A health-promoting community dental service in Melbourne, Victoria, Australia: protocol for the North Richmond model of oral health care.

PubMed

Hall, Martin; Christian, Bradley

2017-10-01

Despite the best efforts and commitment of oral health programs, there is no evidence that the current surgical output-based model of oral health care is delivering better oral health outcomes to the community. In fact, Australian evidence indicates the oral health of the community could be getting worse. It is now well-understood that this traditional surgical model of oral health care will never successfully manage the disease itself. It is proposed that a health-promoting, minimally invasive oral disease management model of care may lead to a sustainable benefit to the oral health status of the individual and community groups. The aim of this paper is to describe such a model of oral health care (MoC) currently being implemented by the North Richmond Community Health Oral Health (NRCH-OH) program in Melbourne, Victoria, Australia; this model may serve as a template for other services to re-orient their healthcare delivery towards health promotion and prevention. The paper describes the guiding principles and theories for the model and also its operational components, which are: pre-engagement while on the waitlist; client engagement at the reception area; the assessment phase; oral health education (high-risk clients only); disease management; and reviews and recall.

Patient satisfaction with E-Oral Health care in rural and remote settings: a systematic review protocol.

PubMed

Emami, Elham; Kadoch, Naomi; Homayounfar, Sara; Harnagea, Hermina; Dupont, Patrice; Giraudeau, Nicolas; Mariño, Rodrigo

2017-08-29

Individuals living in rural and remote settings face oral health problems and access-to-care barriers due to the shortage of oral health care providers in these areas, geographic remoteness, lack of appropriate infrastructure and lower socio-economic status. E-Oral Health technology could mitigate these barriers by providing the delivery of some aspects of health care and exchange of information across geographic distances. This review will systematically evaluate the literature on patient satisfaction with received E-Oral Health care in rural and remote communities. This systematic review will include interventional and observational studies in which E-Oral Health technology is used as an intervention in rural and remote communities of any country worldwide. Conventional oral health care will be used as a comparator when provided. Patient satisfaction with received E-Oral Health care will be considered as a primary outcome for this review. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Global Health will be searched using a comprehensive search strategy. Two review authors will independently screen results to identify potentially eligible studies and independently extract the data from the included studies. A third author will resolve any discrepancies between reviewers. Two independent researchers will assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation. The potential implications and benefits of E-Oral Health care can inform policymakers and health care professionals to take advantage of this technology to address health care challenges in these areas. PROSPERO CRD42016039942 .

A survey of National Cancer Institute-designated comprehensive cancer centers' oral health supportive care practices and resources in the USA.

PubMed

Epstein, Joel B; Parker, Ira R; Epstein, Matthew S; Gupta, Anurag; Kutis, Susan; Witkowski, Daniela M

2007-04-01

The oral complications and morbidity resulting from overall cancer therapy utilizing radiation, chemotherapy, and/or stem cell transplantation can have significant impact on a patient's health, quality of life, cost of care, and cancer management. There has been minimal health services research focusing on the status of medically necessary, oral supportive services at US cancer centers. A pre-tested, survey questionnaire was distributed to the directors of National Cancer Institute (NCI)-designated comprehensive cancer centers to assess each institution's resource availability and clinical practices, as it relates to the prevention and management of oral complications during cancer treatment. Sixteen of the 39 comprehensive cancer centers responded to the survey. Of the respondents, 56% of the centers did not have a dental department. The sites of delivery of oral supportive care services range from the provision of in-house dental care to community-based, private practice sites. No standard protocols were in place for either oral preventive care or for supportive services for oral complications during or after cancer therapy. Fifty percent of the responding comprehensive cancer centers reported orally focused research and/or clinical trial activities. Comprehensive cancer care must include an oral care component, particularly for those cancer patients who are at high risk for oral complications. This requires a functional team of oral care providers collaborating closely within the oncology team. Considering the number of cancer patients receiving aggressive oncologic treatment that may result in oral toxicity, the impact of oral conditions on a compromised host, and the potential lack of appropriate resources and healthcare personnel to manage these complications, future research efforts are needed to identify the strengths and weaknesses of present oral supportive care delivery systems at both NCI-designated cancer centers and community-based oncology practices.

Cryotherapy effect on oral mucositis severity among recipients of bone marrow transplantation: a literature review.

PubMed

Tayyem, Abdel-Qader Mahmoud

2014-08-01

Oral mucositis is a distressing toxic effect of cancer therapy and one of the major side effects of the myeloablative conditioning used to prepare patients for bone marrow transplantation (BMT). Oral cryotherapy is one of the recent modalities used to prevent and manage oral mucositis. The purpose of this review is to clarify the cryotherapy effect on oral mucositis severity among patients receiving myeloablative conditioning followed by BMT. A literature search was performed using six different electronic databases: CINAHL®, MEDLINE®, Nursing Ovid, PubMed, Springer, and Science Direct. Six articles were deemed relevant and included in this review. Oral mucositis increases mortality rate, length of hospital stay, opioid use, and the need for parenteral nutrition usage. It also decreases patient's quality of life and his or her desire to complete treatment. However, oral cryotherapy significantly minimizes the incidence and severity of oral mucositis and decreases secondary oral mucositis complications. Using oral cryotherapy concurrently with a regular oral care protocol can improve its efficacy for preventing and managing oral mucositis. Additional studies should be conducted to create standard oral cryotherapy protocols.

Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment

PubMed Central

RAMOS-GOMEZ, FRANCISCO J.; CRYSTAL, YASMI O.; NG, MAN WAI; CRALL, JAMES J.; FEATHERSTONE, JOHN D.B.

2012-01-01

Recent increases in caries prevalence in young children, especially among minorities and the economically disadvantaged, highlight the need for early establishment of dental homes and simple, effective infant oral care preventive programs for all children as part of a medical disease prevention management model.1–3 This article presents an updated approach and practical tools for pediatric dental caries management by risk assessment, CAMBRA, in an effort to stimulate greater adoption of infant oral care programs among clinicians and early establishment of dental homes for young children. PMID:21162350

Study protocol of a randomized controlled trial to test the effect of a smartphone application on oral-health behavior and oral hygiene in adolescents with fixed orthodontic appliances.

