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Awooda EM. Twelve-Year Follow-Up of Laser Frenectomy during Early Mixed Dentition. Case Rep Dent 2023; 2023:5525534. [PMID: 38187163 PMCID: PMC10769751 DOI: 10.1155/2023/5525534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024] Open
Abstract
Median maxillary labial frenum (MMLF) is one of the oral freni, found on the inner side of the centre of the upper lip. Maxillary midline diastema (MMD) is commonly associated with highly attached frenum, and frenectomy during early mixed dentition is controversial. A 6-year-old boy came with a chief complaint of unpleasant spacing between the two upper front teeth. A median maxillary high attached labial frenum with midline spacing of 5 mm was diagnosed. A consensus was made with the child's father to remove the frenum by laser. Diode laser frenectomy was done, and subsequent follow-up for 12 years revealed no relapse and complete closure of the diastema. Frenectomy during early mixed dentition could be a suitable option for the closure of midline diastema.
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Olsson J, Wolf E, Ljunggren A. Pre-medical assessment of root-canal-filled teeth with asymptomatic apical periodontitis-A multifaceted balancing act. Int Endod J 2023; 56:1063-1076. [PMID: 37269098 DOI: 10.1111/iej.13941] [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: 03/08/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023]
Abstract
AIM Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision-making process regarding the pre-medical management of root-canal-filled teeth with asymptomatic apical periodontitis (AAP). METHODOLOGY Hospital-affiliated dentists in Sweden were contacted for a semi-structured, in-depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root-canal-filled teeth with AAP-one case having resulted in pre-medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open-ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach. RESULTS A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes-difficult risk-benefit-estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub-categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference. CONCLUSIONS The current interview study found pre-medical decision-making regarding root-canal-filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence-based treatment guidelines, is suggested necessary.
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Affiliation(s)
- Jenny Olsson
- Department of Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Eva Wolf
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Anna Ljunggren
- Department of Oral Pathology, Faculty of Odontology, Malmö University, Malmö, Sweden
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Hui L. A new pathway for considering trigger factors based on parallel-serial connection models and displaying the relationships of causal factors in low-probability events. BMC Med Res Methodol 2023; 23:93. [PMID: 37061684 PMCID: PMC10105445 DOI: 10.1186/s12874-023-01919-3] [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: 09/30/2022] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND To determine the effect size of observed factors considering trigger factors based on parallel-serial models and to explore how multiple factors can be related to the result of complex events for low-probability events with binary outcomes. METHODS A low-probability event with a true binary outcome can be explained by a trigger factor. The models were based on the parallel-serial connection of switches; causal factors, including trigger factors, were simplified as switches. Effect size values of an observed factor for an outcome were calculated as SAR = (Pe-Pn)/(Pe + Pn), where Pe and Pn represent percentages in the exposed and nonexposed groups, respectively, and SAR represents standardized absolute risk. The influence of trigger factors is eliminated by SAR. Actual data were collected to obtain a deeper understanding of the system. RESULTS SAR values of < 0.25, 0.25-0.50, and > 0.50 indicate low, medium, and high effect sizes, respectively. The system of data visualization based on the parallel-serial connection model revealed that at least 7 predictors with SAR > 0.50, including a trigger factor, were needed to predict schizophrenia. The SAR of the HLADQB1*03 gene was 0.22 for schizophrenia. CONCLUSIONS It is likely that the trigger factors and observed factors had a cumulative effect, as indicated by the parallel-serial connection model for binary outcomes. SAR may allow better evaluation of the effect size of a factor in complex events by eliminating the influence of trigger factors. The efficiency and efficacy of observational research could be increased if we are able to clarify how multiple factors can be related to a result in a pragmatic manner.
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Affiliation(s)
- Liu Hui
- College of Medical Laboratory, Dalian Medical University, Dalian, 116044, China.
