Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 39
Filtrar
1.
Prev Med ; 124: 117-123, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31122615

RESUMO

General dentists (GDs) have the opportunity to examine their patients for oral premalignancy/malignancy. We estimated the annualized per dentist number of oral lesions suspicious for premalignancy/malignancy discovered by United States (U.S.) general dentists and the annualized per dentist number of histologically-confirmed cancers subsequently diagnosed. Eligible participants were licensed, clinically-active U.S. GDs who were members of the U.S. National Dental Practice-Based Research Network. An a priori sample size of 900 was determined; 2000 GDs were invited to participate; 1,073 completed the study. Self-reported, cross-sectional data were obtained via an online questionnaire during 4/12/2017-8/31/2017 and analyzed. The reported numbers of suspicious oral lesions and histologically-confirmed oral cancer cases diagnosed over the previous six months were quantified. Potential outcome predictors were evaluated as covariates in multivariable analyses. Crude and adjusted statistics were produced by regressing each outcome on each independent variable while assuming a Poisson distribution, log link and utilizing robust standard errors. Eighty-seven percent of dentists reported discovering 1+ lesion suspicious for oral premalignancy/malignancy during the preceding six months. The mean number of suspicious lesions/dentist/year was 9.5; adjusted mean: 9.6. Fifteen percent of participants reported discovering 1+ lesion confirmed as cancer during the same period, 213 confirmed cancer cases/6 months or 426/year. Crude and adjusted mean numbers of histologically-confirmed oral cancers were both 0.4 cancers/dentist/year. Our findings suggest that many U.S. general dentists are actively identifying oral lesions suspicious for premalignancy/malignancy, thereby aiding in the discovery of oral malignancies and representing an important component in the frontline against cancer.


Assuntos
Odontólogos/estatística & dados numéricos , Neoplasias Bucais/diagnóstico , Estudos Transversais , Humanos , Inquéritos e Questionários , Estados Unidos
2.
J Trop Pediatr ; 64(1): 45-50, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28444362

RESUMO

Objective: The aim of the present study is to assess the burden of severe acute malnutrition (SAM) and other malnutrition in a tertiary care hospital in Delhi. Methods: All patients aged 2-59 months admitted from August 2012 to July 2014 were screened for malnutrition by anthropometry using standard techniques, and SAM was diagnosed as per guidelines [1, 2]. Results: During the study period, 4520 children of age 2-59 months were admitted and complete data of 4354 children were available, which were analysed. Of these, 50.4% were underweight, 44.6% were stunted, 33.5% were wasted, 0.76% had oedematous malnutrition and 18.3% had SAM. Of all patients with SAM, 80% were <24 months old, with 54.1% males and 45.9% females. Moderate acute malnutrition was present in 21.4%. Associated co-morbidities were diarrhoea or respiratory infection or both. Conclusion: Hospitals of Delhi have a high load of complicated SAM and need adequate infrastructure and facilities for management of these children.


Assuntos
Efeitos Psicossociais da Doença , Desnutrição Aguda Grave/complicações , Antropometria , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Índia , Lactente , Masculino , Estado Nutricional , Centros de Atenção Terciária/estatística & dados numéricos
3.
BMC Oral Health ; 17(1): 70, 2017 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-28347303

RESUMO

BACKGROUND: The objectives were to: (1) quantify patient satisfaction with treatment for early dental caries overall, and according to whether or not (2a) the patient received invasive treatment; (2b) was high-risk for dental caries, and had dental insurance; and (3) encourage practitioners to begin using non-invasive approaches to early caries management. METHODS: Ten practitioners recorded patient, lesion, and treatment information about non-cavitated early caries lesions. Information on 276 consecutive patients with complete data was included, who received either non-invasive (no dental restoration) or invasive (dental restoration) treatment. Patients completed a patient satisfaction questionnaire and were classified as dissatisfied if they did not "agree" or "strongly agree" with any of 14 satisfaction items. RESULTS: Patients had a mean (± SD) age of 41.8 (±15.8) years, 64% were female and 88% were white. Twenty-five percent (n = 68) were dissatisfied in at least one of the 14 satisfaction items. Satisfaction levels did not significantly vary by patient's gender, race, caries risk category, or affected tooth surface location. Overall, 11% (28 of 276) received invasive treatment; satisfaction did not differ between patients who had invasive or non-invasive treatment. Seven patients received invasive treatment at their request even though that was not what their practitioner recommended; 5 out of 6 were satisfied with their treatment nonetheless. CONCLUSIONS: About one-fourth of patients treated for non-cavitated early caries were dissatisfied with at least some aspect of their dental care experience. Satisfaction of patients who received invasive treatment did not differ from those who received non-invasive treatment.


