Practice-based Research Network Research Articles

Improving Vaccination Coverage in Children and Adolescents: The Role of Professional Societies.

Improving Vaccination Coverage in Children and Adolescents: The Role of Professional Societies.

Antibiotic Use in Periodontal Therapy among French Dentists and Factors Which Influence Prescribing Practices.

The aim of the present survey is to investigate the use of antibiotics during periodontal therapy among French dentists with a focus on exploring potential differences between various groups of practitioners. A self-administered questionnaire was distributed to different groups of practitioners including members of (i) the French Society of Periodontology and Implantology; (ii) the College of University Teachers in Periodontology and, (iii) private practitioners participating in the French general dental practice-based research network. 272 questionnaires were included in the analysis. Prescription patterns were globally in line with the current recommendations. Systemic antibiotics are most frequently used as a first-line therapy in necrotizing periodontitis (92%) and aggressive periodontitis (53.3% to 66.1%). However, malpractice still exists, including in the management of periodontal abscesses. Antibiotics are prescribed (i) less frequently for periodontal abscesses and (ii) more frequently for generalized aggressive periodontitis by members of the periodontal society and University college (p < 0.05). Amoxicillin (59.9%) and the amoxicillin + metronidazole (59.6%) combination were the most frequently prescribed molecules. Providing a high number of periodontal treatments per week, being more recently graduated, having a post-graduate certificate in periodontology and holding or having held an academic position/hospital practice were all factors associated with a better knowledge of and/or more adequate antibiotic use.

Exploratory factor analysis of PROMIS-29 V1.0, PROMIS Global Health and the RAND SF-36 from chiropractic responders attending care in a practice-based research network

BackgroundThe SF-36 questionnaire is perhaps the most widely used quality of life instrument in the world today, while the PROMIS instruments continue to gain popularity. Given their continued use in chiropractic research and practice, we examined their latent domain structure using exploratory factor analysis (EFA).MethodsTo uncover latent structures of a large series of measured variables from the PROMIS-29, PROMIS Global Health and RAND SF-36 domains, we defined a factor analysis model represented by the equation X = mu + Lambda F +epsilon, where X = (X_{1} , ldots ,X_{p} )^{T} is the matrix of random vectors corresponding to the domains with a mean of mu and the covariance matrix Sigma ,Lambda = { l_{jk} }_{pxm} denotes the matrix of factor loadings, F = (F_{1} , ldots ,F_{m} )^{T} denotes the matrix of unobserved latent variables that influence the collection of domains and epsilon = (_{1} , ldots ,_{p} )^{T} is the vector of latent error terms. The matrix of item responses X was the only observed quantity with restrictions such that variable scores were uncorrelated and of unit variance with the latent errors being independent with the variance vector psi. The inherited structure of X was expressed simply by Sigma = Lambda Lambda^{T} + psi. Orthogonal and oblique rotations were performed on the Lambda matrix with this equation to improve clarity of the latent structure. Model parameters left( {mu ,Lambda ,psi } right) were optimized using the method of minimum residuals. Each EFA model was constructed with Pearson and Polychoric correlation.ResultsFor the PROMIS-29, domains were confirmed to be strongly correlated with Factor 1 (i.e., mental health) or Factor 2 (i.e., physical health). Satisfaction with participation in social roles was highly correlated with a 3rd factor (i.e., social health). For the PROMIS Global Health Scale, a 2-factor EFA confirmed the GPH and GMH domains. For the RAND SF-36, an apparent lack of definable structure was observed except for physical function which had a high correlational relationship with Factor 2. The remaining domains lacked correlation with any factors.ConclusionDistinct separation in the latent factors between presumed physical, mental and social health domains were found with the PROMIS instruments but relatively indistinguishable domains in the RAND SF-36. We encourage continued efforts in this area of research to improving patient reported outcomes.

