Biomedical subjects

Kerstin Knutsson

Publications and source records attributed to Kerstin Knutsson.

6 recordsLinked to original sources

PubMed2005

Clinicians' management strategies for patients with dyspepsia: a qualitative approach.

BACKGROUND: Symptoms from the upper gastrointestinal tract are frequently encountered in clinical practice and may be of either organic or functional origin. For some of these conditions, according to the literature, certain management strategies can be recommended. For other conditions, the evidence is more ambiguous. The hypothesis that guided our study design was twofold: Management strategies and treatments suggested by different clinicians vary considerably, even when optimal treatment is clear-cut, as documented by evidence in the literature. Clinicians believe that the management strategies of their colleagues are similar to their own. METHODS: Simulated case histories of four patients with symptoms from the upper gastrointestinal tract were presented to 27 Swedish clinicians who were specialists in medical gastroenterology, surgery, and general practice and worked at three hospitals in the southern part of Sweden. The patients' histories contained information on the patient's sex and age and the localisation of the symptoms, but descriptions of subjective symptoms and findings from examinations differed from history to history. Interviews containing open-ended questions were conducted. RESULTS: For the same patient, the management strategies and treatments suggested by the clinicians varied widely, as did the strategies suggested by clinicians in the same speciality. Variation was more pronounced if the case history noted symptoms but no organic findings than if the case history noted unambiguous findings and symptoms. However, even in cases with a consensus in the scientific literature on treatment, the variations in clinicians' opinion on management were pronounced. CONCLUSION: Despite these variations, the clinicians believed that the decisions made by their colleagues would be similar to their own. The overall results of this study indicate that we as researchers must make scientific evidence comprehensible and communicate evidence so that clinicians are able to interpret and implement it in practice. Of particular significance is that scientific evidence leads to an evidence-based care which is effective clinical practice and to the promotion of health from the perspective of the patient, together with cost-effectiveness as a priority.

Adult↗

PubMed2005

Antibiotic prophylaxis in oral health care: administration strategies of general dental practitioners.

OBJECTIVE: To examine the strategies that general dental practitioners (GDPs) use to administer antibiotic prophylaxis and to study the agreement between the administration strategies of GDPs and local recommendations. METHODS: Postal questionnaires in combination with telephone interviews were used. Two hundred GDPs in two Swedish counties, Skåne and Orebro, were asked to participate. The response rate was 51% (n = 101). The GDPs were presented with eight simulated cases of patients with different medical conditions for which antibiotic prophylaxis might be considered necessary when performing dental procedures (scaling, tooth removal, root canal treatment). The administration strategies of the GDPs were compared with local recommendations. RESULTS: In general, the variation in the administration strategies of the GDPs was large. For two medical conditions, type 1 diabetes that was not well controlled and hip prosthesis, significantly more GDPs in Skåne than in Orebro administered antibiotic prophylaxis for tooth removal. Agreement between the administration strategies of the GDPs and local recommendations was low. Differences between the two counties were non-significant. Furthermore, within Orebro, GDPs who did not have formal access to local recommendations did not differ in their administration strategies from those who did. The choice of substance was seldom in agreement with the substance recommended, while the majority followed the recommended duration of treatment. CONCLUSION: Although recommendations existed, their impact appeared to be limited. This is significant, since the implementation of recommendations is crucial in making clinical practice more effective and in promoting the health of patients.

Adult↗

PubMed2005

Patient flows in the care process of mandibular third molar surgery.