Assuntos
Assistência Odontológica , Cárie Dentária/terapia , Satisfação do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica/métodos , Feminino , Humanos , Seguro Odontológico , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
Caries Res ; 50(3): 271-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27160516

RESUMO

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance]. A sensitivity analysis added treatment to the models for both the control and treatment participants (n = 301) to predict RC for the control participants. Forty-nine percent of the control participants had incident RC. The model including the number of follow-up years at risk, the number of root surfaces at risk, RC index, gender, race, age, and smoking resulted in the best prediction performance, having the highest AUC and lowest Brier score. The sensitivity analysis supported the primary analysis and gave slightly better performance summary measures. The set of risk indicators best able to predict RC incidence included an increased number of root surfaces at risk and increased RC index at baseline, followed by white race and nonsmoking, which were strong nonsignificant predictors. Gender, age, and increased number of follow-up years at risk, while included in the model, were also not statistically significant. The inclusion of health, diet, RPD use, toothbrush use, income, education, and dental insurance variables did not improve the prediction performance.


Assuntos
Cárie Dentária/epidemiologia , Cárie Radicular/epidemiologia , Edulcorantes/administração & dosagem , Xilitol/administração & dosagem , Adulto , Fatores Etários , Idoso , Cárie Dentária/etiologia , Cárie Dentária/prevenção & controle , Diagnóstico por Imagem , Inquéritos sobre Dietas/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Multicêntricos como Assunto , Saúde Bucal/estatística & dados numéricos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Cárie Radicular/etiologia , Cárie Radicular/prevenção & controle , Fatores Sexuais , Escovação Dentária
5.
Int J Paediatr Dent ; 23(2): 145-52, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22502601

RESUMO

BACKGROUND: Alternatives to vital pulpotomy treatment in primary teeth are being sought because of the high formaldehyde content of traditional formocresol (FC) pulpotomy medicaments. AIM: The aim was to compare the clinical and radiographic success of vital pulpotomy treatment in primary molars using 3% sodium hypochlorite (NaOCl) versus a 1:5 dilution of Buckley's FC. DESIGN: Pulpotomies were performed in primary molars of healthy children between 3 and 10 years old. Sixty-five primary teeth were randomized into two groups that were evaluated for treatment outcomes. Following treatment, the pulp chamber was filled with zinc oxide eugenol (ZnOE) and restored with a stainless steel crown cemented with glass ionomer cement. Clinical and radiographic outcomes were recorded at 6 and 12 months. RESULTS: The control (FC) and experimental (NaOCl) groups demonstrated 100% clinical success at 6 and 12 months. The NaOCl group had 86% (19/22) radiographic success at 6 months and 80% (12/15) at 12 months. The FC group had 84% (21/25) radiographic success at 6 months and 90% (9/10) at 12 months. No significant differences were found in the radiographic outcomes between the two groups at 6 and 12 months (Fisher's exact test; P=0.574 and P=0.468, respectively). CONCLUSION: NaOCl demonstrated clinical and radiographic success comparable to FC.


