Publications by authors named "Jeffrey Fellows"

52 Publications

Practitioner Engagement in Activities of the National Dental Practice-Based Research Network (PBRN): 7-Year Results.

J Am Board Fam Med 2020 Sep-Oct;33(5):687-697

From the Department of Periodontics, School of Dentistry, University of Texas Health Science Center, San Antonio, TX (RM); Department of Medicine, School of Medicine, University of Alabama-Birmingham, AL (EF); Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, AL (SKM); Regional Coordinator, Department of Periodontics, School of Dentistry, University of Texas Health Science Center-San Antonio, TX (SCR, DLC); Westat, Rockville, MD (RC); Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY (CM); HealthPartners Institute, Minneapolis, MN (DBR); Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL (VVG); Kaiser Permanente Center for Health Research, Portland, OR (JLF); College of Medicine, Baylor College of Medicine, Houston, TX (MT); School of Dentistry, University of Maryland, Baltimore, MS (TWO); Private Practitioner, Chandler, AZ (JDM); Gold Canyon Dentistry, Gold Canyon, AZ (PAM); Department of Clinical & Community Sciences, University of Alabama-Birmingham, AL (GHG); The National Dental PBRN Collaborative Group comprises practitioner, faculty, and staff investigators who contributed to this Network activity. A list of these persons is at http://www.nationaldentalpbrn.org/collaborative-group.php.

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.
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http://dx.doi.org/10.3122/jabfm.2020.05.190339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895471PMC
September 2019

Concordance between practitioner questionnaire responses and observed clinical treatment recommendations for treatment of dentin hypersensitivity: findings from the National Dental Practice-Based Research Network.

BMC Oral Health 2019 06 14;19(1):112. Epub 2019 Jun 14.

Department of Clinical and Community Sciences, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL, 35294-0007, USA.

Background: Few published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners' questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations.

Methods: A total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen's kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated.

Results: For individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner's top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low.

Conclusions: Concordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen's kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration. Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.
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http://dx.doi.org/10.1186/s12903-019-0772-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570951PMC
June 2019

Leadership in practice-based research: The National Dental PBRN.

J Dent 2019 08 7;87:24-27. Epub 2019 May 7.

Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States.

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.
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http://dx.doi.org/10.1016/j.jdent.2019.05.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020881PMC
August 2019

Engaging clinicians in research.

J Am Dent Assoc 2018 12;149(12):1007-1008

Investigator, HealthPartners Dental Group and HealthPartners Institute, Minneapolis, MN.

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http://dx.doi.org/10.1016/j.adaj.2018.10.005DOI Listing
December 2018

Practitioner Participation in National Dental Practice-based Research Network (PBRN) Studies: 12-Year Results.

J Am Board Fam Med 2018 Nov-Dec;31(6):844-856

From the University of Texas Health-San Antonio, San Antonio, TX (RM, MKBT, SR); University of Alabama at Birmingham, Birmingham, AL (EF, SKM, GHG); Westat, Rockville, MD (RC); University of Rochester, Rochester, NY (CM); HealthPartners Institute, Minneapolis, MN (DBR); University of Florida, Gainesville, FL (VVG); Kaiser Permanente Center for Health Research, Portland, OR (JLF); Private Practitioner, Jason D McCargar DMD LTD, (DBA) Scottsdale Dental Arts, Scottsdale, AZ (JDM); Private Practitioner, Gold Canyon Dentistry, Gold Canyon (PAM); The National Dental PBRN Collaborative Group comprises practitioner, faculty, and staff investigators who contributed to this network activity. A list of these persons is at http://www.nationaldentalpbrn.org/collaborative-group.php.

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.
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http://dx.doi.org/10.3122/jabfm.2018.06.180019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936735PMC
October 2019

Barriers to sealant guideline implementation within a multi-site managed care dental practice.

BMC Oral Health 2018 02 2;18(1):17. Epub 2018 Feb 2.

Julie Frantsve-Hawley Consulting, 621 Brier Street, Kenilworth, IL, 60043-0000, USA.

Background: The purpose of this study was to identify barriers frequently endorsed by dentists in a large, multi-site dental practice to implementing the American Dental Association's recommendation for sealing noncavitated occlusal carious lesions as established in their 2016 pit-and-fissure sealant clinical practice guideline. Although previous research has identified barriers to using sealants perceived by dentists in private practice, barriers frequently endorsed by dentists in large, multi-site dental practices have yet to be identified. Identifying barriers for these dentists is important, because it is expected that in the future, the multi-site group practice configuration will comprise more dental practices.

Methods: We anonymously surveyed the 110 general and pediatric dentists at a multi-site dental practice in the U.S. The survey assessed potential barriers in three domains: practice environment, prevailing opinion, and knowledge and attitudes. Results were summarized using descriptive statistics.