PubMed

Scheerman, Janneke F M; van Meijel, Berno; van Empelen, Pepijn; Kramer, Gem J C; Verrips, Gijsbert H W; Pakpour, Amir H; Van den Braak, Matheus C T; van Loveren, Cor

2018-02-07

Adolescents with fixed orthodontic appliances are at high risk of developing dental caries. To date, new smartphone technologies have seldom been used to support them in the preventive behavior that can help prevent dental caries. After an intervention-mapping process, we developed a smartphone application (the WhiteTeeth app) for preventing dental caries through improved oral-health behavior and oral hygiene. The app, which is intended to be used at home, will help adolescents with fixed orthodontic appliances perform their oral self-care behavior. The app is based on the Health Action Process Approach (HAPA) theory, and incorporates several behavior-change techniques that target the psychosocial factors of oral-health behavior. This article describes the protocol of a randomized controlled trial (RCT) to evaluate the effects of the WhiteTeeth app on oral-health behavior and oral-hygiene outcomes (presence of dental plaque and gingival bleeding) compared with those of care as usual, in patients aged 12-16 with fixed orthodontic appliances. The RCT has two conditions: an experimental group that will receive the WhiteTeeth app in addition to care as usual, and a control group that will only receive care as usual. Care as usual will include routine oral-health education and instruction at orthodontic check-ups. In the western part of the Netherlands 146 participants will be recruited from four orthodontic clinics. Data will be collected during three orthodontic check-ups: baseline (T0), 6 weeks of follow-up (T1) and 12 weeks of follow-up (T2). The primary study outcomes are the presence of dental plaque (measured with a modified Silness and Loë Plaque Index); and gingival bleeding (measured with the Bleeding on Marginal Probing Index). Secondary outcomes include changes in self-reported oral-health behaviors and its psychosocial factors identified by the HAPA theory, such as outcome expectancies, intention, action self-efficacy, coping planning and action control. Since the intervention was designed to target psychosocial factors in the motivational and volitional components of the behavior-change process, we hypothesize that the app will cause greater improvements in oral-health behavior and oral hygiene more than traditional oral-health-promotion programs (i.e., care as usual). The trial has been registered with the Dutch Trial Register ( NTR6206 : 20 February 2017).

Effect of an oral healthcare protocol in nursing homes on care staffs' knowledge and attitude towards oral health care: a cluster-randomised controlled trial.

PubMed

Janssens, Barbara; De Visschere, Luc; van der Putten, Gert-Jan; de Lugt-Lustig, Kersti; Schols, Jos M G A; Vanobbergen, Jacques

2016-06-01

To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses' and nurses' aides' oral health-related knowledge and attitude. A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses' aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation. At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009). The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses' aides. In contrast, no significant improvements could be demonstrated in attitude. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Prevention of oral mucositis in children receiving cancer therapy: a systematic review and evidence-based analysis.

PubMed

Qutob, Akram F; Gue, Sumant; Revesz, Tamas; Logan, Richard M; Keefe, Dorothy

2013-02-01

This systematic review investigated, critically appraised, and rated the evidence on agents used to prevent oral mucositis in children. A comprehensive search of the relevant literature was performed up to December 2011. Articles were included according to the inclusion/exclusion criteria and were critically appraised for validation and quality assessment using a checklist consisting of 18 categories. Each article was then rated for its strength of evidence. 16,471 articles were retrieved from 19 different databases and then reduced to 27 articles that fit the inclusion criteria. Five articles on oral care protocols supported their use to prevent oral mucositis in children. Seven articles on chlorhexidine mouthwash and three on laser therapy had conflicting evidence of its use. The preventative agents that were supported by one or two articles included: benzydamine mouthwash, iseganan mouthwash, granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash, oral/enteral glutamine, oral propantheline and cryotherapy, oral cryotherapy, oral sucralfate suspension, prostaglandin E2 tablets, and chewing gum. The reduction in the rates of occurrence of oral mucositis when using agents of fair (B) to good (A) evidence ranged from 22% to 52%. In conclusion, this review suggests the use of oral care protocols to prevent oral mucositis in children because of their strength of evidence (fair to good). The authors suggest avoiding agents with fair to good evidence against their use (oral sucralfate suspension, prostaglandin E2 tablets, and GM-CSF mouthwash). Agents with conflicting evidence (chlorhexidine mouthwash (used solely), laser therapy, and glutamine) should also be avoided until further research confirms their efficacy. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Effectiveness of Intraoral Chlorhexidine Protocols in the Prevention of Ventilator-Associated Pneumonia: Meta-Analysis and Systematic Review.

PubMed

Villar, Cristina C; Pannuti, Claudio M; Nery, Danielle M; Morillo, Carlos M R; Carmona, Maria José C; Romito, Giuseppe A

2016-09-01

Ventilator-associated pneumonia (VAP) is common in critical patients and related with increased morbidity and mortality. We conducted a systematic review and meta-analysis, with intention-to-treat analysis, of randomized controlled clinical trials that assessed the effectiveness of different intraoral chlorhexidine protocols for the prevention of VAP. Search strategies were developed for the MEDLINE, EMBASE, and LILACS databases. MeSH terms were combined with Boolean operators and used to search the databases. Eligible studies were randomized controlled trials of mechanically ventilated subjects receiving oral care with chlorhexidine or standard oral care protocols consisting of or associated with the use of a placebo or no chemicals. Pooled estimates of the relative risk and corresponding 95% CIs were calculated with random effects models, and heterogeneity was assessed with the Cochran Q statistic and I(2). The 13 included studies provided data on 1,640 subjects that were randomly allocated to chlorhexidine (n = 834) or control (n = 806) treatments. A preliminary analysis revealed that oral application of chlorhexidine fails to promote a significant reduction in VAP incidence (relative risk 0.80, 95% CI 0.59-1.07, I(2) = 45%). However, subgroup analyses showed that chlorhexidine prevents VAP development when used at 2% concentration (relative risk 0.53, 95% CI 0.31-0.91, I(2) = 0%) or 4 times/d (relative risk 0.56, 95% CI 0.38-0.81, I(2) = 0%). We found that oral care with chlorhexidine is effective in reducing VAP incidence in the adult population if administered at 2% concentration or 4 times/d. Copyright © 2016 by Daedalus Enterprises.

Optimizing radiologist e-prescribing of CT oral contrast agent using a protocoling portal.

PubMed

Wasser, Elliot J; Galante, Nicholas J; Andriole, Katherine P; Farkas, Cameron; Khorasani, Ramin

2013-12-01

The purpose of this study is to quantify the time expenditure associated with radiologist ordering of CT oral contrast media when using an integrated protocoling portal and to determine radiologists' perceptions of the ordering process. This prospective study was performed at a large academic tertiary care facility. Detailed timing information for CT inpatient oral contrast orders placed via the computerized physician order entry (CPOE) system was gathered over a 14-day period. Analyses evaluated the amount of physician time required for each component of the ordering process. Radiologists' perceptions of the ordering process were assessed by survey. Descriptive statistics and chi-square analysis were performed. A total of 96 oral contrast agent orders were placed by 13 radiologists during the study period. The average time necessary to create a protocol for each case was 40.4 seconds (average range by subject, 20.0-130.0 seconds; SD, 37.1 seconds), and the average total time to create and sign each contrast agent order was 27.2 seconds (range, 10.0-50.0 seconds; SD, 22.4 seconds). Overall, 52.5% (21/40) of survey respondents indicated that radiologist entry of oral contrast agent orders improved patient safety. A minority of respondents (15% [6/40]) indicated that contrast agent order entry was either very or extremely disruptive to workflow. Radiologist e-prescribing of CT oral contrast agents using CPOE can be embedded in a protocol workflow. Integration of health IT tools can help to optimize user acceptance and adoption.

