribing. Clin Pharmacol Ther 2017; 102:859-869. [PMID: 28398598 PMCID: PMC5636653 DOI: 10.1002/cpt.709] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 12/22/2022]
Abstract
Changes in behavior are necessary to apply genomic discoveries to practice. We prospectively studied medication changes made by providers representing eight different medicine specialty clinics whose patients had submitted to preemptive pharmacogenomic genotyping. An institutional clinical decision support (CDS) system provided pharmacogenomic results using traffic light alerts: green = genomically favorable, yellow = genomic caution, red = high risk. The influence of pharmacogenomic alerts on prescribing behaviors was the primary endpoint. In all, 2,279 outpatient encounters were analyzed. Independent of other potential prescribing mediators, medications with high pharmacogenomic risk were changed significantly more often than prescription drugs lacking pharmacogenomic information (odds ratio (OR) = 26.2 (9.0-75.3), P < 0.0001). Medications with cautionary pharmacogenomic information were also changed more frequently (OR = 2.4 (1.7-3.5), P < 0.0001). No pharmacogenomically high-risk medications were prescribed during the entire study when physicians consulted the CDS tool. Pharmacogenomic information improved prescribing in patterns aimed at reducing patient risk, demonstrating that enhanced prescription decision-making is achievable through clinical integration of genomic medicine.
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Affiliation(s)
- Peter H. O’Donnell
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, U.S.A
| | - Nisha Wadhwa
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, U.S.A
| | - Keith Danahey
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
- Center for Research Informatics, The University of Chicago, Chicago, IL, U.S.A
| | - Brittany A. Borden
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Sang Mee Lee
- Department of Health Sciences, The University of Chicago, Chicago, IL, U.S.A
| | - Julianne P. Hall
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Catherine Klammer
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Sheena Hussain
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Mark Siegler
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, U.S.A
- MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, U.S.A
| | - Matthew J. Sorrentino
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Andrew M. Davis
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Yasmin A. Sacro
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Rita Nanda
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Tamar S. Polonsky
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Jay L. Koyner
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Deborah L. Burnet
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Kristen Lipstreuer
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - David T. Rubin
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Cathleen Mulcahy
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Mary E. Strek
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, U.S.A
| | - William Harper
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Adam S. Cifu
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Blase Polite
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - Linda Patrick-Miller
- Center for Clinical Cancer Genetics, The University of Chicago, Chicago, IL, U.S.A
| | - Kiang-Teck J. Yeo
- Department of Pathology, The University of Chicago, Chicago, IL, U.S.A
| | | | | | - Russ B. Altman
- Departments of Bioengineering, Genetics, and Medicine, Stanford University, Palo Alto, CA, U.S.A
| | | | - Walter M. Stadler
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
| | - David O. Meltzer
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Health and the Social Sciences, The University of Chicago, Chicago, IL, U.S.A
| | - Mark J. Ratain
- Department of Medicine, The University of Chicago, Chicago, IL, U.S.A
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, U.S.A
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, U.S.A
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Abstract
PURPOSE This study describes survey responses about implementation of the congenital muscular torticollis clinical practice guideline (CMT-CPG) by pediatric physical therapists (PT) and successes and challenges with knowledge-brokering activities. METHODS An online survey was distributed to pediatric PTs who self-identified with practice experience with congenital muscular torticollis. Data were analyzed for implementation frequency of guideline recommendations and differences pre and postpublication of the CMT-CPG. RESULTS After publication, guideline recommendation implementation improved such that no recommendation was being implemented by less than 50% of respondents, and most were implemented by greater than 90%. The majority of respondents participated in knowledge brokering; however, many indicated minimal effectiveness of those activities. CONCLUSIONS The CMT-CPG has successfully aided in changing practice. Participants identified areas of challenge and success in translating recommendations into practice and in knowledge brokering that may be helpful for the development of future CPGs.
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