https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Background Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet, audit and feedback has not been found to be consistently effective. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy We searched the Cochrane Effective Practice and Organisation of Care Group's register up to January 2001. This was supplemented with searches of MEDLINE and reference lists, which did not yield additional relevant studies. Selection criteria Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results We included 85 studies, 48 of which have been added to the previous version of this review. There were 52 comparisons of dichotomous outcomes from 47 trials with over 3500 health professionals that compared audit and feedback to no intervention. The adjusted RDs of non-compliance with desired practice varied from 0.09 (a 9% absolute increase in non-compliance) to 0.71 (a 71% decrease in non-compliance) (median = 0.07, inter-quartile range = 0.02 to 0.11). The one factor that appeared to predict the effectiveness of audit and feedback across studies was baseline non-compliance with recommended practice. Reviewer's conclusions Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The absolute effects of audit and feedback are more likely to be larger when baseline adherence to recommended practice is low.

Audit and feedback: effects on professional practice and healthcare outcomes

Polydopamine and Its Derivative Materials: Synthesis and Promising Applications in Energy, Environmental, and Biomedical Fields

Background: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience.

Methods: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a “psychological theory” group (n = 18), a “health services research” group (n = 13), and a “health psychology” group (n = 30).

Results: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour.

Conclusions: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.

https://qualitysafety.bmj.com/content/qhc/14/1/26.full.pdf

Making psychological theory useful for implementing evidence based practice: a consensus approach

Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.

/pdf/making-sense-of-implementation-theories-models-and-9m1o7axeoi.pdf

Making sense of implementation theories, models and frameworks

The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice.

Clinical diagnosis of dental caries: a European perspective.

Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists.

Objective To investigate the outcome of non-restoration of carious deciduous teeth by means of a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care. Design Using a carefully defined protocol the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored was determined from the sequential examination of the clinical records of 481 children attending at least annually. Results The age at initial diagnosis of carious teeth ranged from 1–12 years with the majority of cavities (1,005) presenting by 6 years of age. In all, 1,587 teeth were followed until loss from the mouth. Of these, 190 (12%) were extracted because of pain and a further 60 (4%) became painful and were treated, leaving 1,337 (84%) that remained symptomless until being lost. Of the 1,337 symptomless teeth, 178 were extracted under general anaesthesia at the same time as painful ones. The final group of 1,159 (74%) teeth were exfoliated without causing pain after a mean survival time of 1,332 days. Excluding from the analysis the 178 extracted, but symptomless teeth, leaves a total of 1,409 teeth of which 18% gave pain and were extracted or treated and the remaining 82% exfoliated. The strongest determinant of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. The carious teeth most likely to cause symptoms were found to be molars that developed cavities with pulpal involvement by the age of 3 years, 34% of which caused pain. In contrast, those least likely to cause pain were carious molar teeth presenting without pulpal involvement after 8 years, only 6% of which produced symptoms. Conclusion In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. The results provide evidence to aid the treatment planning of carious deciduous teeth in children regularly receiving regular preventive dental care.

The fate of 1,587 unrestored carious deciduous teeth: a retrospective general dental practice based study from northern England

–Objectives: To develop a method for recording dental caries at the D1 (enamel and dentine) diagnostic threshold (without loss of D3 information) and assess its reliability, ‘benchmark’ validity and potential effects on reported caries prevalence and needs assessment. Methods: Multi-examiner training, calibration and validation trial. Two groups of 10 dental examiners were trained to diagnose dental caries at the D1 (enamel and dentine) diagnostic threshold under the conditions of a caries prevalence survey, prior to a calibration trial being undertaken. Results: Where ‘experienced examiners’ were trained to examine at the D1 (enamel and dentine) diagnostic threshold, under the conditions of a cross-sectional epidemiological survey, there was no significant deterioration in inter-examiner agreement on the assessment of teeth and a significant difference in one of two comparisons on the assessment of surfaces using the kappa statistic. Assessed against a benchmark examiner, there was no significant loss of sensitivity at the D1 diagnostic threshold compared with the D3 threshold and, although there was a significant loss of specificity at the D1 threshold, all specificity values could be considered to be high. Conclusions: Modifying the diagnostic criteria typically used in surveys of caries prevalence (to allow assessment of the levels of enamel caries which could benefit from preventive care as well as dentinal caries requiring restorative care) in adolescents does not adversely affect the reliability or benchmark validity of experienced examiners to a significant degree.

Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM).

– Objectives:  To validate the Oral Health Impact Profile (OHIP)-14 in a sample of patients attending general dental practice.

Methods:  Patients with pathology-free impacted wisdom teeth were recruited from six general dental practices in Tayside, Scotland, and followed for a year to assess the development of problems related to impaction. The OHIP-14 was completed at baseline and at 1-year follow-up, and analysed using three different scoring methods: a summary score, a weighted and standardized score and the total number of problems reported. Instrument reliability was measured by assessing internal consistency and test–retest reliability. Construct validity was assessed using a number of variables. Linear regression was then used to model the relationship between OHIP-14 and all significantly correlated variables. Responsiveness was measured using the standardized response mean (SRM). Adjusted R2s and SRMs were calculated for each of the three scoring methods. Estimates for the differences between adjusted R2s and the differences between SRMs were obtained with 95% confidence intervals.

Results:  A total of 278 and 169 patients completed the questionnaire at baseline and follow-up, respectively. Reliability – Cronbach's α coefficients ranged from 0.30 to 0.75. Alpha coefficients for all 14 items were 0.88 and 0.87 for baseline and follow-up, respectively. Test–retest coefficients ranged from 0.72 to 0.78. Validity – OHIP-14 scores were significantly correlated with number of teeth, education, main activity, the use of mouthwash, frequency of seeing a dentist, the reason for the last dental appointment, smoking, alcohol intake, pain and symptoms. Adjusted R2s ranged from 0.123 to 0.202 and there were no statistically significant differences between those for the three different scoring methods. Responsiveness – The SRMs ranged from 0.37 to 0.56 and there was a statistically significant difference between the summary scores method and the total number of problems method for symptomatic patients.

Conclusions:  The OHIP-14 is a valid and reliable measure of oral health-related quality of life in general dental practice and is responsive to third molar clinical change. The summary score method demonstrated performance as good as, or better than, the other methods studied.

Nigel Pitts

Papers

Clinical diagnosis of dental caries: a European perspective.

Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists.

The fate of 1,587 unrestored carious deciduous teeth: a retrospective general dental practice based study from northern England

Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM).

Assessing oral health-related quality of life in general dental practice in Scotland: validation of the OHIP-14.