An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy.

PubMed

Benton, Katie; Thomson, Iain; Isenring, Elisabeth; Mark Smithers, B; Agarwal, Ekta

2018-06-01

Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care. Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests. There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group. A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.

Use of a combined oxygen/nitrous oxide/morphine chlorydrate protocol for analgesia in burned children requiring painful local care.

PubMed

Ozil, Camille; Vialle, Raphaël; Thevenin-Lemoine, Camille; Conti, Elvira; Annequin, Daniel

2010-03-01

We present the results of the use of a protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids on a prospective cohort of 33 children undergoing local care for acute but limited burned skin lesions. All the children were orally administered 0.4 mg/kg morphine chlorydrate, and nitrous oxide was administered as an equimolar mixture (50% N2O, 50% O2) via a face mask during the procedure. Pain and comfort of the patient were evaluated by the use of a validated behavioural score. After the end of the procedure, child and parent satisfactions were noted. Mean age was 3 years 6 months (10 months-11 years). A successful detersion procedure was performed in all the cases. Behavioural score was 6 in 15 cases out of 33, comprising between 7 and 9 in 15 patients and 10 in three patients. Subjective satisfaction of pain management was noted in 16 out of 20 patients after the procedure. Subjective satisfaction of the parents was noted in all the cases. Our study demonstrates that the use of a simple protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids could be safe and effective. This association was well tolerated without any adverse effect.

Are we ready for the ERAS protocol in colorectal surgery?

PubMed

Kisielewski, Michał; Rubinkiewicz, Mateusz; Pędziwiatr, Michał; Pisarska, Magdalena; Migaczewski, Marcin; Dembiński, Marcin; Major, Piotr; Rembiasz, Kazimierz; Budzyński, Andrzej

2017-01-01

Modern perioperative care principles in elective colorectal surgery have already been established by international surgical authorities. Nevertheless, barriers to the introduction of routine evidence-based clinical care and changing dogmas still exist. One of the factors is the surgeon. To assess perioperative care trends in elective colorectal surgery among general surgery consultants in surgical departments in Malopolska Voivodeship, Poland. An anonymous standardized 20-question questionnaire was developed based on ERAS principles and sent out to Malopolska Voivodeship general surgery departments. Answers of general surgery consultants showed the level of acceptance of elements of perioperative care. The overall response rate was 66%. Several elements (antibiotic and antithrombotic prophylaxis, postoperative oxygen therapy, no nasogastric tubes) had quite a high acceptance rate. On the other hand, most crucial surgical perioperative elements (lack of mechanical bowel preparation, preoperative oral carbohydrate loading, use of laparoscopy and lack of drains, early fluid and oral diet intake, early mobilization) were not followed according to evidence-based ERAS protocol recommendations. Surgeons were not willing to change their practice, but were supportive of changes in anesthesiologist-dependent elements of perioperative care, such as restrictive fluid therapy, use of transversus abdominis plane blocks, etc. Many elements of perioperative care in elective colorectal surgery in Malopolska Voivodeship are still dictated by dogma and are not evidence-based. The level of acceptance of many important ERAS protocol elements is low. Surgeons are ready to accept only changes that do not interfere with their practice.

Pain management for joint arthroplasty: preemptive analgesia.

PubMed

Mallory, Thomas H; Lombardi, Adolph V; Fada, Robert A; Dodds, Kathleen L; Adams, Joanne B

2002-06-01

Scheduled preoperative and postoperative analgesia should be offered in a multimodal management model. By a combined drug synergy effect, the central nervous system, afferent pathways, and peripheral wound site are modified collectively. In an ongoing effort to improve perioperative pain management, we retrospectively compared the results of a previously reported pain management protocol with 2 more recent groups of patients managed with modified pain protocols. In the earlier control protocol, epidural anesthesia was discontinued on arrival to the postanesthesia care unit, and regularly scheduled oral opioids and intravenous hydromorphone for breakthrough pain were initiated. The first more recent group used epidural anesthesia, and the second group used spinal anesthesia. Both protocols featured the use of cyclooxygenase-2-inhibiting anti-inflammatory medication administered for 2 weeks preoperatively and continued for 10 days postoperatively and patient-controlled analgesia for 24 hours followed by scheduled oral opioids. Copyright 2002, Elsevier Science (USA).

Multimodal analgesia without parenteral narcotics for total knee arthroplasty.

PubMed

Dorr, Lawrence D; Raya, Julio; Long, William T; Boutary, Myriam; Sirianni, Leigh Ellen

2008-06-01

Use of parenteral narcotics after total knee arthroplasty is considered by most orthopedic surgeons to be the standard of care. This study tested the hypothesis that a multimodal oral pain medication protocol could control pain and minimize complications of parenteral narcotics. Postoperative oral analgesia was augmented with either continuous epidural infusion or continuous femoral infusion using ropivacaine only. Seventy patients had total knee arthroplasty with a protocol that included preemptive oral analgesics, epidural anesthesia, pericapsular analgesic injection, and postoperative analgesia without parenteral opioids. The average daily pain score was less than 4 out of 10, nausea occurred in 15 patients (21%), emesis in 1 patient (1.4%), and there were no severe complications. This study proved the hypothesis that pain after total knee arthroplasty could be effectively managed without routine use of parenteral opioids.

The effect of preventive oral care on treatment outcomes of a cohort of oral cancer patients.

PubMed

Morais, Marilia Oliveira; Elias, Marcela Ramos Abrahão; Leles, Cláudio Rodrigues; Dourado Pinezi, Juliana Castro; Mendonça, Elismauro Francisco

2016-04-01

The purpose of this study was to assess patient adherence to an oral preventive measures (OPM) protocol and its impact on cancer treatment outcomes. A retrospective cohort of oral cancer of 133 patients submitted to radiotherapy (RT) was selected, excluding those with metastasis. Patients were grouped according to their local tumor response after finishing RT (favorable or unfavorable) and adherence to an OPM (none, ≤6 months, and >6 months). OPM included education and counseling about adverse effects, elimination of infection foci, restorative procedures, fluoride therapy, oral rehydration, and maintenance and supervision of oral hygiene throughout treatment. Clinical and pathological characteristics were recorded, and patient outcomes (frequency of adverse effects, RT interruption, and overall survival) were analyzed. Patients with higher adherence to the OPM had greater occurrence of RT interruption as a consequence of symptoms (p = 0.01); however, these patients were more likely to complete the established RT protocol (p = 0.02). Overall survival (p = 0.01) was higher in the group with higher adherence. This study suggests that the implementation of oral preventive measures may contribute to improving the prognosis of squamous cell carcinoma (SCC) treatment by reducing the negative impact of oral complications.