Assuntos
Formocresóis/uso terapêutico , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Pulpotomia/métodos , Hipoclorito de Sódio/uso terapêutico , Dente Decíduo/cirurgia , Criança , Pré-Escolar , Coroas , Feminino , Humanos , Masculino , Dente Molar/cirurgia , Variações Dependentes do Observador , Tratamento do Canal Radicular/métodos , Estatísticas não Paramétricas , Resultado do Tratamento
6.
Clin Oral Investig ; 16(6): 1647-57, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22198596

RESUMO

OBJECTIVE: This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults. MATERIALS AND METHODS: Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires. We examined associations between baseline characteristics and (1) the presence of any root caries using Mantel-Haenszel hypothesis tests and odds ratio (OR) estimators and (2) the number of root surfaces with caries among study participants with exposed root surfaces (n = 349) using Mantel-Haenszel mean score tests and Mann-Whitney estimators. RESULTS/CONCLUSIONS: Adjusting for study site and age, male gender [OR, 1.72; 95% confidence interval (CI), 1.08, 2.78], white race (OR, 2.39; 95% CI, 1.43, 3.98), recent dental visit (OR, 1.98; 95% CI, 1.07, 3.66), poor self-described oral health (OR, 2.65; 95% CI, 1.10, 6.39), and recent professional fluoride treatment (OR, 1.85; 95% CI, 1.06, 3.25) were significantly associated with increased odds to have any root caries, and study participants with exposed root surfaces characterized by male gender [Mann-Whitney probability estimate (MW) = 0.57; 95% CI, 0.51, 0.63), white race (MW, 0.61; 0.55, 0.68), recent dental visit (MW, 0.58; 0.50, 0.67), poor self-described oral health (MW, 0.61; 0.53, 0.69), and flossing at least once per day (MW, 0.57; 95% CI, 0.51, 0.62) were significantly more likely to have a greater number of root surfaces with caries than a randomly selected study participant from their respective complementary subgroups (female gender, non-white, etc.). CLINICAL RELEVANCE: Our findings may help identify individuals at higher root caries risk.


Assuntos
Cariostáticos/uso terapêutico , Cárie Dentária/epidemiologia , Cárie Radicular/epidemiologia , Edulcorantes/uso terapêutico , Xilitol/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alabama/epidemiologia , Estudos Transversais , Assistência Odontológica/estatística & dados numéricos , Dispositivos para o Cuidado Bucal Domiciliar/estatística & dados numéricos , Método Duplo-Cego , Feminino , Fluoretos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Saúde Bucal/estatística & dados numéricos , Placebos , Fatores de Risco , Cárie Radicular/classificação , Fatores Sexuais , Escovação Dentária/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adulto Jovem
7.
J Evid Based Dent Pract ; 12(1): 31-2, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22326157

RESUMO

PURPOSE/QUESTION: To evaluate the scientific evidence regarding laser technology for removal of carious tissue. SOURCE OF FUNDING: Information is not available. TYPE OF STUDY/DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.

8.
J Public Health Dent ; 71(4): 335-44, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22320292

RESUMO

OBJECTIVES: This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter- and intra-examiner reliability scores from the initial standardization sessions. METHODS: Study examiners were trained to use a modified International Caries Detection and Assessment System II system to detect the visual signs of non-cavitated and cavitated dental caries in adult subjects. Dental caries was classified as no caries (S), non-cavitated caries (D1), enamel caries (D2), and dentine caries (D3). Three standardization sessions involving 60 subjects and 3,604 tooth surface calls were used to calculate several measures of examiner reliability. RESULTS: The prevalence of dental caries observed in the standardization sessions ranged from 1.4 percent to 13.5 percent of the coronal tooth surfaces examined. Overall agreement between pairs of examiners ranged from 0.88 to 0.99. An intra-class coefficient threshold of 0.60 was surpassed for all but one examiner. Inter-examiner unweighted kappa values were low (0.23-0.35), but weighted kappas and the ratio of observed to maximum kappas were more encouraging (0.42-0.83). The highest kappa values occurred for the S/D1 versus D2/D3 two-level classification of dental caries, for which seven of the eight examiners achieved observed to maximum kappa values over 0.90. Intra-examiner reliability was notably higher than inter-examiner reliability for all measures and dental caries classifications employed. CONCLUSION: The methods and results for the initial examiner training and standardization sessions for two large clinical trials are reported. Recommendations for others planning examiner training and standardization sessions are offered.