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Kherul Anuwar AH, Saub R, Safii SH, Ab-Murat N, Mohd Taib MS, Mamikutty R, Ng CW. Systemic Antibiotics as an Adjunct to Subgingival Debridement: A Network Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11121716. [PMID: 36551373 PMCID: PMC9774554 DOI: 10.3390/antibiotics11121716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
This review aimed to evaluate the effectiveness of systemic antibiotics as adjunctive treatment to subgingival debridement in patients with periodontitis. Randomized controlled trials were included that assessed the effectiveness of systemic antibiotics in improving periodontal status, indicated by clinical attachment gain level, probable pocket depth reduction, and bleeding on probing reduction of patients with any form of periodontitis at any follow-up time. Network meta-analyses with a frequentist model using random effects was employed to synthesize the data. The relative effects were reported as mean difference with a 95% confidence interval. Subsequently, all treatments were ranked based on their P-scores. A total of 30 randomized controlled trials were included in this network meta-analyses. Minimally important clinical differences were observed following the adjunctive use of satranidazole, metronidazole, and clindamycin for clinical attachment gain level and probable pocket depth reduction. For bleeding on probing reduction, minimally important clinical differences were observed following the adjunctive use of metronidazole and a combination of amoxycillin and metronidazole. However, the network estimates were supported by evidence with certainty ranging from very low to high. Therefore, the findings of this network meta-analyses should be interpreted with caution. Moreover, the use of these antibiotics adjunct to subgingival debridement should be weighed against possible harm to avoid overuse and inappropriate use of these antibiotics in patients with periodontitis.
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Affiliation(s)
- Ainol Haniza Kherul Anuwar
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Roslan Saub
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Syarida Hasnur Safii
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence:
| | - Norintan Ab-Murat
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Syukri Mohd Taib
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Chiu Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Youssef N, Alharbi H. Validity and reliability of the English version of the Student Evidence-Based Practice Questionnaire among Arabic-speaking undergraduate students at health sciences colleges: A cross-sectional study. NURSE EDUCATION TODAY 2022; 118:105525. [PMID: 36057146 DOI: 10.1016/j.nedt.2022.105525] [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: 03/07/2022] [Revised: 07/23/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence-based practice is vital for the provision of high-quality and safe healthcare. However, a rigorous, standardised, and unified evidence-based practice measure that could be applied to Arabic-speaking undergraduate students did not exist prior to this study. Moreover, translating questionnaires requires considerable time and money. OBJECTIVES Thus, this study aimed to investigate the psychometric properties of the Student Evidence-Based Practice Questionnaire (English version) among Arabic-speaking undergraduate students at health sciences colleges in Saudi Arabia. DESIGN A cross-sectional survey was adopted. SETTINGS The survey was conducted online over a six-month period. PARTICIPANTS A convenience sample of 395 undergraduate nursing students was recruited from health sciences colleges at seven universities in Saudi Arabia. METHODS The students were requested to complete the survey, including the Student Evidence-Based Practice Questionnaire, as well as a background and academic data sheet. Construct validity, discriminant sensitivity, and internal reliability were evaluated. RESULTS An exploratory factor analysis was performed. The Kaiser-Meyer-Olkin test value was 0.901, which was higher than the acceptable value of 0.70, indicating the adequacy of the sample size. Bartlett's test of sphericity was significant (chi-square (df: 210) = 4768.818, p < .001), indicating significant correlations within the variables and matrix. Based on Kaiser's criterion with eigenvalues > 1, four factors were detected that explained 62.03 % of the variance. The exploratory factor analysis of the 21 items generated factor loadings from 0.64 to 0.87. The Student Evidence-Based Practice Questionnaire has discriminant validity. The Cronbach's alpha and split-half reliability were over 0.7, indicating that the questionnaire had good internal consistency (Cronbach's alpha = 0.922). No evidence for floor or ceiling effects was observed. CONCLUSIONS The English version of the Student Evidence-Based Practice Questionnaire has a satisfactory validity and reliability level and can be used among Arabic-speaking undergraduate students without the need to translate it into Arabic.
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Affiliation(s)
- Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia.
| | - Hanan Alharbi
- Department of Maternity and Child Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia.