Oral feeding readiness assessment in premature infants.

PubMed

Gennattasio, Annmarie; Perri, Elizabeth A; Baranek, Donna; Rohan, Annie

2015-01-01

Oral feeding readiness is a complex concept. More evidence is needed on how to approach beginning oral feedings in premature hospitalized infants. This article provides a review of literature related to oral feeding readiness in the premature infant and strategies for promoting safe and efficient progression to full oral intake. Oral feeding readiness assessment tools, clinical pathways, and feeding advancement protocols have been developed to assist with oral feeding initiation and progression. Recognition and support of oral feeding readiness may decrease length of hospital stay and have a positive impact on reducing healthcare costs. Supporting effective cue-based oral feeding through use of rigorous assessment or evidence-based care guidelines can also optimize the hospital experience for infants and caregivers, which, in turn, can promote attachment and parent satisfaction.

Applying Adult Ventilator-associated Pneumonia Bundle Evidence to the Ventilated Neonate.

PubMed

Weber, Carla D

2016-06-01

Ventilator-associated pneumonia (VAP) in neonates can be reduced by implementing preventive care practices. Implementation of a group, or bundle, of evidence-based practices that improve processes of care has been shown to be cost-effective and to have better outcomes than implementation of individual single practices. The purpose of this article is to describe a safe, effective, and efficient neonatal VAP prevention protocol developed for caregivers in the neonatal intensive care unit (NICU). Improved understanding of VAP causes, effects of care practices, and rationale for interventions can help reduce VAP risk to neonatal patients. In order to improve care practices to affect VAP rates, initial and annual education occurred on improved protocol components after surveying staff practices and auditing documentation compliance. In 2009, a tertiary care level III NICU in the Midwestern United States had 14 VAP cases. Lacking evidence-based VAP prevention practices for neonates, effective adult strategies were modified to meet the complex needs of the ventilated neonate. A protocol was developed over time and resulted in an annual decrease in VAP until rates were zero for 20 consecutive months from October 2012 to May 2014. This article describes a VAP prevention protocol developed to address care practices surrounding hand hygiene, intubation, feeding, suctioning, positioning, oral care, and respiratory equipment in the NICU. Implementation of this VAP prevention protocol in other facilities with appropriate monitoring and tracking would provide broader support for standardization of care. Individual components of this VAP protocol could be studied to strengthen the inclusion of each; however, bundled interventions are often considered stronger when implemented as a whole.

Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia.

PubMed

Ory, Jérôme; Mourgues, Charline; Raybaud, Evelyne; Chabanne, Russell; Jourdy, Jean Christophe; Belard, Fabien; Guérin, Renaud; Cosserant, Bernard; Faure, Jean Sébastien; Calvet, Laure; Pereira, Bruno; Guelon, Dominique; Traore, Ousmane; Gerbaud, Laurent

2018-06-01

Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. NCT02400294.

Journal of Special Operations Medicine, Spring 2008, Training Supplement

DTIC Science & Technology

2008-01-01

Tactical Combat Casualty Care (CoTCCC), have been changed in the TME Protocols. (2007) • The Fentanyl oral dosage of 800 mcg, as recommended by the...14aTMEP Behavioral Changes (Includes Psychosis, Depression, Suicidal Impulses)------------------------- 15 aTMEP Bronchitis/ Pneumonia

Oral care may reduce pneumonia in the tube-fed elderly: a preliminary study.

PubMed

Maeda, Keisuke; Akagi, Junji

2014-10-01

Pneumonia is one of the most important diseases in terms of mortality in the elderly. In particular, bedridden patients who are forbidden oral ingestion during enteral nutrition may have a poor outcome resulting from a respiratory infection. Oral hygiene can play a positive role in preventing aspiration pneumonia in the elderly. The aim of this study was to investigate the effectiveness of oral hygiene for bedridden and tube-fed patients at an increased risk of pneumonia. This retrospective study was conducted from July 2011 to June 2013 on a long-term-care hospital unit. The oral care protocol (OCP) intervention commenced in July 2012, during the study period. The subjects of this study were 63 elderly patients with a mean age of 81.7 years. Thirty-one patients were enrolled in the OCP intervention group, and the mean observation length was 130.4 days; the mean observation length for the 32 patients in the control group was 128.4 days. The incidence of pneumonia and the numbers of days with a recorded fever, antibiotics administration, blood tests, and radiological examinations were reduced from 1.20 to 0.45, 24.57 to 17.48, 25.52 to 10.12, 10.91 to 6.54, and 6.33 to 3.09 %, respectively. These reductions were significantly less in the OCP intervention group. In conclusion, the results of the present study suggest that daily oral care for tube-fed patients who do not receive nutrition by mouth reduced the incidence of pneumonia. In addition to patients consuming food by mouth, all tube-fed patients require dedicated oral care to maintain healthy oral conditions.

Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial.

PubMed

Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R Michael; Bailit, Howard L; Huebner, Colleen E; Conrad, Douglas; Ludwig, Sharity; Mitchell, Melissa; Dysert, Jeanne; Allen, Gary; Scott, JoAnna; Mancl, Lloyd

2015-06-20

To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. This is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records. If effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations. ClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.

[A preliminary study on dental-manpower forecasting model of Miyun County in Beijing].

PubMed

Huang, H; Wang, H; Yang, S

1999-01-01

To explore the dental-manpower forecasting model of Chinese rural region and provide references for Chinese dental-manpower researches. Chose rural Miyun County in Beijing as a sample, according to the need-based and demand-weighted forecasting method, a protocol WHO-CH model and corresponding JWG-6-M package developed by authors were used to calculate the present and future need and demand of dental-manpower in Miyun County. Further predications were also calculated on the effects of four modeling parameters to the demand of dental manpower. The present need and demand of oral care personnel for Miyun were 114.5 and 29.1 respectively. At present, Miyun has 43 oral care providers who can satisfy the demand but not the need. The change of oral health demand had a major effect on the forecast of the manpower. Dental-manpower planning should consider the need as a prime factor but must be modified by the demand. It was suggested that corresponding factors of oral care personnel need to be discussed further.

Fast-track surgery for uncomplicated appendicitis in children: a matched case-control study.

PubMed

Cundy, Thomas P; Sierakowski, Kyra; Manna, Alexandra; Cooper, Celia M; Burgoyne, Laura L; Khurana, Sanjeev

2017-04-01

Standardized post-operative protocols reduce variation and enhance efficiency in patient care. Patients may benefit from these initiatives by improved quality of care. This matched case-control study investigates the effect of a multidisciplinary criteria-led discharge protocol for uncomplicated appendicitis in children. Key protocol components included limiting post-operative antibiotics to two intravenous doses, avoidance of intravenous opioid analgesia, prompt resumption of diet, active encouragement of early ambulation and nursing staff autonomy to discharge patients that met assigned criteria. The study period was from August 2015 to February 2016. Outcomes were compared with a historical control group matched for operative approach. Outcomes for 83 patients enrolled to our protocol were compared with those of 83 controls. There was a 29.2% reduction in median post-operative length of stay in our protocol-based care group (19.6 versus 27.7 h; P < 0.001). The rate of discharges within 24 h improved from 12 to 42%. There was no significant difference in complication rate (4.8 versus 7.2%; P = 0.51). Mean oral morphine dose equivalent per kilogram requirement was less than half (46%) that of control group patients (P < 0.001). Mean number of ondansetron doses was also significantly lower. Projected annual direct cost savings following protocol implementation was AUD$77 057. Implementation of a criteria-led discharge protocol at our hospital decreased length of stay, reduced variation in care, preserved existing low morbidity, incurred substantial cost savings, and safely rationalized opioid and antiemetic medication. These protocols are inexpensive and offer tangible benefits that are accessible to all health care settings. © 2016 Royal Australasian College of Surgeons.

Evaluation of a protocol-based intervention to promote timely switching from intravenous to oral paracetamol for post-operative pain management: an interrupted time series analysis.

PubMed

Sabry, Nirmeen; Dawoud, Dalia; Alansary, Adel; Hounsome, Natalia; Baines, Darrin

2015-12-01

Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting. An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis. Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001). A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation. © 2015 John Wiley & Sons, Ltd.

Preliminary study on radio-chemo-induced oral mucositis and low level laser therapy

NASA Astrophysics Data System (ADS)

Merigo, Elisabetta; Fontana, Matteo; Fornaini, Carlo; Clini, Fabio; Cella, Luigi; Vescovi, Paolo; Oppici, Aldo

2012-09-01

Background: Oral mucositis remains one of the most common and troubling side effects of antineoplastic radiation and drug therapy: its incidence in onco-hematological radio-chemotreated patients is variable between 50 and 100% and its impact on this populations is directly linked with the experience of intense pain causing reduction and modification of therapy regimens, decreased survival rates and increased cost of care. Purpose: Aim of this study is the preliminary evaluation of a Low Level Laser therapy (LLLT) protocol on healing process of oral mucositis and on pain and quality of life of patients experiencing this dramatic side-effect. Materials and methods: Patients were evaluated and treated at the Unita` Operativa Semplice Dipartimentale di Odontostomatologia e Chirurgia Maxillo-Facciale of the Hospital of Piacenza were they were treated for primary disease with protocols of chemotherapy and/or radiotherapy. LLLT protocol was performed with a diode laser (808 nm -XD Smile - Fotona -Slovenia) on a two weeks-6 treatments schedule with power of 0.5 W and application of 30 seconds. Mucositis grading was scored on the basis of WHO classification by two blind operators at each treatment and at 1 and 2 weeks after treatment. Pain and capability of deglutition were described by patients by means questionnaires based on Visual Analogue Scale, Numerical Rating Scale and Quality of Life. Results: A relevant improvement of healing of oral mucositis, in terms of reduction of grading score, and of pain, swallowing discomfort and quality of life was recorded. Discussion and conclusion: Results of this preliminary study are encouraging for the realization of larger studies focused on the application of LLLT protocols in management of radio-chemotreated patients with oral mucositis.

Translation of oral care practice guidelines into clinical practice by intensive care unit nurses.

PubMed

Ganz, Freda DeKeyser; Ofra, Raanan; Khalaila, Rabia; Levy, Hadassa; Arad, Dana; Kolpak, Orly; Ben Nun, Maureen; Drori, Yardena; Benbenishty, Julie

2013-12-01

The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Descriptive comparison of ICU nurses in 2004-2005 and 2012. Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was found to be significant with the time of participation (2004-2005 vs. 2012) and priority level of oral care significantly contributing to the regression model. The national effort was partially successful in improving evidence-based oral care practices; however, increased awareness to EBP also might have come from other sources. Other strategies related to knowledge translation need to be attempted and researched in this clinical setting such as the use of opinion leaders, audits and feedback, small group consensus, provider reminder systems, incentives, clinical information systems, and computer decision support systems. This national effort to improve EBP did reap some rewards; however, other knowledge translation strategies should be used to further improve clinical practice. © 2013 Sigma Theta Tau International.

Caries risk assessment appropriate for the age 1 visit (infants and toddlers).

PubMed

Ramos-Gomez, Francisco J; Crall, James; Gansky, Stuart A; Slayton, Rebecca L; Featherstone, John D B

2007-10-01

This article discusses caries management by risk assessment for children age 0-5. Risk assessment is the first step in a comprehensive protocol for infant oral care. The program includes opportunities to establish a "dental home" and provide guidance for improved health outcomes. Risk assessment forms, instructions for use, and guidance-related education points have been included. Collaboration among all health professionals regarding early and timely intervention to promote children's oral health and disease prevention is emphasized.

Program for coordinated dental care under general anaesthesia for children with special needs.

PubMed

de Nova-García, M Joaquín; Martínez, M Rosa Mourelle; Sanjuán, Carmen Martín; López, Nuria E Gallardo; Cabaleiro, Esther Carracedo; García, Yolanda Alonso

2007-12-01

To draw up a program for coordination of dental care for children with special needs between the Course at the Universidad Complutense de Madrid (UCMC) (Specialisation in holistic dental care for children with special needs), and the Disabled Children's Oral Health Unit (DCOHU) within the Madrid Health Service (SERMAS). UCMC Protocol for children with special needs. Design of a clinical pathway based on consensus amongst the professionals involved. Algorithm for dental care for children with special needs. Matrix covering all activities and timing for full dental diagnosis in such patients (general health, oral health and behaviour) to facilitate proper referral of patients requiring general anaesthesia. Inclusion in the matrix of those responsible for each activity. Improved team work (University - primary health care) in patient evaluation, in provision of information to parents and guardians and in health care quality. From the teaching point of view, students learn to adopt a systematic approach in the decision-making process.

Implementing oral chemotherapy services in community pharmacies: a qualitative study of chemotherapy nurses' and pharmacists' views.