Assuntos
Cárie Dentária/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Ensino/normas , Adulto , Calibragem , Coroas , Índice CPO , Cárie Dentária/classificação , Esmalte Dentário/patologia , Restauração Dentária Permanente , Dentina/patologia , Humanos , Variações Dependentes do Observador , Selantes de Fossas e Fissuras/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Reprodutibilidade dos Testes , Projetos de Pesquisa/estatística & dados numéricos , Cárie Radicular/diagnóstico , Materiais de Ensino
9.
J Public Health Dent ; 70(3): 171-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20459464

RESUMO

As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four "lessons learned" or considerations important in the planning and initial implementation of RCTs in dentistry that, to our knowledge, have not been discussed in the general dental literature describing trial techniques. These considerations are a) preparing or securing a thorough systematic review; b) developing a comprehensive set of study documents; c) designing and testing multiple recruitment strategies; and d) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful.


Assuntos
Cárie Dentária/prevenção & controle , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Protocolos Clínicos , Coleta de Dados , Pesquisa em Odontologia/normas , Humanos , Estudos Multicêntricos como Assunto/normas , Seleção de Pacientes , Técnicas de Planejamento , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Literatura de Revisão como Assunto
10.
BMJ Open Qual ; 9(3)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32764028

RESUMO

OBJECTIVE: Hub and spoke model has been used across industries to augment peripheral services by centralising key resources. This exercise evaluated the feasibility of whether such a model can be developed and implemented for quality improvement across rural and urban settings in India with support from a network for quality improvement. METHODS: This model was implemented using support from the state and district administration. Medical colleges were designated as hubs and the secondary and primary care facilities as spokes. Training in quality improvement (QI) was done using WHO's point of care quality improvement methodology. Identified personnel from hubs were also trained as mentors. Both network mentors (from QI network) and hub-mentors (from medical colleges) undertook mentoring visits to their allotted facilities. Each of the participating facility completed their QI projects with support from mentors. RESULTS: Two QI training workshops and two experience sharing sessions were conducted for implementing the model. A total of 34 mentoring visits were undertaken by network mentors instead of planned 14 visits and rural hub-mentors could undertake only four visits against planned 18 visits. Ten QI projects were successfully completed by teams, 80% of these projects started during the initial intensive phase of mentoring. The projects ranged from 3 to 10 months with median duration being 5 months. DISCUSSION: Various components of a health system must work in synergy to sustain improvements in quality of care. Quality networks and collaboratives can play a significant role in creating this synergy. Active participation of district and state administration is a critical factor to produce a culture of quality in the health system.


Assuntos
Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/normas , Educação/métodos , Estudos de Viabilidade , Humanos , Índia , Tutoria/métodos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde/métodos , Melhoria de Qualidade/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos
11.
J Am Board Fam Med ; 33(5): 687-697, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989063

RESUMO

PURPOSE: To 1) quantify practitioner activities of the National Dental Practice-Based Research Network (Network) for which Continuing Education (CE) credits were received (study training, videos, webinars, meetings, and symposia); 2) quantify practitioner coauthoring Network publications and presentations; and 3) test whether practitioner characteristics were associated with participation in these activities. METHODS: A retrospective analysis of 4361 practitioners who enrolled in the Network between April 12, 2012 and October 12, 2018. RESULTS: Overall, 59% (n = 2586) of practitioners earned CE credit from the Network; among these, 68% (n = 1757) from a video, 38% (n = 993) attended an annual Network meeting, 31% (n = 798) due to training for a Network clinical study, 9% (n = 226) attended a national symposium, and 7% (n = 170) participated in a Network webinar. Members of 2 large group practices earned on average more CEs than practitioners from other practice settings. Four percent (n = 159) of practitioners coauthored a Network presentation or publication. Practitioners who received their dental degree before 2000, were general practitioners, or were members of 2 large group practices, were more likely to have coauthored a publication or presentation. CONCLUSION: This Network used a broad range of activities to engage community practitioners. These activities were successful in sustaining a high level of practitioner engagement in clinical research and its relevance to everyday clinical practice.


