***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND An increase in the number of dentists conducting tobacco-use cessation treatment is needed . The authors assessed the effects of high-intensity training ( HIT ) or low-intensity training ( LIT ) and reimbursement on general dentists ' tobacco-use-related attitudes and treatment behaviors . METHODS The authors r and omly selected 265 dentists in three states and assigned them to one of five groups : HIT workshop groups with and without tobacco-use cessation counseling reimbursement , LIT mailed self- study groups with and without reimbursement or a control group . Outcomes at follow-up were dentists ' self-reported tobacco-use-related attitudes and behaviors and patients ' reports of dentists ' behaviors . RESULTS Significantly more dentists in the intervention groups reported having positive attitudes and behaviors at follow-up than did dentists in the control group . Dentists in the HIT groups , however , reported assessing patients ' willingness to quit and assisting them with the quitting process significantly more often than did dentists in the LIT groups . Significantly more patients of dentists in the intervention groups who used tobacco reported receiving advice and assistance from their dentists than did patients of dentists in the control group . Adding reimbursement to HIT or LIT conditions did not provide additional intervention effect . CONCLUSION Dentists trained by means of a workshop or self- study program used components of a recommended guideline more frequently and felt more positive toward tobacco-use cessation counseling than did dentists in the control group . CLINICAL IMPLICATION S Although the workshop training was more successful than the self- study training , the latter 's reach among dentists could have a more significant public health impact . The effect of reimbursement needs further study Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies , using the Scottish Intercollegiate Guidelines Network ( SIGN ) Guideline 42 ' Management of unerupted and impacted third molar teeth ' ( published 2000 ) as a model . Design A pragmatic , cluster RCT ( 2 × 2 factorial design ) .Subjects Sixty-three dental practice s across Scotl and . Clinical records of all 16—24-year-old patients over two , four-month periods in 1999 ( pre-intervention ) and 2000 ( post-intervention ) were search ed by a clinical research er blind to the intervention group . Data were also gathered on the costs of the interventions . Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course ( PGEC ) . In addition to this , group 2 received audit and feedback ( A and F ) . Group 3 received a computer aided learning ( CAL ) package . Group 4 received A and F and CAL.Principal outcome measurement The proportion of patients whose treatment complied with the guideline . Results The weighted t-test for A and F versus no A and F ( P=0.62 ) and CAL versus no CAL ( P=0.76 ) were not statistically significant . Given the effectiveness results ( no difference ) the cost effectiveness calculation became a cost-minimisation calculation . The minimum cost intervention in the trial consisted of providing general dental practitioners ( GDPs ) with guidelines and the option of attending PGEC courses . Routine data which subsequently became available showed a Scotl and -wide fall in extraction s prior to data collection . Conclusion In an environment in which pre-intervention compliance was unexpectedly high , neither CAL nor A and F increased the dentists ' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course . The cost of the CAL arm of the trial was greater than the A and F arm . Further work is required to underst and dental professionals ' behaviour in response to guideline implementation strategies 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 r and omized 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 review ing 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 IMPLICATION S 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 . Exp and ed use of CDS via EDRs can help dental care providers achieve this objective OBJECTIVES Tobacco use adversely affects oral health . Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief  tobacco use  cessation counselling . Research shows that these guidelines are seldom implemented successfully . This study aim ed to evaluate two interventions to enhance tobacco use prevention and cessation ( TUPAC ) counselling among oral health professionals in Finl and . METHODS We used a cluster-r and omized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists ( n=73 ) and dental hygienists ( n=22 ) in Finl and .  Educational intervention consisted of 1 day of training , including lectures , interactive sessions , multimedia demonstrations and a role play session with st and ard patient cases . Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling . TUPAC counselling procedures provided were reported and measured using an electronic dental records system . In data analysis , intent-to-treat principles were followed at both individual and cluster levels . Descriptive analysis included chi-square and t-tests . A general linear model for repeated measures was used to compare the outcome measures by intervention group . RESULTS Of 95 providers , 73 participated ( 76.8 % ) . In preventive counselling , there was no statistically significant time effect or group-by-time interaction . In cessation counselling , statistically significant group-by-time interaction was found after a 6-month follow-up ( F=2.31 ; P=0.007 ) , indicating that counselling activity increased significantly in intervention groups . On average , dental hygienists showed greater activity in tobacco prevention ( F=12.13 ; P=0.001 ) and cessation counselling ( F=30.19 ; P<0.001 ) than did dentists . In addition , cessation counselling showed a statistically significant provider-by-group-by-time interaction ( F=5.95 ; P<0.001 ) , indicating that interventions to enhance cessation counselling were more effective among dental hygienists . CONCLUSIONS Educational intervention yielded positive short-term effects on cessation counselling , but not on preventive counselling . Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance . Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention . Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed This study tested the feasibility of using information technology to improve dentists ' adherence to the Treating Tobacco Use and Dependence Clinical Practice Guidelines by offering a web-based computer-mediated clinical decision support system ( CDSS ) for tobacco use treatment in dental clinics . The authors developed a CDSS tool , deployed the software in one of New York University College of Dentistry 's general practice clinics , interviewed associate student dentists , and review ed a r and om selection of patients ' charts to determine if , after implementation , there were changes in tobacco use screening and referral to treatment . Students reported that the CDSS was easy to use , increased their efficiency , and provided better quality of evidence than was available prior to the intervention . Chart review s demonstrated that , after CDSS implementation , patients in the target clinic were significantly more likely to be screened for tobacco use ( < 0.001 ) , and tobacco-using patients were more likely to be advised ( < 0.001 ) , referred to the state 's Quit Line ( < 0.001 ) , and prescribed nicotine replacement therapy ( 0.035 ) . This study concludes that it is feasible to implement a CDSS for tobacco use treatment in dental clinics . The CDSS is a promising method for improving adherence to tobacco use treatment guidelines and warrants further study OBJECTIVES Cases of antimicrobial resistance are increasing , partly due to inappropriate prescribing practice s by dentists . The purpose of this study was to investigate the prescribing practice s and knowledge of dentists with regards to antibiotics . Moreover , this study aim ed to determine whether the prescriptions comply with the recommended guidelines and whether clinical audit can alter the prescribing practice s of dentists leading to better use of antibiotics in the dental service . MATERIAL S AND METHODS A clinical audit ( before/after non-controlled trial ) was carried out in two dental clinics in the northeast of Engl and . Retrospective data were collected from 30 antibiotic prescriptions  , analysed and compared with the recommended guidelines . Data collected included age and gender of patients , type of prescribed antibiotics and their dosage , frequency and duration , clinical condition and reason for prescribing . The principles of appropriate prescribing based on guidance by the Faculty of General Dental Practice in the United Kingdom ( UK ) , FGDP , were discussed with the dental clinicians . Following this , prospect i ve data were collected and similarly managed . Pre and post audit data were then compared . Changes were tested for significance using McNemar 's test and P value<0.05 was considered statistically significant . RESULTS After intervention , data revealed that antibiotic prescribing practice s of dentists improved , as there was an increase in the percentage of prescriptions that were in accordance with the FGDP ( UK ) guidelines . CONCLUSION In view of the limited data collected , this study concludes that there are inappropriate antibiotic prescribing practice s amongst general dental practitioners and that clinical audit can address this situation , leading to a more rational use of antibiotics in dental practice BACKGROUND AND OVERVIEW The authors set out to identify factors associated with implementation by U.S. dentists of four practice s first recommended in the Centers for Disease Control and Prevention 's Guidelines for Infection Control in Dental Health-Care Setting s-2003 . METHODS In 2008 , the authors surveyed a stratified r and om sample of 6,825 U.S. dentists . The response rate was 49 percent . The authors gathered data regarding dentists ' demographic and practice characteristics , attitudes toward infection control , sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures . Then they assessed the impact of those factors on the implementation of four recommendations : having an infection control coordinator , maintaining dental unit water quality , documenting percutaneous injuries and using safer medical devices , such as safer syringes and scalpels . The authors conducted bivariate analyses and proportional odds modeling . RESULTS Responding dentists in 34 percent of practice s had implemented none or one of the four recommendations , 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations . The likelihood of implementation was higher among dentists who acknowledged the importance of infection control , had practice d dentistry for less than 30 years , had received more continuing dental education credits in infection control , correctly identified more surgical procedures that require the use of sterile water , worked in larger practice s and had at least three sources of instruction regarding the guidelines . Dentists with practice s in the South Atlantic , Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied . CONCLUSIONS Implementation of the four recommendations varied among U.S. dentists . Strategies targeted at raising awareness of the importance of infection control , increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service ( PHS ) guideline Treating Tobacco Use and Dependence in six r and omly selected dental clinics in New York University 's College of Dentistry . The main outcome measure-provider adherence to tobacco use treatment guidelines -was assessed by auditing a r and om selection of patient charts pre ( 698 ) and post ( 641 ) intervention . The intervention components included a chart reminder and referral system , free nicotine replacement therapy ( NRT ) , and provider training and feedback . The results showed that rates of screening for tobacco use did not change between pre and post test chart audits . However , providers were significantly more likely to offer advice ( 28.4 percent pre , 49 percent post ) , assess readiness to quit ( 17.8 percent pre ,  
    Output:
    
Although there were some conflicting evidence , studies within each category of implementation strategy indicated a positive effect on guideline adherence .
Conclusions This study has identified education , reminders and multifaceted interventions as effective implementation strategies for the dental practice setting .
Although this is similar to research findings from other health sectors , there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting .