Recording of diagnoses in public primary oral health care in a retrospective longitudinal observational study in a Finnish town: Underrepresentation of periodontitis diagnoses

Abstract Objectives This study investigates which oral diagnoses public primary dental care dentists record. Methods An observational register-based retrospective follow-up study was performed in the public primary oral health care of a Finnish town after the dentists were advised to mark the diagnoses in their practices. The rate of recorded diagnoses resulting from visits to the public primary care dentists was studied. The assessed diagnoses were recorded with the 10th revision of the International Classification of Diseases. The distribution of diagnoses was recorded during a 2-year follow-up period. Results The most frequent diagnosis groups were dental caries (K02, 38.6%), other diseases of dental hard tissues (K03, 14.9%), diseases of pulp and periapical tissues (K04, 11.4%), periodontal diseases (K05, 9.7%), and different types of bone fractures (S02, 8.1%). Periodontitis was underrepresented. Conclusions In public primary oral health care, there may be difficulties in adequate recording of certain chronic diseases.Peer reviewe

Improving the Recording of Diagnoses in Primary Care with Team Incentives : A Controlled Longitudinal Follow-Up Study

Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6-22.3) but not in either of the controls (-2.0 to -0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7-25.2) and 33.7% (26.6-41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.Peer reviewe

Electromechanical film sensor device for dynamic force recordings from canine limbs

An equipment based on the electromechanical film (EMF) sensors was designed for the measurementof forces acting upon canine limbs. EMF forms an elastic electret, which generates on its surface an electric charge proportional to the the force applied on it. The EMF sensors were calibrated using a conventional material testing device with cyclic loads. The beagles were trained on a treadmill working at horizontal position or with either 15° uphill or downhill inclination. The treadmill belt speed varied from 2.5 km/h to 7.5 km/h. The force under the canine paws varied depending on the inclination of the treadmill. When the dogs ran uphill, weight-bearing on hind1imbs increased 11% but the weight-bearing 0n forelimbs did not change. Downhill running increased weight-bearing on forelimbs by 8% and decreased weight-bcaring of the hindlimbs by 5%. Immobilization of the right hind] imb increased weightbearing on both forelimbs by 7-25% and on the left hindlimb by 56%. One month after a 30° valgus osteotomy operation at the right tibia, the dynamic force recorded From the operated hindlimb was 69% of the control value. Three months after osteotomy, the weight-bearing of the operated limb approachednormal situation. Our results suggest that the EMF sensor is a reliable method for the measurement of dynamic forces acting on the weight-bearing limbs of the dogs

Financial team incentives improved recording of diagnoses in primary care : a quasi-experimental longitudinal follow-up study with controls

Abstract Background In primary care, financial incentives have usually been directed to physicians because they are thought to make the key decisions in order to change the functions of a medical organization. There are no studies regarding the impact that directing these incentives to all disciplines of the care team (e.g. group bonuses for both nurses and doctors) may have, despite the low frequency with which diagnoses were being recorded for primary care visits to doctors. This study tested the effect of offering group bonuses to the care teams. Methods This was a retrospective quasi-experimental study with before-and-after settings and two control groups. In the intervention group, the mean percentage of visits to a doctor for which a diagnosis was recorded by each individual care team (mean team-based percentage of monthly visits to a doctor with recorded diagnoses) and simultaneously the same data was gathered from two different primary care settings where no team bonuses were applied. To study the sustainability of changes obtained with the group bonuses the respective data were derived from the electronic health record system for 2 years after the cessation of the intervention. The differences in the rate of marking diagnoses was analyzed with ANOVA and RM-ANOVA with appropriate post hoc tests, and the differences in the rate of change in marking diagnoses was analyzed with linear regression followed by t-test. Results The proportion of doctor visits having recorded diagnoses in the teams was about 55 % before starting to use group bonuses and 90 % after this intervention. There was no such increase in control units. The effect of the intervention weakened slightly after cessation of the group bonuses. Conclusion Group bonuses may provide a method to alter clinical practices in primary care. However, sustainability of these interventions may diminish after ceasing this type of financial incentive

Accuracy of measurements used to quantify cranial asymmetry in deformational plagiocephaly

Abstract Objective: Various measurements are used to quantify cranial asymmetry in deformational plagiocephaly (DP), but studies validating cut-off values and comparing the accuracy of such measurements are lacking. In this study, we compared the accuracy of four different measurements in classifying children with and without DP diagnosed by visual assessment, and sought to determine their optimal cut-off values. Study design: Two experts rated 407 3D craniofacial images of children aged between 3 and 36 months old using the Argenta classification. We then measured the following asymmetry-related variables from the images: Oblique Cranial Length Ratio (OCLR), Diagonal Difference (DD), Posterior Cranial Asymmetry Index (PCAI), and weighted Asymmetry Score (wAS). We created receiver operating characteristic curves to evaluate the accuracy of these variables. Results: All variables performed well, but OCLR consistently provided the best discrimination in terms of area under the curve values. Subject’s age had no clear effect on the cut-off values for OCLR, PCAI, and wAS; however, the cut-off for DD increased monotonically with age. When subjects with discrepant expert ratings were excluded, the optimal cut-off values for DP (Argenta class $\ge$ 1) across all age-groups were 104.0% for OCLR (83% sensitivity, 97% specificity), 10.5% for PCAI (90% sensitivity, 90% specificity), and 24.5 for wAS (88% sensitivity, 90% specificity). Conclusion: We recommend using OCLR as the primary measurement, although PCAI and wAS may also be useful in monitoring cranial asymmetry. The threshold of relative asymmetry required for a deformation to appear clinically significant is not affected by the child’s age, and DD has no additional utility in monitoring DP compared to using only OCLR

Effect of once-yearly zoledronic acid on the spine and hip as measured by quantitative computed tomography: results of the HORIZON Pivotal Fracture Trial.

Changes in bone mineral density and bone strength following treatment with zoledronic acid (ZOL) were measured by quantitative computed analysis (QCT) or dual-energy X-ray absorptiometry (DXA). ZOL treatment increased spine and hip BMD vs placebo, assessed by QCT and DXA. Changes in trabecular bone resulted in increased bone strength. INTRODUCTION: To investigate bone mineral density (BMD) changes in trabecular and cortical bone, estimated by quantitative computed analysis (QCT) or dual-energy X-ray absorptiometry (DXA), and whether zoledronic acid 5 mg (ZOL) affects bone strength. METHODS: In 233 women from a randomized, controlled trial of once-yearly ZOL, lumbar spine, total hip, femoral neck, and trochanter were assessed by DXA and QCT (baseline, Month 36). Mean percentage changes from baseline and between-treatment differences (ZOL vs placebo, t-test) were evaluated. RESULTS: Mean between-treatment differences for lumbar spine BMD were significant by DXA (7.0%, p < 0.01) and QCT (5.7%, p < 0.0001). Between-treatment differences were significant for trabecular spine (p = 0.0017) [non-parametric test], trabecular trochanter (10.7%, p < 0.0001), total hip (10.8%, p < 0.0001), and compressive strength indices at femoral neck (8.6%, p = 0.0001), and trochanter (14.1%, p < 0.0001). CONCLUSIONS: Once-yearly ZOL increased hip and spine BMD vs placebo, assessed by QCT vs DXA. Changes in trabecular bone resulted in increased indices of compressive strength