The association between professional stratification and use of online sources: Evidence from the National Dental Practice-Based Research Network.

The use of online information sources in most professions is widespread, and well researched. Less understood is how the use of these sources vary across the strata within a single profession, and how question context affects search behaviour. Using the dental profession as a case of a highly stratified discipline, we examine search preferences for sources by professional strata among dentists in a practice-based network. Results show that variation exists in information search behaviour across professional strata of dental clinicians. This study highlights the importance of addressing information literacy across different levels of a profession. Findings also underscore that search behaviour and source preference vary with perceived question relevance.

Comparison of the accuracy of CBCT effective radiation dose information in peer-reviewed journals and dental media.

Accessible sources of clinical information have proliferated over the past decade. Although these new sources that contextualize information for practice are user friendly, there are questions about their accuracy because much of the material is not peer reviewed. On the other hand, traditional peer-reviewed material can be somewhat removed from the needs of practicing dentists, and recently questions have been raised about the accuracy of journals. This study assessed the accuracy of cone beam computed tomography (CBCT) radiation safety information in both professional media and peer-reviewed journals. Articles introducing CBCT technology to dentists and published in peer-reviewed journals were compared to articles appearing in professional magazines, clinically oriented news sites, and blogs written by clinicians for clinicians. The reported radiation doses of CBCT and conventional dental radiographs were recorded, as were conclusions about the comparative doses of these 2 imaging modalities. The proportion of articles reporting CBCT dose to be greater than, equal to, or less than that of conventional dental radiographs was not different between the peer-reviewed and professional media articles during the period 2003-2016. There is weak evidence that the conclusions of peer-reviewed journal articles, but not professional media sources, became more conservative after the 2010 publication of an article in The New York Times that was critical of misinformation concerning the safety and efficacy of CBCT in dentistry. Professional media articles that were not peer reviewed were as accurate as peer-reviewed journals for this topic and during the time period assessed. However, the method used here necessitated a narrow focus, and more studies are needed to broaden understanding.

Dental Blogs, Podcasts, and Associated Social Media: Descriptive Mapping and Analysis.

BACKGROUND: Studies of social media in both medicine and dentistry have largely focused on the value of social media for marketing to and communicating with patients and for clinical education. There is limited evidence of how dental clinicians contribute to and use social media to disseminate and access information relevant to clinical care. OBJECTIVE: The purpose of this study was to inventory and assess the entry, growth, sources, and content of clinically relevant social media in dentistry. METHODS: We developed an inventory of blogs, podcasts, videos, and associated social media disseminating clinical information to dentists. We assessed hosts' media activity in terms of their combinations of modalities, entry and exit dates, frequency of posting, types of content posted, and size of audience. RESULTS: Our study showed that clinically relevant information is posted by dentists and hygienists on social media. Clinically relevant information was provided in 89 blogs and podcasts, and topic analysis showed motives for blogging by host type: 55% (49 hosts) were practicing dentists or hygienists, followed by consultants (27 hosts, 30%), media including publishers and discussion board hosts (8 hosts, 9%), and professional organizations and corporations. CONCLUSIONS: We demonstrated the participation of and potential for practicing dentists and hygienists to use social media to share clinical and other information with practicing colleagues. There is a clear audience for these social media sites, suggesting a changing mode of information diffusion in dentistry. This study was a first effort to fill the gap in understanding the nature and potential role of social media in clinical dentistry.

Making Homes Healthy: International Code Council Processes and Patterns.

CONTEXT: Americans spend more than 90% of their time indoors, so it is important that homes are healthy environments. Yet many homes contribute to preventable illnesses via poor air quality, pests, safety hazards, and others. Efforts have been made to promote healthy housing through code changes, but results have been mixed. In support of such efforts, we analyzed International Code Council's (ICC) building code change process to uncover patterns of content and context that may contribute to successful adoptions of model codes. OBJECTIVE: Discover patterns of facilitators and barriers to code amendments proposals. DESIGN: Mixed methods study of ICC records of past code change proposals. N = 2660. SETTING: N/A. PARTICIPANTS: N/A. MAIN OUTCOME MEASURE(S): There were 4 possible outcomes for each code proposal studied: accepted as submitted, accepted as modified, accepted as modified by public comment, and denied. RESULTS: We found numerous correlates for final adoption of model codes proposed to the ICC. The number of proponents listed on a proposal was inversely correlated with success. Organizations that submitted more than 15 proposals had a higher chance of success than those that submitted fewer than 15. Proposals submitted by federal agencies correlated with a higher chance of success. Public comments in favor of a proposal correlated with an increased chance of success, while negative public comment had an even stronger negative correlation. CONCLUSIONS: To increase the chance of success, public health officials should submit their code changes through internal ICC committees or a federal agency, limit the number of cosponsors of the proposal, work with (or become) an active proposal submitter, and encourage public comment in favor of passage through their broader coalition.

The role of Zambia's expansive Inter-agency Coordinating Committee (ICC) in supporting evidence-based vaccine and health sector programming.

New vaccines, technologies, and regulations, alongside increased demand for vaccines, all require prioritization and coordination from key players within the vaccine sector. Inter-agency Coordinating Committees (ICC) support decision-making and coordination at the national-level and act as key drivers for sustainable improvements in vaccination programming. We utilized a previous qualitative case study, which investigated critical success factors for high routine immunization coverage in Zambia from 2000-2018, specifically to study the Zambian ICC. Qualitative data were collected between October 2019 and February 2020, including key informant interviews (n = 66) at the national, provincial, district, and health facility levels. Thematic analysis was applied to understand the role of the Zambian ICC and its impact on the policy environment over time. Within our study period, the ICC demonstrated the following improvements: 1) expanded membership to include diverse representation; 2) expanded scope and mandate to include maternal and child health in decision-making; and 3) distinct roles for collaboration with the Zambia Immunization Technical Advisory Group (ZITAG). The diverse and expansive membership of the Zambian ICC, along with its ability to foster government commitment and lobby for additional resources, supported improvements in immunization programming. The Zambian ICC holds considerable influence on government agencies and external partners, which facilitates procurement of funding, policy decisions, and strategic planning.

In and across bureaucracy: structural and administrative issues for the tobacco endgame.

This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I discuss issues related to implementation of the endgame within a specific single agency, and issues related to a more widespread, broad implementation involving several agencies. Where appropriate, I provide examples of how the dynamics discussed would apply to particular endgame strategies. Issues related to design, administration, authority and finances are raised.

Temporal search persistence, certainty, and source preference in dentistry: Results from the National Dental PBRN.

OBJECTIVES: The primary goal of this paper was to investigate an old question in a new way: what are the search patterns that professionals demonstrate when faced with a specific knowledge gap? METHODS: We examine data from a cascading survey question design that captures details about searching for information to answer a self-nominated clinical question from 1027 dental professionals enrolled in the National Dental Practice Based Research Network. Descriptive and conditional logistical regression analysis techniques were used. RESULTS: 61% of professionals in our sample choose informal sources of information, with only about 11% looking to formal peer reviewed evidence. The numbers of professionals turning to general internet searches is more than twice as high as any other information source other than professional colleagues. Dentists with advanced training and specialists are significantly more likely to consult peer-reviewed sources, and women in the sample were more likely than men to continue searching past a first source. CONCLUSIONS: Speed/availability of information may be just as, or in some cases, more important than credibility for professionals' search behavior. Additionally, our findings suggest that more insights are needed into how various categories of professionals within a profession seek information differently.

Association between predoctoral evidence-based practice training and later use of peer-reviewed journals: National dental PBRN.

