Safety attributes in primary care: understanding the needs of patients, health professionals, and managers.

OBJECTIVES: The aims of this study were (1) to identify attributes for patient safety at a primary healthcare level and (2) to analyze conceptions of patients, professionals, and managers about how these attributes are being addressed. STUDY DESIGN: This was a qualitative study. METHODS: Participants were recruited from three primary care settings in Brazil. A total of 37 subjects (four physicians, three nurses, three dentists, three managers, five community assistants, and 19 patients) participated on interviews about their perceptions of safety attributes at the primary care settings involved in the study. Some of these participants attended a focus group meeting. A thematic categorical analysis was carried out to interpret the interviews. RESULTS: The main attributes for patient safety were valued by the participants. However, barriers such as discontinuity of care, interruptions during consultations, breakdowns in the communication, and ineffective teamwork were reported as frequent sources of patient safety issues. Reports of patients left unattended for excessive time because of the lack of accurate information and disruptions that took up to 35 min show that there is still a long way to go for primary care to be safe and effective in the study settings. CONCLUSIONS: It is necessary that the strategies meet the patient safety needs more effectively and efficiently. Further research is needed to understand the complex nature of the problems that affect patient safety in these settings so that appropriate decisions can be made.

Trends and attitudes regarding head and neck oncologic surgery: a survey of United States oral and maxillofacial surgery programs.

PURPOSE: The purposes of this study were to: 1) estimate the prevalence and trends of American oral and maxillofacial surgery (OMS) programs in recruiting head and neck oncologic surgery (HNOS) -trained faculty, performing HNOS oncologic procedures and microvascular reconstruction, and presenting HNOS research at academic meetings; 2) estimate whether HNOS and microvascular reconstruction involvement varies among programs with or without a program director or chair trained in HNOS; 3) estimate whether HNOS involvement varies among those OMS programs that regularly attend and do not attend tumor board; 4) estimate whether HNOS involvement varies among those programs that have and have not presented HNOS research at an academic meeting; 5) estimate whether HNOS involvement varies among doctor of medicine-integrated and 4-year OMS programs. MATERIALS AND METHODS: Investigators developed and distributed a survey to all US OMS program directors and/or chair composed of questions regarding faculty prevalence and recruitment, frequency and trends in cases, and the priority of applicants for residency with regard to HNOS. There were 18 close-ended questions, and one open-ended question. Responses were recorded in categorical, Likert, ordinal, and numerical format. Bivariate associations were calculated using Fisher exact test and logistic regression. RESULTS: Sixty-three of 101 surveys were returned (62.3%). Ten program directors or chair completed a fellowship in HNOS (15.9%). Programs with an HNOS-trained program director or chair were more likely to have another HNOS-trained faculty member (P = .01), performed more malignant tumor resections (P < .001), neck dissections (P < .001), and microvascular free-flap reconstructions (P = .02) than programs without program directors or chair trained in HNOS. Programs that regularly attended tumor board performed an increasing number of malignant tumor resections (P = .008); and neck dissections (P = .003) than programs that did not regularly attend their institution's tumor board. Presentations of HNOS-related research at national meetings did not differ between doctor of medicine-integrated and 4-year OMS programs (P = .7). There was no difference in the prevalence of HNOS-trained program directors and chair between doctor of medicine-integrated and 4-year programs (P = .7). CONCLUSIONS: This study's data and comments suggest that programs involved in HNOS have a strong involvement in expanded scope OMS and related academic activities.

Ten-year survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PURPOSE: This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10-year data on trends in prosthodontics as reported by program directors. MATERIALS AND METHODS: A national e-mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. RESULTS: Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US-trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10-year survey, there was a positive, statistically significant correlation that society's demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state-sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. CONCLUSIONS: A nearly doubled applicant pool and more US-trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as society's demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States.

Emerging allied dental workforce models: considerations for academic dental institutions.