Results: The response rate to the survey was 62%. The principal barrier characterizing the practice environment was concern regarding liability; endorsed by 33% of the dentists. Many barriers of prevailing opinion were frequently endorsed. These included misunderstanding the standard of practice (59%), being unaware of the expectations of opinion leaders (56%) including being unaware of the guideline itself (67%), and being unaware of what is currently being taught in dental schools (58%). Finally, barriers of knowledge and attitudes were frequently endorsed. These included having suboptimal skill in applying sealants (23% - 47%) and lacking knowledge regarding the relative efficacy of the different ways to manage noncavitated occlusal carious lesions (50%).

Conclusions: We identified barriers frequently endorsed by dentists in a large, multi-site dental practice relating to the practice environment, prevailing opinion, and knowledge and attitudes. All the barriers we identified have the potential to be addressed by implementation strategies. Future studies should devise and test implementation strategies to target these barriers.
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http://dx.doi.org/10.1186/s12903-018-0480-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797385PMC
February 2018

Repair or Replacement of Restorations: A Prospective cohort study by dentists in The National Dental Practice-Based Research Network.

Tex Dent J 2017 01;134(1):20-32

Background: A prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure.

Methods: Dentists recorded data for 50 or more consecutive defective restorations. The restorations that were either - repaired or replaced were recalled after 12 months and characterized for developing defects.

Results: Dentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6).

Conclusions: An additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations.

Practical Implications: One year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.
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January 2017

Provision of Specific Dental Procedures By General Dentists in the National Dental Practice-Based Research Network: Questionnaire Findings.

Tex Dent J 2016 12;133(12):726-746

Background: Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics.

Methods: GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the 3 sets of characteristics.

Results: Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), 3 were "common" (molar endodontics; implants; non-surgical periodontics), and 5 were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part- time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients.

Conclusions: As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.
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December 2016

CHARTing a Path to Pragmatic Tobacco Treatment Research.

Am J Prev Med 2016 10;51(4):630-6

Department of Family Medicine and Public Health, University of California, San Diego, California.

Introduction: It is important to consider the degree to which studies are explanatory versus pragmatic to understand the implications of their findings for patients, healthcare professionals, and policymakers. Pragmatic trials test the effectiveness of interventions in real-world conditions; explanatory trials test for efficacy under ideal conditions. The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of seven NIH-funded trials designed to identify effective programs that can be widely implemented in routine clinical practice.

Methods: A cross-sectional analysis of CHART trial study designs was conducted to place each study on the pragmatic-explanatory continuum. After reliability training, six raters independently scored each CHART study according to ten PRagmatic Explanatory Continuum Indicator Summary (PRECIS) dimensions, which covered participant eligibility criteria, intervention flexibility, practitioner expertise, follow-up procedures, participant compliance, practitioner adherence, and outcome analyses. Means and SDs were calculated for each dimension of each study, with lower scores representing more pragmatic elements. Results were plotted on "spoke and wheel" diagrams. The rating process and analyses were performed in October 2014 to September 2015.

Results: All seven CHART trials tended toward the pragmatic end of the spectrum, although there was a range from 0.76 (SD=0.23) to 1.85 (SD=0.58). Most studies included some explanatory design elements.

Conclusions: CHART findings should be relatively applicable to clinical practice. Funders and reviewers could integrate PRECIS criteria into their guidelines to better facilitate pragmatic research. CHART study protocols, coupled with scores reported here, may help readers improve the design of their own pragmatic trials.
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http://dx.doi.org/10.1016/j.amepre.2016.05.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919279PMC
October 2016

Referring Hospitalized Smokers to Outpatient Quit Services: A Randomized Trial.

Am J Prev Med 2016 10;51(4):609-19

Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.

Introduction: Linking outpatient cessation services to bedside counseling for hospitalized smokers can improve long-run quit rates. Adding an assisted referral (AR) offer to a tobacco treatment specialist consult service fits the team approach to care in U.S. hospitals.

Design: A two-arm patient-randomized trial tested the effectiveness of adding an AR offer to outpatient smoking-cessation services and interactive voice recognition (AR+IVR) follow-up to a usual care (UC) tobacco-cessation consult for hospitalized smokers.

Setting/participants: Over 24 months (November 2011-November 2013), 898 hospitalized adult smokers interested in quitting smoking were recruited from three large hospitals in the Portland, Oregon, area: an integrated group model HMO (n=622), a community hospital (n=195), and an academic health center (n=81).

Intervention: Tobacco treatment specialists identified smokers and provided an intensive bedside tobacco use assessment and cessation consultation (UC). AR+IVR recipients also received proactive ARs to available outpatient counseling programs and medications, and linked patients to a tailored IVR telephone follow-up system.

Main Outcome Measures: The primary outcome was self-reported 30-day abstinence at 6-month follow-up. Secondary outcomes included self-reported and continuous abstinence and biochemically confirmed 7-day abstinence at 6 months. Follow-up was completed in September 2014; data were analyzed in 2015.