Characteristics of Australian Osteopaths Managing Tendinopathies: Analysis of a Nationally Representative Survey of 989 Practitioners

Background. Tendinopathies are a common complaint presenting to health professionals, including osteopaths. Evidence supports the use of exercise rehabilitation, with a potential role for manual therapy. This study sought to profile the practice and clinical management characteristics of Australian osteopaths who often treat tendinopathies. Methods. The study was designed as a cross-sectional survey of Australian osteopaths. Participants were Australian osteopaths who were members of the Osteopathy Research and Innovation Network (ORION)-the Australian professions’ practice-based research network. Participants were invited to complete a 27-item practice and clinical management characteristic questionnaire. The questionnaire asked participants to identify demographic, practice and clinical management characteristics associated with their practice. Regression modelling was used to identify significant characteristics associated with often treating tendinopathies. Results. Nine hundred and eighty-nine osteopaths responded and over 41% (n = 410) reported often treating tendinopathies. This group were more likely to be female (ORa 1.5), often treat patients with chronic pain (ORa 3.8) and sports injury (ORa 2.5) and often use exercise prescription (ORa 1.6) in patient care. Conclusions. Australian osteopaths who often treat tendinopathies demonstrate different clinical practice and management characteristics compared to their colleagues who do not often treat this complaint. Research into patient outcomes and cost-effectiveness of osteopathy care for the management of tendinopathies is now required.

14154 Facilitating Community/Campus Research Teams and Projects: Community Health Small Grants Program

ABSTRACT IMPACT: The UTMB Institute for Translational Sciences (ITS) seeks to advance the field of community engagement and facilitate competency in community-engaged and community-based participatory research as a means of expanding team science to integrate community involvement and to assist investigators in building relationships that enable them to contribute to community initiatives. OBJECTIVES/GOALS: The UTMB ITS recently implemented a new Community Health Small Grants program to promote and enhance community-campus partnerships. Our goal is to better translate science from discovery to clinical practice and public health through community-engaged research, education, and dissemination. METHODS/STUDY POPULATION: Applications were solicited from community and academic research partners. Community partners may include existing collaborative groups, community health centers, health departments, nonprofits, schools, social services agencies, practice-based research networks, or Community Advisory Boards. Academic partners may include faculty and/or students. The PI may be a community or academic partner. While this Grants Program will transition to the ITS Pilot Project Program, it will utilize a separate review process and scoring rubric focused on immediate and future community benefit, project feasibility, organizational fit, and other factors unique to community-based partnership projects. RESULTS/ANTICIPATED RESULTS: We received an enthusiastic response to our RFA, based upon a long-standing program of a sister CTSA hub. Proposals received include target populations representative of our most vulnerable’‘ children, the elderly, those lacking access to health care, and those for whom language is a barrier. One addresses the Institution’s and the CEC’s need to conduct community needs assessments to enable the implementation of evidence-based programs driven by data and metrics identified and developed by our communities. Each awarded proposal demonstrates a significant and sometimes critical need for the project. Partnerships are anticipated to have significant impacts on the community and its population. DISCUSSION/SIGNIFICANCE OF FINDINGS: We generate, test, and disseminate team science, education and best practices through stakeholder involvement. Our Community Health Small Grants program aims to involve community in our scientific teams and to involve academics in community-derived projects as well as foster relationships and trust.

Rural Obesity Medical Education for Primary Care in West Virginia: A Needs Assessment

ABSTRACT INTRODUCTION Obesity is a serious disease associated with adverse health effects and costs, West Virgini(WV) has one of the highest obesity rates in the nation. Addressing obesity largely falls on primary care practitioners, but many feel ill -equipped to counsel patients on weight loss. It is critical for clinicians to be adequately trained to treat obesity, We conducted this study to assess the obesity medical education needs of WV primary care practices. METHODS Data was collected from 17 health systems through W/V Practice-Based Research Network's Collective Outreach and Research Engagement survey. Survey results were analyzed using descriptive statistics to summarize demographics; obesity treatment knowledge and confidence, topics of interest; and preferred educational delivery methods. RESULTS The majority of respondents agreed that medical training in obesity should be strengthened (96.4%). Relatively low confidence levels were reported for prescribing anti-obesity medications (49,4%), optimizing chronic medications for weight (61.0%), and counseling/managing patients before/after bariatric surgery (52,4%). Highest reported interest levels were in strategies for discussing weight with patients (87.2%), food and nutrition (85.7%), physical activity plans (84.4%), motivational interviewing (84.0%), and optimizing chronic medications for weight (79,2%). The highest rated educational delivery method was virtual Continuing Medical Education (91.5%) with lecture format (89.0%). CONCLUSIONS These results can be used to develop obesity medical education for primary care that can ultimately help to reduce health disparities in rural WV. An educational plan should ideally be delivered in virtual lecture format and should address lifestyle modifications, motivational interviewing, bariatric surgery, and obesity pharmacotherapy.