OBJECTIVE: We examined whether evidence-based practice (EBP) during dental school was associated with the increased use of peer-reviewed literature during subsequent clinical practice for National Dental Practice-Based Research Network (PBRN) dentists. We also sought to understand whether this association was moderated by being a dental specialist. METHODS: We analyzed cross-sectional data from 1228 dentists participating in the PBRN. We used logistic regression to examine the association between self-reported EBP training during dental school and the use of peer-reviewed journals in clinical practice, controlling for the number of years since dental school graduation and dental practice type. We stratified the data by dental specialists and examined effect modification using the Breslow-Day test for homogeneity of the odds ratio. RESULTS: The prevalence of peer-reviewed journal use by PBRN dentists in clinical practice was 87% (n = 1070) with no statistical evidence of effect modification by dental specialists on the EBP peer-reviewed journal use relationship (p > 0.05). After controlling for years since dental school graduation and dental practice type, dentists who self-reported EBP training during dental school had greater odds of using peer-reviewed journals in clinical practice than dentists who did not self-report EBP training during dental school (OR, 1.47; 95%CI = 1.01, 2.15). CONCLUSION: The use of peer-reviewed published literature by PBRN dentists who had EBP predoctoral training is one important step in the EBP process by which practicing dentists can implement evidence-based findings, interventions, and policies into routine health care and public health settings. These findings add to the body of support for EBP curricula in dental education.

Stewardship in mental health policy: inspiration, influence, institution?

The venerable but amorphous concept of stewardship has lately gained prominence in discussions of public policy and management and is sometimes offered as a "strategy" with a distinctive potential to mobilize effective public leadership in the service of broad social missions. In this article we explore how stewardship may be useful to the theory and practice of mental health policy, and, reciprocally, how examples from mental health policy may elucidate the dynamics of stewardship. After examining its key political ingredients--authority, advocacy, and analysis--we discuss the practical challenges in moving stewardship from moral inspiration to institutional reality.

Managed care and provider satisfaction in mental health settings.

We assess the satisfaction of mental health providers using four dimensions from the medical practice literature--degree of autonomy, relationship with patients, compensation, and administrative burden--and extend current work on professional satisfaction to include frontline service providers rather than only psychiatrists or other physicians. In contrast to results reported for primary care settings, we find that the impact of managed care on satisfaction is minimal for the mental health providers in our study of a Medicaid capitation demonstration in the southeastern US. Instead, variables relevant to everyday working conditions have an important effect on job satisfaction.

A characterization of professional media and its links to research.

The publishing industry is a vast system whose elements form a metaphorical ecosystem with knowledge flowing through connections between heterogeneous elements. In this paper we seek a more robust understanding of different types of literature, and whether and how they support one another in the diffusion of knowledge. We analyze a corpus comprising professional electronic media in US dentistry and its relation to the peer reviewed journal literature. Our corpus includes full text from magazines, news sites and blogs that provide information to clinicians. We find links to research are made through several mechanisms: articles describing new clinical guidelines, referencing, summaries of recently published journal articles and crossover authoring. There is little to no apparent time lag in the diffusion of information from research literature to professional media.

Preferences for peer-reviewed versus other publication sources: a survey of general dentists in the National Dental PBRN.

BACKGROUND: Medical professionals have access to a broad range of resources to address clinical information needs. While much attention is given to new sources of data such as those available on the internet, it is less clear how clinicians choose between peer-reviewed research literature and other publication-based sources. This analysis distinguishes between possible drivers of publication type preference (namely, practice setting, advanced training, professional development experiences). Dentists enrolled in the National Dental Practice-Based Research Network (PBRN) are the population for this study. Theories of human and intellectual capital and institutional logics theory are used to understand how advanced training and other clinical experiences may explain the choices that dentists make when faced with clinical questions. METHODS: An online questionnaire was implemented with general dentists in the US National Dental PBRN. A series of logistic and Ordinary Least Squares (OLS) regression models were used to explain the use of peer-reviewed and other publications. Measures of knowledge-based human capital distinctions (advanced clinical training and research engagement, advanced professional status, personal motivation for professional advancement) were used to explain preferences for research literature as a clinical resource. RESULTS: General dentists with advanced training, as well as those with a skill advancement motivation, show a preference for peer-reviewed materials. General dentists who have been practicing longer tend to favor other dental publications, preferring those sources as a resource when faced with clinical challenges. Human capital and professional motivation distinguish the information preferences among general dentists. Further, these factors explain more variance in use of peer-reviewed materials than practice setting does. Few differences by demographic groups were evident. CONCLUSIONS: Results point to a distinct variation in the general dentistry professional community. Advanced training among general dentists, as well as the types of procedures typically conducted in their practice, distinguishes their information preferences from other general dentists, including those with more years of clinical experience.