Assuntos
Odontólogos , Educação Continuada em Odontologia , Adulto , Idoso , Pesquisa em Odontologia , Odontólogos/educação , Odontólogos/psicologia , Odontólogos/estatística & dados numéricos , Educação Continuada em Odontologia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sociedades Médicas , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-32561250

RESUMO

OBJECTIVE: The aim of this study was to assess the influence of clinical cues on risk assessment of cancer-associated mucosal abnormalities. STUDY DESIGN: We differentiated lesions with a low risk from those with a high risk for premalignancy or malignancy by using 4 cues: (1) color, (2) location, (3) induration, and (4) pain on exploration. Combinations of color and location were presented through 8 photographs, with induration and pain status variably presented in the standardized history and physical findings. This created 16 clinical scenarios (vignettes) that were permutations of the 4 cues. Three questions assessed the extent to which each cue was used in obtaining a clinical impression as to whether a lesion was benign, premalignant, or malignant. RESULTS: Completed vignette questionnaires were obtained from 130 of 228 invited dentists, (two-thirds males; 79% white; mean age 52 years; average weekly hours of practice 33 hours). Only 40% of the responding dentists had statistically significant decision policies to assign a clinical diagnosis of a lesion as benign, premalignant, or malignant. Lesion location and color were the 2 dominant cues. As a cue, induration was used as a cue by more of the respondents in determining a clinical diagnosis of malignancy, and pain was infrequently used as a cue. CONCLUSIONS: Many dentists do not to have a decision strategy for the clinical diagnosis and risk stratification of oral potentially malignant lesions.


Assuntos
Neoplasias Bucais , Lesões Pré-Cancerosas , Sinais (Psicologia) , Odontólogos , Detecção Precoce de Câncer , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico , Inquéritos e Questionários
13.
BMC Oral Health ; 9: 26, 2009 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-19832991

RESUMO

BACKGROUND: Practice-based research networks offer important opportunities to move recent advances into routine clinical practice. If their findings are not only generalizable to dental practices at large, but can also elucidate how practice characteristics are related to treatment outcome, their importance is even further elevated. Our objective was to determine whether we met a key objective for The Dental Practice-Based Research Network (DPBRN): to recruit a diverse range of practitioner-investigators interested in doing DPBRN studies. METHODS: DPBRN participants completed an enrollment questionnaire about their practices and themselves. To date, more than 1100 practitioners from the five participating regions have completed the questionnaire. The regions consist of: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia (Denmark, Norway, and Sweden). We tested the hypothesis that there are statistically significant differences in key characteristics among DPBRN practices, based on responses from dentists who participated in DPBRN's first network-wide study (n = 546). RESULTS: There were statistically significant, substantive regional differences among DPBRN-participating dentists, their practices, and their patient populations. CONCLUSION: Although as a group, participants have much in common with practices at large; their substantial diversity offers important advantages, such as being able to evaluate how practice differences may affect treatment outcomes, while simultaneously offering generalizability to dentists at large. This should help foster knowledge transfer in both the research-to-practice and practice-to-research directions.


Assuntos
Ensaios Clínicos como Assunto , Diversidade Cultural , Pesquisa em Odontologia , Pesquisa Translacional Biomédica/métodos , Odontologia Geral , Humanos , Disseminação de Informação , Padrões de Prática Odontológica , Inquéritos e Questionários
14.
Gen Dent ; 57(3): 270-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19819818

RESUMO

Practice-based research networks (PBRNs) aim to improve clinical practice by engaging dental practitioners in studies that are directly relevant to daily clinical practice. The Dental Practice-Based Research Network (DPBRN) consists of dentists from seven U.S. states and three Scandinavian countries. All DPBRN dentists complete an enrollment questionnaire about their practices and themselves; as of this writing, 1,086 have done so. To quantify the similarities between DPBRN dentists and U.S. dentists at large, this article compared DPBRN practice characteristics to those of dentists who responded to the 2004 ADA Survey of dental practice, which is not limited to ADA members. DPBRN dentists were similar to U.S. dentists in terms of gender, race, ethnicity, number of offices, percentage of patients with insurance coverage, number of operatories, patient visits per week, days for a new appointment, and waiting room time. DPBRN dentists were statistically more likely to be recent graduates. The commonalities should increase the likelihood that DPBRN studies will be applicable to U.S. practices, thereby fostering knowledge transfer in both research-to-practice and practice-to-research.