Association between predoctoral evidence-based practice training and later use of peer-reviewed journals: National dental PBRN.

We examined whether evidence-based practice (EBP) during dental school was associated with the increased use of peer-reviewed literature during subsequent clinical practice for National Dental Practice-Based Research Network (PBRN) dentists. We also sought to understand whether this association was moderated by being a dental specialist. We analyzed cross-sectional data from 1228 dentists participating in the PBRN. We used logistic regression to examine the association between self-reported EBP training during dental school and the use of peer-reviewed journals in clinical practice, controlling for the number of years since dental school graduation and dental practice type. We stratified the data by dental specialists and examined effect modification using the Breslow-Day test for homogeneity of the odds ratio. The prevalence of peer-reviewed journal use by PBRN dentists in clinical practice was 87% (n=1070) with no statistical evidence of effect modification by dental specialists on the EBP peer-reviewed journal use relationship (p>0.05). After controlling for years since dental school graduation and dental practice type, dentists who self-reported EBP training during dental school had greater odds of using peer-reviewed journals in clinical practice than dentists who did not self-report EBP training during dental school (OR, 1.47; 95%CI=1.01, 2.15). The use of peer-reviewed published literature by PBRN dentists who had EBP predoctoral training is one important step in the EBP process by which practicing dentists can implement evidence-based findings, interventions, and policies into routine health care and public health settings. These findings add to the body of support for EBP curricula in dental education.

A data quality assessment to inform hypertension surveillance using primary care electronic medical record data from Alberta, Canada

BackgroundHypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal patient-level details such as sociodemographics, blood pressure, weight, prescribed medications, and behavioural risk factors. As EMR data are generated from patient care and administrative tasks, assessing data quality is essential before using for secondary purposes. This study evaluated the quality of primary care EMR data from one province in Canada within the context of hypertension surveillance.MethodsWe conducted a cross-sectional, descriptive study using primary care EMR data collected by two practice-based research networks in Alberta, Canada. There were 48,377 adults identified with hypertension from 53 clinics as of June 2018. Summary statistics were used to examine the quality of data elements considered relevant for hypertension surveillance.ResultsPatient year of birth and sex were complete, but other sociodemographic information (ethnicity, occupation, education) was largely incomplete and highly variable. Height, weight, body mass index and blood pressure were complete for most patients (over 90%), but a small proportion of outlying values indicate data inaccuracies were present. Most patients had a relevant laboratory test present (e.g. blood glucose/glycated hemoglobin, lipid profile), though a very small proportion of values were outside a biologically plausible range. Details of prescribed antihypertensive medication, such as start date, strength, dose, frequency, were mostly complete. Nearly 80% of patients had a smoking status recorded, though only 66% had useful information (i.e. categorized as current, past, or never), and less than half had their alcohol use described; information related to amount, frequency or duration was not available.ConclusionsBlood pressure and prescribed medications in primary care EMR data demonstrated good completeness and plausibility, and contribute valuable information for hypertension epidemiology and surveillance. The use of other clinical, laboratory, and sociodemographic variables should be used carefully due to variable completeness and suspected data errors. Additional strategies to improve these data at the point of entry and after data extraction (e.g. statistical methods) are required.

A Survey of Primary Care Practices on Their Use of the Intensive Behavioral Therapy for Obese Medicare Patients.

To fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. A mixed modality survey (paper and online) of primary care practices obtained from a random sample of Medicare databases and a convenience sample of practice-based research network practices. A total of 287 practices responded to the survey, including 140 (7.4% response rate) from the random sample and 147 (response rate not estimable) from the convenience sample. We found differences between the IBT-using and non-using practices in practice ownership, patient populations, and participation in Accountable Care Organizations. The non-IBT-using practices, though not billing for IBT, did offer some other assistance with obesity for their patients. Among those who had billed for IBT, but stopped billing, the most commonly cited reason was billing difficulties. Many providers experienced denied claims due to billing complexities. Although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10years. A survey completed by both a random and convenience sample of practices using and not using IBT for obesity payment codes revealed that billing for these services was problematic, and many providers that began using the codes discontinued using them over the past 7years.

Practice-Based Primary Care Clinical Research During the COVID Pandemic.

Practice-Based Primary Care Clinical Research During the COVID Pandemic Barbara P Yawn Acknowledgments. Thank you to the investigators, research staff and Practice Based Research Network (PBRN) staff and practices in the CAPTURE trial. Funding. This work is funded by the lung division of the National Heart Lung and Blood Institute. All clinical research became challenging early in 2020 with the first surge of the SARS-CoV-2 (COVID) pandemic. All multi-centered academic clinical trials faced many challenges. Our study based not in academic centers or practices, but in primary care practice-based research networks (PBRNs) seemed to have added layers of challenges to identify, understand, and overcome. Our project enrolled primary care practices and then patients directly in their primary care practices for a single in-person visit. Before COVID, the clinical staff of the practices were invited to a lunch session that provided a 45-minute online review of the clinical topic. Patient participants completed the questionnaires and spirometry and peak flow testing required for this study at the time of their visit to their primary care office for another reason. 12-month follow up was done with an online, telephone or mailed patient survey, and from review of the past 12 months of health care use from participant's medical record abstraction and designed to be completed in about 50% of participants. Beginning in early March 2020, the practice sites and all of our practice-based research networks halted all research. Over the next few months, the sites allowed some COVID-related research to begin or resume. Our study did not fit that category. Over the summer months of 2020, some other studies that could be accomplished via virtual interactions like telephone or online surveys were allowed to restart. We did not meet that standard either since we need spirometry and peak flow testing. Most of our work had to be refocused from completing enrollment to identifying safety protocols and procedures for the consent and questionnaires. The spirometry and peak flow procedures, which were considered a nebulizing procedure, were a very large concern in the summer of 2020. The primary care clinics saw them as potentially viral spreading procedures. We were working with six PBRNs spread around the country with different periods of "surge" and very different oversight of practice-based primary care research. In some PBRNs, the requirements for safety were set by the PBRN's affiliated academic medical center. For other PBRNs, requirements were set, or also set, by regional health care systems. All practices needed to work with the local practices to understand their concerns, educate them on levels of risk, and address safety needs unique to that site. Obtaining personal protective equipment (PPE) was difficult since our study was not being completed in the hospital setting and was often not directly associated with an academic medical center. Once we obtained PPE through the AMA, SGIM, and AAFP programs, we needed to work on "fit testing" for the N95 masks, which is not readily available at all primary care practices or PBRNs (e.g., those based in rural areas). We needed to develop "cleaning and re-use" policies that fit with the academic and CDC guidance but were realistic for our broad spectrum of sites. [End Page 22] One approach that appeared to be acceptable to several primary care practices and research oversight groups was to offer visits virtually. While virtual enrollment and visit completion would have been a nice solution, our academic pulmonology investigators and the experts on our DSMB did not feel that at home pre- and postbronchodilator spirometry could be done with sufficient accuracy to meet the needs of our study. So, we developed the concept of "mixed" research visits—part virtual and part in person. Virtual visits, however, required a change in consenting to online or e-consent. For many sites, the use of e-consent was a barrier requiring new formats, new tools, and in some cases, extensive work with local IRBs to approve not only specific e-consent tools but also garner support for the concept of e-consent, even for our minimal risk study. IRBs expressed concerns that potential participants would not understand or be engaged...

Improving Iowa Research Network Patient Recruitment for an Advance Care Planning Study.

Introduction/ObjectivesIn February 2019, recruitment began in Iowa Research Network offices for a Patient-Centered Outcomes Research Institute (PCORI) funded Advance Care Planning (ACP) study to be conducted in 7 primary care practice-based research networks across the United States and Canada. The main study trained clinicians and nursing staff in serious illness care conversations and requested they refer eligible patients. Eligible patients were those with serious illness or frailty expected to live 1 to 2 years. Clinicians indicated it was difficult to identify eligible patients. This study aimed to find better methods for increasing patient recruitment for the ACP study.MethodsResearch staff brainstormed and implemented strategies to increase patient referrals from clinicians. Participating offices used Epic for their medical record and the Gagne Index was used to generate a list of eligible patients in Epic SlicerDicer. When patients from the Epic SlicerDicer report appeared on the schedule, clinicians and nursing staff were notified that they might be eligible for ACP. Clinicians and nursing staff were asked to complete a survey identifying their perception of implemented strategies. A Wilcoxon signed-rank test was conducted to compare referral numbers before and after the Gagne Index/Epic SlicerDicer intervention.ResultsSeven clinicians referred patients prior to and 11 after the Gagne Index/Epic SlicerDicer intervention. Clinicians referred a total of 120 patients; 31 patients prior to and 89 patients after the Gagne Index/Epic SlicerDicer implementation (P = .002). Survey results indicated that several strategies facilitated clinician referrals, including patients identified as potentially appropriate on the schedule, quarterly meetings with researchers, and e-mails with a list of potentially eligible patients.ConclusionsNotifying clinical staff about potential study participants increased patient referrals in this ACP study. Research staff must have time, funding, and patience to support clinical staff who are expected to refer patients to studies.