Results: A total of 597 and 301 hospitalized smokers were randomized to AR+IVR and UC, respectively. AR+IVR and UC recipients received 19.3 and 17.0 minutes of bedside counseling (p=0.372), respectively. Most (58%) AR+IVR patients accepted referrals for counseling, 43% accepted medications, and 28% accepted both. Self-reported 30-day abstinence for AR+IVR (17.9%) and UC (17.3%) were not statistically significant (p=0.569). Differences in 7-day, continuous, and biochemically confirmed abstinence by treatment group also were insignificant, overall and adjusting for site.

Conclusions: Adding an AR to outpatient counseling and medications did not increase cigarette abstinence at 6 months compared to UC alone.
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http://dx.doi.org/10.1016/j.amepre.2016.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031367PMC
October 2016

Repair or replacement of restorations: A prospective cohort study by dentists in The National Dental Practice-Based Research Network.

J Am Dent Assoc 2015 Dec;146(12):895-903

Background: A prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure.

Methods: Dentists recorded data for 50 or more consecutive defective restorations. The restorations that were either repaired or replaced were recalled after 12 months and characterized for developing defects.

Results: Dentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6).

Conclusions: An additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations.

Practical Implications: One year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.
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http://dx.doi.org/10.1016/j.adaj.2015.05.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663659PMC
December 2015

Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART).

Tob Induc Dis 2015 3;13(1):29. Epub 2015 Sep 3.

University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA.

Background: This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles.

Methods: Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented.

Results: Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures.

Conclusion: While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability.

Trial Registration: Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217.Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275.Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928.Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250.Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245.Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176.Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.
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http://dx.doi.org/10.1186/s12971-015-0056-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557818PMC
September 2015

Methods dentists use to diagnose primary caries lesions prior to restorative treatment: Findings from The Dental PBRN.

Tex Dent J 2015 Feb;132(2):102-9

Objective: To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use.

Methods: A total of 228 DPBRN dentists recorded information on 5,676 consecutive restorations inserted due to primary caries lesions on 3,751 patients. Practitioner-investigators placed a mean of 24.9 (SD = 12.4) restorations. Lesions were categorized as posterior proximal, anterior proximal, posterior occiusal, posterior smooth, or anterior smooth. Techniques used to diagnose the lesion were categorized as clinical assessment, radiographs, and/or optical. Statistical analysis utilized generalized mixed-model ANOVA to account for the hierarchical structure of the data.

Results: By lesion category, the diagnostic technique combinations used most frequently were clinical assessment plus radiographs for posterior proximal (47%), clinical assessment for anterior proximal (51%), clinical assessment for posterior occlusal (46%), clinical assessment for posterior smooth (77%), and clinical assessment for anterior smooth (80%). Diagnostic technique was significantly associated with lesion category after adjusting for clustering in dentists (p < 0.0001).

Conclusion: These results--obtained during actual clinical procedures rather than from questionnaire-based hypothetical scenarios--quantified the diagnostic techniques most commonly used during the actual delivery of routine restorative care. Diagnostic technique varied by lesion category and with certain practice and patient characteristics.
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February 2015

A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines.

BMJ Open 2015 Jun 29;5(6):e007260. Epub 2015 Jun 29.

Alere Wellbeing, Seattle, Washington, USA.

Objective: To test adding an interactive voice response (IVR)-supported protocol to standard quitline treatment to prevent relapse among recently quit smokers.

Design: Parallel randomised controlled trial with three arms: standard quitline, standard plus technology enhanced quitline with 10 risk assessments (TEQ-10), standard plus 20 TEQ assessments (TEQ-20).

Setting: Quit For Life (QFL) programme.

Participants: 1785 QFL enrolees through 19 employers or health plans who were 24+ h quit.

Interventions: QFL is a 5-call telephone-based cessation programme including medications and web-based support. TEQ interventions included 10 or 20 IVR-delivered relapse risk assessments over 8 weeks with automated transfer to counselling for those at risk.

Main Outcome Measures: Self-reported 7-day and 30-day abstinence assessed at 6-month and 12-month post-enrolment (response rates: 61% and 59%, respectively). Missing data were imputed.

Results: 1785 were randomised (standard n=592, TEQ-10 n=602, TEQ-20 n=591). Multiple imputation-derived, intent-to-treat 30-day quit rates (95% CI) at 6 months were 59.4% (53.7% to 63.8%) for standard, 62.3% (57.7% to 66.9%) for TEQ-10, 59.4% (53.7% to 65.1%) for TEQ-20 and 30-day quit rates at 12 months were 61.2% (55.6% to 66.8%) for standard, 60.6% (56.0% to 65.2%) for TEQ-10, 54.9% (49.0% to 60.9%) for TEQ-20. There were no significant differences in quit rates. 73.3% of TEQ participants were identified as at-risk by IVR assessments; on average, participants completed 0.41 IVR-transferred counselling calls. Positive risk assessments identified participants less likely (OR=0.56, 95% CI 0.42 to 0.76) to be abstinent at 6 months.

