timothy a. derouen uw center for global oral...
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Timothy A. DeRouen
UW Center for Global Oral Health
Practice-Based
REsearch
Collaborative in
Evidence-based
DENTistry
1. To create an infrastructure for the Network Chair component
of this application with personnel who possess outstanding
expertise and experience in all areas relevant to the creation
and administration of Northwest PRECEDENT.
Northwest PRECEDENT: Specific Aims
Northwest PRECEDENT Administrative Structure
P.I.: Timothy A. DeRouen (UW)
Co-P.I.: Jack Ferracane (OHSU)
Office of the Network Chair
Regional Coordinators
0.4 FTE TBN
Seattle
0.4 FTE TBN
Boise
0.4 FTE TBN
Spokane
0.4 FTE TBN
Salt Lake City
0.4 FTE TBN
Portland
Joel Berg (UW)
Tom Hilton (OHSU)
Co-Investigators
P.I.: Brian Leroux
Co-Investigators:
Lloyd Mancl, Philippe Hujoel,
Ruth McBride
Data Coordinating Center
Western Washington
30–35 practices
Eastern Washington
& Montana
30 practices
Eastern Oregon
& Idaho
30 practices
Utah &
Southern Idaho
25–30 practices
Western Oregon &
Southwestern
Washington
30 practices
2. To develop and implement a plan for recruitment of network
practitioners who will be representative of the demographics
of the regional practitioner population, but who will also be
highly motivated to be active, reliable network participants.
Northwest PRECEDENT: Specific Aims
Demographic Data from Practitioner Questionnaire:
Motivation
Motivation for interest in PRECEDENT. No
Motivation
Little
Motivation
Substantial
Motivation
Total
Responses
CDE Credits 24 (11%) 128 (58%) 65 (29%) 217 (94%)
Opportunity to design a dental research
project
25 (11%) 88 (40%) 105 (48%) 218 (94%)
Opportunity to conduct research in your
practice
6 (2%) 38 (17%) 173 (79%) 217 (94%)
Interaction with colleagues 3 (1%) 51 (23%) 166 (75%) 220 (95%)
Opportunity to give back to the profession 3 (1%) 32 (14%) 185 (84%) 220 (95%)
University faculty appointment 40 (18%) 103 (47%) 76 (34%) 219 (95%)
Professional growth and development 0 (0%) 11 (5%) 208 (94%) 219 (95%)
Opportunity to contribute to dental clinical
knowledge
1 (0%) 12 (5%) 205 (94%) 218 (94%)
3. To develop and implement an educational program for
participants that will ensure high quality of network studies.
Northwest PRECEDENT: Specific Aims
Part I: What is the Question?
PICO: Patient, Intervention, Control, Outcome
Part II: What are the Options?
Levels of Evidence
Part III: How to Evaluate the Evidence?
Statistical Analysis & Sample Size
Part IV: How to Do a Research Study
Recruitment, Informed Consent, Retention, Randomization,
Masking, Measurement
Part V: How PRECEDENT Works
Session on Protocol Ideas
Northwest PRECEDENT
Research Methods Course Outline
4. To develop and implement a strategy for eliciting ideas for new
network studies that are relevant to and likely to have an impact
upon the general practice of dentistry.
Northwest PRECEDENT: Specific Aims
• A large number of study ideas proposed
• Topics include restorative dentistry & others
• Many are amenable to randomized trials
• DCC works on experimental designs for selected
study ideas
Northwest PRECEDENT
Study Ideas
5. To work closely with Northwest PRECEDENT Data Coordinating
Center (DCC) at the University of Washington to carry out clinical
research studies through the network, ensuring that adequate
communication, training, and trouble shooting occurs at the
initiation of each study protocol approved for the network, and is
maintained throughout the conduct of each study.
6. To ensure dissemination of study findings by taking the lead, but
working closely with the Coordinating Center and practitioner
investigators in presenting and writing up the results of each
completed protocol and submitting it for publication.
