Advancing understanding and identifying strategies for sustaining evidence-based practices: a review of reviews

Background Implementation science has focused mainly on the initial uptake and use of evidence-based practices (EBPs), with less attention to sustainment—i.e., continuous use of these practices, as intended, over time in ongoing operations, often involving adaptation to dynamic contexts. Declining EBP use following implementation is well-documented yet poorly understood. Using theories, models, and frameworks (TMFs) to conceptualize sustainment could advance understanding. We consolidated knowledge from published reviews of sustainment studies to identify TMFs with the potential to conceptualize sustainment, evaluate past uses of TMFs in sustainment studies, and assess the TMFs’ potential contribution to developing sustainment strategies. Methods We drew upon reviews of sustainment studies published within the past 10 years, evaluated the frequency with which included articles used a TMF for conceptualizing sustainment, and evaluated the relevance of TMFs to sustainment research using the Theory, Model, and Framework Comparison and Selection Tool (T-CaST). Specifically, we examined whether the TMFs were familiar to researchers, hypothesized relationships among constructs, provided a face-valid explanation of relationships, and included sustainment as an outcome. Findings Nine sustainment reviews referenced 648 studies; these studies cited 76 unique TMFs. Only 28 TMFs were used in more than one study. Of the 19 TMFs that met the criteria for T-CaST analysis, six TMFs explicitly included sustainment as the outcome of interest, 12 offered face-valid explanations of proposed conceptual relationships, and six identified mechanisms underlying relationships between included constructs and sustainment. Only 11 TMFs performed adequately with respect to all these criteria. Conclusions We identified 76 TMFs that have been used in sustainment studies. Of these, most were only used once, contributing to a fractured understanding of sustainment. Improved reporting and use of TMFs may improve understanding of this critical topic. Of the more consistently used TMFs, few proposed face-valid relationships between included constructs and sustainment, limiting their ability to advance our understanding and identify potential sustainment strategies. Future research is needed to explore the TMFs that we identified as potentially relevant, as well as TMFs not identified in our study that nonetheless have the potential to advance our understanding of sustainment and identification of strategies for sustaining EBP use.

Howe’s dental cast analysis of students at the University of Sumatera Utara

Background: Cast analysis is the measurement of the upper and lower arch in a 3-dimensional occlusal relationship. Howe’s Analysis can be used to observe total tooth material, arch length, and basal arch width. Howe’s Analysis was conducted to analyse abnormalities of both teeth and the jaw to help diagnose and plan dental care. Purpose: To analyse the difference in total tooth material, arch length, basal arch width, and Howe’s Index between male and female undergraduate students from the University of Sumatera Utara who are of Proto-Malay origin. Methods: Ninety-six samples comprised of 48 male and 48 female students were recruited through the purposive sampling method. All samples were undergraduate students at the University of Sumatera Utara and of Proto-Malay origin, aged between 18 to 26, and have met the exclusion and inclusion criteria. We measured the variables using a digital caliper to measure basal arch width and arch length and Moorrees’ method to measure total tooth material. Data were analysed statistically using an independent t-test to compare means between groups (p<0.05). Results: The male samples’ average value of total tooth material 98.49 mm±3.79, arch length 45.55 mm±2.28, basal arch width 41.07 mm±2.83, and Howe’s Index were 41.71 %±2.63, respectively. The female samples had a lower value compared to the male samples, 94.51 mm, 43.27 mm, 36.89 mm, and 39.05 % respectively. There was a significant difference in the total tooth material, arch length, basal arch width, and Howe’s Index between male and female undergraduate students from the University of Sumatera Utara of Proto-Malay origin (p=0.001; p<0.05). Conclusion: The average measurement of total tooth material, arch length, basal arch width, and Howe’s Index was higher in male than female undergraduate students from the University of Sumatera Utara of Proto-Malay origin.