Conclusions: Standard treatment was highly effective, with 61% remaining abstinent at 12 months using multiple imputation intent-to-treat (intent-to-treat missing=smoking quit rate: 38%). TEQ assessments identified quitters at risk for relapse. However, adding IVR-transferred counselling did not yield higher quit rates. Research is needed to determine if alternative designs can improve outcomes.

Trial Registration Number: NCT00888992.
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http://dx.doi.org/10.1136/bmjopen-2014-007260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486943PMC
June 2015

Concordance between responses to questionnaire scenarios and actual treatment to repair or replace dental restorations in the National Dental PBRN.

J Dent 2015 Nov 18;43(11):1379-84. Epub 2015 May 18.

University of Alabama at Birmingham, Department of Clinical and Community Sciences, 1919 7th Avenue South, Birmingham, AL 35294-0007, USA.

Objective: To quantify the agreement between treatment recommended during hypothetical clinical scenarios and actual treatment provided in comparable clinical circumstances.

Methods: A total of 193 practitioners in the National Dental Practice-Based Research Network participated in both a questionnaire and a clinical study. The questionnaire included three hypothetical scenarios about treatment of existing restorations. Clinicians then participated in a clinical study about repair or replacement of existing restorations. We quantified the overall concordance between their questionnaire responses and what they did in actual clinical treatment.

Results: Practitioners who recommended repair (instead of replacement) of more scenario restorations also had higher repair percentages in clinical practice. Additionally, for each of the three hypothetical scenario restorations, practitioners who recommended repair had higher repair percentages in clinical practice.

Conclusions: The questionnaire scenarios were a valid measure of clinicians' tendency to repair or replace restorations in actual clinical practice.

Clinical Implications: Although there was substantial variation in practitioners' tendency to repair or replace restorations, responses to questionnaire scenarios by individual practitioners were concordant with what they did in actual clinical practice.
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http://dx.doi.org/10.1016/j.jdent.2015.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604066PMC
November 2015

Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings.

BMC Oral Health 2015 Jan 22;15:11. Epub 2015 Jan 22.

Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, SDB Room 109, 1530 Third Avenue South, Birmingham, AL 35294-0007, USA.

Background: Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics.

Methods: GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics.

Results: Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), three were "common" (molar endodontics; implants; non-surgical periodontics), and five were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients.

Conclusions: As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.
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http://dx.doi.org/10.1186/1472-6831-15-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324862PMC
January 2015

Increasing prevalence of electronic cigarette use among smokers hospitalized in 5 US cities, 2010-2013.

Nicotine Tob Res 2015 Feb 28;17(2):236-44. Epub 2014 Aug 28.

Division of General Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Introduction: Little is known about the pattern of electronic cigarette (e-cigarette) use over time or among smokers with medical comorbidity.

Methods: We assessed current cigarette smokers' use of e-cigarettes during the 30 days before admission to 9 hospitals in 5 geographically dispersed US cities: Birmingham, AL; Boston, MA; Kansas City, KS; New York, NY; and Portland, OR. Each hospital was conducting a randomized controlled trial as part of the NIH-sponsored Consortium of Hospitals Advancing Research on Tobacco (CHART). We conducted a pooled analysis using multiple logistic regression to examine changes in e-cigarette use over time and to identify correlates of e-cigarette use.

Results: Among 4,660 smokers hospitalized between July 2010 and December 2013 (mean age 57 years, 57% male, 71% white, 56% some college, average 14 cigarettes/day), 14% reported using an e-cigarette during the 30 days before admission. The prevalence of e-cigarette use increased from 1.1% in 2010 to 10.3% in 2011, 10.2% in 2012, and 18.4% in 2013; the increase was statistically significant (p < .0001) after adjustment for age, sex, education, and CHART study. Younger, better educated, and heavier smokers were more likely to use e-cigarettes. Smokers who were Hispanic, non-Hispanic black, and who had Medicaid or no insurance were less likely to use e-cigarettes. E-cigarette use also varied by CHART project and by geographic region.

Conclusions: E-cigarette use increased substantially from 2010 to 2013 among a large sample of hospitalized adult cigarette smokers. E-cigarette use was more common among heavier smokers and among those who were younger, white, and who had higher socioeconomic status.
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http://dx.doi.org/10.1093/ntr/ntu138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837996PMC
February 2015

Dentist and practice characteristics associated with restorative treatment of enamel caries in permanent teeth: multiple-regression modeling of observational clinical data from the National Dental PBRN.

Am J Dent 2014 Apr;27(2):91-9

Purpose: Current evidence in dentistry recommends non-surgical treatment to manage enamel caries lesions. However, surveyed practitioners report they would restore enamel lesions that are confined to the enamel. Actual clinical data were used to evaluate patient, dentist, and practice characteristics associated with restoration of enamel caries, while accounting for other factors.

