Showing papers by "Jan E Clarkson published in 2004"

Dental Recall. Recall Interval between Routine Dental Examinations

Abstract: Acknowledgements v Stakeholder Organisations vii Abbreviations used in Guideline ix 1 Introduction 1 1.1 Background 1 1.2 What is a guideline? 2 1.3 Remit of the Guideline 3 1.4 What the guideline covers 3 1.5 What the guideline does not cover 3 1.6 Who developed the guideline? 3 1.7 Guideline Methodology 4 1.7.1 Outline of methods used 4 1.7.2 Questions addressed in developing the guideline 4 1.7.3 Systematic Review Methods for Key Clinical Questions 5 1.7.4 Hierarchy of evidence 6 1.7.5 Health economics methods 6 1.7.6 Forming and grading the recommendations 7 2 Clinical effectiveness and cost-effectiveness of routine dental checks (HTA update) 9 2.1 Characteristics of the Included Studies 9 2.1.1 Characteristics of the study settings and study design 9 2.1.2 The accuracy of clinical oral examinations in detecting oral cancer and potentially malignant conditions 31 3.3.5 Toluidine blue dye 31 3.3.6 Potentially malignant lesions and conditions 31 3.4

Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care, a cluster randomised controlled trial.

Abstract: Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 'Management of unerupted and impacted third molar teeth' (published 2000) as a model. Design A pragmatic, cluster RCT (2×2 factorial design). Subjects Sixty-three dental practices across Scotland. Clinical records of all 16—24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions. Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PGEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL. Principal outcome measurement The proportion of patients whose treatment complied with the guideline. Results The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection. Conclusion In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and F arm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

Getting Research into Clinical Practice - Barriers and Solutions

Abstract: The success of current efforts towards evidence-based health services in many countries depends on efficient transfer of research findings to health practitioners. However, there is a lag in research being adopted. In part this is due to difficulties in interpreting or generalising research findings, in part to inertia, organisational structures and information. Clinical guidelines are usually cited as being the most effective product of evidence assessment and means of getting research into practice. The processes by which they are prepared and disseminated are discussed. Current clinical practice requires that health professionals adapt to changing systems and adopt new techniques. Therefore, in future, practice research to evaluate (a) clinical interventions and (b) dissemination and implementation strategies will become increasingly important. Recognised barriers to such research include lack of interest, lack of involvement, lack of time and lack of remuneration. High-quality research in dental primary care requires academics and dental service providers working in partnership on topics that are relevant both to clinicians and policy makers. Good project management, education and training are essential.

Current practice with regard to oral care for children being treated for cancer

Abstract: The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.