The U.S. surgeon general defined the national oral health care crisis in 2001 in Oral Health in America: A Report of the Surgeon General. The report concluded that the public infrastructure for oral health is not sufficient to meet the needs of disadvantaged groups and is disproportionately available depending upon certain racial, ethnic, and socioeconomic factors within the U.S. population. Now, several new workforce models are emerging that attempt to address shortcomings in the oral health care workforce. Access to oral health care is the most critical issue driving these new workforce models. Currently, three midlevel dental workforce models dominate the debate. The purpose of this report is to describe these models and their stage of development to assist the dental education community in preparing for the education of these new providers. The models are 1) the advanced dental hygiene practitioner; 2) the community dental health coordinator; and 3) the dental health aide therapist.

[Prevalence and factors associated with dental pain that prevents the performance of routine tasks by civil servants in Rio de Janeiro, Brazil]. / Prevalência e fatores associados à ocorrência da dor de dente que impediu a realização de tarefas habituais em uma população de funcionários públicos no Rio de Janeiro, Brasil.

The aims of this study were to estimate the prevalence of dental pain preventing the performance of routine tasks and to assess its association with socioeconomic factors, minor psychiatric disorders, number of missing teeth, and dental consultation patterns. A cross-sectional study was conducted using a self-completed questionnaire answered by 4,030 administrative employees at a university in Rio de Janeiro, Brazil (the Pró-Saúde Study). Data were analyzed using multiple logistic regression. Prevalence of toothache preventing the performance of routine tasks in the two weeks prior to the interview was 2.9% (95%CI: 2.5-3.6). Men (OR = 1.6; 95%CI: 1.1-2.4), individuals with minor psychiatric disorders (OR = 1.7; 95%CI: 1.2-2.6), individuals with extensive tooth loss (OR = 3.4; 95%CI: 1.5-7.8), and those failing to appear for regular dental checkups (OR = 2.5; 95%CI: 1.8-17.3) showed increased odds of experiencing dental pain. Dental pain was an important problem in this population. Unfavorable living conditions and lack of regular dental checkups increased the odds of dental pain.

Principal dental admissions officers: Who are dentistry's gatekeepers?

Little is known about principal dental admissions officers (PDAO) in U.S. dental schools who may be viewed as the gatekeepers to our schools. To address this gap, this study examined the characteristics of PDAOs in U.S. dental schools. A web-based, fifty-five-question survey on the personal and professional characteristics, roles, areas of responsibilities, and areas considered of importance to PDAOs was sent to fifty-six principal dental admissions officers at U.S. dental schools, followed by telephone calls to encourage participation. Thirty-eight PDAOs responded. The typical PDAO was Caucasian, fifty-two years of age, and had been in the position about eight years, earning dollar 80,000 annually. Most supervised one or more employees and spent time working for the school outside the admissions process. Student contact activity considered most important was counseling prospective students, while maintaining health and financial records was considered unimportant. Minority recruitment efforts were considered highly important by a majority of PDAOs. The PDAOs have varied educational backgrounds and positions, but perform functions primarily dedicated to admissions.

Leadership in your midst: tapping the hidden strengths of minority executives.

All companies value leadership-some of them enough to invest dearly in cultivating it. But few management teams seem to value one engine of leadership development that is right under their noses, churning out the kind of talent they need most. It's the complicated, overburdened but very rich lives of their minority managers. Minority professionals-particularly women of color-are called upon inordinately to lend their skills and guidance to activities outside their jobs. Sylvia Ann Hewlett, who heads the Center for Work-Life Policy, and her coauthors, Carolyn Buck Luce of Ernst & Young and Cornel West of Princeton, present new research on the extent to which minority professionals take on community service and other responsibilities outside the workplace and more than their share of recruiting, mentoring, and committee work within the workplace. These invisible lives, argue the authors, can be a source of competitive strength if companies can learn to recognize and further cultivate the cultural capital they represent. But it's hard to convince minority professionals that their employer respects and values their off-hours responsibilities. A lack of trust keeps many people from revealing much about their personal lives. The authors outline four ways companies can leverage hidden skills: Develop a new level of awareness of minority professionals' invisible lives; appreciate the outsize burdens these professionals carry and try to lighten them; build trust by putting teeth into diversity goals; and, to finish the job of leadership development, help minorities reflect on their off-hours experiences, extract and generalize the lessons, and apply what's been learned in other settings.