Missed Opportunities for Detecting Alternative Nicotine Product Use in Youth: Data From the National Dental Practice-Based Research Network.

PURPOSE: With growing rates of youth e-cigarette and hookah use, and the fact that use of these products is difficult to detect, surveillance and early detection efforts need to be reassessed. Physicians and pediatricians both report that their level of knowledge about these products is low. Given that over 80% of youth have had dental visits in the past year and that the effects of nicotine use are visible early in routine dental examinations, it is likely that dental professionals are well positioned to play a critical role in detection. Currently, the knowledge about alternative nicotine among practicing dental clinicians is unknown. METHODS: One thousand seven hundred and twenty-two dental professionals in community practice in the United States National Dental Practice-Based Research Network responded to a survey in the summer/fall of 2016. These data were supplemented with network membership enrollment data, and the American Community Survey, and were analyzed using descriptive statistics, measures of association, and logistic regression. RESULTS: Only 25%-36% of dental professionals feel knowledgeable about the most common types of alternative nicotine products, including e-cigarettes and hookahs. Thirty-eight percent of respondents reported not screening at all for e-cigarettes. CONCLUSIONS: A substantial percentage of dental professionals do not have a working understanding of alternative nicotine products, nor are aware of their patients' use rates. Better access to information and training on alternative nicotine products could provide an opportunity to improve surveillance for early use of these products in youth populations.

The state policy context of implementation issues for evidence-based practices in mental health.

OBJECTIVES: This study analyzed implementation issues related to several evidence-based practices for adults with serious mental illness that were included in a national demonstration project. The five evidence-based practices included in this investigation are assertive community treatment, family psychoeducation, illness management and recovery, integrated dual diagnosis treatment, and supported employment. The objective of the study was to assess the role of state mental health authorities as agents of change. METHODS: Two-person teams conducted interviews with state mental health authorities, consumers, families, representatives of local mental health authorities, and representatives of other relevant state agencies--more than 30 individuals at each of the eight sites. Interviews took place at two time points at least one year apart and probed the facilitators and barriers to implementation at the state level. Data were assessed qualitatively to identify common trends and issues across states related to leadership, training, and regulatory issues for each evidence-based practice. RESULTS: Each of the five practices has different critical contingencies for statewide implementation and requires unique assets to address those contingencies by the state mental health authorities. The contingencies are related to these critical areas: financing and regulations, leadership, and training and quality. CONCLUSIONS: States are key to implementing evidence-based practices, but state mental health authorities should note that each of the practices requires different skill sets and involves different stakeholders. Thus implementing many evidence-based practices at once may not yield economies of scale.

Improving practice-research connections through technology transfer networks.

This paper presents a first look at network and survey data collected to ascertain the salience and value-added of technology transfer networks in reducing the science-to-service gap in behavioral healthcare services. The National Child Traumatic Stress Network served as the case setting upon which administrative and survey data were analyzed. Results show a rich set of formal relationships within the National Child Traumatic Stress Network and suggest participants found these relationships and this medium useful in altering their day-to-day practices and increasing their professional knowledge. The implications of these findings are that technology transfer networks are useful mechanisms worthy of investment of scarce resources.

Assessing delayed effects of a multi-site system intervention for homeless persons with serious mental illness.

ACCESS demonstration sites were followed for an additional two years beyond the scheduled four-year evaluation to assess whether any delayed effects had occurred in system and project integration. For system integration, findings indicate that there was a sharp increase between Wave 3 (1998) and Wave 4 (2000), but experimental and comparison sites had identical trends. For project integration, experimental sites at Wave 4 sustained the high level of integration achieved at Wave 3, but the comparison sites achieved the same level as the experimental sites at Wave 4, through an abrupt increase in their scores. The absence of delayed effects is likely due to diffusion of the interventions to comparison sites both in the latter stages of the demonstration and immediately afterwards. Further, aggressive lobbying on the part of ACCESS program managers to generate local and state support to sustain their services following the termination of federal funding, had an integrating effect thereby creating linkages among comparison site agencies. Implications of these findings for policy and further research are highlighted.