PubMed Health⌕ Search

Biomedical subjects

D Bonetti

Publications and source records attributed to D Bonetti.

5 recordsLinked to original sources
PubMed2004

Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care, a cluster randomised controlled trial.

OBJECTIVE: To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 "Management of unerupted and impacted third molar teeth" (published 2000) as a model. DESIGN: A pragmatic, cluster RCT (2x2 factorial design). SUBJECTS: Sixty-three dental practices across Scotland. Clinical records of all 16-24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions. INTERVENTIONS: Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PGEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL. PRINCIPAL OUTCOME MEASUREMENT: The proportion of patients whose treatment complied with the guideline. RESULTS: The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection. CONCLUSION: In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and F arm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

Adolescent↗
PubMed2003

Can psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to implement evidence-based practice.

OBJECTIVE: The lag between publication of evidence for clinical practice and implementation by clinicians may be decades. Research using psychological models demonstrates that changing intention is very important in changing behaviour. This study examined an intervention (rehearsing alternative actions) to change dentists' intention to implement evidence-based practice (EBP) for third molar (TM) management. DESIGN: Randomised controlled trial / postal. SETTING: Primary care. SUBJECTS AND METHODS: Dentists were randomly selected from the Scottish Dental Practice Board Register, then randomly allocated to intervention or control groups, and sent a questionnaire. The intervention group listed management alternatives to TM extraction prior to their TM extraction intention, and the control group did not. Based on psychological models for reducing a behaviour's frequency (EBP is weighted against TM extraction), prior listing of alternatives should decrease extraction intention. MAIN OUTCOME MEASURES: Intention to extract TMs. RESULTS: A total of 99 dentists - 70 Males, 29 Females; mean age = 41.42 years (SD = 8.62) participated in the study. The intervention significantly influenced intention to extract TMs, as desired. Despite similar background and knowledge of management alternatives, participants in the intervention group had significantly lower intention to extract: control group mean (SD) = 0.39 (1.99); intervention group mean (SD) = -0.78 (1.89); mean difference (SE) = 1.17 (0.42); 95% confidence interval for the difference = 0.34 to 1.99. CONCLUSION: Results suggest this intervention, which successfully influenced a proximal predictor of behaviour pertinent to dental EBP, may result in improved EBP in a service-level trial. Basing implementation interventions and trial methodology on psychological models may effectively bridge the gap between clinical guidelines and practice.

Adult↗
PubMed2001

The effect of three different warm-up intensities on kayak ergometer performance.

PURPOSE: The purpose of this study was to investigate the influence of warm-up (WU) intensity on supramaximal kayak ergometer performance. METHODS: In the initial testing session, eight institute of sport kayak squad members performed a graded exercise test for determination of VO2max and lactate (La) parameters. In a random, counterbalanced order, subjects subsequently performed WU for 15-min at either their aerobic threshold (W1), their anaerobic threshold (W3), or mid-way between their aerobic threshold and anaerobic threshold (W2). A 5-min passive rest period and then a 2-min, all-out kayak ergometer test followed the WU. RESULTS: For the three different WU conditions, no significant differences were observed for average power, peak VO2, total VO2, total VCO2, or accumulated oxygen deficit (AOD) during the 2-min test. However, when compared with W3, differences in average power approached significance after both W1 (P = 0.09) and W2 (P = 0.10). Furthermore, when compared with W3, average power during the first half of the 2-min test was significantly greater after W2 (P < 0.05) and approached significance after W1 (P = 0.06). After each WU period, there was a significant difference in blood pH (W1>W2>W3; P < 0.05) and blood [La] (W1<W2<W3; P < 0.05). Despite the significantly different metabolic acidemia after each WU condition, there were no significant differences in the VO2 responses to the 2-min test. However, the greater metabolic acidemia after W3 was associated with impaired 2-min kayak ergometer performance. CONCLUSIONS: It was concluded, that although a degree of metabolic acidemia may be necessary to speed O2 kinetics, if the WU is too intense, the associated metabolic acidemia may impair supramaximal performance by reducing the anaerobic energy contribution and/or interfering with muscle contractile processes.

Adolescent↗
PubMed1989

[The quality of life of patients with cardiac arrhythmia undergoing surgical treatment].

The handling of patients with malign ventricular arrhythmia, since 1979, can count on intracardiac electrophysiological studies, cardiac mapping and unconventional cardiac surgery. Such service, which requires the use of sophisticated equipment and specialized professionals, is being provided to patients from all over the country and from all social strata. The Hospital, which maintains the costly, infrastructure required to provide such service, is interested in knowing the reach of the therapeutic action, going beyond the mere knowledge of the success in the immediate treatment. In order to situate the patient as well as his family and social relations, a Social Service professional has been appointed, and same, from a group of 37 patients under treatment (there were 15 deaths), has selected for the survey 17 residents in the metroplitan region of São Paulo, because of contact with them was easier. Evaluation of the changes in the quality of life of the patients that have undergone surgery has been structured in such a way to detail the research procedure, treatment of the data and discussion of the results. Thus, an attempt has been made to characterize the extent of the benefits obtained in the surgeries, at the individual, familiar and social level. Basicaly, in the group of patients surveyed, 70% have been identified as males, 70% as married, 65% older than 50 years, 76% associated to the social security system, 70% with primary level schooling and thus a low family income (1.6 minimum wages per capita).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