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Schneider-Smith EG, Suda KJ, Lew D, Rowan S, Hanna D, Bach T, Shimpi N, Foraker RE, Durkin MJ. How decisions are made: Antibiotic stewardship in dentistry. Infect Control Hosp Epidemiol 2023; 44:1731-1736. [PMID: 37553682 PMCID: PMC10782556 DOI: 10.1017/ice.2023.173] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND We performed a preimplementation assessment of workflows, resources, needs, and antibiotic prescribing practices of trainees and practicing dentists to inform the development of an antibiotic-stewardship clinical decision-support tool (CDST) for dentists. METHODS We used a technology implementation framework to conduct the preimplementation assessment via surveys and focus groups of students, residents, and faculty members. Using Likert scales, the survey assessed baseline knowledge and confidence in dental providers' antibiotic prescribing. The focus groups gathered information on existing workflows, resources, and needs for end users for our CDST. RESULTS Of 355 dental providers recruited to take the survey, 213 (60%) responded: 151 students, 27 residents, and 35 faculty. The average confidence in antibiotic prescribing decisions was 3.2 ± 1.0 on a scale of 1 to 5 (ie, moderate). Dental students were less confident about prescribing antibiotics than residents and faculty (P < .01). However, antibiotic prescribing knowledge was no different between dental students, residents, and faculty. The mean likelihood of prescribing an antibiotic when it was not needed was 2.7 ± 0.6 on a scale of 1 to 5 (unlikely to maybe) and was not meaningfully different across subgroups (P = .10). We had 10 participants across 3 focus groups: 7 students, 2 residents, and 1 faculty member. Four major themes emerged, which indicated that dentists: (1) make antibiotic prescribing decisions based on anecdotal experiences; (2) defer to physicians' recommendations; (3) have limited access to evidence-based resources; and (4) want CDST for antibiotic prescribing. CONCLUSIONS Dentists' confidence in antibiotic prescribing increased by training level, but knowledge did not. Trainees and practicing dentists would benefit from a CDST to improve appropriateness of antibiotic prescribing.
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Affiliation(s)
- Erika G Schneider-Smith
- Division of Medical Education, Washington University School of Medicine, St. Louis, Missouri
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and the University of Pittsburgh, School of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Rowan
- Division of General Dentistry, University of Illinois College of Dentistry, Chicago, Illinois
| | - Danny Hanna
- Division of General Dentistry, University of Illinois College of Dentistry, Chicago, Illinois
| | - Tracey Bach
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Neel Shimpi
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Randi E Foraker
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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Christensen HQ, Linde BR, Bårdsen A, Vilhjalmsson VH, Haug SR. Influence of dental education on adoption and integration of technological aids in the delivery of endodontic care by dental practitioners: a survey. Acta Odontol Scand 2022; 80:611-618. [PMID: 35531869 DOI: 10.1080/00016357.2022.2071986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate adoption and integration of technological aids during endodontic treatment and where dental practitioners (DPs) learnt to use this technology. MATERIALS AND METHODS An electronic questionnaire was distributed to all 459 dentists who graduated from University of Bergen between 2008 and 2018. The respondents were divided into two cohorts, older graduates (2008-2013) and newer graduates(2014-2018). RESULTS A total of 314(68.4%) DPs answered the questionnaire. Magnification in the form of dental operating microscopes (DOM) and dental loupes was used by 180 (59.6%), electronic apex locators (EAL) by 271(89.7%) and motor-driven files by 281 (93.4%) DPs. The most frequent response, as to where they learnt to use them was: during undergraduate dental (UG) education. Significantly more newer graduates (90.7%) performed instrumentation based on what they learnt during UG education (p < .001). Older graduates based their instrumentation method equally on what they learnt during UG education (51.9%) and continuing dental education(42.6%). Rubber dam was used during all treatment procedures by 93% of the DPs. CONCLUSIONS UG education is a communication channel with long-lasting importance for adoption and integration of technology by DPs. Exposure to innovations (awareness) during UG education is adequate for integration of technology. Continuing dental education is as valuable as UG education for adoption of technology for older graduates.
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Affiliation(s)
- Hanne Q. Christensen
- Department of Clinical Dentistry, Section for Endodontics, Faculty of Medicine, University of Bergen, Norway
| | - Brita R. Linde
- Department of Clinical Dentistry, Section for Endodontics, Faculty of Medicine, University of Bergen, Norway
| | - Asgeir Bårdsen
- Department of Clinical Dentistry, Section for Endodontics, Faculty of Medicine, University of Bergen, Norway
| | - Vilhjalmur H. Vilhjalmsson
- Department of Clinical Dentistry, Section for Endodontics, Faculty of Medicine, University of Bergen, Norway
| | - Sivakami R. Haug
- Department of Clinical Dentistry, Section for Endodontics, Faculty of Medicine, University of Bergen, Norway
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Jordal K, Skudutyte-Rysstad R, Sen A, Torgersen G, Ørstavik D, Sunde PT. Effects of an individualized training course on technical quality and periapical status of teeth treated endodontically by dentists in the Public Dental Service in Norway: An observational intervention study. Int Endod J 2021; 55:240-251. [PMID: 34817881 DOI: 10.1111/iej.13669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
AIM To investigate the effect of a continuing education course on technical quality and treatment outcome for root filled permanent teeth in Møre and Romsdal County, Norway. METHODOLOGY Fifty-two dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, completed a two-day continuing education course in root canal treatment. Periapical radiographs of root filled teeth treated before and after the course, with at least one-year follow-up were identified and scored for technical quality and periapical status. Technical root filling quality was assessed by density and length and the treatment outcome by PAI scores. Treatment information was achieved from the county's electronic dental record system. Information regarding the dental practitioners' background and treatment procedure routines was collected by a questionnaire. Descriptive statistics analyses and mixed-effect logistic regression analyses were performed to evaluate the effect of the course. RESULTS Radiographs were available for 224 teeth root filled before and for 221 teeth after the course. The proportion of teeth with adequate root filling quality was significantly lower after the course (p = .006), associated mainly with short root fillings (p < .001). No significant differences were observed in treatment outcome. There were, however, large differences in treatment outcome amongst subgroups of dentists. Further, there was evidence of effect modification by the continuing education course on periapical outcome by patient's age (pinteraction = .0023) suggesting that teeth in patients ≤18 years healed relatively better post-course compared to patients >18 years. CONCLUSIONS A two-day continuing education course in root canal treatment attended by Public Dental Service dentists in Norway did not improve the technical quality of root fillings or periapical status associated with root filled teeth.
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Affiliation(s)
- Kristin Jordal
- Department of Endodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Center for Oral Health Services and Research, TkMidt, Trondheim, Norway
| | - Rasa Skudutyte-Rysstad
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Abhijit Sen
- Center for Oral Health Services and Research, TkMidt, Trondheim, Norway
| | - Gerald Torgersen
- IT Section, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Dag Ørstavik
- Department of Endodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Pia Titterud Sunde
- Department of Endodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Jordal K, Sen A, Skudutyte-Rysstad R, Ørstavik D, Sunde PT. Effects of an individualised training course in endodontics on the knowledge and insights of dentists in Public Dental Service in Norway. Acta Odontol Scand 2021; 79:426-435. [PMID: 33503389 DOI: 10.1080/00016357.2021.1876915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the knowledge and insights of general dental practitioners regarding endodontic diagnosis and treatment principles before and after attending a 2-days continuing education course. MATERIALS AND METHODS Sixty-seven dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, were invited to a continuing education course in endodontics. Before and after the course, they answered a questionnaire weighing the importance of factors influencing the prognosis of endodontic treatment. The same questionnaire was answered by specialists in endodontics (n = 56; Spec Group) and a reference group consisting of general dental practitioners from both private and public practice (n = 21; Ref Group). The Test Group answered both before and after the course, while the Spec and Ref Groups completed the questionnaire once. The responses were compared using the Wilcoxon Sign test and Mann-Whitey U test. RESULTS Of the 67 dentists in the Test Group, 49 (73%) completed the course and answered both questionnaires. Before attending the course, the Test Group differed significantly from the Spec Group in 18 out of 27 prognostic factors (p ≤ .05). After the course, there was only moderate improvement in the Test Group responses. On only three factors, they agreed significantly more with the specialists than before attending the course (p ≤ .05). After the Test Group participants had attended the course, their responses were comparable to the responses of the Ref Group. CONCLUSIONS A two-days continuing education course only marginally improved dentists' level of knowledge and insights regarding the influence of prognostic factors in endodontics.
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Affiliation(s)
- Kristin Jordal
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
| | - Abhijit Sen
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
- Department of Public health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rasa Skudutyte-Rysstad
- Department of Cariology and Gerodontology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Dag Ørstavik
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Pia Titterud Sunde
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Shelley A, Horner K. Questionnaire surveys - sources of error and implications for design, reporting and appraisal. Br Dent J 2021; 230:251-258. [PMID: 33637929 DOI: 10.1038/s41415-021-2654-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/22/2020] [Indexed: 11/09/2022]
Abstract
Questionnaire surveys of dentists are a commonly used research method which can yield important results. Nevertheless, in order to give reliable information, surveys must be carefully designed to avoid bias. The challenge of planning, designing and implementing a questionnaire study is often underestimated. While headline response rate is commonly used as an indication of survey quality, there are four potential areas of survey error. These are coverage, sampling, measurement and response. These four areas of error are discussed, with examples from the current literature, to assist readers in critically appraising questionnaire studies. We make 12 key recommendations to researchers to help avoid bias in their research; approaches to response enhancement are also considered. Reporting guidelines for questionnaire studies are suggested which improve transparency and assist in understanding of research methodologies and results. We have termed these guidelines: Reporting Items for Surveys and Questionnaires (RISQ). In conclusion, there is no single solution that can guarantee a successful study. Conversely, failure to pay careful attention to any one of many crucial aspects of survey design can be the downfall of an otherwise robust study.
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Affiliation(s)
- Andrew Shelley
- Shelley & Pope Dental Practice, 117 Stockport Road, Denton, Manchester, M34 6DH, UK.
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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