The prevalence of oral health problems in participants of the 1992 Olympic Games in Barcelona.

The Olympic Games are the focus of attention for millions of people in the world and provide the pinnacle of sporting excellence. The health and welfare of the participating sportsmen and women is paramount for successful competition and this must include oral health. The purpose of this paper is to describe a study undertaken at the Barcelona Olympic Games in 1992 into the attendance patterns and oral health of patients visiting the dental clinic provided in the Olympic Village. Recommendations are made for the conduct of future dental care facilities at Olympic Games and the collection of data.

A profile of dental school deans, 2002.

Dental school deans were surveyed to update and expand the profile of a dean developed in a 1999 survey and to assess whether the profile has changed since the initial survey. The demographic characteristics and qualifications of dental school deans were similar in 1999 and 2002. The dean turnover rate and average length of deanship have not significantly changed since 1990. There was a shift in the current and emerging issues described by deans in the 1999 and 2002 surveys. In 2002, infrastructure and resource management, future workforce needs, and access to care were much more likely to be mentioned. Nearly all deans have a dental degree and additional advanced degrees or certificates, and they are likely to be specialists. Dental school deans are almost always full professors with tenure and have had significant administrative experience as department chairs and assistant/associate deans and have served on boards outside of their institution. Deans typically are scholars with multiple published journal articles, textbooks, or chapters and have been the principal investigator for grants and contracts. This information provides insight into the background necessary to become a dental school dean and the qualities sought by dental schools.

Perceptions of dental schools from within and outside the university.

Perceptions of dental schools held by high-level administrators of their parent institutions and officials in the local community have great potential to influence the future of dental education. The intent of this investigation was to gain a preliminary knowledge of such perceptions at seven institutions in the United States and to use this information to formulate hypotheses that can provide the basis for further targeted investigations that provide evidence useful in decision making and planning processes within dental schools. Interviews with university administrators, executive directors of state dental associations, and state government officials in seven areas of the United States were conducted. The hypotheses drawn from these interviews are: 1) dental schools are generally too insular and need to interact more with their parent institutions and external community; 2) dental schools need to systematically and continually get the message of the value of their services out to the public and political constituencies; and 3) multidisciplinarity and integration with other units are important to university administrators but largely outside the concerns of those external to the university. We suggest that these hypotheses form the basis of subsequent, more targeted, follow-up investigations with the intent of formulating specific recommendations for action.

Administrative trends in U.S. dental schools.

The aims of this study were to analyze the administrative trends in U.S. dental schools at the beginning and end of a thirteen-year period and to identify the predictive factors for those changes. Administrative trends were measured by the difference in the number of major administrative positions for 1997 and 2010 reported in American Dental Education Association (ADEA) and American Dental Association (ADA) publications. Secondary measures (program length, student enrollment, and tuition) were also gathered. The mean numbers of administrative positions per school significantly increased over the study period, while the mean number of clinical science departments per school significantly decreased. The change in the number of directors was positively correlated with the change in student enrollment, but inversely correlated with the change in number of vice/associate/assistant deans. The change in the number of clinical science departments was positively correlated with changes in student enrollment and out-of-state tuition, but inversely correlated with the change in in-state tuition. The number of all departments per U.S. dental school significantly decreased in this period. The schools that had consolidation of clinical science departments were less likely to have increases in student enrollment and out-of-state tuition, but more likely to have increases in in-state tuition.

Dental school vacant budgeted faculty positions, academic years 2008-09 to 2010-11.

