Astrochronology of the Paleocene-Eocene Thermal Maximum on the Atlantic Coastal Plain.

The chronology of the Paleocene-Eocene Thermal Maximum (PETM, ~56 Ma) remains disputed, hampering complete understanding of the possible trigger mechanisms of this event. Here we present an astrochronology for the PETM carbon isotope excursion from Howards Tract, Maryland a paleoshelf environment, on the mid-Atlantic Coastal Plain. Statistical evaluation of variations in calcium content and magnetic susceptibility indicates astronomical forcing was involved and the PETM onset lasted about 6 kyr.

Dental Decision Simulation (DDSim): Development of a virtual training environment.

Purpose: Case-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence.

Development, validity and reliability of the Orofacial Esthetic Scale - Spanish version.

Purpose: To develop a Spanish version of the Orofacial Esthetic Scale (OES-Sp) and to determine its psychometric properties in dental patients.

Methods: We performed a validation study for OES development and validation into Spanish. In the development phase, eight individuals participated in the translation process (cross-cultural adaptation) following the PROMIS methodology.

Quantifying Dental Office-Originating Adverse Events: The Dental Practice Study Methods.

Background: Preventable medical errors in hospital settings are the third leading cause of deaths in the United States. However, less is known about harm that occurs in patients in outpatient settings, where the majority of care is delivered. We do not know the likelihood that a patient sitting in a dentist chair will experience harm.

Overcoming stability challenges in the quantification of tissue nucleotides: determination of 2'-C-methylguanosine triphosphate concentration in mouse liver.

A conventional, rapid and high throughput method for tissue extraction and accurate and selective LC-MS/MS quantification of 2'-C-methylguanosine triphosphate (2'-MeGTP) in mouse liver was developed and qualified. Trichloroacetic acid (TCA) was used as the tissue homogenization reagent that overcomes instability challenges of liver tissue nucleotide triphosphates due to instant ischemic degradation to mono- and diphosphate nucleotides. Degradation of 2'-MeGTP was also minimized by harvesting livers using in situ clamp-freezing or snap-freezing techniques.

Persistence of smoking-cessation decision support use in a dental practice.

Introduction: A computer-assisted tobacco decision support tool increased dental practitioners' (dentists and dental hygienists) advice to quit smoking and referral to a quitline during a group randomized trial. The purpose of this study is to document the extent to which use persisted after the trial.

Methods: Electronic dental record (EDR) data from 2010 to 2013 were analyzed in 2014 for use of computer-assisted tobacco intervention tool advice scripts and referral to a quitline during four periods: during the trial and post-trial when only intervention clinic dental practitioners had access to the tool, and during full deployment, both before and after an EDR modification.

Personalised physician learning intervention to improve hypertension and lipid control: randomised trial comparing two methods of physician profiling.

Purpose: To assess the impact of personalised physician learning (PPL) interventions using simulated learning cases on control of hypertension and dyslipidaemia in primary care settings.

Methods: A total of 132 primary care physicians, 4568 eligible patients with uncontrolled hypertension, and 15 392 eligible patients with uncontrolled dyslipidaemia were cluster-randomised to one of three conditions: (a) no intervention, (b) PPL-electronic medical record (EMR) intervention in which 12 PPL cases were assigned to each physician based on observed patterns of care in the EMR in the previous year, or (c) PPL-ASSESS intervention in which 12 PPL cases were assigned to each physician based on their performance on four standardised assessment cases. General and generalised linear mixed models were used to account for clustering and to model differences in patient outcomes in the study arms.

Educating resident physicians using virtual case-based simulation improves diabetes management: a randomized controlled trial.

Purpose: To test a virtual case-based Simulated Diabetes Education intervention (SimDE) developed to teach primary care residents how to manage diabetes.

Method: Nineteen primary care residency programs, with 341 volunteer residents in all postgraduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The Web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models.

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 simulation technology to teach diabetes care management skills to resident physicians.

Background: Simulation is widely used to teach medical procedures. Our goal was to develop and implement an innovative virtual model to teach resident physicians the cognitive skills of type 1 and type 2 diabetes management.

Methods: A diabetes educational activity was developed consisting of (a) a curriculum using 18 explicit virtual cases, (b) a web-based interactive interface, (c) a simulation model to calculate physiologic outcomes of resident actions, and (d) a library of programmed feedback to critique and guide resident actions between virtual encounters.

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.

A comparison of dental restoration outcomes after placement by restorative function auxiliaries versus dentists.

Objectives: To compare the outcomes of restorations placed by restorative function auxiliaries (RFAs) with those placed by dentists.

Methods: Between July 1, 2007, and June 30, 2008, we matched 455 restorations placed by RFAs working at HealthPartners Dental Group with the same number placed by dentists. Restorations were matched by tooth number, American Dental Association procedure code, and patient age-group.

Cost-effectiveness of an electronic medical record based clinical decision support system.

