| 1. |
- Rawski, A. A., et al.
(författare)
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The major factors that influence endodontic retreatment decisions
- 2003
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 27:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- The presence of a new or persistent periapical radiolucency adjacent to a rootfilled tooth is often used as a criterion of endodontic treatment "failure". However, clinicians' suggested management of such cases is subject to substantial interindividual variation. Several components that might influence endodontic retreatment decision making have been explored, but data on which factors dentists actually think they consider, are missing. The aim was to interview 20 general dental practitioners (GDPs) and 20 endodontists about factors they thought would influence the prescription of endodontic retreatment. Six simulated cases were presented as cartoons accompanied with a clinical history. In two of the cases the teeth were planned to serve as an abutment tooth in a fixed prosthodontic construction. The status of the periapical bone tissue and the quality of rootfilling seal were varied. Between 1 and 6 factors per case were reported to influence decision making. In cases not planned to serve as abutment teeth most dentists considered that the periapical condition was the most important factor, whilst they considered the fixed prosthodontic construction to be the most important factor in cases planned as abutment teeth. Generally, endodontists seem to be more inclined to retreat and act on the mere presence of a periapical lesion regardless of size than GDPs. In a real clinical setting in direct contact with patients, additional factors like economy and patients' preferences might be expected to exert a major influence. The majority of the dentists stated that they thought that their colleagues would make similar decisions as they did themselves.
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| 2. |
- Bondemark, Lars, et al.
(författare)
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A Self-directed Summative Examination in Problem-based Learning in Dentistry : a New Approach
- 2004
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Ingår i: Medical teacher. - : Informa UK Limited. - 0142-159X .- 1466-187X. ; 26:1, s. 46-51
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This paper describes and evaluates a new method of assessment in PBL, which was developed with two cohorts of dental students. The method involves students in PBL groups designing PBL problems and assessment tasks that are in line with the objectives of the course and the principles of PBL. Construction of tasks and feedback were provided. The student groups based the summative assessment on a selection of the PBL assessments provided. The evaluation indicates that senior students are capable of designing challenging PBL assessment tasks that are in line with course objectives and PBL principles. This experience raised the pass rates of the students compared those of with earlier cohorts of students. The students rated the method favourably; they considered it enabled them to demonstrate their competences and that it was more closely in line with PBL principles than other methods of assessment that they had experienced. The method is a promising innovation, which could be used in a variety of PBL courses.
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| 3. |
- Domeij, Rickard, et al.
(författare)
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Different ways of evaluating a Swedish grammar checker
- 2002
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Ingår i: Proceedings of the third international conference on language resources and evaluation (LREC). ; , s. 262-267
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Three different ways of evaluating a Swedish grammar checker are presented and discussed in this article. The first evaluationconcerns measuring the program's detection capacity on five text genres. The measures (precision and recall) are often used inevaluating grammar checkers. However, in order to test and improve the usability of grammar checking software, they need to becomplemented with user-oriented methods. Consequently, the second and the third evaluations presented in the article both involveusers. The second evaluation focuses on user reactions to grammar error presentations, especially with regard to false alarms anderroneous error identification. The third and last evaluation focuses on problems in supporting users' cognitive revision processes. Italso examines user motives behind choosing to correct or not to correct problems highlighted by the program. Advantages anddisadvantages of the different evaluation methods are discussed.
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| 4. |
- Ellervall, Eva, et al.
