Objectives: State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches. Methods: This 362 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months. Results: Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT. Conclusion: Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.T he past decade has produced a dramatic nationwide dissemination of a new form of behavioural therapy. In 1999, only four states (Oregon, Arizona, California, and Massachusetts) provided centralised telephone support services (quitlines) and none offered free nicotine replacement therapy (NRT). By 2005, all states in the United States, all provinces of Canada, Australia, New Zealand and many countries in the European Union and elsewhere had established quitlines. [1][2][3] Services range from information, counselling, and referral in a single call to multisession counselling with proactive followup. [4][5][6] More than 18 states currently provide NRT to some or all callers. 1 Cessation medications, including nicotine replacement, 7 8 bupropion, 9 and varenicline, 10-12 all increase success rates. Proactive, multiple session telephone counselling 7 13-16 also improves outcomes, and the efficacy of cessation quitlines has been confirmed in statewide programmes 17-19 serving large and diverse populations. 4 6 20 21 The US clinical practice guideline for tobacco concluded that both medications and quitlines are effective. 7 Proactive quitlines provide support over multiple contacts, but are more convenient than group counselling and are often provided free of charge. These features allow quitlines to attract more and more diverse, tobacco users than do group programmes. 22 The efficacy and broad reach of quitlines create a potentially large population impact.Few randomised trials have assessed the relative effectiveness and cost effectiveness of alternative quitline services. Borland 23 and Zhu 24 found that adding follow-up calls to an init...

Objectives (1) Quantify at which carious lesion depths dentists intervene surgically for cases of varying caries penetration and caries risk; (2) Identify characteristics that are associated with surgical intervention. Methods Dentists in a practice-based research network who reported doing at least some restorative dentistry were surveyed. Dentists were asked to indicate whether they would surgically intervene in a series of cases depicting occlusal caries. Each case included a photograph of an occlusal surface displaying typical characteristics of caries penetration, and a written description of a patient at a specific level of caries risk. Using logistic regression, we analyzed associations of surgical treatment with dentist and practice characteristics, and patient caries risk levels. Results 519 DPBRN practitioner-investigators responded, of whom 63% indicated that they would surgically restore lesions located on inner enamel surfaces, and 90% of lesions located in outer dentin surfaces in a low caries risk individual. Regarding individuals at high caries risk, 77% reported that they would surgically restore inner enamel lesions and 94% reported restoring lesions located on the outer dentin surface. Dentists who did not assess caries risk were more likely to intervene on dentin lesions (p=.004). Practitioner-investigators who were in private practice were significantly more likely to intervene surgically on enamel lesions, compared to dentists from large group practices (p<.001). Conclusion Most dentists chose to provide some treatment to lesions that were within the enamel surface. Decisions to intervene surgically in the caries process differ by caries lesion depth, patient caries risk, assessment of caries risk, type of practice model, and percent of patients who self-pay.

Objective Following a successful2005–2012 phase with three regional practice-based research networks (PBRNs), a single, unified national network called “The National Dental PBRN” was created in 2012 in the United States to improve oral health by conducting practice-based research and serving dental professionals through education and collegiality. Methods Central administration is based in Alabama. Regional centres are based in Alabama, Florida, Minnesota, Oregon, New York and Texas, with a Coordinating Centre in Maryland. Ideas for studies are prioritized by the Executive Committee, comprised mostly of full-time clinicians. Results To date, 2736 persons have enrolled, from all six network regions; enrollment continues to expand. They represent a broad range of practitioners, practice types, and patient populations. Practitioners are actively improving every step of the research process, from idea generation, to study development, field testing, data collection, and presentation and publication. Conclusions Practitioners from diverse settings are partnering with fellow practitioners and academics to improve clinical practice and meet the needs of clinicians and their patients. Clinical significance This “nation’s network” aims to serve as a precious national resource to improve the scientific basis for clinical decision-making and foster movement of the latest evidence into routine practice.

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Objectives to (1) identify and quantify the types of treatment that dentists in general dental practice use to manage defective dental restorations; and (2) identify characteristics that are associated with these dentists’ decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) comprises dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi, FL/GA: Florida/Georgia, MN: dentists employed by HealthPartners and private practitioners in Minnesota, PDA: Permanente Dental Associates in cooperation with Kaiser Permanente’s Center for Health Research, and SK: Denmark, Norway, and Sweden. Methods A questionnaire was sent to all DPBRN practitioner-investigators who reported doing at least some restorative dentistry (n=901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment, if any, they would do in each scenario. Treatment options ranged from no treatment to full replacement of the restoration, with or without different preventive treatment options. We used logistic regression to analyze associations between the decision to intervene surgically (repair or replace) and specific dentist, practice, and patient characteristics. Results 512 (57%) DPBRN practitioner-investigators completed the survey. A total of 65% of dentists would replace a composite restoration when the defective margin is located on dentin; 49% would repair it when the defective margin is located on enamel. Most (52%) would not intervene surgically when the restoration in the scenario was amalgam. Dentists participating in solo or small private practice (SPP) chose surgical intervention more often than dentists who participate in large group practices (LGP) or in public health practices (PHP) (p<.0001). Dentists who do not routinely assess caries risk during treatment planning were more likely to intervene surgically and less likely to choose prevention treatment (p<.05). Dentists from the SK region chose the “no treatment” option more often than dentists in the other regions. Conclusions Dentists were more likely to intervene surgically when the restoration was an existing composite, compared to an amalgam restoration. Treatment options chosen by dentists varied significantly by specific clinical case scenario, whether the dentist routinely does caries risk assessment, type of practice, and DPBRN region.