Assuntos
Pesquisa Participativa Baseada na Comunidade/organização & administração , Pesquisa em Odontologia/organização & administração , Padrões de Prática Odontológica , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Padrões de Prática Odontológica/estatística & dados numéricos , Países Escandinavos e Nórdicos , Inquéritos e Questionários , Pesquisa Translacional Biomédica/organização & administração , Estados Unidos
15.
J Dent ; 87: 24-27, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31075374

RESUMO

Practice-based research networks with strong leadership can be effective venues for the translation of research findings. Coordinating all the efforts across a Network composed of individuals with a broad range of expertise, goals, and expectations can, however, be cumbersome, posing many different leadership challenges.


Assuntos
Pesquisa em Odontologia , Liderança , Coleta de Dados
16.
Indian J Pediatr ; 85(9): 738-745, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-28770443

RESUMO

The assessment of a child is quite different from that of adults and requires knowledge of normal variations in anatomy and physiology with growth and development. An important part of initial assessment includes triage and recognizing children with emergency signs so that they can be managed at the earliest to prevent death and referred timely to the specialist. After ruling out emergency signs, the children with priority signs require prompt assessment, management and referral to the specialist. In addition to normal history as in adults, prenatal and birth history, developmental history, immunization history, feeding history and social history are important for complete assessment of the child. The approach to physical examination should consider age and developmental level. It is important to make the child comfortable with pleasant surroundings and playful behavior to yield maximum information from the examination. In addition to diagnosing disease, pediatric assessment should involve identification of malnutrition, immunization status, level of development, screening for 4 Ds (Defects at birth, Deficiencies, Diseases and Developmental Delay including Disability), hearing and visual assessment and detection of child abuse. Tanner staging and psychosocial assessment should be done in adolescents.


Assuntos
Serviços Médicos de Emergência , Encaminhamento e Consulta , Triagem , Adolescente , Criança , Pré-Escolar , Emergências , Feminino , Humanos , Índia , Lactente , Masculino , Pais , Exame Físico
17.
J Am Dent Assoc ; 149(4): 299-307.e1, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29475554

RESUMO

BACKGROUND: A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin. METHODS: Eighty-two dentists participated. In phase 1 of the study, dentists identified approximately 20 SOCLs, obtained patient consent, and recorded information about the lesion, treatment or treatments, and depth, if opened. Dentists were then randomly assigned into 1 of 3 groups: no device, DIAGNOdent (KaVo), and Spectra (Air Techniques). In phase 2, dentists enrolled approximately 20 additional patients and recorded the same phase 1 information while using the assigned device to help make their treatment decisions. A mixed-model logistic regression was used to determine any differences after randomization in the proportion of lesions opened and, if opened, the proportion of lesions that penetrated into dentin. RESULTS: A total of 1,500 SOCLs were enrolled in each phase. No statistically significant difference was found in the change in proportion of lesions receiving invasive treatment from phase 1 to phase 2 across the 3 groups (P = .33) or in the change in proportion of percentage of opened lesions that extended into dentin (P = .31). CONCLUSION: Caries-detecting devices in the study did not change substantially dentists' decisions to intervene or the accuracy of the intervention decision in predicting lesion penetration into dentin. PRACTICAL IMPLICATIONS: The caries-detecting devices tested may not improve dentists' clinical decision making for SOCLs.


Assuntos
Cárie Dentária , Restauração Dentária Permanente , Tomada de Decisão Clínica , Tomada de Decisões , Esmalte Dentário , Dentina , Humanos , Padrões de Prática Odontológica
18.
J Am Board Fam Med ; 31(6): 844-856, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30413541

