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1.  Caries treatment in a dental practice-based research network: movement toward stated evidence-based treatment 
Community dentistry and oral epidemiology  2012;41(2):10.1111/cdoe.12008.
Practice-based research networks (PBRNs) provide a venue to foster evidence-based care. We tested the hypothesis that a higher level of participation in a dental PBRN is associated with greater stated change toward evidence-based practice.
A total of 565 dental PBRN practitioner-investigators completed a baseline questionnaire entitled “Assessment of Caries Diagnosis and Treatment”; 405 of these also completed a follow-up questionnaire about treatment of caries and existing restorations. Certain questions (6 treatment scenarios) were repeated at follow-up a mean (S.D.) of 36.0 (3.8) months later. A total of 224 were “full participants” (enrolled in clinical studies and attended at least one network meeting); 181 were “partial participants” (did not meet “full” criteria).
From 10% to 62% of practitioners were “surgically invasive” at baseline, depending on the clinical scenario. Stated treatment approach was significantly less-invasive at follow-up for 4 of 6 items. Change was greater among full participants and those with a more-invasive approach at baseline, with an overall pattern of movement away from the extremes.
These results are consistent with a preliminary conclusion that network participation fostered movement of scientific evidence into routine practice. PBRNs may foster movement of evidence into everyday practice as practitioners become engaged in the scientific process.
PMCID: PMC3811014  PMID: 23036131
Implementation research; practice-based research; dentistry; quality improvement; dental caries; dental restorations
2.  Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): Development of Image Analysis Criteria and Examiner Reliability for Image Analysis 
As a part of a multi-site RDC/TMD Validation Project, comprehensive TMJ diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computed tomography (CT).
Inter-examiner reliability was estimated using the kappa (k) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. CT was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA).
For the radiological diagnosis of OA, reliability of the three examiners was poor for panoramic radiography (k = 0.16), fair for MRI (k = 0.46), and close to the threshold for excellent for CT (k = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (k = 0.78) and for DD without reduction (k = 0.94), and was good for effusion (k = 0.64). Overall percent agreement for pair-wise ratings was ≥ 82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and for effusion was 81%. Negative percent agreement was ≥ 88% for all conditions. Compared to CT, panoramic radiography and MRI had poor to marginal sensitivity, respectively, but excellent specificity, in detecting OA.
Comprehensive image analysis criteria for RDC/TMD Validation Project were developed, which can reliably be employed for assessing OA using CT, and for disc position and effusion using MRI.
PMCID: PMC3139469  PMID: 19464658
RDC/TMD; osteoarthritis; temporomandibular disorders; panoramic radiography; MRI; CT; diagnostic criteria
3.  Comparison of Oral and Intravenous Diazepam Sedation for Periodontal Surgery 
Anesthesia Progress  1987;34(2):46-50.
Intravenous and oral diazepam were evaluated as to their effectiveness in conscious sedation during two similar surgical episodes. Ten patients, six females and four males, from 30 to 60 years of age were included in the study. Patients received either 10 mg oral diazepam and saline intravenous injection or oral placebo and 10 mg intravenous (IV) diazepam at each trial. Half the patients received the oral diazepam first and the other half received the IV diazepam first. Patients were not informed as to the route of administration during each trial. Physiologic stress was measured by monitoring blood pressure, heart rate, skin temperature, galvanic skin response, and plasma catecholamine levels. Patients evaluated their comfort and nervousness levels on a questionnaire. Anterograde amnesia was tested by patient's ability to recall objects shown them during the procedure. As evidenced by the physiologic and biochemical parameters, intravenous diazepam was more effective in reducing anxiety and stress as compared with an equivalent oral dose. Patients' subjective ratings were consistent with these findings. Intravenous diazepam was effective in producing anterograde amnesia in the majority of patients, whereas no amnesic effect was noted with oral diazepam. Correlation statistics demonstrated a relative independence of the parameters measured in the present study indicating that all parameters must be considered in overall patient evaluation. Reduction of anxiety during the first surgery resulted in less anxiety on the subsequent visit.
PMCID: PMC2148577  PMID: 3474910
4.  Effects of Nitrous Oxide on Chloral Hydrate Sedation of Young Children 
Anesthesia Progress  1986;33(6):298-302.
This study was performed to test the hypothesis that nitrous oxide augments the effects of chloral hydrate sedation of young children. Twenty children with a mean age of 32 months were sedated on two occasions with two different treatment regimens. All subjects received a standard dose of 50 mg/kg of chloral hydrate with or without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for a period of 20 minutes followed by 100% oxygen and, during the other visit, the reverse concentrations were used. All subjects were restrained in a Papoose Board* with an auxiliary head restraint. Successful sedation, as evident by lack of crying or movement which interrupted treatment, occurred in 84% of administrations. During the first twenty minutes, subjects receiving nitrous oxide moved and cried significantly less than when they were treated without nitrous oxide. During the remainder of the appointment, there was no difference in behavior between the two treatment regimens. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted and local anesthesia was administered. It is concluded that nitrous oxide augments the effect of chloral hydrate sedation of young children, but does not do so uniformly for all children receiving sedation.
PMCID: PMC2148557  PMID: 3468814

Results 1-4 (4)