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Liew J, Zainal Abidin I, Cook N, Kanagasingam S. Clinical decision-making in complex endodontic cases between postgraduate students across dental specialties at a UK dental school: A pilot study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:707-716. [PMID: 34936724 DOI: 10.1111/eje.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/03/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Treatment decisions for a heavily restored endodontically treated tooth vary amongst clinicians owing to multitude of factors. This phenomenon not only often poses dilemmas to clinicians of different clinical backgrounds, but also exerts a degree of treatment difficulty to the treating clinician. Previous studies indicated that specialty training and clinical experience significantly impacted clinical decision-making process. MATERIALS AND METHODS Master of Science postgraduate students in endodontics, prosthodontics, periodontics, oral surgery and implantology participated in a questionnaire-based cross-sectional study. The dental specialties were further categorised into restorative and surgical dentistry. A multiple-choice questionnaire with three clinical cases was distributed to the students. Data were analysed for trends using descriptive statistics. RESULTS There was a 44% response rate; the majority of respondents were from restorative dentistry specialties. Cases 1 and 2 were rated as moderate to high difficulty, and Case 3 was predominantly rated as high difficulty with procedure predictability being the main factor affecting their clinical decision-making in three cases. Endodontic retreatment was selected as the preferred treatment in Cases 1 and 2 and periradicular surgery in Case 3. The students were fairly confident in managing Cases 1 and 2, but not in Case 3. Referral patterns were consistent in Cases 1 and 2 with endodontists being the first choice of referral except for Case 3 where 48% preferred to refer to oral surgeons and 35% choosing endodontists. Some indication of differences between specialties were noted throughout. Years in practice appeared to be related to the importance of predictability in Case 3 only. CONCLUSION Considerable inter-clinician variability was noted whereby specialty postgraduate training impacted on clinical decision-making. Overall, procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most highly ranked factors affecting clinical decision-making. Evidence-based treatment guidelines and dental curricula should be reviewed to enhance inter-clinician agreement in clinical decision-making, ultimately improving patient care.
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Affiliation(s)
| | - Imran Zainal Abidin
- International Islamic University Malaysia, Faculty of Dentistry, Kuantan, Malaysia
| | - Neil Cook
- University of Central Lancashire, School of Dentistry, Preston, UK
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Jameson LM, Al‐Tarawneh SK. Informed Consent from a Historical, Societal, Ethical, Legal, and Practical Perspective. J Prosthodont 2022; 31:464-471. [PMID: 35184338 PMCID: PMC9541224 DOI: 10.1111/jopr.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/02/2022] [Indexed: 12/01/2022] Open
Abstract
Informed consent is often perceived as a regulatory obligation without recognizing its educational potential in the dynamic provider/patient relationship. This article discusses the complex interaction of ethics, society, and law through a historical and practical perspective. The purpose is to provide general dentists and specialists with a comprehensive understanding of the complexity and practical dimensions of informed consent.
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Affiliation(s)
- Lee M. Jameson
- Department of Restorative Dentistry, College of Dentistry University of Illinois at Chicago Chicago Illinois
| | - Sandra K. Al‐Tarawneh
- Department of Restorative Dentistry, College of Dentistry University of Illinois at Chicago Chicago Illinois
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Nassar A, Aboalshamat K, Alharbi R, Alharbi A, Alfozan A, Alahdal S, Aldehri S. The perception of evidence-based dentistry among dental professionals in Saudi Arabia during COVID-19 pandemic. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S99-S105. [PMID: 36110818 PMCID: PMC9469449 DOI: 10.4103/jpbs.jpbs_575_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022] Open
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Hui L. Need for discriminating between diagnostic and screening efficacy to estimate a biomarker based on case control and cohort studies. Sci Rep 2021; 11:22450. [PMID: 34789793 PMCID: PMC8599673 DOI: 10.1038/s41598-021-01904-0] [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: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
This study proposes the comprehensive index of biomarker (CIB), based on the consistency of a biomarker in case control (Youden index, J) and cohort studies (Crc), to evaluate biomarker efficacy. CIB was calculated as the mean of J and Crc. Analysis of the effect of sensitivity and specificity on CIB and ROC analysis of CIB were performed in simulated and actual datasets. J and CIB had similar values for high-probability events (say probability was 0.50), but there was a significant difference between J and CIB for low-probability events (say probability was 0.05). Therefore, as the subjects considered for diagnosis are usually symptomatic, the occurrence of a disease can be assumed to be a high-probability event. In contrast, as the subjects considered in screening for a disease are usually healthy and asymptomatic, the occurrence of a disease is assumed to be a low-probability event. Although J is the common index used to evaluate the diagnostic effectiveness, unfortunately, the J value is significantly larger than CIB value in a low-probability event, showing overestimation for screening purpose. CIB could have more potential than J for determining the screening efficacy of a biomarker. The efficacy of a biomarker could differ for diagnostic, screening, predictive, and prognostic purposes, and it would be better to evaluate the efficacy of biomarkers for specific systems or contexts.