RESUMO

PURPOSE: This study examines practitioner participation over 12 years in the National Dental Practice-Based Research Network (PBRN) studies and practitioner meetings, average length of participation, and association of practitioner- and practice-level characteristics with participation. Little information exists about practitioners' long-term participation in PBRNs. METHODS: The network conducted a retrospective analysis of practitioner participation in 3 main network activities during 2005 to 2017. Practitioners who completed an enrollment questionnaire, practiced in the United States, and either attended a network meeting or received an invitation to complete a questionnaire or clinical study were included in the analysis. Practitioners (n = 3669) met inclusion criteria. The network implemented 38 studies (28 clinical and 10 questionnaire), 23 of which (15 clinical and 8 questionnaire) met the criteria for the current analysis. RESULTS: Overall, 86% (N = 3148) participated in at least 1 network activity during 2005 to 2017. Questionnaire studies had the highest rate with 81% (N = 2963) completing at least 1, 21% (N = 762) completed at least 1 clinical study and 19% (N = 700) attended at least 1 network meeting. Among 1578 practitioners enrolled in the first 5 years of the Network launch, 20% (N = 320) participated in multiple network activities over 5 to 9 years, and 14% (N = 238) for 10 to 12 years. Practitioner characteristics associated with participation varied depending on the activity assessed. CONCLUSION: The network engaged practitioners in its research activities with relatively high participation rates over a 12-year period. Strategies employed by the network to engage practitioners may serve as a model for PBRN networks for other allied health professions.


Assuntos
Atitude do Pessoal de Saúde , Odontologia/organização & administração , Odontólogos/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Participação dos Interessados/psicologia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Odontólogos/psicologia , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
19.
J Dent ; 69: 83-87, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29138112

RESUMO

OBJECTIVE: Case presentations (vignettes) were completed by dentists in the National Dental Practice-Based Research Network study "Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)". The objective was to determine dentists' decision strategies for SOCLs. METHODS: 107 dentists viewed a series of 16 vignettes that represented all combinations of 4 clinical cues: color, luster, lesion roughness, and patient-level caries risk. Each vignette included a patient description and a photograph of a tooth presenting the 4 cues. Dentists were asked to decide the likelihood that a suspected lesion extended into dentin. A lens model analysis was used to examine how dentists use these cues in making their decisions. RESULTS: 86% of dentists had a consistent pattern of cue use that defined their decision strategy. On average, 70% of the variance in their decisions was accounted for by their use of the 4 cues. However, there was considerable variability in the individual cues used by each dentist. The percentages of dentists who used the different cues consistently were: luster (58%), color (48%), roughness (36%), and risk (35%). 14% of dentists reliably used only color, 7% used only luster, 4% used only roughness, and 1% used only risk when making SOCL decisions. CONCLUSIONS: The online vignette system suggests that clinical SOCL decision strategies are highly individualized and dentists do not use all cues available to them to make these decisions. CLINICAL SIGNIFICANCE: Prior to this study, there has been little evidence about how dentists use these cues (either individually or in combination) when judging the extent of caries progression. Such knowledge would be valuable when designing interventions to help dentists maximize the likelihood of appropriate treatment decisions.


Assuntos
Tomada de Decisões , Cárie Dentária/diagnóstico , Odontólogos/psicologia , Adulto , Idoso , Cor , Cárie Dentária/classificação , Cárie Dentária/patologia , Cárie Dentária/terapia , Esmalte Dentário/patologia , Restauração Dentária Permanente/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Odontológica , Propriedades de Superfície , Inquéritos e Questionários
20.
J Health Care Poor Underserved ; 18(4): 847-67, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17982211

RESUMO

We recently demonstrated with the Florida Dental Care Study (FDCS) that the racial mix of the dental practice attended was significantly associated with patient-specific service receipt and health outcome. Therefore, our objective here was to determine if African Americans and lower-income people attended dental practices with characteristics systematically different from the practices attended by their counterparts. The FDCS was a prospective cohort study of 873 people at baseline who were followed for 48 months. Participants' dentists were asked to complete questionnaires about their practices. Significant racial and income differences were evident in dentists' reports of payment mix, characteristics of typical patients, types of procedures typically done, typical fees, practice busyness, waiting room times, and delays to get an appointment. Systematic differences in the dental practices attended were evident, as a function of the person's race and income, differences that are associated with social disparities in oral health.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Serviços de Saúde Bucal/normas , Disparidades em Assistência à Saúde , Renda , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Qualidade da Assistência à Saúde , Classe Social , Negro ou Afro-Americano/psicologia , Idoso , Inquéritos de Saúde Bucal , Feminino , Florida , Acessibilidade aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/etnologia , Relações Profissional-Paciente , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA