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Biomedical subjects

D A Shugars

Publications and source records attributed to D A Shugars.

At least 55 records · Page 3Linked to original sources
PubMed1995

Practice parameters in dentistry: where do we stand?

Practice parameters or guidelines have been touted as a means of enhancing clinical decision making. The authors surveyed dental organizations and reviewed the literature to determine the availability of parameters for dental conditions. An Institute of Medicine report has suggested that for parameters to provide the desired benefits, they must meet certain criteria and possess certain characteristics. Using these criteria, the authors assess available parameters in dentistry.

Clinical Protocols↗
PubMed1994

The physician's role. Views of the public and the profession on seven aspects of patient care.

OBJECTIVES: To determine the importance of various areas of physician competency and to assess the public's ratings of their own physicians. DESIGN: A nationwide household telephone survey. PARTICIPANTS: A random sample of 640 US adults (61% response rate). MAIN OUTCOME MEASURES: Ratings of importance and physicians' competencies in diagnosing and treating illness, communication, ethical conduct, cooperation with other health care professionals, promotion of preventive care, use of technology, and consideration of the cost of care to the patient. RESULTS: Physicians were rated lowest on communication skills and on attention to the costs of the recommended treatment. A comparison of the results with a similar survey of physicians shows that physicians rate their training the lowest in these same areas. Physicians in general practice were rated lower on several competencies than were other physicians. CONCLUSIONS: Health care consumers and physicians share similar values about what is important in the role of a physician. In the areas of communication and attention to the costs of treatment, public needs are not always being met.

Adult↗
PubMed1994

Non-carious cervical lesions.

Non-carious cervical lesions are commonly encountered in clinical practice and present in a variety of forms. A knowledge of the aetiology of these lesions is important for preventing further lesions, halting progression of lesions already present, and determining appropriate treatment. The most commonly cited aetiological factors thought to lead to the development of cervical lesions are erosion, abrasion and tooth flexure. Evidence supports a multifactorial aetiology for non-carious cervical lesions. The purpose of this paper is to review the evidence for each of these aetiological factors as it relates to the development of non-carious cervical lesions. Specific features of cervical lesions linked to these factors, including their morphology, location, prevalence and distribution by age and sex will be discussed. Suggestions for future research into the cause and prevention of non-carious cervical lesions will be presented.

Dental Occlusion, Traumatic↗
PubMed1994

An integrated health care model in medical education: interviews with faculty and administrators.

PURPOSE: To broaden the understanding of how medical schools can help students learn an approach to health care that reflects the integration of psychosocial and biomedical factors in health and illness. METHOD: A qualitative research design was used, with data collected through document review and semi-structured interviews conducted in the spring and summer of 1992 with 22 faculty and administrators from 17 U.S. and Canadian medical schools. The interviewees represented the following disciplines: internal medicine, family medicine, pediatrics, psychiatry, and preventive/behavioral medicine. An analytic framework was developed, within which the constant comparative method was used on a continuous basis during and after data collection. Category development focused on (1) defining the scope and character of an integrated perspective, (2) delineating various ways to incorporate such a perspective in medical education, and (3) identifying barriers to and facilitative factors for incorporating such a perspective in medical education. Validity was assessed by having the interviewees and three other faculty members review the analyses and preliminary results. RESULTS: The interviewees' conceptions of an integrated perspective on health care focused on the theoretical need for a broader scientific model and on the practical need for more inclusive approaches to medical practice. The interviewees described patient-level and community-level approaches as equally important. The ideal curricula envisioned by the interviewees were patient-centered, integrated, developmental, and population-based. In addition to naming many barriers to integration (e.g., negative attitudes of faculty and administrators, diffuse organization of medical schools, ignorance of appropriate curriculum design and implementation), the interviewees identified certain facilitative factors (e.g., strong leaders, faculty development programs, and reform of the faculty reward system). CONCLUSION: The interviewees envisioned an integrated model of health care that suggests that medical curricula should address the development of physicians' knowledge, attitudes, and skills regarding physicians' relationships with both patients and community.

Administrative Personnel↗
PubMed1993

Relationship between epidemiologic coronal caries assessments and practitioners' treatment recommendations in adults.

Caries incidence determinations in adults reflect dentists' treatment decisions as well as epidemiologists' caries assessments because many patients receive treatment between the two assessments that are required to determine incidence. Yet knowledge of the relationship between epidemiologically assessed caries and practitioners' treatment recommendations is poor. In this study, the proportions of practitioners recommending treatment for a tooth, and the reasons for those recommendations, were compared across teeth grouped by their caries status as determined from an epidemiologic assessment. On average, for a tooth deemed carious by epidemiologic assessment, a mean of almost 90% of examining practitioners recommended treatment. Most but not all of these recommendations for treatment of teeth with epidemiologically determined caries were for caries-related reasons. Among teeth classified as sound by epidemiological assessment, the mean proportion of dentists recommending treatment was 11%. For restored, non-carious teeth a mean of 35% of examining dentists recommended treatment. Across all noncarious teeth, 25% of all treatment recommendations were related to caries. The mean patient F increment (number of newly filled surfaces) that would result from treatment recommendations practitioners indicated as being associated with caries was slightly less than one-half of the total F increment. Thus, F increments may substantially overestimate caries incidence.

Adult↗
PubMed1993

Agreement among dentists' recommendations for restorative treatment.

Differences among dentists in their decisions to recommend treatment have been studied principally at a "macro" level by examinations of variations in dentists' treatment recommendations for individual patients, or for patients aggregated to the practice level. If reasons for these differences are to be understood, however, a "micro" level examination of differences in dentists' decisions to recommend treatment for individual teeth is necessary. Extent of agreement to recommend treatment among dentists was explored for 1187 teeth in 43 patients. Each tooth was examined by a mean of 6.6 general practitioners. A modified reliability index and distributions of raw levels of agreement were used for quantification of agreement rates across an incomplete cross-classification for practitioners and patients. Overall inter-dentist reliability in recommending individual teeth for treatment was moderate, p = 0.62. Among unrestored teeth with no clinically evident caries, as judged by an independent experienced evident caries, as judged by an independent experienced examiner, reliability in treatment recommendations due to caries was fair, p = 0.51. Reliability was lowest for recommendations concerning previously restored teeth, p = 0.43. Among all teeth receiving at least one recommendation for treatment, only 22% received a unanimous recommendation. Over one-half of all instances of lack of agreement resulted from a single dentist's recommendation differing from those of all other dentists examining the tooth. The results suggest that much of the variation in dentists' practice profiles is due to basic differences in decisions to recommend treatment for individual teeth with specific conditions, and that the presence of previous restorations seems to magnify these differences.

Adult↗
PubMed1993

How dentists classified and treated non-carious cervical lesions.

All North Carolina general dentists were shown color photographs of three non-carious cervical lesions. A fourth picture showed cervical caries. Respondents were asked how they defined each lesion, its cause, treatment and frequency of appearance in practice. Cervical caries was identified and treated by almost all responding dentists, but they applied more varied terms, causes and treatments to non-carious defects.

Clinical Competence↗
PubMed1992

Expanding health insurance coverage and the implications for dentistry.

Numerous proposals have been suggested for expanding health insurance coverage to the over 30 million Americans without health insurance. These proposals range from establishing a program of national health insurance modeled after the Canadian system to establishing statewide risk pools. Many of these proposals could have an impact on financial access to dental care for the approximately 120 million people without dental insurance. Dental insurance coverage has been shown to increase access to dental services and improve oral health status. Oral health professionals could facilitate discussions concerning health insurance expansion by informing policymakers about important preventive benefits to be gained by improving access to dental services. Dental public health professionals can serve as a bridge between organized dentistry and health policymakers by providing information to help formulate the priorities and characteristics of a dental health insurance program. This visibility and influence in the health policy arena would be beneficial to dentistry and could ultimately result in greater access to dental services and improved oral health for the uninsured.

Dental Health Services↗
PubMed1992

Understanding dentists' restorative treatment decisions.

A critical review of the literature is presented that examines variation in dentists' restorative treatment decisions and the factors associated with this variation. Substantial variation has been documented in dentists' assessment of caries, in dentists' decisions to intervene, and in the selection of treatment recommended to the patient. However, the factors associated with this variation are not well documented. Following discussion of this review, a model is proposed to help guide further studies of dentists' restorative treatment decisions. This explanatory model incorporates the factors identified in the review, as well as others either observed informally or found in the medical literature. The implications of variation in dentists' treatment decisions highlight the importance of a full explication of the process dentists follow in making treatment decisions. Understanding this process, which heretofore has been examined only superficially because it has been regarded as a function of "clinical judgement," is fundamental to determinations of normative treatment needs, to interventions designed to reduce the frequency of inappropriate treatment, and to the development of valid practice parameters.

Decision Making↗
PubMed1992

Clinical board examinations: variation found in pass rates.

This study found significant variation in pass rates within and among state and regional dental board clinical examinations during 1979-1988. This suggests that factors other than the abilities of the candidates influence exam outcomes. As long as individual states can argue that there is currently no definitive system to assure the quality of dental care, states may remain reluctant to relax their restrictions on dentists' freedom of movement.

Educational Measurement↗
PubMed1992

Attitudes of dentists toward emerging competencies for health care practitioners.

Dentists' attitudes about the importance of formal training in a variety of skills were assessed as a part of the Pew Health Professions Commission initiative to help health professional schools prepare for the future. Through a telephone survey with a 54 percent participation rate, attitudes of a national sample of practitioners were determined concerning the importance of training in 16 competencies that reflect skills, attitudes, and behaviors identified by the commission. Most respondents indicated that competency in treating and preventing disease, practicing ethically, communicating with patients, applying problem solving techniques, and continuing to learn were very important. Conversely, less than half of dentists indicated that competency in managing information, responding to cultural diversity, supporting community agencies, and working in managed care settings were very important. The opinions of graduates since 1980 about their own training in the competencies tended to mirror their ratings of importance. These results demonstrate the continuing need for dental educators to consider prevailing opinion of practicing professionals as a part of any evaluation or planning effort.

Adult↗
PubMed1991

Development of an instrument to measure job satisfaction among dentists.

Because of the rapid changes that have occurred in the dental profession, the Dentist Satisfaction Survey (DSS) was developed to assess both facet and overall job satisfaction among dentists. The DSS was administered to a sample of 558 California general dentists. The results suggest that the DSS is a practical, reliable, and valid measure of dentists' job satisfaction. Internal consistency reliability coefficients for all facet subscales and the overall job satisfaction scale ranged from 0.60-0.92. The DSS discriminated between groups of dentists known to have different levels of job satisfaction; dentists identified by dental society presidents as being very dissatisfied scored significantly differently in the hypothesized direction on the DSS. A high correlation (r = 0.68) was found between judges' independent ratings of dentists' satisfaction based on their open-ended comments and DSS scores. While the majority of respondents were satisfied with most facets of their jobs, substantial variation was found among dentists in their levels of satisfaction.

Adult↗