Methods: Data from a National Dental Practice-Based Research Network observational study of consecutive restorations placed in previously unrestored permanent tooth surfaces and practice/demographic data from 229 participating network dentists were combined. ANOVA and logistic regression, using generalized estimating equations (GEE) and variable selection within blocks, were used to test the hypothesis that patient, dentist, and practice characteristics were associated with variations in enamel restorations of occlusal and proximal caries compared to dentin lesions, accounting for dentist and patient clustering.

Results: Network dentists from five regions placed 6,891 restorations involving occlusal and/or proximal caries lesions. Enamel restorations accounted for 16% of enrolled occlusal caries lesions and 6% of enrolled proximal caries lesions. Enamel occlusal restorations varied significantly (P < 0.05) by patient age and race/ethnicity, dentists' use of caries risk assessment, network region, and practice type. Enamel proximal restorations varied significantly (P < 0.05) by dentist race/ethnicity, network region, and practice type.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090699PMC
April 2014

Supplementing online surveys with a mailed option to reduce bias and improve response rate: the National Dental Practice-Based Research Network.

J Public Health Dent 2014 7;74(4):276-82. Epub 2014 Apr 7.

University of Alabama at Birmingham, Birmingham, AL, USA.

Objective: Dentists in the National Dental Practice-Based Research Network are offered online and mail options for most questionnaire studies. We sought to quantify differences a) in characteristics of dentists who completed a questionnaire online as compared with those who completed a mail option offered to online nonresponders and b) in prevalence estimates for certain practice characteristics.

Methods: Invitation letters to participants provided an identification number and log-in code with which to complete the online survey. Nonrespondents received a reminder letter after the fourth week, and after an additional 4-week period, a final reminder was sent, along with a paper questionnaire version, allowing completion online or by paper.

Results: Of 632 US dentists who completed the survey, 84 (13 percent) used the paper version. Completion by paper was more common among males, older dentists, and those in general practice (P<0.05). The proportions of dentists who used electronic dental records, who consistently used a rubber dam when performing root canals, and who either worked with or employed expanded-function auxiliaries were lower among dentists who completed the survey using the paper-mail version than among those who completed it online; these differences remained significant in models adjusted for gender, age, and practice type.

Conclusion: Even in an era of increasingly electronic communication by dentists, not including a paper option when conducting surveys can result in overestimation of the prevalence of key dental practice characteristics.
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http://dx.doi.org/10.1111/jphd.12054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352546PMC
September 2015

Agreement among dentists' restorative treatment planning thresholds for primary occlusal caries, primary proximal caries, and existing restorations: findings from The National Dental Practice-Based Research Network.

J Dent 2013 Aug 3;41(8):718-25. Epub 2013 Jun 3.

University of Alabama at Birmingham, Department of Restorative Sciences, 1919 7th Avenue South, AL 35294-0007, United States.

Objectives: The aim of this study was to quantify the agreement among individual National Dental Practice-Based Research Network dentists' self-reported treatment decisions for primary occlusal caries, primary proximal caries, and existing restorations.

Methods: Five hypothetical clinical scenarios were presented: primary occlusal caries; primary proximal caries; and whether three existing restorations should be repaired or replaced. We quantified the probability that dentists who recommended later restorative intervention for primary caries were the same ones who recommended that existing restorations be repaired instead of replaced.

Results: Dentists who recommended later restorative treatment of primary occlusal caries and proximal caries at a more-advanced stage were significantly more likely to recommend repair instead of replacement. Agreement among dentists on a threshold stage for the treatment of primary caries ranged from 40 to 68%, while that for repair or replacement of existing restorations was 36 to 43%.

Conclusions: Dentists who recommended repair rather than replacement of existing restorations were significantly more likely to recommend later treatment of primary caries. Conversely, dentists who recommended treatment of primary caries at an earlier stage were significantly more likely to recommend replacement of the entire restoration. Between-dentist agreement for primary caries treatment was better than between-dentist agreement for repair or replacement of existing restorations.

Clinical Implications: These findings suggest consistency in how individual dentists approach the treatment of primary caries and existing restorations. However, substantial variation was found between dentists in their treatment decisions about the same teeth.
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http://dx.doi.org/10.1016/j.jdent.2013.05.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788573PMC
August 2013

A 24-month evaluation of amalgam and resin-based composite restorations: Findings from The National Dental Practice-Based Research Network.

J Am Dent Assoc 2013 Jun;144(6):583-93

Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, AL, USA.

Background: Knowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from The National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations.

Methods: In this prospective cohort study, the authors gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement and annually thereafter. Data collected included patient factors, practice factors and dentist factors, and the authors analyzed them by using mixed-model logistic regression.

Results: A total of 226 practitioners followed up 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.2 percent) during the mean (standard deviation) follow-up of 23.7 (8.8) months. The number of tooth surfaces restored at baseline helped predict subsequent restoration failure; restorations with four or more restored surfaces were more than four times more likely to fail. Restorative material was not associated significantly with longevity; neither was tooth type. Older patient age was associated highly with failure (P < .001). The failure rate for children was 4 percent, compared with 10 percent for people 65 years or older. Dentist's sex and practice workload were associated significantly with restoration longevity.

Conclusions: In this prospective cohort study, these factors were significantly predictive of failure for amalgam and RBC restorations: patient's age, a higher number of surfaces restored at baseline, the dentist's sex and the practice workload. Material choice was not significantly predictive in these early results. Practical Implications. If clinicians can recognize and identify the risk factors associated with early restoration failure, more effective treatment plans may be offered to the patient.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694730PMC
http://dx.doi.org/10.14219/jada.archive.2013.0169DOI Listing
June 2013

Purpose, structure, and function of the United States National Dental Practice-Based Research Network.

J Dent 2013 Nov 15;41(11):1051-9. Epub 2013 Apr 15.

Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States. Electronic address:

Objective: Following a successful 2005-2012 phase with three regional practice-based research networks (PBRNs), a single, unified national network called "The National Dental PBRN" was created in 2012 in the United States to improve oral health by conducting practice-based research and serving dental professionals through education and collegiality.

Methods: Central administration is based in Alabama. Regional centres are based in Alabama, Florida, Minnesota, Oregon, New York and Texas, with a Coordinating Centre in Maryland. Ideas for studies are prioritized by the Executive Committee, comprised mostly of full-time clinicians.

Results: To date, 2763 persons have enrolled, from all six network regions; enrollment continues to expand. They represent a broad range of practitioners, practice types, and patient populations. Practitioners are actively improving every step of the research process, from idea generation, to study development, field testing, data collection, and presentation and publication.

Conclusions: Practitioners from diverse settings are partnering with fellow practitioners and academics to improve clinical practice and meet the needs of clinicians and their patients.

Clinical Significance: This "nation's network" aims to serve as a precious national resource to improve the scientific basis for clinical decision-making and foster movement of the latest evidence into routine practice.
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http://dx.doi.org/10.1016/j.jdent.2013.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812393PMC
November 2013

Electronic dental record use and clinical information management patterns among practitioner-investigators in The Dental Practice-Based Research Network.

J Am Dent Assoc 2013 Jan;144(1):49-58

Center for Dental Informatics, School of Dental Medicine, University of Pittsburgh, 3501 Terrace St., Suite 339, Pittsburgh, PA 15261, USA.

Background: The growing availability of electronic data offers practitioners increased opportunities for reusing clinical data for research and quality improvement. However, relatively little is known about what clinical data practitioners keep on their computers regarding patients.

Methods: The authors conducted a web-based survey of 991 U.S. and Scandinavian practitioner-investigators (P-Is) in The Dental Practice-Based Research Network to determine the extent of their use of computers to manage clinical information; the type of patient information they kept on paper, a computer or both; and their willingness to reuse electronic dental record (EDR) data for research.

Results: A total of 729 (73.6 percent) of 991 P-Is responded.A total of 73.8 percent of U.S. solo practitioners and 78.7 percent of group practitioners used a computer to manage some patient information, and 14.3 percent and 15.9 percent, respectively, managed all patient information on a computer. U.S. practitioners stored appointments, treatment plans, completed treatment and images electronically most frequently, and the periodontal charting, diagnosis, medical history, progress notes and the chief complaint least frequently.More than 90 percent of Scandinavian practitioners stored all information electronically.A total of 50.8 percent of all P-Is were willing to reuse EDR data for research, and 63.1 percent preferred electronic forms for data collection.

Conclusion: The results of this study show that the trend toward increased adoption of EDRs in the United States is continuing, potentially making more data in electronic form available for research. Participants appear to be willing to reuse EDR data for research and to collect data electronically.

Clinical Implications: The rising rates of EDR adoption may offer increased opportunities for reusing electronic data for quality improvement and research.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539217PMC
http://dx.doi.org/10.14219/jada.archive.2013.0013DOI Listing
January 2013

Large-scale clinical endodontic research in the National Dental Practice-Based Research Network: study overview and methods.

J Endod 2012 Nov 11;38(11):1470-8. Epub 2012 Sep 11.

Division of Temporomandibular Disorders and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.

Introduction: This article reports on the feasibility of conducting a large-scale endodontic prospective cohort study in The National Dental Practice-Based Research Network. This study was designed to measure pain and burden associated with initial orthograde root canal therapy (RCT) and to explore potential prognostic factors for pain outcomes. The main objectives of this first report in a series are to describe the project's feasibility and methods and the demographics of the sample obtained.

Methods: Sixty-two dentist practitioner-investigators (ie, 46 generalists and 16 endodontists) in 5 geographic areas were certified within the network and trained regarding the standardized study protocol. Enrollment and baseline data collection occurred over 6 months with postobturation follow-up for another 6 months. Patients and dentists completed questionnaires before and immediately after treatment visits. Patients also completed questionnaires at 1 week, 3 months, and 6 months after obturation.

Results: Enrollment exceeded target expectations, with 708 eligible patient-participants. Questionnaire return rates were good, ranging between 90% and 100%. Patient demographics were typical of persons who receive RCT in the United States (ie, mean age = 48 years [standard deviation = 13 years], with most being female [59%], college educated [81%], white non-Hispanic [86%], and having dental insurance [81%]). The tooth types being treated were also typical (ie, 61% molars, 28% premolars, and 11% anteriors, with maxillary teeth being predominant [59%]).

Conclusions: This study shows the feasibility of conducting large-scale endodontic prospective cohort studies in the network. Patients were rapidly recruited with high levels of compliance in data collection.
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http://dx.doi.org/10.1016/j.joen.2012.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652657PMC
November 2012

Caries treatment in a dental practice-based research network: movement toward stated evidence-based treatment.

Community Dent Oral Epidemiol 2013 Apr 5;41(2):143-53. Epub 2012 Oct 5.

Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.

Objectives: Practice-based research networks (PBRNs) provide a venue to foster evidence-based care. We tested the hypothesis that a higher level of participation in a dental PBRN is associated with greater stated change toward evidence-based practice.

Methods: A total of 565 dental PBRN practitioner-investigators completed a baseline questionnaire entitled 'Assessment of Caries Diagnosis and Treatment'; 405 of these also completed a follow-up questionnaire about treatment of caries and existing restorations. Certain questions (six treatment scenarios) were repeated at follow-up a mean (SD) of 36.0 (3.8) months later. A total of 224 were 'full participants' (enrolled in clinical studies and attended at least one network meeting); 181 were 'partial participants' (did not meet 'full' criteria).

Results: From 10% to 62% of practitioners were 'surgically invasive' at baseline, depending on the clinical scenario. Stated treatment approach was significantly less invasive at follow-up for four of six items. Change was greater among full participants and those with a more-invasive approach at baseline, with an overall pattern of movement away from the extremes.

Conclusions: These results are consistent with a preliminary conclusion that network participation fostered movement of scientific evidence into routine practice. PBRNs may foster movement of evidence into everyday practice as practitioners become engaged in the scientific process.
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http://dx.doi.org/10.1111/cdoe.12008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811014PMC
April 2013

Use of online sources of information by dental practitioners: findings from The Dental Practice-Based Research Network.

J Public Health Dent 2014 21;74(1):71-9. Epub 2012 Sep 21.

Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA Department of Restorative Dentistry, College of Dentistry, University of Florida, Gainesville, FL, USA HealthPartners Dental Group, and HealthPartners Research Foundation, Minneapolis, MN, USA Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA Department of Cariology and Endodontics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark General dentistry private practice, Alabaster, AL, USA Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA.

Objective: Estimate the proportion of dental practitioners who use online sources of information for practice guidance.

Methods: From a survey of 657 dental practitioners in The Dental Practice-Based Research Network, four indicators of online use for practice guidance were calculated: read journals online, obtained continuing education (CDE) through online sources, rated an online source as most influential, and reported frequently using an online source for guidance. Demographics, journals read, and use of various sources of information for practice guidance in terms of frequency and influence were ascertained for each.

Results: Overall, 21 percent (n = 138) were classified into one of the four indicators of online use: 14 percent (n = 89) rated an online source as most influential and 13 percent (n = 87) reported frequently using an online source for guidance; few practitioners (5 percent, n = 34) read journals online, fewer (3 percent, n = 17) obtained CDE through online sources. Use of online information sources varied considerably by region and practice characteristics. In general, the four indicators represented practitioners with as many differences as similarities to each other and to offline users.

Conclusion: A relatively small proportion of dental practitioners use information from online sources for practice guidance. Variation exists regarding practitioners' use of online source resources and how they rate the value of offline information sources for practice guidance.
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http://dx.doi.org/10.1111/j.1752-7325.2012.00373.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883955PMC
November 2014

Components of patient satisfaction with a dental restorative visit: results from the Dental Practice-Based Research Network.

J Am Dent Assoc 2012 Sep;143(9):1002-10

Department of Community Dentistry and Behavioral Sciences, College of Dentistry, University of Florida, Gainesville 32610, USA.

Background: The authors conducted a study to identify components of patient satisfaction with restorative dental care and to test the hypothesis that certain dentist, patient and procedure factors are associated with patient satisfaction.

Methods: Practitioner-investigators (P-Is) from 197 practices in The Dental Practice-Based Research Network (DPBRN) recruited consecutively seen patients who had defective permanent-tooth restorations that were replaced or repaired. At the end of the treatment visit, P-Is asked each participant to complete a satisfaction survey and mail it directly to a DPBRN regional coordinator.