Background And Objective: Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system.

Data Sources/setting: Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model.

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.

Impact of electronic health record clinical decision support on diabetes care: a randomized trial.

Purpose: We wanted to assess the impact of an electronic health record-based diabetes clinical decision support system on control of hemoglobin A(1c) (glycated hemoglobin), blood pressure, and low-density lipoprotein (LDL) cholesterol levels in adults with diabetes.

Methods: We conducted a clinic-randomized trial conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians' 2,556 patients with diabetes.

Simulated physician learning program improves glucose control in adults with diabetes.

Objective: Inexpensive and standardized methods to deliver medical education to primary care physicians (PCPs) are desirable. Our objective was to assess the impact of an individualized simulated learning intervention on diabetes care provided by PCPs.

Research Design And Methods: Eleven clinics with 41 consenting PCPs in a Minnesota medical group were randomized to receive or not receive the learning intervention.

Does diabetes double the risk of depression?

Purpose: In this study, we compared the rate of depression diagnoses in adults with and without diabetes mellitus, while carefully controlling for number of primary care visits.

Methods: We matched adults with incident diabetes (n = 2,932) or prevalent diabetes (n = 14,144) to nondiabetic control patients based on (1) age and sex, or (2) age, sex, and number of outpatient primary care visits. Logistic regression analysis was used to assess the association between various predictors and a diagnosis of depression in each diabetes cohort relative to matched nondiabetic control patients.

Customized feedback to patients and providers failed to improve safety or quality of diabetes care: a randomized trial.

Objective: To assess whether providing customized clinical information to patients and physicians improves safety or quality of diabetes care.

Research Design And Methods: Study subjects included 123 primary care physicians and 3,703 eligible adult diabetic patients with elevated A1C or LDL cholesterol, who were randomly assigned to receive customized feedback of clinical information as follows: 1) patient only, 2) physician only, 3) both the patient and physician, or 4) neither patient nor physician. In the intervention groups, patients received customized mailed information or physicians received printed, prioritized lists of patients with recommended clinical actions and performance feedback.

Simulated physician learning intervention to improve safety and quality of diabetes care: a randomized trial.

Objective: To assess two physician learning interventions designed to improve safety and quality of diabetes care delivered by primary care physicians (PCPs).

Research Design And Methods: This group randomized clinical trial included 57 consenting PCPs and their 2,020 eligible adult patients with diabetes. Physicians were randomized to no intervention (group A), a simulated case-based physician learning intervention (group B), or the same simulated case-based learning intervention with physician opinion leader feedback (group C).

Exploring the contributions of components of caries risk assessment guidelines.

Objective: To examine the relative contribution of current caries activity, past caries experience, and dentists' subjective assessment of caries risk classifications.

Methods: Administrative data from two dental plans were analyzed to determine dentists' risk classification, as well as current caries activity and previous caries experience at the time of the classification. The performance of these predictors in identifying patients who would experience subsequent caries was then modeled using logistic regression.

Depression in patients with diabetes: does it impact clinical goals?

Introduction: To examine whether depressive symptoms are associated with achievement of recommended goals for control of glucose, lipids, and blood pressure among patients with diabetes.

Methods: We used a prospective cohort study of 1223 adults with diabetes that obtained self-reported depression symptoms from a survey. Medication use was obtained from claims data, and pharmacy and clinical data were obtained by manual review of paper medical records.

Clinical inertia in dentistry: a review of the phenomenon.

Aim: Dentistry has been slow to adopt innovations in dental practice even when they are recommended by national organizations and supported by evidence-based guidelines. The objective of this review is to describe clinical inertia, a concept described frequently in the medical literature, and to use findings from tobacco cessation and dental sealant studies as evidence of its existence.

Methods And Materials: A review of the literature published during the past 30 years was conducted to determine the state of affairs of two very different areas of dental practice, tobacco cessation intervention and application of sealants, to demonstrate the concept of clinical inertia in dental practice.

Variation in quality of diabetes care at the levels of patient, physician, and clinic.

Introduction: We studied variance in glycated hemoglobin (HbA1c) values among adults with diabetes to identify variation in quality of diabetes care at the levels of patient, physician, and clinic, and to identify which levels contribute the most to variation and which variables at each level are related to quality of diabetes care.

Methods: Study subjects were 120 primary care physicians and their 2589 eligible adult patients with diabetes seen at 18 clinics. The dependent variable was HbA1c values recorded in clinical databases.

Outcomes associated with dentists' risk assessment.

Objective: To examine retrospectively the caries-related restorative experience of at-risk individuals who received fluoride-based preventive interventions to determine if the intervention resulted in fewer caries-related procedures.

Methods: Administrative data from two dental health plans were used to determine the relationship between caries risk assessment (CRA) scores, preventive treatment and caries-related treatment procedures. We identified 45 693 adults who were consecutively enrolled for at least 1 year before and 2.