Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.

BackgroundDocumenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record.MethodsKotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed.ResultsKotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element.ConclusionChange strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care.Practical implicationsA practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture

Characterizing the molecular and metabolic mechanisms of insecticide resistance in Anopheles gambiae in Faranah, Guinea.

BACKGROUND: In recent years, the scale-up of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) has greatly reduced malaria transmission. However, malaria remains a global public health concern with the majority of the disease burden in sub-Saharan Africa. Insecticide resistance is a growing problem among Anopheles vector populations, with potential implications for the continued effectiveness of available control interventions. Improved understanding of current resistance levels and underlying mechanisms is essential to design appropriate management strategies and to mitigate future selection for resistance. METHODS: Anopheles gambiae sensu lato mosquitoes were collected from three villages in Faranah Prefecture, Guinea and their levels of susceptibility to seven insecticides were measured using CDC resistance intensity bioassays. Synergist assays with piperonyl butoxide (PBO) were also undertaken to assess the role of elevated mixed-function oxidases in resistance. Five hundred and sixty-three mosquitoes underwent molecular characterization of vector species, presence of target site mutations (L1014F kdr, N1575Y and G119S Ace-1), Plasmodium falciparum infection, and relative expression of three metabolic genes (CYP6M2, CYP6P3 and GSTD3). RESULTS: In Faranah, resistance to permethrin and deltamethrin was observed, as well as possible resistance to bendiocarb. All assayed vector populations were fully susceptible to alpha-cypermethrin, pirimiphos-methyl, clothianidin and chlorfenapyr. Plasmodium falciparum infection was detected in 7.3% (37/508) of mosquitoes tested. The L1014F kdr mutation was found in 100% of a sub-sample of 60 mosquitoes, supporting its fixation in the region. The N1575Y mutation was identified in 20% (113/561) of individuals, with ongoing selection evidenced by significant deviations from Hardy-Weinberg equilibrium. The G119S Ace-1 mutation was detected in 62.1% (18/29) of mosquitoes tested and was highly predictive of bendiocarb bioassay survival. The metabolic resistance genes, CYP6M2, CYP6P3 and GSTD3, were found to be overexpressed in wild resistant and susceptible An. gambiae sensu stricto populations, compared to a susceptible G3 colony. Furthermore, CYP6P3 was significantly overexpressed in bendiocarb survivors, implicating its potential role in carbamate resistance in Faranah. CONCLUSIONS: Identification of intense resistance to permethrin and deltamethrin in Faranah, is of concern, as the Guinea National Malaria Control Programme (NMCP) relies exclusively on the distribution of pyrethroid-treated LLINs for vector control. Study findings will be used to guide current and future control strategies in the region

La définition de la gestion hydraulique du barrage de FOMI (Guinée) en regard de ses impacts environnementaux aval

Definition of Fomi's reservoir water management according to downstream environmental impacts. In the prospect of integrated catchment water management, the Niger Basin Authority is responsible for the study of the major future hydraulic projects of the river Niger catchment. Fomi multipurpose project, located in Guinea, in the head of Niger catchment, will contribute to reach the objectives of the Sustainable Development Action Plan of the Niger basin. It will regulate the discharges of the Niger River and will reduce downstream flooded areas as far as the Inner Delta, 600 km away, wetland of international interest according to Ramsar convention. The decrease of the flooded areas will impact not only human activities such as fishing, stockbreeding and agriculture but also on environment with the decrease of species indentured to habitats of flooded areas. In order to characterize the downstream impacts of the dam project, hydraulic simulations of scenarios of different variants of sizing and reservoir water management has been computed. Five scenarios have been defined as inputs of the model. Simulations are compared each other and to the reference state, according to analysis criteria related to objectives associated to Fomi’s project. The aim of this analysis is to recommend dam sizing guidelines and measures to mitigate negative environmental impacts.Dans la perspective d’une gestion par bassins, l’Autorité du Bassin du Niger (ABN) est responsable de l’étude des futurs grands ouvrages hydrauliques du bassin du fleuve Niger. L’aménagement à but multiples de Fomi, situé en Guinée, en tête du bassin du Niger, contribuera à atteindre les objectifs du Plan d’Action de Développement Durable du bassin du Niger. Il régularisera les débits du fleuve Niger et entraînera de ce fait la réduction des surfaces inondées par la crue annuelle dans la vallée à l’aval jusqu’à plus de 600 km de distance, dans le Delta Intérieur du Niger, zone humide d’importance internationale au titre de la convention de Ramsar. La réduction des superficies inondées aura non seulement un impact sur les activités humaines telles que la pêche, l’élevage transhumant et l’agriculture mais aussi sur le milieu nature, par la réduction des espèces inféodées aux habitats des zones inondées. Afin de caractériser les impacts de l’aménagement sur l’aval, des simulations hydrauliques de scénarios de dimensionnement et de gestion de la retenue ont été effectués sur un modèle de gestion des ressources en eau. Cinq scénarios de dimensionnement et de gestion ont été définis comme point d’entrée du modèle. Les simulations sont comparées entre elles, ainsi qu’à la situation actuelle représentant l’état de référence, d’après des critères d’analyse définis en fonction des objectifs associés à l’ouvrage. Cette analyse a pour objectif d’orienter le choix des critères de conception basiques de l’aménagement de Fomi et de préconiser des mesures d’atténuation des impacts environnementaux.Le Clerc Sandrine, Galet-Lalande Noel, Enoumba Henri-Claude, Yansane A.-B. La définition de la gestion hydraulique du barrage de FOMI (Guinée) en regard de ses impacts environnementaux aval. In: 32èmes Journées de l’Hydraulique de la Société Hydrotechnique de France Environnement et Hydroélectricité Lyon - 6 et 7 octobre 2010. 2010

Burnout and Work Engagement among US Dentists

© Wolters Kluwer Health, Inc. All rights reserved.Background Burnout is a threat to patient safety. It relates to emotional exhaustion, depersonalization, and lack of personal accomplishment. Work engagement conversely composed of levels of vigor, dedication, and absorption in one's profession. The aim of this study was to examine burnout and work engagement among US dentists. Methods This study used the extensively validated Maslach Burnout Inventory-Human Services Survey and Utrecht Work Engagement Scale to measure burnout in a self-administered survey of 167 US dentists who attended continuing education courses held in Boston, Pittsburg, Iowa City, and Las Vegas. The mean scores on the 3 subscales of Maslach Burnout Inventory-Human Services Survey and Utrecht Work Engagement Scale were computed. The interscale correlations between the components of burnout and work engagement were assessed using Pearson correlations. We used 1-way analysis of variance and independent 2 sample t tests to examine the relationship between burnout and work engagement across sex and various age categories. Prevalence of burnout in our study population was also computed. Results We observed that 13.2% of our study population experienced burnout and 16.2% of our study population was highly work engaged. There was a statistically significant, unadjusted association between burnout risk and work engagement (χ2 = 22.51, P < 0.0001). Furthermore, the scores in the subscales of burnout were significantly correlated with scores in the subscales of work engagement. Conclusions In this preliminary study, we observed some evidence of burnout among practicing US dentists. It is imperative that the dental profession understands this and works to promote professional practices that increase work engagement and decrease burnout

Utilization and Validity of the Dental Diagnostic System over Time in Academic and Private Practice

INTRODUCTION:To fill the void created by insufficient dental terminologies, a multi-institutional workgroup was formed among members of the Consortium for Oral Health Research and Informatics to develop the Dental Diagnostic System (DDS) in 2009. The adoption of dental diagnosis terminologies by providers must be accompanied by rigorous usability and validity assessments to ensure their effectiveness in practice. OBJECTIVES:The primary objective of this study was to describe the utilization and correct use of the DDS over a 4-y period. METHODS:Electronic health record data were amassed from 2013 to 2016 where diagnostic terms and Current Dental Terminology procedure code pairs were adjudicated by calibrated dentists. With the resultant data, we report on the 4-y utilization and validity of the DDS at 5 dental institutions. Utilization refers to the proportion of instances that diagnoses are documented in a structured format, and validity is defined as the frequency of valid pairs divided by the number of all treatment codes entered. RESULTS:Nearly 10 million procedures ( n = 9,946,975) were documented at the 5 participating institutions between 2013 and 2016. There was a 1.5-fold increase in the number of unique diagnoses documented during the 4-y period. The utilization and validity proportions of the DDS had statistically significant increases from 2013 to 2016 ( P &lt; 0.0001). Academic dental sites were more likely to document diagnoses associated with orthodontic and restorative procedures, while the private dental site was equally likely to document diagnoses associated with all procedures. Overall, the private dental site had significantly higher utilization and validity proportions than the academic dental sites. CONCLUSION:The results demonstrate an improvement in utilization and validity of the DDS terminology over time. These findings also yield insight into the factors that influence the usability, adoption, and validity of dental terminologies, raising the need for more focused training of dental students. KNOWLEDGE TRANSFER STATEMENT:Ensuring that providers use standardized methods for documentation of diagnoses represents a challenge within dentistry. The results of this study can be used by clinicians when evaluating the utility of diagnostic terminologies embedded within the electronic health record

Finding Dental Harm to Patients through Electronic Health Record–Based Triggers

BackgroundPatients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs).MethodsWe developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs.ResultsOf the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room.ConclusionBy developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future.Knowledge transfer statementA retrospective review of patients' health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record-based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered