Academic detailing in oral healthcare - results of the ADVOCATE Field Studies.

Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms.Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies.Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs.

Correction: Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare-A Q-methodology study.

[This corrects the article DOI: 10.1371/journal.pone.0219931.].

Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare-A Q-methodology study.

OBJECTIVE: In the last 30 years, innovations in oral healthcare (OHC), such as advanced restorative techniques, shifts towards preventive and evidence-based care and changes in patients' expectations, have increased the complexity of clinical decision-making in OHC. Little is known about the perspectives of general dental practitioners (GDPs) on the value of providing preventive, patient-centred and evidence-based OHC. This study aimed to explore the range of perspectives present amongst GDPs on OHC. METHOD: Q-methodology was used to explore perspectives among 78 GDPs working in the Netherlands. Participants were asked to sort 50 statements representing three central domains in OHC: i.) restorative versus preventative OHC, ii.) disease-centred versus patient-centred OHC and iii.) expertise-based versus evidence-based OHC. Opinion statements about delivering OHC were formulated on the basis of published literature and input from OHC professionals. By-person factor analysis was used to reveal clusters of communality in statement rankings, which were interpreted and formed perspectives on OHC. RESULTS: Four perspectives, explaining 47% of variance, on OHC were identified amongst GDPs: 'the patient-focused dentist who values prevention', 'the outcome-oriented dentist who values learning from colleagues', 'the team player with ultimate care responsibility' and 'the dentist who considers oral health the responsibility of the patient.' CONCLUSION: Q-methodology can be effectively used to describe the different perspectives that GDPs have on the challenges of preventive, patient-centred and evidence-based OHC. GDPs should not be seen as a homogenous group; rather they have different views and approaches to the care they provide. This has implications for health systems; awareness of the heterogeneity of practitioners' perspectives can potentially be used to develop bespoke quality of care improvement strategies that constructively engage with each of these different groups.

Granular cell tumor of the gallbladder: case report and review of the literature.

BACKGROUND: Granular cell tumors (GCTs) are rare benign tumors, which originate in the tongue, ovary, oropharynx, GIT and respiratory tract. Biliary GCTs are rarities. Clinical presentations depend on tumor site. CASE REPORT: A 62-year-old male, presented with acute and severe abdominal pain for fifteen days. He was in pain, not pale or jaundiced. Abdominal imaging showed thick-walled gallbladder with multiple stones suggestive of calcular cholecystitis and liver cirrhosis. The diagnosis of acute-on-chronic cholecystitis was made. Following informed consent open cholecystectomy showed a cirrhotic liver with enlarged Calot's lymph node and thick adhesions. Histopathology revealed a benign GCT of the gallbladder. The patient recovered uneventfully. The patient was well with no tumor recurrence after one year follow up. CONCLUSION: GCT of the gallbladder should be considered in patients presenting as acute-on-chronic cholecystitis without imaging evidence of tumor. Surgical removal with wide safety margins should be contemplated.