Variation in a Darwin Wasp (Hymenoptera: Ichneumonidae) Community along an Elevation Gradient in a Tropical Biodiversity Hotspot: Implications for Ecology and Conservation.

Understanding how biodiversity varies from place to place is a fundamental goal of ecology and an important tool for halting biodiversity loss. Parasitic wasps (Hymenoptera) are a diverse and functionally important animal group, but spatial variation in their diversity is poorly understood. We survey a community of parasitic wasps (Ichneumonidae: Pimplinae) using Malaise traps up a mountain in the Brazilian Atlantic Rainforest, and relate the catch to biotic and abiotic habitat characteristics. We find high species richness compared with previous similar studies, with abundance, richness, and diversity peaking at low to intermediate elevation. There is a marked change in community composition with elevation. Habitat factors strongly correlated with elevation also strongly predict changes in the pimpline community, including temperature as well as the density of bamboo, lianas, epiphytes, small trees, and herbs. These results identify several possible surrogates of pimpline communities in tropical forests, which could be used as a tool in conservation. They also contribute to the growing evidence for a typical latitudinal gradient in ichneumonid species richness, and suggest that low to medium elevations in tropical regions will sometimes conserve the greatest number of species locally, but to conserve maximal biodiversity, a wider range of elevations should also be targeted.

Feasibility and acceptance of oral human papillomavirus detection in the dental office: Results from The National Dental Practice-Based Research Network.

BACKGROUND: Oral human papillomavirus (HPV) infection is the principal underlying cause of a dramatic increase in oropharyngeal cancer. Dentistry can play an important role in developing clinical algorithms for secondary prevention. METHODS: The authors conducted this cross-sectional pilot study with practices of The National Dental Practice-Based Research Network. The authors evaluated the feasibility and acceptability of screening and testing procedures as judged by practitioners and patients. The authors used tablet devices for patient screening, obtaining consent, and administering a confidential oral HPV risk factor survey. RESULTS: Most patients (85%) were comfortable being asked about their cigarette use and their sexual behavior (69%) and were interested in participating again (79%). More than 90% of practitioners were comfortable with study procedures except the extra time required for patient participation (75% comfortable). There were no problems with oral rinse collection as reported by patients or practitioners. CONCLUSIONS: It is feasible in community dental offices to collect oral rinses for HPV detection and to ask patients explicit questions about sexual history when using a tablet device for confidentiality. PRACTICAL IMPLICATIONS: Discussing high-risk types of HPV and appropriately assessing that risk are a challenge for oral health care professionals. These results are positive from a research perspective but do not address the advisability of routine HPV screening in dentistry.

Survey Methods to Optimize Response Rate in the National Dental Practice-Based Research Network.

Surveys of health professionals typically have low response rates, and these rates have been decreasing in the recent years. We report on the methods used in a successful survey of dentist members of the National Dental Practice-Based Research Network. The objectives were to quantify the (1) increase in response rate associated with successive survey methods, (2) time to completion with each successive step, (3) contribution from the final method and personal contact, and (4) differences in response rate and mode of response by practice/practitioner characteristics. Dentist members of the network were mailed an invitation describing the study. Subsequently, up to six recruitment steps were followed: initial e-mail, two e-mail reminders at 2-week intervals, a third e-mail reminder with postal mailing a paper questionnaire, a second postal mailing of paper questionnaire, and staff follow-up. Of the 1,876 invited, 160 were deemed ineligible and 1,488 (87% of 1,716 eligible) completed the survey. Completion by step: initial e-mail, 35%; second e-mail, 15%; third e-mail, 7%; fourth e-mail/first paper, 11%; second paper, 15%; and staff follow-up, 16%. Overall, 76% completed the survey online and 24% on paper. Completion rates increased in absolute numbers and proportionally with later methods of recruitment. Participation rates varied little by practice/practitioner characteristics. Completion on paper was more likely by older dentists. Multiple methods of recruitment resulted in a high participation rate: Each step and method produced incremental increases with the final step producing the largest increase.

Integrating tobacco dependence counseling into electronic dental records: a multi-method approach.

Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentistry has not adopted or developed effective interventions to deal with tobacco dependence. With the expanded use of electronic dental records, the authors identified an opportunity to incorporate standardized expert support for tobacco dependence counseling during the dental visit. Using qualitative results from observations and focus groups, a decision support system was designed that suggested discussion topics based on the patient's desire to quit and his or her level of nicotine addiction. Because dental providers are always pressed for time, the goal was a three-minute average intervention interval. To fulfill the provider's need for an easy way to track ongoing interventions, script usage was recorded. This process helped the provider track what he or she had said to the patient about tobacco dependence during previous encounters and to vary the messages. While the individual elements of the design process were not new, the combination of them proved to be very effective in designing a usable and accepted intervention. The heavy involvement of stakeholders in all components of the design gave providers and administrators ownership of the final product, which was ultimately adopted for use in all the clinics of a large dental group practice in Minnesota.

Practice change toward better adherence to evidence-based treatment of early dental decay in the National Dental PBRN.

BACKGROUND: Significant national investments have aided the development of practice-based research networks (PBRNs) in both medicine and dentistry. Little evidence has examined the translational impact of these efforts and whether PBRN involvement corresponds to better adoption of best available evidence. This study addresses that gap in knowledge and examines changes in early dental decay among PBRN participants and non-participants with access to the same evidence-based guideline. This study examines the following questions regarding PBRN participation: are practice patterns of providers with PBRN engagement in greater concordance with current evidence? Does provider participation in a PBRNs increase concordance with current evidence? Do providers who participate in PBRN activities disseminate knowledge to their colleagues? METHODS: Logistic regression models adjusting for clustering at the clinic and provider levels compared restoration (dental fillings) rates from 2005-2011 among 35 providers in a large staff model practice. All new codes for early-stage caries (dental decay) and co-occurring caries were identified. Treatment was determined by codes occurring up to 6 months following the date of diagnosis. Provider PBRN engagement was determined by study involvement and meeting attendance. RESULTS: In 2005, restoration rates were high (79.5%), decreased to 47.6% by 2011 (p < .01), and differed by level of PBRN engagement. In 2005, engaged providers were less likely to use restorations compared to the unengaged (73.1% versus 88.2%; p < .01). Providers with high PBRN involvement decreased use of restorations by 15.4% from 2005 to 2008 (2005: 73%, 2008: 63%; p < .01). Providers with no PBRN involvement decreased use by only 7.5% (2005: 88%, 2008: 82%; p = .041). During the latter half of 2008 following the May PBRN meeting, attendees reduced restorations by 7.5%, compared to a 2.4% among non-attendees (OR = .64, p < .01). CONCLUSIONS: Based on actual clinical data, PBRN engagement was associated with practice change consistent with current evidence on treatment of early dental decay. The impact of PBRN engagement was most significant for the most-engaged providers and consistent with a spillover effect onto same-clinic providers who were not PBRN-engaged. PBRNs can generate relevant evidence and expedite translation into practice.

Computer-assisted guidance for dental office tobacco-cessation counseling: a randomized controlled trial.

BACKGROUND: Decreases in smoking prevalence from recent decades have slowed, and national goals to reduce tobacco use remain unmet. Healthcare providers, including those in physician and dental teams, have access to evidence-based guidelines to help patients quit smoking. Translation of those guidelines into practice, however, remains low. Approaches that involve screening for drug use, brief intervention, and referral to treatment (SBIRT) are a promising, practical solution. PURPOSE: This study examined whether dentists and dental hygienists would assess interest in quitting, deliver a brief tobacco intervention, and refer to a tobacco quitline more frequently as reported by patients if given computer-assisted guidance in an electronic patient record versus a control group providing usual care. DESIGN: A blocked, group-randomized trial was conducted from November 2010 to April 2011. Randomization was conducted at the clinic level. Patients nested within clinics represented the lowest-level unit of observation. SETTING/PARTICIPANTS: Participants were patients in HealthPartners dental clinics. INTERVENTION: Intervention clinics were given a computer-assisted tool that suggested scripts for patient discussions. Usual care clinics provided care without the tool. MAIN OUTCOME MEASURES: Primary outcomes were post-appointment patient reports of the provider assessing interest in quitting, delivering a brief intervention, and referring them to a quitline. RESULTS: Patient telephone surveys (72% response rate) indicated that providers assessed interest in quitting (control 70% vs intervention 87%, p=0.0006); discussed specific strategies for quitting (control 26% vs intervention 47%, p=0.003); and referred the patient to a tobacco quitline (control 17% vs intervention 37%, p=0.007) more frequently with the support of a computer-assisted tool integrated into the electronic health record. CONCLUSIONS: Clinical decision support embedded in electronic health records can effectively help providers deliver tobacco interventions. These results build on evidence in medical settings supporting this approach to improve provider-delivered tobacco cessation. TRIAL REGISTRATION: This study is registered at ClinicalTrials.govNCT01584882.

Large-scale clinical endodontic research in the National Dental Practice-Based Research Network: study overview and methods.

INTRODUCTION: This article reports on the feasibility of conducting a large-scale endodontic prospective cohort study in The National Dental Practice-Based Research Network. This study was designed to measure pain and burden associated with initial orthograde root canal therapy (RCT) and to explore potential prognostic factors for pain outcomes. The main objectives of this first report in a series are to describe the project's feasibility and methods and the demographics of the sample obtained. METHODS: Sixty-two dentist practitioner-investigators (ie, 46 generalists and 16 endodontists) in 5 geographic areas were certified within the network and trained regarding the standardized study protocol. Enrollment and baseline data collection occurred over 6 months with postobturation follow-up for another 6 months. Patients and dentists completed questionnaires before and immediately after treatment visits. Patients also completed questionnaires at 1 week, 3 months, and 6 months after obturation. RESULTS: Enrollment exceeded target expectations, with 708 eligible patient-participants. Questionnaire return rates were good, ranging between 90% and 100%. Patient demographics were typical of persons who receive RCT in the United States (ie, mean age = 48 years [standard deviation = 13 years], with most being female [59%], college educated [81%], white non-Hispanic [86%], and having dental insurance [81%]). The tooth types being treated were also typical (ie, 61% molars, 28% premolars, and 11% anteriors, with maxillary teeth being predominant [59%]). CONCLUSIONS: This study shows the feasibility of conducting large-scale endodontic prospective cohort studies in the network. Patients were rapidly recruited with high levels of compliance in data collection.

The effect of electronic health records on the use of clinical care guidelines for patients with medically complex conditions.

BACKGROUND: The emergence of health information technology provides an opportunity for health care providers to improve the quality and safety of dental care, particularly for patients with medically complex conditions. METHODS: The authors randomized each of 15 dental clinics (HealthPartners, Bloomington, Minn.) to one of three groups to evaluate the impact of two clinical decision support (CDS) approaches during an 18-month study period. In the first approach--provider activation through electronic dental records (EDRs)--a flashing alert was generated at the dental visit to identify patients with medically complex conditions and to direct the dental care provider to Web-based personalized care guidelines. In the second approach--patient activation through personal health records--a secure e-mail was generated or a letter was mailed to patients before dental visits encouraging them to ask their dental care provider to review the care guidelines specific to their medical conditions. RESULTS: The authors evaluated the rate of reviewing care guidelines among 102 providers. Participants in the provider and patient activation groups increased their use of the system during the first six months, which had a generalized effect of increasing use of the guidelines for all patients, even if they were not part of the study (P < .05). The study results showed that provider activation was more effective than was patient activation. However, providers did not sustain their high level of use of the system, and by the end of the study, the rate of use had returned to baseline levels despite participants' continued receipt of electronic alerts. CONCLUSIONS: The study results demonstrated that review of clinical care guidelines for patients with medically complex conditions can be improved with CDS systems that involve the use of electronic health records. CLINICAL IMPLICATIONS: As the U.S. population ages, dentists must be vigilant in adapting care for patients with medically complex conditions to ensure therapeutic safety and effectiveness. Expanded use of CDS via EDRs can help dental care providers achieve this objective.