Results: Analysis of the results of 5,879 satisfaction surveys revealed three satisfaction components: interpersonal relationship-comfort factors, material choice-value factors and sensory-evaluative factors. Satisfaction was highest among patients who received care in a private practice model, whose restorations were repaired rather than replaced and whose restored teeth were not molars.

Conclusion: These data suggest that a patient's judgments of a dentist's skills and quality of care are based on personal interactions with the dentist, the level of comfort the patient perceives while receiving care and any experience of posttreatment sensitivity in the treated tooth. These conclusions have direct implications for management of patient care before, during and after the procedure.

Practice Implications: By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, thereby enabling themselves to focus on what each patient values most.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432985PMC
http://dx.doi.org/10.14219/jada.archive.2012.0329DOI Listing
September 2012

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial.

Trials 2012 Aug 1;13:129. Epub 2012 Aug 1.

Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA.

Background: Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231).

Methods/design: The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven-day, thirty-day, and continuous abstinence at twelve months, intervention dose response at six and twelve months for AR + IVR recipients, incremental cost-effectiveness of AR + IVR intervention compared to usual care at six and twelve months, and health-care utilization and expenditures at twelve months for AR + IVR recipients compared to UC.

Discussion: This study will provide important evidence for the effectiveness and cost-effectiveness of linking hospital-based tobacco treatment specialists' services with discharge follow-up care.

Trial Registration: ClinicalTrials.gov: NCT01236079.
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http://dx.doi.org/10.1186/1745-6215-13-129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517349PMC
August 2012

Repair or replacement of defective restorations by dentists in The Dental Practice-Based Research Network.

J Am Dent Assoc 2012 Jun;143(6):593-601

Department of Restorative Dental Sciences, College of Dentistry, University of Florida, P.O. Box 100415, Gainesville, FL 32610-0415, USA.

Background: The authors aimed to determine whether dentists in practices belonging to The Dental Practice-Based Research Network (DPBRN) were more likely to repair or to replace a restoration that they diagnosed as defective; to quantify dentists' specific reasons for repairing or replacing restorations; and to test the hypothesis that certain dentist-, patient- and restoration-related variables are associated with the decision between repairing and replacing restorations.

Methods: This cross-sectional study had a consecutive patient and restoration recruitment design. Practitioner-investigators (P-Is) recorded data for consecutively seen restorations in permanent teeth that needed repair or replacement. The DPBRN is a consortium of dental practitioners and dental organizations in the United States and Scandinavia. The collected data included the primary reason for repair or replacement, tooth surface or surfaces involved, restorative materials used and patients' demographic information.

Results: P-Is collected data regarding 9,484 restorations from 7,502 patients in 197 practices. Seventy-five percent (7,073) of restorations were replaced and 25 percent (2,411) repaired. Secondary caries was the main reason (43 percent, n = 4,124) for treatment. Factors associated with a greater likelihood of repairing versus replacing restorations (P < .05) included having graduated from dental school more recently, practicing in a large group practice, being the dentist who placed the original restoration, patient's being of an older age, the original restorative material's being something other than amalgam, restoration of a molar and the original restoration's involving fewer tooth surfaces.

Conclusions: DPBRN dentists were more likely to replace than to repair restorations. Secondary caries was the most common reason for repairing or replacing restorations. Certain dentist-, patient- and restoration-related variables were associated with the repair-or-replace decision.

Clinical Implications: The selection of minimally invasive treatment for an existing restoration is critical, as it may affect the longevity of the tooth.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368503PMC
http://dx.doi.org/10.14219/jada.archive.2012.0238DOI Listing
June 2012

Restoration of noncarious tooth defects by dentists in The Dental Practice-Based Research Network.

J Am Dent Assoc 2011 Dec;142(12):1368-75

Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA.

Background: The authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The Dental Practice-Based Research Network (DPBRN) and to assess the tooth, patient and dentist characteristics associated with those reasons.

Methods: Data were collected by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists' and dental practices' characteristics; teeth and surfaces restored; and restorative materials used.

Results: Dentists most often placed restorations to treat lesions caused by abrasion, abfraction or erosion (AAE) (46 percent) and tooth fracture (31 percent). Patients 41 years or older received restorations mainly because of AAE (P < .001). Premolars and anterior teeth were restored mostly owing to AAE; molars were restored mostly owing to tooth fracture (P < .001). Dentists used directly placed resin-based composite (RBC) largely to restore AAE lesions and fractured teeth (P < .001).

Conclusions: Among DPBRN practices, AAE and tooth fracture were the main reasons for restoring noncarious tooth surfaces. Pre-molars and anterior teeth of patients 41 years and older are most likely to receive restorations owing to AAE; molars are most likely to receive restorations owing to tooth fracture. Dentists restored both types of NCTDs most often with RBC.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229176PMC
http://dx.doi.org/10.14219/jada.archive.2011.0138DOI Listing
December 2011