Twenty-year follow-up of functional treatment with a bionator appliance: A retrospective dental cast analysis

ABSTRACT Objective: To investigate changes in dental arch configuration, relationship, and malocclusion directly after Class II malocclusion treatment with a Balters bionator modified by Ascher as well as 20 years after treatment. Materials and Methods: Orthodontic dental cast analysis of 18 patients with skeletal Class II treated with a bionator without any additional fixed therapy was performed with a digital caliper at three stages: before (T0), after (T1) and 20 years after (T2) treatment. Arch perimeter and depth, intermolar and intercanine distance, overjet, overbite, sagittal molar and canine relationship, mandibular incisor irregularity (Little's index), and malocclusion (PAR index) were assessed. Results: During treatment (T0–T1), upper arch perimeter significantly increased with a significant decrease in the upper and lower arch perimeter long-term (T1–T2), whereas corresponding arch depths changed only slightly in both periods. Transverse intermolar width increased significantly during treatment, remaining almost constant from T1 to T2. Lower intercanine distance remained fairly unchanged during treatment, but decreased significantly during follow-up. Lower incisor irregularity improved slightly during treatment but increased significantly long-term. After treatment, sagittal molar relationships on both sides were improved, overjet and overbite reduced; these significant changes remained stable long-term. The peer assessment rating (PAR) index was significantly lower after treatment and increased insignificantly during follow-up. Conclusions: 20 years after bionator treatment without additional fixed appliances, the improved sagittal relationship and the reduced overjet and PAR index remained fairly stable. Long-term changes are most likely due to physiological aging processes and are not associated with bionator treatment.

PENGGUNAAN ANALISIS PONT PADA POPULASI MAHASISWA SUKU MINANG DI FAKULTAS KEDOKTERAN GIGI UNIVERSITAS ANDALAS

Dental cast analysis is one of the important thing in orthodontic treatments. One of the dental cast analysis which is usually used is Pont analysis, proposed in 1909. Pont did his research to a population in French which is Caucasian and stated that his theory needs to be tested to another ethnics to verify the applicability of Pont analysis to that population. On each race, there are some specific physical characteristics such as the form and width of dentition and dental arch. Minang population are Mongolian who has the different characteristics of dentition and dental arch with the Caucasians.The aim of this study is to identify whether Pont analysis is precise to be used to Minang population. Method : Cross-sectional design was used in this study. This study was done to 65 upper dental casts from Minang student at the Faculty of Dentistry Andalas University who met the inclusion criteria. The difference between the measured and the calculated interpremolar and intermolar arch width was tested with paired T test with the significant value of 0.05 (p=0.05). Result : Mean value of interpremolar width was 37.8838 ± 2.29042 mm and intermolar width was 47.6046±3.18780 mm. The result of statistical analysis showed that there is no significant differences of the measured and the calculated interpremolar and intermolar width of Minang Student at Faculty of Dentistry Andalas University (p>0.05). Conclusion : Pont analysis can be used as one of the dental cast analysis in orthodontic diagnosis and treatment planning to Minang population. It is suggested to do a further research to identify lower dental arch form of the Minang population whose upper dental arch width equals to the predicted arch width according to Pont’s formula.

A CAST Analysis of an Accident of Software Project

We report a CAST analysis of a software project by a team across the primary and subcontractor companies focusing on a kind of safety, psychological safety. By using CAST, we can understand the context of the behaviours leading to the unintended event and avoid personal blames to keep psychological safety. The project was a software maintenance project, in which an online trading system went down in the production migration, the final phase before the system release. The end users had no damages in this case, but some members were going to lose respects from other members and stakeholders. The system down was caused by a defect, and the first investigation report simply blamed the subcontractor members related to the defect injection and leakage. The senior manager, who cares to build and maintain psychological safety in the team, wanted to conduct a deeper analysis to avoid personal blames. The CAST helped to uncover that process changes over time from the originally defined one contributed the injection and leakage of the defect. It turned out the process owner and manager at the primary contractor side had a part of the responsibility for the defect leakage. The senior manager made this conclusion shared among team members and succeeded to avoid losing psychological safety. We conclude the CAST based on STAMP is useful in analyzing issues of software project management such as psychological safety.