Abstract Objectives The aim of this retrospective practice-based study was to investigate the longevity of direct restorations placed by a group of general dental practitioners (GDPs) and to explore ...the effect of practice/operator, patient, and tooth/restoration related factors on restoration survival. Methods Electronic Patient Files of 24 general dental practices were used for collecting the data for this study. From the patient files, longevity of 359,548 composite, amalgam, glass-ionomer and compomer placed in 75,556 patients by 67 GDPs between 1996 and 2011 were analyzed. Survival was calculated from Kaplan-Meier statistics. Results A wide variation in annual failure rate (AFR) exists between the different dental practices varying between 2.3% and 7.9%. Restorations in elderly people (65 years and older, AFR 6.9%) showed a shorter survival compared to restorations placed in patients younger than 65 years old (AFR 4.2%–5.0%). Restorations in molar teeth, multi-surface restorations and restorations placed in endodontically treated teeth seemed to be more at risk for re-intervention. Conclusion The investigated group of GDPs place restorations with a satisfactory longevity (mean AFR 4.6% over 10 years), although substantial differences in outcome between practitioners exist. Several potential risk factors on practice/operator, patient, and tooth/restoration level have been identified and require further multivariate investigation.
Various guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health ...outcomes, however, is not conclusive.
The main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.
This was an observational prospective cohort study (2005-2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.
Therapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.
Higher percentages of adherence were associated with fewer functional limitations (beta=-0.21, P=.023) and fewer treatment sessions (beta=-0.27, P=.005).
The relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.
The results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.
Highlights • We examined the prevalence and trend of the influenza vaccination-rate of the at-risk population from 2008 to 2013. • For the fifth subsequent year, we notice a lowering trend of the ...vaccination rate in the Dutch population at risk. • The influenza vaccination rate of the overall at risk group decreased significantly from 71.5% in 2008, to 59.6% in 2013. • The difference of 11.9% was gradual over the years (mean yearly decrease 2.4%). • The decrease was seen in all specified groups, but mainly among patients aged 60–65 years (mean yearly decrease 3.3%).
Universal tumor DNA testing in epithelial ovarian cancer patients can function not only as an efficient prescreen for hereditary cancer testing, but may also guide treatment choices. This innovation, ...introduced as Tumor-First workflow, offers great opportunities, but ensuring optimal multidisciplinary collaboration is a challenge. We investigated factors that were relevant and important for large-scale implementation. In three multidisciplinary online focus groups, healthcare professionals (gynecologic oncologists, pathologists, clinical geneticists, and clinical laboratory specialists) were interviewed on factors critical for the implementation of the Tumor-First workflow. Recordings were transcribed for analysis in Atlas.ti according to the framework of Flottorp that categorizes seven implementation domains. Healthcare professionals from all disciplines endorse implementation of the Tumor-First workflow, but more detailed standardization and advice regarding the logistics of the workflow were needed. Healthcare professionals explored ways to stay informed about the different phases of the workflow and the results. They emphasized the importance of including all epithelial ovarian cancer patients in the workflow and monitoring this inclusion. Overall, healthcare professionals would appreciate supporting material for the implementation of the Tumor-First workflow in the daily work routine. Focus group discussions have revealed factors for developing a tailored implementation strategy for the Tumor-First workflow in order to optimize care for epithelial ovarian cancer patients. Future innovations affecting multidisciplinary oncology teams including clinical geneticists can benefit from the lessons learned.
Non-modifiable patient characteristics, including age, gender, ethnicity as well as the occurrence of multi-morbidities, are associated with processes and outcomes of diabetes care. Information on ...these factors can be used in case mix adjustment of performance measures. However, the practical relevance of such adjustment is not clear. The aim of this study was to assess the strength of associations between patient factors and diabetes care processes and outcomes.
We performed an observational study based on routinely collected data of 12,498 diabetes patients in 59 Dutch primary care practices. Data were collected on patient age, gender, whether the patient lived in a deprived area, body mass index and the co-occurrence of cardiovascular disease, chronic obstructive pulmonary disease, depression or anxiety. Outcomes included 6 dichotomous measures (3 process and 3 outcome related) regarding glycosylated hemoglobin, systolic blood pressure and low density lipoprotein-cholesterol. We performed separate hierarchical logistic mixed model regression models for each of the outcome measures.
Each of the process measure models showed moderate effect sizes, with pooled areas under the curve that varied between 0.66 and 0.76. The frequency of diabetes related consultations as a measure of patient compliance to treatment showed the strongest association with all process measures (odds ratios between 5.6 and 14.5). The effect sizes of the outcome measure models were considerably smaller than the process measure models, with pooled areas under the curve varying from 0.57 to 0.61.
Several non-modifiable patient factors could be associated with processes and outcomes of diabetes care. However, associations were small. These results suggest that case-mix correction or stratification in assessing diabetes care has limited practical relevance.
