#7 Preliminary Questionnaire Survey for formulating Clinical Practice Guidelines applying for the Magnetic Attachments - Analysis and Selection of the Clinical Questions (CQ) -

M.Hideshima, Y.Igarashi, T.Ichikawa, J.Tanaka, T.Kochi, T.Ishigami, T.Andoh, A.Nishiyama*
	Council for the Dental Care of the Japanese Society of Magnetic Applications in Dentistry, Section of Removable Prosthodontics, Tempromandibular Joint and Occlusion*, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University

Introduction

During the past decades, major methodological developments have taken place with regard to the clinical domains of etiology, diagnosis, prognosis and therapy. As a result the development of evidence based guidelines for clinical practice in dentistry has increased as well as the scientific journals has increasingly demanded high standard research designs. The Japanese Society of Magnetic Applications in Dentistry has also developed the council for the dental care and the committee discussed how to formulate clinical practice guidelines (CPG) for magnetic applications in dentistry according to the direction of Japanese Association for Dental Science. In addition, the committee discussed the social health (dental treatment) insurance should cover the treatment of magnetic attachments or not. As a result the committee decided to perform a survey of questionnaires for magnetic attachments to general practitioners including non-members in order to analyze what kind of clinical questions they have and whether they agree social insurance covering.

Objective

The objective of this survey was to analyze what kind of clinical questions general practitioners have for magnetic attachments and refer them to formulate clinical practice guidelines (CPG).

Materials and Methods

For a preliminary study, 30 present and former council members of the society of magnetic applications in dentistry were surveyed by E-mail attached with a questionnaire file. The committee asked the council members to distribute and answer the questionnaire to their acquaintances or office staffs. The committee also delivered the questionnaire to the attendances at the 19th annual academic meeting of the society of magnetic applications in dentistry at Morioka in Iwate prefecture. The questionnaire was involved in clinical experience, work place and member or non-member of the answerer (Tab.1). Clinical questions (CQ) were required to describe according to the PICO-procedure; ‘P’ stands for problem or patient, ‘I’ for intervention, ‘C’ for comparison and ‘O’ for outcome with a couple of sample questions (Tab.2). The questionnaire also included whether social health insurance should cover the treatment with magnetic attachments (MA)(Tab.3). The answers of the questionnaire were returned by E-mail or FAX to the committee and those of the meeting attendances were collected directly by the committee.

Tab.1: Contents of the questionnaire (Q1～4: clinical experience and affiliation)

Results

Seventy four answerers including 12 council members and 23 attendances of the 19th annual meeting responded to the questionnaire and 102 CQ were collected. Clinical experience and affiliation of the answerers were as follows.

Clinical experience and affiliation

Tab.4: Q1. Number of answerers classified by years of clinical experience (N=74)

Tab.5: Q2. Number of answerers classified by workplace (N=74)

Tab.6: Q3. Number of answerers classified by member/non-member (N=74)

Tab.7: Q4. Number of answerers classified by number of experienced cases of MA (N=74)

Clinical questions (CQ)

Collected 102 CQ were classified in to 5 categories according to their application as follows.
1) Applying MA to abutments of dental implants (Implant): 14CQ
2) Comparing to other type of retainers when applying in certain type of defects (Defects): 40CQ
3) Comparing to other type of retainers when applying in certain type of occlusion (Occlusion): 9CQ
4) Arrangement in the remaining dentition or configuration of MA (Arrange / Form): 21CQ
5) Management of MA or others (Manage / etc): 18CQ

Fig.1: Distribution of each categorized CQ classified by workplace


	Fig.2: Distribution of each categorized CQ classified by member/non-member

Social health insurance

The answers about the social health insurance were as follows.

	agree	agree with reservation	disagree	both acceptable	incompre- hensible	Total
Member	13	12	17	2	5	49
Non-member	7	4	8	1	5	25
Total	20	16	25	3	10	74

Tab.8: Number of answers on social health insurance classified by member/non-member

	agree	agree with reservation	disagree	both acceptable	incompre- hensible	Total
Dental Office	4	1	7	1	0	13
Univ. Hospital	9	11	10	1	5	36
Total	13	12	17	2	5	49

Tab.9: Number of answers within the member on social health insurance classified by workplace.

Discussion

The results of this preliminary survey showed that approximate half of the answerers had more than 10 years and 10 MA cases of clinical experience. Sixty percent of the answerers belong to University hospital and 2/3 of them were the member of this society. From the standpoint of making clinical guidelines reflecting general practitioners opinion, more beginners, dental office workers or non-members have to be surveyed in the next official questionnaire.
The PICO-procedure is an effective way of answering clinical questions. First the PICO-question is formulated and next the relevant domain (therapy/prevention, diagnosis, etiology/risk or prognosis) is established, along with the type of research by means of which the question will have to be answered.
According to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) group system, PICO format question and corresponding answers which should be synthetically recommended by evidences from the concerning articles, doctors’ skill and patients conditions.
To make it possible to search professional literature files, the PICO-question then has to be converted into key words. Articles subsequently located should then be evaluated in terms of their scientific quality and usefulness for answering the question. After this procedure has been followed, an evidence-based answer can be given to the original question.
Around 40% of the 102 collected CQ were classified into type of defects; ex. lower few remaining dentition or free-end saddle cases, and 60% of them were from university hospital practitioners and 80% were from the members. On the other hand, 14% of CQ were classified into implant and 80% of them were from dental office practitioners and 50% were from the members. Affiliation of the answerers was considered to reflect differences of their clinical interest.
As for applying social health insurance to MA, 25 of 74 answers represented disagree and 36 represented agree of which 16 answers were agree with reservations. Member and non-member showed the same tendency of the answers. Within the members, more than half of the dental office practitioners showed disagree, whereas around 30% of university hospital practitioner showed evenly in agree; 9, agree with reservations; 11 and disagree; 10.
The academic society should take cautious steps referring to general practitioners opinion when applying MA to social health insurance.

Conclusion

・Preliminary questionnaire survey for Clinical Questions (CQ) was conducted and 74 answers and 102 CQ were collected.
・Half of the answerers were clinicians with more than 10 years and 10 cases clinical experience.
・CQ were classified to 5 categories; Implant 14, Defects 40, Occlusion9, Arrange/Form21 and Manage/etc18.
・As for social health insurance, 25 of 74 answers were disagree, 20 agree and 16 were agree with reservations.

Acknowledgement

The committee expresses sincere gratitude for the corporation of respondents to this questionnaires and requests continued corporation during the next survey.

References

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4. Loveren C, Aartman I.: The PICO question. Nederlands Tijdschrift voor Tandheelkunde 114: 172-178, 2007

Discussion Board