Utilization and Validity of the Dental Diagnostic System over Time in Academic and Private Practice.

INTRODUCTION: To fill the void created by insufficient dental terminologies, a multi-institutional workgroup was formed among members of the Consortium for Oral Health Research and Informatics to develop the Dental Diagnostic System (DDS) in 2009. The adoption of dental diagnosis terminologies by providers must be accompanied by rigorous usability and validity assessments to ensure their effectiveness in practice. OBJECTIVES: The primary objective of this study was to describe the utilization and correct use of the DDS over a 4-y period. METHODS: Electronic health record data were amassed from 2013 to 2016 where diagnostic terms and Current Dental Terminology procedure code pairs were adjudicated by calibrated dentists. With the resultant data, we report on the 4-y utilization and validity of the DDS at 5 dental institutions. Utilization refers to the proportion of instances that diagnoses are documented in a structured format, and validity is defined as the frequency of valid pairs divided by the number of all treatment codes entered. RESULTS: Nearly 10 million procedures ( n = 9,946,975) were documented at the 5 participating institutions between 2013 and 2016. There was a 1.5-fold increase in the number of unique diagnoses documented during the 4-y period. The utilization and validity proportions of the DDS had statistically significant increases from 2013 to 2016 ( P < 0.0001). Academic dental sites were more likely to document diagnoses associated with orthodontic and restorative procedures, while the private dental site was equally likely to document diagnoses associated with all procedures. Overall, the private dental site had significantly higher utilization and validity proportions than the academic dental sites. CONCLUSION: The results demonstrate an improvement in utilization and validity of the DDS terminology over time. These findings also yield insight into the factors that influence the usability, adoption, and validity of dental terminologies, raising the need for more focused training of dental students. KNOWLEDGE TRANSFER STATEMENT: Ensuring that providers use standardized methods for documentation of diagnoses represents a challenge within dentistry. The results of this study can be used by clinicians when evaluating the utility of diagnostic terminologies embedded within the electronic health record.

Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.

BACKGROUND: Documenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record. METHODS: Kotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed. RESULTS: Kotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element. CONCLUSION: Change strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care. PRACTICAL IMPLICATIONS: A practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture.

Culicoides bottimeri as a vector of Haemoproteus lophortyx to quail in California, USA.

Arthropod sampling via periodic direct bird examination and regular light trapping was conducted between June 2000 and October 2002 to survey for potential vectors of Haemoproteus lophortyx to nonnative, captive-raised bobwhite quail (Colinus virginianus) in northern California, USA. Examination of individual bobwhite quail (from 5 weeks of age through adult, total n=76) was conducted on several dates during the transmission period (June-October). No ectoparasites, including hippoboscid flies (reported as Haemoproteus vectors to wild quail in early literature), were collected from the birds. Trapping with ultraviolet light suction traps near the quail revealed nine species of biting midges (Culicoides spp.). Of these, 94% were C. bottimeri, which was abundant near the birds, and 65% of collected C. bottimeri were engorged with blood. C. bottimeri adult activity began in late-April, slightly before the onset of disease in the quail. Activity peaked between July and late-September, coincident with maximum reported transmission, and adult activity ceased by early-November. Nonengorged C. bottimeri had a parity rate of 43.6% overall, suggesting excellent survival for biological transmission of a pathogen like H. lophortyx. A controlled study was done injecting a macerated slurry of pooled, nonengorged, wild-caught C. bottimeri into the peritoneum of 1-day-old bobwhite quail hatchlings held in insect-proof containers. Blood smears 13-19 days later confirmed H. lophortyx infection in zero controls but all insect-injected quail. Biting midges, especially C. bottimeri, transmit H. lophortyx to captive quail and probably are the dominant vector to native California quail (Callipepla californica) as well.

The Mouse Genome Database (MGD): from genes to mice--a community resource for mouse biology.

The Mouse Genome Database (MGD) forms the core of the Mouse Genome Informatics (MGI) system (http://www.informatics.jax.org), a model organism database resource for the laboratory mouse. MGD provides essential integration of experimental knowledge for the mouse system with information annotated from both literature and online sources. MGD curates and presents consensus and experimental data representations of genotype (sequence) through phenotype information, including highly detailed reports about genes and gene products. Primary foci of integration are through representations of relationships among genes, sequences and phenotypes. MGD collaborates with other bioinformatics groups to curate a definitive set of information about the laboratory mouse and to build and implement the data and semantic standards that are essential for comparative genome analysis. Recent improvements in MGD discussed here include the enhancement of phenotype resources, the re-development of the International Mouse Strain Resource, IMSR, the update of mammalian orthology datasets and the electronic publication of classic books in mouse genetics.

Cerebrospinal fluid lipoperoxides quantified by liquid chromatography, and determination of reference values.