The annual turnover of dental school faculty creates a varying number of vacant budgeted positions from year to year. The American Dental Education Association (ADEA) conducts an annual survey to determine the status and characteristics of these vacant faculty positions. The number of vacant budgeted faculty positions in U.S. dental schools increased throughout the 1990s, with a peak of 417 positions in 2005-06. Since that time, there has been a decrease in the number of estimated vacancies, falling to 227 in 2010-11. The 2008-09 to 2010-11 faculty vacancy surveys explored these decreases, along with information relevant to the number and characteristics of dental faculty vacancies, including data on the distribution of full-time, part-time, and volunteer faculty, reasons for faculty separations, and sources of new faculty.

Teaching atraumatic restorative treatment in U.S. dental schools: a survey of predoctoral pediatric dentistry program directors.

The International Dental Federation and World Health Organization have promoted the use of Atraumatic Restorative Treatment (ART) in modern clinical settings worldwide. In the United States, the practice of ART is not believed to be widely used, which may be a result of little attention given to ART training in predoctoral pediatric dentistry curricula in U.S. dental schools. This study investigated the extent of clinical and didactic instruction on ART provided in U.S. dental schools by surveying the predoctoral pediatric dentistry programs in 2010. Of the fifty-seven directors asked to complete the survey, forty-four responded for a response rate of 77 percent. Of these forty-four programs, 66 percent reported providing clinical training on ART, though only 14 percent provide this training often or very often. The types of ART training provided often or very often included interim treatment (18 percent) and single-surface cavities (14 percent) in primary teeth. However, ART was said to be rarely taught as a definitive treatment in permanent teeth (2 percent). Attitude was a major predictor, for clinical training provided and using professional guidelines in treatment decisions were associated with a positive attitude towards ART. These predoctoral pediatric dentistry programs used ART mainly in primary, anterior, and single-surface cavities and as interim treatment. As ART increases access of children to dental care, the incorporation of the ART approach into the curricula of U.S. dental schools should be facilitated by professional organizations.

The role of women in dental education: monitoring the pipeline to leadership.

The purpose of this study was to analyze data collected by the American Dental Association and the American Dental Education Association over the past two decades relating to changes in the number of women active in dental education and dental practice. The concept of a pipeline of women in dentistry was explored by analyzing predoctoral, postdoctoral, dental practice, and dental education domains for the inclusion of women. Statistical analyses show that there has been a consistent and progressive increase in the number of women in all stages of the pipeline. Over the past two decades, the number of female students attending and graduating from dental school has steadily increased. In 1984-85, 23.7 percent of all predoctoral students were women; in 2009-10, 45.1 percent were women. Similarly, in 1999, the graduating class was 35.3 percent women; in 2009, it was 46.1 percent women. In the postdoctoral domain, in 1996, 29.9 percent of all residents were women; in 2010, this had increased to 39.0 percent. In dental practice, the number of actively licensed women dentists in 1999 was 15.3 percent of the workforce; in 2010, this percentage had grown to 24.0 percent. In dental education, the number of women clinical faculty members has gradually increased from 669 in 1997-98 to 902 in 2007-08. Until 2000, there had been only two women deans and very few associate/assistant deans, with only sixteen in 1990. In 2000, major changes began with three women deans and seventy-two women associate/assistant deans. In 2009-10, there were 111 associate/assistant women deans and twelve women deans. These data show a progressive increase in the presence of women in all domains of dentistry, especially in leadership positions in dental education.

Factors associated with the satisfaction of millennial generation dental residents.

Data from the 2010 Learners' Perceptions Survey (LPS) administered through the Office of Academic Affiliations, Department of Veterans Affairs (VA) were analyzed to identify factors associated with dental residents' satisfaction with the VA as a clinical training environment. Satisfaction scores were linked to clinic workloads, dental procedure complexity levels, staffing patterns, and facility infrastructure data to explore conditions that may improve residents' satisfaction. Findings supported the construct validity of the LPS survey data and underscored the importance of maintaining optimal ratios of attending dentists, dental assistants, and administrative staff to residents so that each trainee will have opportunities to perform an adequate level of dental workload. As programs strive to improve the quality of graduate dental education, findings from this study are vital for setting curriculum design guidelines and for providing infrastructure support for dental resident education.

Introduction of implants into postdoctoral endodontic residency programs.

The purpose of this study was to survey the directors of postdoctoral endodontic programs in the United States to ascertain their attitudes and approaches regarding incorporation of implants into the endodontic curriculum. We hypothesized that program directors would agree that implant training should be incorporated into the endodontic curriculum. We also hypothesized that they would all prefer apical surgeries and retreatment over implants when plausible. A twenty-item online survey was emailed to all fifty-two postdoctoral endodontic program directors in the United States. A 100 percent response was received. The results showed that 78.6 percent agreed that implant training should be incorporated, 85.7 percent preferred the didactic approach, and 42.9 percent preferred clinical implant training. One hundred percent preferred apical surgeries and retreatment over implants when plausible, and 53.8 percent did not prefer implants over endodontic treatment for teeth with a questionable prognosis. This survey indicates that implant training has been incorporated into postdoctoral endodontic programs and that the Commission on Dental Accreditation standards are being met. The trend may be to become more hands-on in the future if program directors believe there is a need to provide training in actual placement of implants.

Factors influencing pediatric dental program directors' selection of residents and demographics of current directors.

The primary goal of this study was to examine the criteria that influence rankings of candidates by advanced education program directors in pediatric dentistry. Secondary objectives were to obtain information on the resident selection process and to explore demographics of current program directors. A survey was sent in 2005 to all sixty-three program directors of pediatric dentistry residency programs accredited within the United States for the graduating class of 2007. The survey had a response rate of almost 78 percent (49/63). Respondents were requested to rank the importance of eleven factors that are typically included in the selection criteria for pediatric dentistry residents. Factors were rated on a scale of critical, very important, fairly important, somewhat important, and not important. The four highest ranked criteria by program directors were the following, in order: National Board scores, dental school clinical grades, class rank, and grade point average (GPA). Other factors ranked in descending order of perceived importance were the following: dental school basic science grades, experience in pediatric dentistry, extracurricular activities, completion of a general practice residency or advanced education in general dentistry program, the application essay, a publication or professional presentation, and private practice experience. All directors ranked personal interviews as very important to critical. Letters of recommendation from a pediatric dentistry department chairperson or faculty member were viewed more favorably than letters from dental school deans and non-pediatric dentistry faculty. Fifty-seven percent of the directors responding (28/49) were male, and 81 percent (40/49) were white, non-Hispanic. Fifty-nine percent of the directors (29/49) graduated from a residency program over twenty years ago, with 39 percent (19/49) having been a director for less than five years.

Dental caries and tooth loss in adults in a Brazilian southeastern state.

OBJECTIVE: The purpose of this study was to analyze dental caries experience of adults living in the southeastern state of São Paulo, Brazil, according to some socio-demographic conditions of this population. MATERIAL AND METHODS: The sample consisted of 1,159 school teachers and workers (35 to 44 years old) from 29 cities of the state of São Paulo, Brazil. RESULTS: 92.3% were dentate and the DMFT index (number of decayed, missing and filled teeth) was 21.0 and the mean number of decayed teeth was 1.1, with no significant difference among adults from regions with and without fluoridation. Male subjects presented the highest mean values of 'D' (decayed teeth) and 'M' (missing teeth) components. The percentage of caries-free subjects was higher among white subjects, as well as the mean number of teeth present in the mouth. The mean values of the 'F' component (filled teeth) [9.81] and present teeth [19.3] were higher for adults from fluoridated water regions. CONCLUSIONS: In this study, the worse condition observed was the early tooth loss in all groups. In addition, people with worse socio-demographic conditions had worse oral health conditions. It is expected that oral health programs targeted to this population could be established with the goal of improving the oral health conditions of this population and hence the maintenance of the teeth for a longer period in function.