(författare)
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Antibiotic prophylaxis in oral health care: administration strategies of general dental practitioners
- 2005
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 63:6, s. 321-329
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To examine the strategies that general dental practitioners (GDPs) use to administer antibiotic prophylaxis and to study the agreement between the administration strategies of GDPs and local recommendations. Methods. Postal questionnaires in combination with telephone interviews were used. Two hundred GDPs in two Swedish counties, Skane and Orebro, were asked to participate. The response rate was 51% (n=101). The GDPs were presented with eight simulated cases of patients with different medical conditions for which antibiotic prophylaxis might be considered necessary when performing dental procedures (scaling, tooth removal, root canal treatment). The administration strategies of the GDPs were compared with local recommendations. Results. In general, the variation in the administration strategies of the GDPs was large. For two medical conditions, type 1 diabetes that was not well controlled and hip prosthesis, significantly more GDPs in Skane than in Orebro administered antibiotic prophylaxis for tooth removal. Agreement between the administration strategies of the GDPs and local recommendations was low. Differences between the two counties were non-significant. Furthermore, within Orebro, GDPs who did not have formal access to local recommendations did not differ in their administration strategies from those who did. The choice of substance was seldom in agreement with the substance recommended, while the majority followed the recommended duration of treatment. Conclusion. Although recommendations existed, their impact appeared to be limited. This is significant, since the implementation of recommendations is crucial in making clinical practice more effective and in promoting the health of patients.
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| 5. |
- Ellervall, E, et al.
(författare)
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Antibiotic prophylaxis in oral healthcare - the agreement between Swedish recommendations and evidence.
- 2010
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Ingår i: British Dental Journal. - : Springer Science and Business Media LLC. - 1476-5373 .- 0007-0610. ; 208:3, s. 5-115
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Almost all (17/20) Swedish counties have pharmaceutical committees that establish recommendations for the use of antibiotic prophylaxis in oral healthcare.Objective To evaluate the evidence for the use of antibiotic prophylaxis in oral healthcare and the agreement between Swedish recommendations and evidence. MATERIAL AND METHODS: We conducted a systematic literature search in PubMed and the Cochrane Controlled Trials Register. The MeSH terms 'antibiotic prophylaxis' and 'dentistry' were used in the database search. Abstracts were reviewed according to specific inclusion and exclusion criteria. A total of 186 articles were read in full text by the four authors independently. Data extraction and interpretation of data was carried out using a pre-defined protocol. In the end, one case-control study was included for evaluation of evidence. RESULTS: The case-control study included patients with specific cardiac conditions. The study reported a 49% protective efficacy (odds ratio: 0.51) of antibiotic prophylaxis for first-time episodes of endocarditis within 30 days of procedure. This result was not statistically significant. The quality of the evidence was low. No studies were evaluated on patients with other medical conditions. The recommendations included several cardiac and other medical conditions for which there is a lack of evidence or no evidence to support the use of antibiotic prophylaxis.CONCLUSIONS: There is a lack of evidence to support the use of antibiotic prophylaxis. To avoid the risk of adverse events from antibiotics and the risk of developing resistant bacterial strains, the use of antibiotic prophylaxis should be minimised and recommendations in Sweden should be revised to be more evidence-based.
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| 6. |
- Ellervall, Eva, et al.
(författare)
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General dental practitioners’ certainty in administration of antibiotic prophylaxis (Boston)
- 2006
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Treatment approaches within health care are highly variable. This is an unavoidable characteristic of clinical practice and could be characterised either by uncertainty of information or outcome or by concern for a person’s preferences or both. Accordingly, several studies have reported large variations in general dental practitioners’ (GDPs’) administration strategies of antibiotic prophylaxis in patients with specific medical conditions. Objectives: To study GDPs' certainty in administration of antibiotic prophylaxis in patients with specific medical conditions, and secondly, to evaluate GDPs’ assessment of risk for complications if antibiotics were not administered. Methods: Postal questionnaires in combination with telephone interviews were used. A total of 101 GDPs participated. The GDPs’ were presented with three simulated cases of patients with specific medical conditions (moderate hypertension, not well-controlled type 1 diabetes, and heart valve prosthesis) for which antibiotic prophylaxis might be considered necessary when performing dental procedures (scaling, tooth removal, and root canal treatment). The GDPs were asked to mark their assessments of certainty and risk on a 100 mm VAS. Differences were analyzed with t-test. The study was supported by the Swedish Research Council (grant 521-2001-6341). Results: Generally, the GDPs presented high certainty in all their decisions independent on whether they administered antibiotic prophylaxis or not (P>0.05). However, when they assessed the risk for complication if not administering antibiotic prophylaxis, the values were much higher for GDPs that would administer antibiotics compared to those that would not (P<0.05). Conclusions: The GDPs presented high certainty in their decisions, independent on whether they administered antibiotic prophylaxis or not. This could implicate that GDPs are less susceptible to modify their behaviour and that implementation of evidence into practice would be difficult.
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| 7. |
- Ellervall, Eva, et al.
(författare)
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How confident are general dental practitioners in their decision to administer antibiotic prophylaxis?
- 2008
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Common dental procedures induce bacteremia. To prevent infectious complications from bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Recommendations are often unclear and ambiguous. In a previous study we reported wide variations in general dental practitioners’ (GDPs’) administrations of antibiotic prophylaxis. We hypothesized that within such a conflicting clinical area, decisions are made with a high level of personal uncertainty. This study examined GDPs’ confidence in their decisions and analyzed the extent to which case-related factors might explain individual variations in confidence. Methods: Postal questionnaires in combination with telephone interviews were used. The response rate was 51% (101/200). There were no significant differences between respondents and non-respondents regarding sex, age, or place of work. The GDPs were presented to patient cases of different medical conditions, where some should receive antibiotic prophylaxis according to recommendations when performing dental procedures that could cause gingival bleeding. The GDPs assessed on visual analogue scales how confident they were in their decisions. The extent to which case-related factors, medical condition and dental procedure, could explain individual variation in confidence was analyzed. Results: Overall the GDPs exhibited high confidence in their decisions regardless of whether they administered antibiotic prophylaxis or not, or whether their decisions were in accordance with recommendations or not. The case-related factors could explain between 30–100% of the individual variation in GDPs’ confidence. For 46%, the medical condition significantly explained the individual variation in confidence. However, for most of these GDPs, lower confidence was not presented for conditions where recommendations are unclear and higher confidence was not presented for conditions where recommendations are more clear. For 8% the dental procedure significantly explained the variation, although all procedures could cause bacteremia. For 46% neither the medical condition nor the dental procedure could significantly explain the individual variation in confidence. Conclusions: The GDPs presented high confidence in their decisions, and the majority of GDPs did not present what could be considered a justified varied level of confidence according to the clarity of recommendations. Clinicians who are overconfident in their decisions may be less susceptible to modifications of their behavior to more evidence-based strategies.
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| 8. |
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| 9. |
- Ellervall, Eva, et al.
(författare)
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Risk Judgment by General Dental Practitioners : Rational but Uninformed
- 2010
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Ingår i: Biomedical Informatics Insights. - : Libertas Academica. - 1178-2226. ; 2010:3, s. 11-17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Decisions by dentists to administer antibiotic prophylaxis to prevent infectious complications in patients involves professional risk assessment. While recommendations for rational use have been published, several studies have shown that dentists have low adherence to these recommendations. Objective: To examine general dental practitioners’ (GDPs’) assessments of the risk of complications if not administering antibiotic prophylaxis in connection with dental procedures in patients with specific medical conditions. Methods: Postal questionnaires in combination with telephone interviews. Risk assessments were made using visual analogue scales (VAS), where zero represented “insignificant risk” and 100 represented a “very significant risk”. Results: Response rate: 51%. The mean risk assessments were higher for GDPs who administered antibiotics (mean = 54, SD = 23, range 26–72 mm on the VAS) than those who did not (mean = 14, SD = 12, range 7–31 mm) (P < 0.05). Generally, GDPs made higher risk assessments for patients with medical conditions that are included in recommendations than those with conditions that are not included. Overall, risk assessments were higher for tooth removal than for scaling or root canal treatment, even though the risk assessments should be considered equal for these interventions. Conclusions: GDPs’ risk assessments were rational but uninformed. They administered antibiotics in a manner that was consistent with their risk assessments. Their risk assessments, however, were overestimated. Inaccurate judgments of risk should not be expected to disappear in the presence of new information. To achieve change, clinicians must be motivated to improve behaviour and an evidence- based implementation strategy is required.
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