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Affiliation(s)
- Liu Hui
- College of Medical Laboratory, Dalian Medical University, Dalian, 116044, People's Republic of China.
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Paci M, Faedda G, Ugolini A, Pellicciari L. Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis. Int J Qual Health Care 2021; 33:6295946. [PMID: 34110410 DOI: 10.1093/intqhc/mzab093] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/09/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To review and meta-analyse the evidence about the prevalence of barriers to evidence-based practice (EBP) reported in physiotherapy. METHODS Two independent investigators conducted an extensive electronic search in EMBASE, PubMed, Scopus, Web of Science and CINAHL databases from their inception to July 2020 and included the retrieved articles if they investigated barriers to EBP among physiotherapy professionals. Subsequently, they extracted data and assessed the methodological quality using a scale described in a similar previous study. The outcome for meta-analysis was frequency of each reported barrier. Sub-analyses were performed grouping studies based on countries where surveys were performed, classified as either developed or developing countries. RESULTS Twenty-nine articles were included in the systematic reviews and meta-analysis. Risk of bias assessment of included studies showed a median score: 4 points (interquartile range: 3-4). The findings of meta-analysis revealed that lack of time was the most frequently reported barrier (53.0% [95% confidence interval, 95%CI, 44.0-62.0]), followed by language (36.0% [95%CI 16.0-62.0]), lack of access (34.0% [95%CI 23.0.27]) and lack of statistical skills (31.0% [95%CI 20.0-44.0]). Lack of skills and lack of generalizability were declared as barriers by 27.0% [95%CI 18.0-38.0] and 23.0% [95%CI 15.0-33.0] of responders, respectively. Lack of support and lack of interest are less frequent, with 16.0% [95%CI 11.0-24.0] and 9.0% [95%CI 6.0-15.0] of responses, respectively. Barriers reported in investigations performed in developed countries were less frequent when compared to those performed in developing countries. CONCLUSION Organizational issues and methodological skills seem key issues to allow the implementation of EBP, suggesting the need to adopt or enhance organizational and training strategies to facilitate the implementation of the EBP. Quantitative synthesis showed high heterogeneity for all analyses, and therefore, pooled data should be interpreted with caution.
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Affiliation(s)
- Matteo Paci
- Unit of Functional Rehabilitation, Azienda USL Toscana Centro, Viale Michelangiolo, 41, Florence 50125, Italy
| | - Gianni Faedda
- Graduate Course in Rehabilitation Sciences, University of Florence, Largo Brambilla, 3, Florence 50134, Italy
| | - Alessandro Ugolini
- Program in Physical Therapy, University of Florence, Largo Brambilla, 3, Florence 50134, Italy
| | - Leonardo Pellicciari
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269 I, Florence 50143, Italy
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Analyzing the Relationship between Cohort and Case-Control Study Results Based on Model for Multiple Pathogenic Factors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2019:7507043. [PMID: 32082409 PMCID: PMC7012262 DOI: 10.1155/2019/7507043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
Objective Although the relative risk from a prospective cohort study is numerically approximate to the odds ratio from a case-control study for a low-probability event, a definite relationship between case-control and cohort studies cannot be confirmed. In this study, we established a different model to determine the relationship between case-control and cohort studies. Methods Two analysis models (the cross-sectional model and multiple pathogenic factor model) were established. Incidences in both the exposure group and the nonexposure group in a cohort study were compared with the frequency of the observed factor in each group (diseased and nondiseased) in a case-control study. Results The relationship between the results of a case-control study and a cohort study is as follows: Pe=(Pd∗m)/(Pc∗m)/(Pd∗m)/(Pn=(m)/(∗PdPc∗m)/(Pd∗m)/(Pe and Pn represent the incidence in the exposed group and nonexposed group, respectively, from the cohort study, while Pd and Pc represent the observed frequencies in the disease group and the control group, respectively, for the case-control study; finally, m)/( Conclusions There is a definite relationship between the results of case-control and cohort studies assessing the same exposure. The outcomes of case-control studies can be translated into cohort study data.
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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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