Our aim was to describe patient flows in mandibular third molar surgery at oral and maxillofacial specialist units. Our hypothesis was that there are variations in how care is delivered and that the variations could be explained by inter-individual variations in surgeons' practice, the quality of the radiographs appended to the referral, and the staffing of the specialist units. A flow chart was constructed to simulate all possible patient flows in the care process. The chart begins with treatment planning, which was drawn up based on documents from the referring dentist or another caregiver; continues with the care process at the oral and maxillofacial surgery unit, including surgical consultations and radiological examinations; and ends with surgery. Surgeons at four oral and maxillofacial surgery units in the National Health Service in southern Sweden participated. The intention was to collect data on at least 100 patients who had undergone mandibular third molar surgery at each unit. Data on 361 patients were collected. The radiographs appended to the referral were judged to be inappropriate for the majority of the patients (61%). For 13% of these patients, supplementary radiographic examinations were made at the radiology clinic included in the unit, whilst 48% were examined at the oral and maxillofacial surgery clinic. There were eight different patient flow patterns. In one unit with three surgeons, eight different flow patterns were recorded, indicating an interindividual variation among the surgeons. In a second unit, six different flow patterns were recorded. In the last two units, the patient flows appeared to be the same at each unit, although the predominant patient flows in these two units differed. The number of patient visits to the specialist units ranged between one and three. In three specialist units, most patients were called twice whilst in one specialist unit most patients were called only once, to have the third molar removed. Differences existed in the care process. Overall, the number of patient visits seemed not to depend on whether the preoperative radiographic examination was judged to be appropriate or whether the additional radiographs were made at the radiology clinic.

Adult↗

PubMed2004

A self-directed summative examination in problem-based learning in dentistry: a new approach.

This paper describes and evaluates a new method of assessment in PBL, which was developed with two cohorts of dental students. The method involves students in PBL groups designing PBL problems and assessment tasks that are in line with the objectives of the course and the principles of PBL. Construction of tasks and feedback were provided. The student groups based the summative assessment on a selection of the PBL assessments provided. The evaluation indicates that senior students are capable of designing challenging PBL assessment tasks that are in line with course objectives and PBL principles. This experience raised the pass rates of the students compared those of with earlier cohorts of students. The students rated the method favourably; they considered it enabled them to demonstrate their competences and that it was more closely in line with PBL principles than other methods of assessment that they had experienced. The method is a promising innovation, which could be used in a variety of PBL courses.

Curriculum↗

PubMed2003

The major factors that influence endodontic retreatment decisions.

The presence of a new or persistent periapical radiolucency adjacent to a rootfilled tooth is often used as a criterion of endodontic treatment "failure". However, clinicians' suggested management of such cases is subject to substantial interindividual variation. Several components that might influence endodontic retreatment decision making have been explored, but data on which factors dentists actually think they consider, are missing. The aim was to interview 20 general dental practitioners (GDPs) and 20 endodontists about factors they thought would influence the prescription of endodontic retreatment. Six simulated cases were presented as cartoons accompanied with a clinical history. In two of the cases the teeth were planned to serve as an abutment tooth in a fixed prosthodontic construction. The status of the periapical bone tissue and the quality of rootfilling seal were varied. Between 1 and 6 factors per case were reported to influence decision making. In cases not planned to serve as abutment teeth most dentists considered that the periapical condition was the most important factor, whilst they considered the fixed prosthodontic construction to be the most important factor in cases planned as abutment teeth. Generally, endodontists seem to be more inclined to retreat and act on the mere presence of a periapical lesion regardless of size than GDPs. In a real clinical setting in direct contact with patients, additional factors like economy and patients' preferences might be expected to exert a major influence. The majority of the dentists stated that they thought that their colleagues would make similar decisions as they did themselves.

Attitude of Health Personnel↗

PubMed2002

Effect of selected literature on dentists' decisions to remove asymptomatic, impacted lower third molars.

The aim of this study was to assess the effect of studying selected literature on dentists' decisions to remove asymptomatic, impacted lower third molars. A pre-test-post-test control group design was used. Given 36 patient cases, two groups of 16 general dental practitioners each were asked to assess the need for removal of asymptomatic impacted lower third molars. The cases were classified by three parameters: 'position of the third molar', 'impaction type', and 'patient age'. After studying selected literature on this subject by the intervention group, both groups were asked to assess the same cases again. Frequencies of decisions to remove the third molars were calculated. For each participant, tables were composed by crosstabulating the indication to remove a third molar with each of the three parameters. T-tests were used to test the significance of the difference between pre-test and post-test decisions. The overall number of indications to remove asymptomatic, impacted lower third molars decreased by 37% in the intervention group. In the control group, the difference between pre- and post-test was not statistically significant. It was concluded that the provision of selected literature significantly influences treatment decision making by dentists in a third molar decision task.

Adult↗