Cerebrospinal fluid lipoperoxides, measured as the malondialdehyde-thiobarbituric acid (MDA-TBA) adduct, were quantified by adapting the plasma liquid-chromatographic method of Wong et al. (Clin Chem 1987;33:214-20) to cerebrospinal fluid. Reference values for spinal fluid specimens from 91 adults, ages 17 to 95 y, and 37 children, ages 8 d to 8 y, were determined. Their concentrations were not significantly different (P = 0.222), adults having a mean (and SD) of 0.11 (0.06) mumol and children 0.10 (0.04) mumol of MDA per liter. Their ranges were 0.02-0.26 and 0.04-0.21 mumol of MDA per liter, respectively. We found concentrations in cerebrospinal fluid to be increased in several central nervous system disorders, including seizures, cerebral infarction, alcoholic encephalopathy, and, perhaps, prematurity. The presence of other thiobarbituric acid-reactive substances in cerebrospinal fluid stresses the importance of using highly specific techniques when lipoperoxides are measured in body fluids.

Metal-catalyzed peroxidation of polyunsaturated fatty acids.

In this study malondialdehyde (MDA) was measured as the thiobarbituric acid (TBA) adduct by high performance liquid chromatography with linolenic acid (LA), as well as with LA to which the following metal ions were added: Ag+1, Al+3, As+5, Ba+2, Cd+2, Co+2, Cu+1, Cu+2, Fe+2, Fe+3, Hg+2, Mn+2, Ni+2, Pb+2, and Zn+2. Our results showed that Fe+3 is a particularly potent catalyst of this oxidation reaction. Several other metals also significantly increased the production of MDA over LA alone, as shown by the Mann-Whitney test, including Al+3 and Fe+2 (p less than 0.001), Cu+2, Ba+2, Mn+2 (p less than 0.01), and As+5 (p less than 0.05). Pb+2 almost completely inhibited the production of MDA from LA (p less than 0.001). Addition of the free radical scavenger, butylated hydroxytoluene (BHT), significantly inhibited MDA formation in these latter reactions, indicating they are free-radical mediated. Pre-incubation of the reaction mixtures at 37 degrees C and physiologic pH with both Fe+2 and Fe+3 greatly increased MDA formation, suggesting that in acute metal toxicity the initiating free-radical process might be primarily due to direct metal catalysis of preformed lipid peroxides.

Specificity of the thiobarbituric acid reaction: its use in studies of lipid peroxidation.

The thiobarbituric acid (TBA) reaction, quantified by colorimetry or fluorimetry, is the method most widely used for studying lipid peroxidation in both laboratory animals and in humans with disorders. However, concerns regarding its analytical specificity have often been expressed, because TBA reacts with a wide variety of chemical species to produce a pink to red color. In this study, we reacted TBA with various saturated and unsaturated aldehydes (both directly and in the presence of sucrose, fructose, and glucose), substituted pyrimidines, 2-deoxyribose, and N-acetylneuraminic acid. We also studied the TBA reaction with bilirubin, biliverdin, icteric serum, and serum containing hemolyzed erythrocytes, comparing the absorption spectra of these reaction products with that for malondialdehyde (MDA). The reaction products were also analyzed for MDA by high-performance liquid chromatography (HPLC). Although the TBA reaction with some of these compounds may not be important in biological studies, others could lead to misinterpretations of increased lipid peroxidation. Use of HPLC to quantify MDA is recommended because of its high analytical sensitivity and specificity, especially in the study of lipid peroxidation in human subjects.

A new patient-circuit adapter for use with high frequency jet ventilators.

Current techniques of connecting a patient's endotracheal tube to the delivery circuit of a high frequency jet ventilator have several disadvantages. We describe a rigid, interchangeable adapter with a built-in jet injector that connects to any type or size of endotracheal tube. The device is reusable and avoids some of the disadvantages, such as catheter kinking, difficulty in accommodating injectors of different diameters, and tracheal tube obstruction, inherent in other commonly used techniques. It has been used successfully on 44 patients ranging in size from premature infants to adults.

A heat and humidification system for high frequency jet ventilation.

The clinical application of high frequency jet ventilation (HFJV), especially in pediatrics, has been hindered by the lack of adequate heating and humidification of the delivered gas. A technique of injecting particulate water into the gas from the jet ventilator has been described in the literature. However, it has been used primarily on adults and may cause fluid overload or hypothermia when used on infants. We describe a device for use during HFJV that provides gas (free of particulate water) to the patient at or near body temperature, with a relative humidity of 91%. This system has been used on 34 persons (14 premature infants, 17 small children, and 3 adults) without complications associated with improper conditioning of inspired gas.

Effects of conventional and high frequency jet ventilation on lung parenchyma.

Despite the increasing acceptance of high frequency jet ventilation (HFJV), very little work has been done to determine if lung damage results from its use. We performed an experimental study to compare the effects of conventional ventilation with those of HFJV on the lung parenchyma of anesthetized dogs. Thirteen animals were studied for periods ranging from 2-24 h. Using a double-lumen Carlen's endotracheal tube, each animals's lungs were ventilated simultaneously but independently, one with conventional ventilation, the other with HFJV. No gross or microscopic evidence of atelectasis or barotrauma was noted in either group. Less hyperaeration was seen in the majority of jet ventilated lungs compared to the conventionally ventilated. In no case did the jet ventilated side show more damage than the control. We concluded that it is possible to use HFJV for 24 h without apparent parenchymal lung damage. Reduced hyperaeration is identified as a possible advantage of HFJV over conventional methods.