Northwest PRECEDENT: Specific Aims (cont’d)
I. Establish Infrastructure
II. Develop Data Capture System
III. Develop & Conduct Research Methods Training
IV. Design Studies
V. Implement Studies
Northwest PRECEDENT
DCC Specific Aims
Principles of Practice-Based Research
1.Identify topics of interest to practitioners, relevant
to practice of dentistry
2.Design studies that are straightforward, with
simple clinical endpoints
3.Carry out studies requiring minimal interference
with everyday practice
4.Evaluate clinical effectiveness of approved
techniques/materials
Surveys •Study 7: Treatments for Hypersensitivity (N=209 dentists)
•Study 10: PIRG (CONDOR) (N=207 dentists)
•Study 11a: Orthodontists’ Attitudes to Temporary Anchorage Devices (N=47 orthodontists)
•Study 12: Overbite Retention Strategies in Orthodontics(N=50 orthodontists, n=302 patients)
•Study 13: TMJD (CONDOR) (N=229 dentists)
•Study 17: Special Needs Patients (N=291 dentists)
Cross-Sectional Studies
Study 1: Disease Prevalence and Treatment
Patterns in PRECEDENT Patients (N=101 dentists, n=1943 patients)
Study 8: Prevalence of Hypersensitivity (N=37 dentists, n=787 patients)
•Estimate needed to design a future RCT
Case-Control Studies
Study 3: ONJ (n=277 patients)
- Determine risk factors for ONJ (eg BP use)
Prospective Cohort Studies
Study 2: Prediction of caries (N=63 dentists,
n=1763 patients)
Study 5: Outcomes of cracked teeth (N=36 dentists, n=827 patients)
Study 9: Outcomes of 3rd molar extraction (N=51 dentists, n=815 patients)
Study 11b: Outcomes of temporary anchorage devices (N=18 orthodontists, n=81)
Randomized Trials
Study 4: Effect of computer-based treatment on needle phobia (N=7 dentists, n=84 patients)
Study 6: Comparison of pulp-capping materials (randomized by dentist) (N=35 dentists, n=376 patients)
Study 15: Effect of remineralization paste on white spots after orthodontic treatment (N=21 orthodontists, n=171 patients)
Final
Active Members 358
Fully Trained Members 217
- Orthodontists 44
- Community Clinic Dentists 20
- Pediatric Dentists 7
Friends 169
24 states 10 countries
Study 001: Oral Disease
Indicators Survey
Study 002: Salivary Markers in
Caries Risk Assessment
Study 003: Case Control Study
of Osteonecrosis of the Jaw
(CONDOR Trans-PBRN Study)
Study 004: Computer Assisted
Relaxation Learning (CARL)
Study 005: Assessing the
Outcomes of Cracked Teeth
Study 006: MTA and Calcium
Hydroxide in Direct Pulp
Capping
Study 007: Treatment of
Dentin Hypersensitivity in
Dental Practices
Study 008: Dentin
Hypersensitivity - Prevalence
in Patients
Study 009: Third Molar
Extraction: Indications
and Outcomes
Study 010: (PIRG) Impact
of Dental Practice-Based
Research
Study 011: TAD
Study 012: Overbite
Retention Strategy
Study 013: Advancing Primary
Care Management for TMJD
Pain
Study 015: Remineralization
Treatment of White Spot
Lesions
Study 017: Special Health Care
Needs
•PEARL
•DPBRN
•PRECEDENT
Ortho Ortho
Ortho +
Some Lessons Learned
Between dentists and their patients
Between regional coordinators and the offices
“We appreciated the visits of PRECEDENT staff – it made us feel that what we are doing is important, and that we are part of a larger operation.”
Different regions have different practices,
interests.
Recruitment, incorporation of community clinic
dentists requires personal touch, flexibility.
The cracked teeth study has from the start been
one of the members’ primary interests
“This is a very important study Just participating in it has changed the way I think and practice.”
“This is such an important program. I am very proud to be part of it.”
Panel discussions of what works
best.
Breakout sessions –dentists/staff sharing experience and advice on conducting the study in their offices.
Member enthusiasm helps recruit participants for ongoing studies.
Feedback TO members about studies:
- report card
- study results
Feedback FROM members about ideas/options:
- “clicker” responses
- SurveyMonkey short questionnaires
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