Contemporary minimally invasive treatment concepts for restorative treatment of primary caries lesions include both delayed intervention and smaller-sized preparations restricted to removal of ...carious tissue. The aim of this study was to investigate whether these concepts have resulted in a trend towards a more conservative choice made by dentists regarding treatment thresholds and restorative techniques. The results from previously conducted, precoded questionnaires developed by Espelid and Tveit, as well as from a recent Dutch questionnaire, were collected and analysed. A worldwide trend towards more minimally invasive strategies in the operative treatment of caries lesions could not be observed, neither for the initiation of operative treatment nor for the preparation techniques. However, in some countries, changes over time could be assessed, especially in Norway, where a reduction in the proportion of interventions is visible for both occlusal and approximal lesions, indicating that more dentists are postponing interventions until the lesions have progressed to a deeper level. From the Dutch national survey, it could be concluded that operators that intervene at an earlier stage of approximal lesioning (stage ≤4) also intervene at an earlier stage of occlusal caries (stage ≤3) (p = 0.012; OR = 2.52; 95% CI: 1.22-5.22). Generally, it can be concluded that dentists worldwide still tend to operatively intervene at a too early stage of caries, although variations exist between countries. A worldwide shift could be observed in the restorative material applied, since composite resin has almost completely replaced amalgam for restoring primary caries lesions.
•Highest AFRs were found for level Failure based on Claims Data and the lowest AFRs for level Survival.•The fact that repair is considered nowadays as a state-of-art minimally invasive intervention, ...justifies the separate analysis of these types of treatment.•Using failure criteria, Success and Survival, in future clinical studies would enable a better comparison of studies.
The aim of this retrospective methodology study was to investigate the influence of using different definitions for restoration failure and inclusion criteria on restoration longevity expressed in AFR.
EPF from fifteen general dental practices were used for collecting the data for this study. From the EPF, 321,749 composite restorations placed in 52,245 patients by forty-seven GDPs between January 2000 and December 2011 were included. Kaplan–Meier statistics were applied and mean AFRs over 2, 5 and 10 years were calculated. The effect on the AFR of using different levels of failure: based on Claims data (CD), Success (SUC), Survival (SUR) and different inclusion criteria of tooth/restoration variables were reported.
Highest AFRs were found for level CD, in which every intervention was considered as failure, and the lowest AFRs for level SUR in which repairs and an endodontic treatments were not considered as a failure. AFRs increased when the observation period prolonged especially for SUR, followed by SUC and CD. An overview of long-term survival studies showed a wide variation in study design, performed clinical examination (USPHS criteria or GDP), number of restorations included, description of restoration failure and found AFRs for CD, SUC and SUR.
Using failure criteria, Success and Survival, in future clinical studies would enable a better comparison of studies as well as demonstrate the impact of more conservative restorative intervention protocols on patient care.
Highlights ► Being vaccinated in 2009 enhanced the vaccination probability in 2010 and 2011. ► This effect was seen for seasonal as well as pandemic A(H1N1)pdm09 vaccinations. ► The positive effects ...for the same cohort were still found after two years. ► The A(H1N1)pdm09 vaccinations did not disturb, but enhanced vaccination routine.
Background: Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. Aim: To assess the quality of care (QoC) of CKD ...in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Design and setting: Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). Method: CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Results: Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Conclusion: Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model.
Key points
Quality of care for chronic kidney disease patients in primary care can be improved.
In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients.
Quality of care was higher in patients with diabetes.
Chronic kidney disease management may be improved by developing strategies similar to diabetes care.
Genetic testing in epithelial ovarian cancer (OC) is essential to identify a hereditary cause like a germline BRCA1/2 pathogenic variant (PV). An efficient strategy for genetic testing in OC is ...highly desired. We evaluated costs and effects of two strategies; (i) Tumor-First strategy, using a tumor DNA test as prescreen to germline testing, and (ii) Germline-First strategy, referring all patients to the clinical geneticist for germline testing.
Tumor-First and Germline-First were compared in two scenarios; using real-world uptake of testing and setting implementation to 100%. Decision analytic models were built to analyze genetic testing costs (including counseling) per OC patient and per family as well as BRCA1/2 detection probabilities. With a Markov model, the life years gained among female relatives with a germline BRCA1/2 PV was investigated.
Focusing on real-world uptake, with the Tumor-First strategy more OC patients and relatives with a germline BRCA1/2 PV are detected (70% versus 49%), at lower genetic testing costs (€1898 versus €2502 per patient, and €2511 versus €2930 per family). Thereby, female relatives with a germline BRCA1/2 PV can live on average 0.54 life years longer with Tumor-First compared to Germline-First. Focusing on 100% uptake, the genetic testing costs per OC patient are substantially lower in the Tumor-First strategy (€2257 versus €4986).
The Tumor-First strategy in OC patients is more effective in identifying germline BRCA1/2 PV at lower genetic testing costs per patient and per family. Optimal implementation of Tumor-First can further improve detection of heredity in OC patients.
•An efficient strategy for genetic testing in epithelial ovarian cancer is highly desired.•We compared costs and effects of two strategies: Tumor-First and Germline-First.•Average testing costs per patient are much lower with the Tumor-First strategy.•In a likely scenario, more patients and relatives with a germline BRCA1/2 PV are identified with the Tumor-First strategy.
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