Implementation of healthcare accreditation in Danish general practice: a questionnaire study exploring general practitioners’ perspectives on external support

ObjectiveTo describe the use and perceived usefulness of implementation support provided to general practice during an accreditation process and to explore potential variations across clinic characteristics.DesignCross-sectional questionnaire study.Setting and subjectsAll Danish general practice clinics undergoing an accreditation survey from 27 September 2016 to 15 December 2017 (n = 608).Main outcome measuresUse and perceived usefulness of seven types of implementation support as reported by general practitioners (GPs). Clinic characteristics included practice type, number of GP partners and staff and employment of GP trainees.ResultsThe total response rate was 74% (n = 447). Most clinics (99.5%) used some type of implementation support (average: 4.8 different types). The most used types of support were peer support (80–92%) and various accreditation documents (85–92%). Support tailored to the individual clinic was most often considered useful (91–97%). However, this type of support was used relatively infrequently (16–40%). In most cases, clinic characteristics were neither significantly associated with the use of support nor with the perceived usefulness of the available support.ConclusionDuring the accreditation processes, each clinic used a broad variety of implementation support. Support tailored to the individual clinic was highly appreciated and should be promoted in future quality interventions in general practice. Discussions with peers were widely used, and it should be investigated further how peer discussions are best facilitated. The study calls for a multifactorial approach to future quality interventions in general practice to target the needs and capacities of the individual clinics.     

Clinical Supervision in Effectiveness and Implementation Research

The role of clinical supervision in the larger‐scale implementation of effective mental health treatments has begun to attract attention in effectiveness research and implementation science. Clinical supervision approaches demonstrated to support the implementation of effective treatments could provide a fruitful basis for adaptation to the contours and implementation of other interventions. The adaptation of the Multisystemic Therapy supervision model to support the implementation of an innovative, experimental mental health service model called Links to Learning is described. An observational study provides the platform for consideration of the extent to which the Links supervision model was implemented as intended and of challenges to Links implementation illuminated by the supervision process. Implications are considered for research on supervision as a tool to effect the implementation and outcomes of effective treatment and service models in community practice contexts.     

Changes in Body Fat Measured by DEXA in Patients Taking Different Formulations of Stavudine

Abstract

Background: Lipoatrophy is a frequent complication of chronic stavudine therapy. Stavudine extended release formulation (stavudine ER) gives lower peak and higher trough levels than the immediate release formulation (stavudine IR), and we hypothesized that the lower peak might result in less lipoatrophy. Objective: To compare the rate of peripheral lipoatrophy between patients taking stavudine ER and stavudine IR. Method: Body composition was measured by dual energy X-ray absorptiometry (DEXA) every 6 months for 18 months in 29 patients taking either stavudine ER or IR as part of a randomized controlled clinical trial. Results: DEXA fat measurements did not differ between the ER and IR groups at baseline, after a median of 32 months on stavudine-containing treatment. Over the 18 months of follow-up in the whole cohort limb fat decreased by a mean of 0.29 ± 0.50 kg (p = .01) and leg fat percent decreased by a mean of 1.23% ± 1.92% (p = .001), whereas trunk fat and trunk-to-limb fat percent ratio did not change significantly. There was no significant difference between the ER and IR groups in the rate of change of any of the fat parameters. At study completion, the proportion of patients with clinical lipodystrophy was similar in the stavudine ER and stavudine IR groups (67% and 64%, respectively; p = .893). Conclusion: Stavudine ER does not appear to cause less peripheral lipoatrophy.     

基于CBCT的下颌第一磨牙区即刻种植相关的影像学研究

目的利用CBCT研究下颌第一磨牙区即刻种植适宜的植入位点、植入角度与植入深度,为术前数字化设计和临床操作提供参考依据。方法选取100例符合纳入标准的患者CBCT影像学资料,测量下颌第一磨牙区的牙槽骨厚度、颊侧及舌侧骨板厚度、牙根间隔宽度,同时测量下颌第一磨牙与下颌神经管及舌侧骨倒凹的关系,并进行统计学分析。结果由近中至远中,下颌第一磨牙的牙槽骨厚度及颊侧骨板厚度逐渐增大,舌侧骨板厚度逐渐减小;由牙槽嵴顶至根尖,牙根间隔宽度逐渐增大,最大为(5.00±1.42)mm;近中根、远中根、远舌根、牙根间隔顶至下颌神经管的距离分别为(7.47±2.38)mm、(7.19±2.49)mm、(9.59±1.94)mm、(15.90±2.39)mm;由近中至远中,下颌神经管颊侧及舌侧骨板最大厚度分别为(6.54±1.25)mm、(2.53±0.84)mm;下颌舌侧骨倒凹角度为(149.67±8.30)°,倒凹深度为(1.51±0.43)mm。结论在下颌第一磨牙区即刻种植前可通过CBCT规划合适的种植路径,注意避开下颌神经管和舌侧骨倒凹。若根尖至下颌神经管的安全距离足够,可从牙根间隔处植入,若安全距离不足,植入位点可偏近中舌侧,植入角度可适当舌倾。     

即刻种植修复的疗效及近期软组织美学效果研究

目的:探讨即刻种植修复的疗效及近期软组织美学效果。方法:择取2017年12月~2018年12月期间某院口腔科收治的牙列缺损患者共84例为研究对象,随机分为对照组与观察组,每组42例。对照组采用延期种植修复法治疗,观察组采用即刻种植修复法治疗,比较两组患者临床疗效、近期软组织美学效果、种植体稳定性及龈沟出血指数。结果:观察组临床疗效高于对照组,软组织美学评分低于对照组,种植体稳定性及龈沟出血指数评分高于对照组,差异有统计学意义(P<0.05)。结论:即刻种植修复对患者具有良好的临床疗效,且其软组织美学效果及患者术后恢复效果相比延期种植更理想,因此即刻种植更值得在临床中推广应用。     

Implementation of evidence‐based dentistry into practice: analysis of awareness,perceptions and attitudes of dentists in the World Dental Federation–European Regional Organization zone

Based on evidence‐based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were comparatively analysed in six countries of the FDI (World Dental Federation‐Federation Dentaire Internationale)‐European Regional Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a questionnaire, ‘The Relationship Between Dental Practitioners and Universities’, was developed by the FDI‐ERO Working Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, similar percentages of respondents reported that they ‘know what it is’ (32.8%) and ‘they practice’ (32.1%). Most respondents believed that ‘EBD is beneficial’ (89.1%); however, they had different thoughts regarding ‘who actually benefited from EBD’. Of the participants, 60% believed that ‘dentists experience difficulties in implementing EBD’. Although lack of time, lack of education and limited availability of evidence‐based clinical guidelines were among the major barriers, there were differences among countries (P < 0.05). Significant differences were also observed between countries regarding certain questions such as ‘where EBD needed to be taught’ (P < 0.05), as both undergraduate and continuing education were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses (P < 0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more information and support to enhance dentists’ knowledge and use of EBD in everyday practice and a specific role for the NDAs.