Methods for Caries Prevention in Children Reported by Dentists from a Brazilian Community

Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors . Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p<0.05). Results: Dentists reported using in-office fluoride (IOF) and dental sealants (DS) in 74.2% and 45.1% of their pediatric patients, respectively. Regression analysis showed that female dentists (p=0.035 for DS; p=0.044 for IOF; p=0.011 for non-prescription fluoride rinse), those with advanced degrees (p=0.032 for prescription of fluoride), those who graduated from a private dental school (p=0.018 for chlorhexidine rinse), those who provided caries prevention regimens (p<0.001 for DS; p=0.004 for IOF; p=0.013 for non-prescription fluoride rinse), those with a greater percentage of patients interested in a caries prevention regimen (p=0.007 for non-prescription fluoride rinse), those working in a private practice model (p=0.047 for prescription of fluoride) were more likely to recommend some type of preventive methods to their pediatric patients . Conclusion: Dentists reported recommending IOF to most of their pediatric patients. Certain dentists’, practices’, and patients’ characteristics were associated to some caries prevention regimens recommended by dentists.

Caries risk assessment in dental practices by dentists from a Brazilian community.

Data on dental practices related to caries risk assessment (CRA) are scarce among Brazilian dentists. This study aimed to determine the prevalence of CRA use by dentists and factors associated with its use, as well as to quantify dentists' ratings of the importance of specific factors when treatment planning. Dentists registered at the Regional Council of Dentistry of São Paulo State - Araraquara region were sent two paper questionnaires that comprised: a) characteristics of dentists themselves, their practices, and their patients; and b) the translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the U.S. National Dental Practice-Based Research Network. Participants were 206 dentists who currently practiced in Araraquara and treated dental caries. Descriptive statistics and multiple logistic regression analyses were used for data analysis. Thirty-six percent of the dentists reported they perform CRA and, among them, 36% indicated they record the assessment on a special form that is kept in the patient chart. More years since dental school graduation (OR = 1.1, p = 0.002) and holding an advanced academic degree (OR=2.6, p=0.005) were associated with a higher likelihood of performing CRA, whereas exclusively using a private practice model (OR = 0.5, p = 0.016) was associated with a lower likelihood of performing CRA. The current oral hygiene and commitment to return for follow-up were the most important risk factors for treatment planning. In conclusion, CRA was not a routine procedure in daily practice among the majority of participating dentists. Specific demographic, practice and academic education characteristics were associated with performing CRA.

1665. Using Electronic Health Records to Describe TB in Community Health Settings: a Cohort Analysis in a Large Safety-Net Population

BackgroundOver 80% of tuberculosis (TB) cases in the United States are attributed to reactivation of latent TB infection (LTBI). Eliminating TB in the United States requires expanding identification and treatment of LTBI. Centralized electronic health records (EHRs) are an unexplored data source to identify persons with LTBI. We explored EHR data to evaluate TB and LTBI screening and diagnoses within OCHIN, Inc., a U.S. practice-based research network with a high proportion of Federally Qualified Health Centers.MethodsFrom the EHRs of patients who had an encounter at an OCHIN member clinic between January 1, 2012 and December 31, 2016, we extracted demographic variables, TB risk factors, TB screening tests, International Classification of Diseases (ICD) 9 and 10 codes, and treatment regimens. Based on test results, ICD codes, and treatment regimens, we developed a novel algorithm to classify patient records into LTBI categories: definite, probable or possible. We used multivariable logistic regression, with a referent group of all cohort patients not classified as having LTBI or TB, to identify associations between TB risk factors and LTBI.ResultsAmong 2,190,686 patients, 6.9% (n=151,195) had a TB screening test; among those, 8% tested positive. Non-U.S. –born or non-English–speaking persons comprised 24% of our cohort; 11% were tested for TB infection, and 14% had a positive test. Risk factors in the multivariable model significantly associated with being classified as having LTBI included preferring non-English language (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 4.09–4.32); non-Hispanic Asian (aOR 5.17, 95% CI 4.94–5.40), non-Hispanic black (aOR 3.02, 95% CI 2.91–3.13), or Native Hawaiian/other Pacific Islander (aOR 3.35, 95% CI 2.92–3.84) race; and HIV infection (aOR 3.09, 95% CI 2.84–3.35).ConclusionThis study demonstrates the utility of EHR data for understanding TB screening practices and as an important data source that can be used to enhance public health surveillance of LTBI prevalence. Increasing screening among high-risk populations remains an important step toward eliminating TB in the United States. These results underscore the importance of offering TB screening in non-U.S.–born populations.Disclosures All Authors: No reported disclosures

885. Feasibility of Observing Traffic Patterns (FOOT Patter) in Veterans Health Administration Operating Rooms

BackgroundSurgical site infections (SSIs) complicate nearly 6% of surgeries performed in Veterans Health Administration (VA) hospitals and occur despite adoption of practices known to reduce them. SSIs are associated with prolonged hospitalization and an increased risk of readmission, reoperation and mortality. Operating room (OR) door openings may increase SSI through disruption of desired OR air flow patterns and increased wound microbe counts. Our study objectives were to: 1) develop a methodological approach for collecting data on entry/exit traffic patterns in VA ORs and 2) characterize patterns across different surgery types.MethodsTrained researchers from 10 VA-Centers for Disease Control and Prevention (CDC) Practice-based Research Network sites observed staff entering and exiting VA ORs. Staff were categorized and identified by role. Exits/entries were recorded on a standardized tracking sheet. Surgery type and observation duration from incision to closure were noted. Mean hourly door openings across procedure and role types were compared via a one-way ANOVA using Stata ver. 15.0.ResultsWe observed 56 surgeries on 55 patients (Fig. 1). During 9,801 observation minutes, 766 staff opened doors 3,882 times. Door openings by role differed significantly (p < 0.001) with nurses, perfusionists, anesthesia and vendors having the highest mean door-opening rate. Coronary artery bypass grafts (CABGs) accounted for most door openings and significantly greater surgical duration than other procedures (p=0.012). Time-adjusted OR door opening rate was similar across procedure types at ~22-26 hourly openings (p=0.186).Figure 1. FOOT Patter results ConclusionThe hourly rate of door openings varied notably by staff role. Our data show that measurement of OR movements is feasible although gaining access and approval to observe, achieving ideal observer positioning in complex floor plans, and potential misidentification of entering/exiting staff are challenges of direct methods. Scaling this study up may require automated processes. Studies exploring influences of traffic patterns on OR air quality metrics and impact on risk of SSI, identifying rationale and necessity for door openings and effective strategies for reducing unneeded door openings are needed.Disclosures All Authors: No reported disclosures

The Current Research Status of Complementary and Integrative Medicine in Practice-Based Research Networks: A Systematic Review

Other SectionsAbstract서 론연구방법결 과고 찰결 론Supplemental MaterialAcknowledgementFundingData availabilityConflicts of interestReference

Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network

BackgroundThe authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes. MethodsTwo-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits. Associations between these characteristics and the subsequent same-tooth fractures and crack progression were quantified. ResultsOf the 2,601 teeth with a crack or cracks at baseline, 78 (3.0%; 95% confidence interval, 2.4% to 3.7%) subsequently developed a fracture. Of the 1,889 patients untreated before year 1, 232 (12.3%; 95% confidence interval, 10.9% to 13.8%) had some type of crack progression. Baseline tooth-level characteristics associated with tooth fracture were the tooth was maxillary and had a wear facet through enamel and a crack was detectable with an explorer, on the facial surface, and in a horizontal direction. Crack progression was associated with males and teeth with multiple cracks at baseline; teeth with a baseline facial crack were less likely to show crack progression. There was no commonality between characteristics associated with tooth fracture and those associated with crack progression. ConclusionsDevelopment of tooth fractures and crack progression over 3 years were rare occurrences. Specific characteristics were associated with the development of tooth fracture and crack progression, although none were common to both. Practical ImplicationsThis information can aid dentists in assessing factors that place posterior cracked teeth at risk of experiencing adverse outcomes.

Using attendance data for social network analysis of a community-engaged research partnership.