PubMed

Butt, Farida; Ream, Emma

2016-05-01

Changes in health-care provision have led to cancer patients being offered oral chemotherapy in the community. Three levels of oral chemotherapy services have been proposed (levels 1, 2 and 3) with community pharmacies playing differing roles within them. This study aims to explore health-care professionals' views on oral chemotherapy services being delivered by community pharmacies and to gain insights into the barriers, facilitators and training/knowledge needs of community pharmacists with respect to providing them. Qualitative semi-structured interviews were conducted with a purposive sample of three chemotherapy nurses, five oncology pharmacists and five community pharmacists. Data were analysed thematically using Framework Analysis. Findings for level 1 and 2 services included uncertainty on community pharmacists' professional responsibilities, the expertise of GPs in prescribing oral chemotherapy and the training and competency of community pharmacists. The lack of patient information, care and support provision was emphasised for all the models. Although level 1 was achievable in current practice, level 2 was considered the safest option, while level 3 was ideal but risky option. For all levels, training and education for community pharmacists and inter-professional issues were facilitators to oral chemotherapy services. The service environment, dispensing process-related constraints (access to blood test results and protocols) were significant barriers for levels 2 and 3. Advanced communication skills, patient education and counselling were identified as key areas for education and training for community pharmacists. The study suggests there are significant concerns and challenges associated with community pharmacies implementing any of the proposed levels of oral chemotherapy services. Educational and training opportunities for community pharmacists and the careful development of safe infrastructures will be essential in the future planning and implementation of any community pharmacy oral chemotherapy service. © 2015 Royal Pharmaceutical Society.

A Protocol for a Feasibility and Acceptability Study of a Participatory, Multi-Level, Dynamic Intervention in Urban Outreach Centers to Improve the Oral Health of Low-Income Chinese Americans.

PubMed

Northridge, Mary E; Metcalf, Sara S; Yi, Stella; Zhang, Qiuyi; Gu, Xiaoxi; Trinh-Shevrin, Chau

2018-01-01

While the US health care system has the capability to provide amazing treatment of a wide array of conditions, this care is not uniformly available to all population groups. Oral health care is one of the dimensions of the US health care delivery system in which striking disparities exist. More than half of the population does not visit a dentist each year. Improving access to oral health care is a critical and necessary first step to improving oral health outcomes and reducing disparities. Fluoride has contributed profoundly to the improved dental health of populations worldwide and is needed regularly throughout the life course to protect teeth against dental caries. To ensure additional gains in oral health, fluoride toothpaste should be used routinely at all ages. Evidence-based guidelines for annual dental visits and brushing teeth with fluoride toothpaste form the basis of this implementation science project that is intended to bridge the care gap for underserved Asian American populations by improving access to quality oral health care and enhancing effective oral health promotion strategies. The ultimate goal of this study is to provide information for the design and implementation of a randomized controlled trial of a participatory, multi-level, partnered (i.e., with community stakeholders) intervention to improve the oral and general health of low-income Chinese American adults. This study will evaluate the feasibility and acceptability of implementing a partnered intervention using remote data entry into an electronic health record (EHR) to improve access to oral health care and promote oral health. The research staff will survey a sample of Chinese American patients (planned n  = 90) screened at three outreach centers about their satisfaction with the partnered intervention. Providers (dentists and community health workers), research staff, administrators, site directors, and community advisory board members will participate in structured interviews about the partnered intervention. The remote EHR evaluation will include group adaptation sessions and workflow analyses via multiple recorded sessions with research staff, administrators, outreach site directors, and providers. The study will also model knowledge held by non-patient participants to evaluate and enhance the partnered intervention for use in future implementations.

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers, Israel.

PubMed

Natapov, Lena; Dekel-Markovich, Dan; Granit-Palmon, Hadas; Aflalo, Efrat; Zusman, Shlomo Paul

2018-01-01

Dental caries is the most prevalent chronic disease in children. Caries risk assessment tools enable the dentists, physicians, and nondental health care providers to assess the individual's risk. Intervention by nurses in primary care settings can contribute to the establishment of oral health habits and prevention of dental disease. In Israel, Mother and Child Health Centers provide free preventive services for pregnant women and children by public health nurses. A caries prevention program in health centers started in 2015. Nurses underwent special training regarding caries prevention. A customized Caries Risk Assessment tool and Prevention Protocol for nurses, based on the AAPD tool, was introduced. A two-step evaluation was conducted which included a questionnaire and in-depth phone interviews. Twenty-eight (out of 46) health centers returned a completed questionnaire. Most nurses believed that oral health preventive services should be incorporated into their daily work. In the in-depth phone interviews, nurses stated that the integration of the program into their busy daily schedule was realistic and appropriate. The lack of specific dental module for computer program was mentioned as an implementation difficulty. The wide use of our tool by nurses supports its simplicity and feasibility which enables quick calculation and informed decision making. The nurses readily embraced the tool and it became an integral part of their toolkit. We provide public health nurses with a caries risk assessment tool and prevention protocol thus integrating oral health into general health of infants and toddlers. © 2017 Wiley Periodicals, Inc.

Impact of a monitored program of care on incidence of ventilator-associated pneumonia: results of a longterm performance-improvement project.

PubMed

Weireter, Leonard J; Collins, J N; Britt, Rebecca C; Reed, Scott F; Novosel, T J; Britt, L D

2009-05-01

Ventilator-associated pneumonia (VAP) remains a major source of morbidity, mortality, and expense in the ICU despite therapies directed against it. A retrospective review of a prospectively developed performance-improvement project monitoring the incidence of VAP in two adjacent ICUs was conducted. In response to an excessive VAP rate, weekly multidisciplinary team meetings were instituted to review data, develop care protocols, and modify care routines. Protocol compliance was monitored daily and feedback provided weekly to the care teams. VAP rates were determined by the institutional Infection Control Committee and reviewed monthly with the ICU multidisciplinary team. Duration of the investigational period was 10 years. A standardized ventilator-weaning protocol was instituted with confirmed 95% use. Additional modifications of care, such as patient positioning, use of specific endotracheal tubes to minimize aspiration of supraglottic secretions, an oral-care regimen, and aggressive antibiotic stewardship were standardized, with a compliance rate >90%. VAP rates dropped from 12.8 per 1,000 patient-days in 1998 to 1.1 in 2007 in the burn trauma ICU and from 21.2 to <1 in the neurotrauma ICU in the same time frame. Also, mean ventilator length of stay decreased from 6 days to 4.2 and from 5.8 days to 4.75 simultaneously in the respective ICUs. Such performance improvement has been sustained since implementation of the program. A systematic, monitored program of standardized care protocols can markedly reduce VAP rate in the ICU.

An Epidemiologic Study on Ageing and Dysphagia in the Acute Care Geriatric-Hospitalized Population: A Replication and Continuation Study.

PubMed

Leder, Steven B; Suiter, Debra M; Agogo, George O; Cooney, Leo M

2016-10-01

United States census data project dramatic increases in the geriatric population ageing demographics by 2060 with concomitant health-care consequences. The purpose of this replication and continuation study was to collect new 2014 demographic data relative to ageing, swallow evaluation referral rates, and oral feeding status in geriatric-hospitalized patients for comparison with published data from 2000 to 2007. This was a planned data acquisition study of consecutive hospitalized patients referred for swallow assessments. Swallow evaluation referral rates for 2014 were described according to inpatient discharges, age range 60-105 years grouped by decade, gender, admitting diagnostic category, results of swallow evaluations, and oral feeding status. Determination of aspiration risk status was made with the Yale Swallow Protocol and diagnosis of dysphagia made with fiberoptic endoscopic evaluation of swallowing (FEES). There were 1348 referrals and 961 patients ≥60 years of age participated. Overall swallow evaluation referral rates increased an average of 63 % between the comparison years 2007 and 2014 with consistent increases corresponding to the decades, i.e., 60-69 (46 %), 70-79 (68 %), 80-89 (53 %), and 90+ (222 %). A total of 75 % of participants resumed oral alimentation and oral medications. Swallow evaluation referral rates increased by 63 % for 60-90+ year-old acute care geriatric-hospitalized participants despite only a 23 % increase in inpatient discharges for the years 2007 versus 2014. This corroborated previously reported increases for individual years from 2000 to 2007. For timely, safe, and successful initiation of oral alimentation, it is important to perform a reliable swallow screen for aspiration risk assessment with the Yale Swallow Protocol and, if failed, instrumental testing with FEES. More dysphagia specialists are needed through 2060 and beyond due to projections of continued population ageing resulting in ever increasing referral rates for swallow assessments.

Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in andalusian tertiary care hospitals.

PubMed

Martínez-Brocca, María Asunción; Morales, Cristóbal; Rodríguez-Ortega, Pilar; González-Aguilera, Beatriz; Montes, Cristina; Colomo, Natalia; Piédrola, Gonzalo; Méndez-Muros, Mariola; Serrano, Isabel; Ruiz de Adana, Maria Soledad; Moreno, Alberto; Fernández, Ignacio; Aguilar, Manuel; Acosta, Domingo; Palomares, Rafael

2015-02-01

In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. 288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for<40 IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P<.05). Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Basic nursing care to prevent nonventilator hospital-acquired pneumonia.

PubMed

Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol

2014-01-01

Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and implementation of policies that allow for adequate time, proper oral care supplies, ease of access to supplies, clear procedures, and outcome monitoring ensuring that patients are protected from NV-HAP. © 2013 Sigma Theta Tau International.

A comparison of sennosides-based bowel protocols with and without docusate in hospitalized patients with cancer.

PubMed

Hawley, Philippa Helen; Byeon, Jai Jun

2008-05-01

Constipation is a common and distressing condition in patients with cancer, especially those taking opioid analgesics. Many institutions prevent and treat constipation with titrated laxatives, which is known as a bowel protocol. An effective and well-tolerated bowel protocol is a very important component of cancer care, and there is little evidence on which to base selection of the most appropriate agents. This study compares a protocol of the stimulant laxative sennosides alone with a protocol of sennosides plus the stool softener docusate, in hospitalized patients at an oncology center. The docusate-containing protocol had an initial docusate-only step for patients not taking opioids, and four to six 100-mg capsules of docusate sodium in addition to the sennosides for the rest of the protocol. Thirty patients received the sennosides-only (S) protocol and 30 the sennosides plus docusate (DS) protocol. The efficacy and adverse effects of the protocols were monitored for 5-12 days. The two protocols were used sequentially, creating two cohorts, one on each protocol. Eighty percent of patients were taking oral opioids and 72% were admitted for symptom control/supportive care. Over a total of 488 days of observation it was found that the S protocol produced more bowel movements than the DS protocol, and in the symptom control/supportive care patients this difference was statistically significant (p < 0.05). In the S group admitted for symptom control/supportive care 62.5% had a bowel movement more than 50% of days, as compared with 32% in those receiving the DS protocol. Fifty-seven percent of the DS group required additional interventions (lactulose, suppositories or enemas) compared to 40% in the S group. Cramps were reported equally by 3 (10%) patients in each group. Eight patients (27%) experienced diarrhea in the S group compared to 4 (13%) in the DS group. The addition of the initial docusate-only step and adding docusate 400-600 mg/d to the sennosides did not reduce bowel cramps, and was less effective in inducing laxation than the sennosides-only protocol. Further research into the appropriate use of docusate and into the details of bowel protocol design are required.

A cluster randomised feasibility trial evaluating six-month nutritional interventions in the treatment of malnutrition in care home-dwelling adults: recruitment, data collection and protocol.

PubMed

Stow, Ruth; Rushton, Alison; Ives, Natalie; Smith, Christina; Rick, Caroline

2015-01-01

Protein energy malnutrition predisposes individuals to disease, delays recovery from illness and reduces quality of life. Care home residents are especially vulnerable, with an estimated 30%-42% at risk. There is no internationally agreed protocol for the nutritional treatment of malnutrition in the care home setting. Widely used techniques include food-based intervention and/or the use of prescribed oral nutritional supplements, but a trial comparing the efficacy of interventions is necessary. In order to define outcomes and optimise the design for an adequately powered, low risk of bias cluster randomised controlled trial, a feasibility trial with 6-month intervention is being run, to assess protocol procedures, recruitment and retention rates, consent processes and resident and staff acceptability. Trial recruitment began in September 2013 and concluded in December 2013. Six privately run care homes in Solihull, England, were selected to establish feasibility within different care home types. Residents with or at risk of malnutrition with no existing dietetic intervention in place were considered for receipt of the allocated intervention. Randomisation took place at the care home level, using a computer-generated random number list to allocate each home to either a dietetic intervention arm (food-based or prescribed supplements) or the standard care arm, continued for 6 months. Dietetic intervention aimed to increase daily calorie intake by 600 kcal and protein by 20-25 g. The primary outcomes will be trial feasibility and acceptability of trial design and allocated interventions. A range of outcome assessments and data collection tools will be evaluated for feasibility, including change in nutrient intake, anthropometric parameters and patient-centric measures, such as quality of life and self-perceived appetite. The complexities inherent in care home research has resulted in the under representation of this population in research trials. The results of this feasibility trial will be used to inform the development and design of a future cluster randomised controlled trial to compare food-based intervention with prescribed oral nutritional supplements (ONS) in the treatment of malnutrition within the care home population. Current Controlled Trials ISRCTN38047922.

Sharing Annotated Audio Recordings of Clinic Visits With Patients-Development of the Open Recording Automated Logging System (ORALS): Study Protocol.

