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What are the challenges of phasing down the use of dental amalgam? (Jocelyn Feine)
- 1. September 9, 2016 Professor Jocelyne Feine Faculty of Dentistry McGill University Editor, JDR Clinical and Translational Research Challenges of Phasing Down the Use of Dental Amalgam FDI World Oral Health Forum The Minamata Convention
- 4. Undergraduate dental education Manage Replace ReduceBest management practices Continuing dental education Industry; closed loop Disposal Safe handling
- 5. Replace Manage Reduce Dentists perspective & incentives Efficacy Effectiveness Product development Uptake of new technology Risk-Benefit Accessibility Patient perspectives Advocacy to policy makers, insurers, etc. Cost
- 6. ReduceManage Replace Behaviours Risk factors and social determinants Implementation strategies Prevention Health Promotion Advocacy Public health awareness
- 7. Manage Reduce Replace Behaviours Risk factors and social determinants Implementation strategies Prevention Health Promotion Advocacy Public health awareness Dentists perspective & incentives Efficacy Effectiveness Product development Attitudes to New technology Risk BenefitAccessibility Patient perspectives Advocacy to policy makers, insurers, etc. Cost Best management practices Continuing dental education Industry; closed loop Disposal Safe handling Undergraduate dental education
- 8. Shifting the Focus • Individual lifestyle approach to health policy • Emphasis on “at risk” populations • One-on-one clinical interventions • Social policy approach • Shared behavioural risks of NCDs • Broad health promotion models
- 10. Basic Science Discovery Proposed Human Application Proven Clinical Application Clinical Practice Public Health Impact T1 T2 T3 T4 Defines mechanisms, targets and molecules. Preclinical and animal studies. New methods of diagnosis, treatment, prevention. Proof of concept & Phase I Clinical Trials. Controlled studies leading to implementation and adoption. Phase II & Phase III Clinical Trials. Biomedical Research Translation Continuum Adapted from Drolet & Lorenzi, 2011 and Fernandez-Moure, 2016 Translation to community Translation to practice Translation to patients Translation to humans Phase IV Clinical Trials and Implementation research for delivery of appropriate care to the population.
- 11. Basic Science Discovery Proposed Human Application Proven Clinical Application Clinical Practice Public Health Impact T1 T2 T3 T4 Manage Safe Handling & Disposal Replace: New product development and uptake Reduce Prevention; Implementation
- 12. Adapted from Peters et al, 2013 Reduce Prevention; Implementation Implementation Research Policy Programmes Practice Intervention Strategies
- 13. Implementation research aims/questions Policy Programmes Practice Adapted from Peters et al, 2013 Pragmatic Trials Effectiveness- Implementation Trials Quality Improvement Studies Participatory Action Research Mixed Methods Research
- 15. Challenges in Uptake of Technologies North America → Private market → Heavy technology dependence → Minimal accountability → Clinicians' autonomy → Regional, socioeconomic disparities → Lack/scarcity of CPGs → High operative costs → Competitive environment
- 16. Barriers and Incentives in Uptake of New Technologies by Dental Professionals Example Participatory Action Research Mixed Methods ResearchPractice Qualitative Research Sequential exploratory design Quantitative Research Interpretative Phase Implementation Research
- 17. Policy Proposals to Strengthen the Amalgam Phase Down Tiered phase-down on amalgam use Establish milestones for phase down period Financial mechanisms to address non-compliance Mackey et al, 2014
- 18. DZIĘKUJĘ Ci
Editor's Notes
- Can the title of presentation be shortened? YES Since your suggestion is merely to shorten the title using the same wording, we can change the title. (In the past, I have left the original title, but added underneath my new title. Then I would explain to the audiences why I changed the title.)
- ENVIRONMENT CANADA (1999): More than 1/3 of the mercury load in sewage systems is due to dental practice.
- Refs: Sheiham and Williams, Billions with oral disease: A global health crisis—a call to action JADA 146(12) 2015. http://jada.ada.org
- Biomedical Research Translation Continuum Ref: Translational research: understanding the continuum from bench to bedside BRIAN C. DROLET, and NANCY M. LORENZI Translational Research 2011;157:1–5 Fernandez-Moure JS (2016) Lost in Translation: The Gap in Scientific Advancements and Clinical Application. Front. Bioeng. Biotechnol. 4:43. doi: 10.3389/fbioe.2016.00043
- Please move the brown box (Prevention; Implementation Education) below the green box (Safe Handling Disposal), and bring each of the boxes into the slide one at a time, starting with ‘New product development’. Since the safe handling and prevention are on the feed back loop from public health impact to clinical practice, I put them below the continuum and the new product is in the opposite direction I put it on the top (closer to the direction of the left to right arrow). Biomedical Research Translation Continuum Ref: Translational research: understanding the continuum from bench to bedside BRIAN C. DROLET, and NANCY M. LORENZI Translational Research 2011;157:1–5 Fernandez-Moure JS (2016) Lost in Translation: The Gap in Scientific Advancements and Clinical Application. Front. Bioeng. Biotechnol. 4:43. doi: 10.3389/fbioe.2016.00043
- Implementation research is the scientific inquiry into questions concerning implementation—the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices (collectively called interventions).”
- Implementation research seeks to understand and work within real world conditions, rather than trying to control for these conditions or to remove their influence as causal effects.
- Implementation research is especially concerned with the users of the research and not purely the production of knowledge.
- Put some ”teeth” into the policy GENERAL MINAMATA PAPER The Minamata Convention on Mercury: Attempting to address the global controversy of dental amalgam use and mercury waste disposal Tim K. Mackey a,b,c,d,⁎, John T. Contreras a, Bryan A. Liang a,b,c Science of the Total Environment 472 (2014) 125–129