The Rockefeller University Center for Clinical and Translational Science (RU-CCTS) and Clinical Directors Network (CDN), a Practice-Based Research Network (PBRN), fostered a community-academic research partnership involving Community Health Center (CHCs) clinicians, laboratory scientists, clinical researchers, community, and patient partners. From 2011 to 2018, the partnership designed and completed Community-Associated Methicillin-Resistant Staphylococcus Aureus Project (CAMP1), an observational study funded by the National Center for Advancing Translational Sciences (NCATS), and CAMP2, a Comparative Effectiveness Research Study funded by the Patient-Centered Outcomes Research Institute (PCORI). We conducted a social network analysis (SNA) to characterize this Community-Engaged Research (CEnR) partnership. Projects incorporated principles of Community-Based Participatory Research (CAMP1/2) and PCORI engagement rubrics (CAMP2). Meetings were designed to be highly interactive, facilitate co-learning, share governance, and incentivize ongoing engagement. Meeting attendance formed the raw dataset enriched by stakeholder roles and affiliations. We used SNA software (Gephi) to form networks for four project periods, characterize network attributes (density, degree, centrality, vulnerability), and create sociograms. Polynomial regression models were used to study stakeholder interactions. Forty-seven progress meetings engaged 141 stakeholders, fulfilling 7 roles, and affiliated with 28 organizations (6 types). Network size, density, and interactions across organizations increased over time. Interactions between Community Members or Recruiters/Community Health Workers and almost every other role increased significantly across CAMP2 (P < 0.005); Community Members' centrality to the network increased over time. In a partnership with a highly interactive meeting model, SNA using operational attendance data afforded a view of stakeholder interactions that realized the engagement goals of the partnership.

Establishment of a Danish endodontic practice-based research network: baseline data

Objective Clinical studies in endodontics are primarily performed in highly controlled environments using strict treatment protocols, inclusion and exclusion criteria, and high success rates have been reported. Most endodontic treatments are, however, performed in private practice, where is has been difficult to obtain similar high success rates. The aim of this pilot project was to evaluate the feasibility of performing practice-based research and to describe baseline information on endodontic procedures used in general practice in Denmark. Materials and methods The baseline data included information from dental practitioners, collected during 2017–2018. The dentists used the procedures and materials they normally would use. Data were systematized and analysed at Aarhus University. Results Seventeen dentists provided information on 581 endodontic treatments. Half of the teeth had initially a necrotic pulp, 20% had a vital pulp and 28% were previously root-filled. Adaptation of contemporary technology such as mechanized instrumentation, use of magnification, seems to be well integrated among the participating dentists. Conclusions Overall, the endodontic treatments performed by the participating dentists follow international guidelines for good quality endodontic treatments. It is anticipated, that among Danish dentist there is basis for further practice-based research, but logistic issues need to be addressed.

Mealtime media use and cardiometabolic risk in children.

To examine the association between mealtime media use and non-HDL-cholesterol as well as other markers of cardiometabolic risk (CMR) in children. A repeated measures study design was used to examine the association between mealtime media use and CMR outcomes. Multivariable linear regression with generalised estimating equations was used to examine the association between mealtime media use and CMR outcomes. Analyses were stratified a priori by age groups (1-4 and 5-13 years). The TARGet Kids! Practice-based research network in Toronto, Canada. 2117 children aged 1-13 years were included in the analysis. After adjusting for covariates, there was no evidence that total mealtime media use was associated with non-HDL-cholesterol in 1-4 year olds (P = 0·10) or 5-13 year olds (P = 0·29). Each additional meal with media per week was associated with decreased HDL-cholesterol in 5-13 year olds (-0·006 mmol/l; 95 % CI -0·009, -0·002; P = 0·003) and log-TAG in 1-4 year olds (β = -0·004; 95 % CI -0·008, -0·00009; P = 0·04). Media use during breakfast was associated with decreased HDL-cholesterol in 5-13 year olds (-0·012 mmol/l; 95 % CI -0·02, -0·004; P = 0·002), while media during lunch was associated with decreased log-TAG (-0·01 mmol/l; 95 % CI -0·03, -0·002; P = 0·03) in children aged 1-4 years. Total mealtime media use was not associated with total cholesterol, glucose or insulin in either age group. Mealtime media use may be associated with unfavourable lipid profiles through effects on HDL-cholesterol in school-aged children but likely not in pre-schoolers.