PubMed

Barr, Paul J; Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn

2017-07-06

Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a US-wide network of primary care practices (www.iorahealth.com), has indicated a willingness to implement ORALS on a larger scale upon completion of this development project. Upon the completion of this project we will have developed a novel recording system that will be ready for large-scale testing. Our long-term goal is for ORALS to seamlessly fit into a clinic's and patient's daily routine, increasing levels of patient engagement and transparency of care. ©Paul J Barr, Michelle D Dannenberg, Craig H Ganoe, William Haslett, Rebecca Faill, Saeed Hassanpour, Amar Das, Roger Arend, Meredith C Masel, Sheryl Piper, Haley Reicher, James Ryan, Glyn Elwyn. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 06.07.2017.

Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial.

PubMed

Hägglund, Patricia; Olai, Lena; Ståhlnacke, Katri; Persenius, Mona; Hägg, Mary; Andersson, Maria; Koistinen, Susanne; Carlsson, Eva

2017-03-23

Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia). This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT <10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups. The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people. This trial was retrospectively registered at ClinicalTrials.gov, on July 4, 2016, identifier: NCT02825927 .

Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study.

PubMed

Alito, Miguel Aprelino; de Aguilar-Nascimento, José Eduardo

2016-04-02

Multimodal protocols of perioperative care may enhance postoperative recovery. However, limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty. We aimed to investigate the effect of a multimodal protocol (ACERTO protocol) plus preoperative immune nutrition on the length of stay (LOS) and the postoperative acute phase response of patients undergoing total hip arthroplasty. Thirty-two patients (mean age, 58 years; range, 26-85 years; 16 males) were randomized to receive either the ACERTO protocol (n = 15, ACERTO Group), which consisted of 6 h preoperative fasting for solids, an oral drink (200 mL of 12.5 % maltodextrin) up to 2 h before induction of anesthesia, restricted intravenous fluids (only 1000 mL of crystalloid fluid after surgery) and preoperative immune nutrition (600 mL/day of Impact - Nestlé, Brazil) for five days prior to surgery, or traditional care (n = 17; control group), which consisted of 6-8 h preoperative fasting, intravenous hydration until the 1(st) postoperative day and no preoperative immune supplementation. The main endpoint was LOS. C-reactive protein (CRP) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2. Neither deaths nor postoperative complications occurred. The median LOS was 3 (2-5) days in the ACERTO group and 6 (3-8) days in controls (P <0.01). Postoperative CRP was higher in the control group (P <0.01). The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty. NCT02580214.

A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries.

PubMed

Solinsky, Ryan; Svircev, Jelena N; James, Jennifer J; Burns, Stephen P; Bunnell, Aaron E

2016-11-01

Autonomic dysreflexia is a potentially life-threatening condition which afflicts a significant proportion of individuals with spinal cord injuries (SCI). To date, the safety and efficacy of several commonly used interventions for this condition have not been studied. A retrospective chart review of the safety of a previously implemented nursing driven inpatient autonomic dysreflexia protocol. Seventy-eight male patients with SCI who experienced autonomic dysreflexia while inpatient at our Veterans Affairs SCI unit over a 3-1/2-year period were included. The safety of a nursing driven protocol utilizing conservative measures, nitroglycerin paste, and oral hydralazine was evaluated. Occurrence of adverse events and relative hypotensive events during all episodes treated with the protocol, and efficacy of attaining target blood pressure for all episodes with protocol adherence and for initial episode experienced by each patient. Four hundred forty-five episodes of autonomic dysreflexia were recorded in the study period, with 92% adherence to the protocol. When the protocol was followed, target blood pressure was achieved for 97.6% of all episodes. Twenty-three total adverse events occurred (5.2% of all episodes). All adverse events were due to hypotension and only 0.9% required interventions beyond clinical monitoring. Of each patient's initial autonomic dysreflexia episode, 97.3% resolved using the protocol without need for further escalation of care. This inpatient nursing driven-protocol for treating autonomic dysreflexia utilizing conservative measures, nitroglycerin paste and oral hydralazine achieved target blood pressure with a high success rate and a low incidence of adverse events.

Development and validation of hospital information system-generated indicators of the appropriateness of oral anticoagulant prescriptions in hospitalised adults: the PACHA study protocol.

PubMed

Petit-Monéger, Aurélie; Thiessard, Frantz; Jouhet, Vianney; Noize, Pernelle; Berdaï, Driss; Kret, Marion; Sitta, Rémi; Salmi, Louis-Rachid; Saillour-Glénisson, Florence

2017-08-31

The appropriateness of oral anticoagulant prescriptions is a major challenge to improve quality and safety of care. As indicators of the appropriateness of oral anticoagulant prescriptions are lacking, the aim of the study is to develop and validate a panel of such indicators, in hospitalised adults, from the hospital information system of two university hospitals in France. The study will be carried out in four steps: (1) a literature review to identify indicators of the appropriateness of oral anticoagulant prescriptions and their conditions of appropriateness; (2) a Delphi consensus method to assess the potential utility and operational implementation of the selected indicators; (3) techniques of medical data search to implement indicators from the hospital information system and; (4) a cross-sectional study to assess the ability of indicators to detect inappropriate oral anticoagulant prescriptions, performance of medical data search techniques for tracking or retrieving information and the ability of tools to be transferred into other institutions. The fourth step will include up to 80 patient hospital stays for each indicator, depending on the prevalence of inappropriate prescriptions estimated in interim analyses. This work addresses the current lack of quality indicators of the appropriateness of oral anticoagulant prescriptions. We aim to develop and validate such indicators for integrating them into hospital clinical practice, as part of a structured approach to improve quality and safety of care. As each hospital information system is different, we will propose tools transferable to other healthcare institutions to allow an automated construction of these indicators. The PACHA study protocol was approved by institutional review boards and ethics committees (CPP Sud-Ouest et Outre Mer III-DC 2016/119; CPP Ile-de-France II-CDW_2016_0014). Clinical Trial.gov registration: NCT02898090. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Development and validation of hospital information system-generated indicators of the appropriateness of oral anticoagulant prescriptions in hospitalised adults: the PACHA study protocol

PubMed Central

Petit-Monéger, Aurélie; Thiessard, Frantz; Jouhet, Vianney; Noize, Pernelle; Berdaï, Driss; Kret, Marion; Sitta, Rémi; Salmi, Louis-Rachid; Saillour-Glénisson, Florence

2017-01-01

Introduction The appropriateness of oral anticoagulant prescriptions is a major challenge to improve quality and safety of care. As indicators of the appropriateness of oral anticoagulant prescriptions are lacking, the aim of the study is to develop and validate a panel of such indicators, in hospitalised adults, from the hospital information system of two university hospitals in France. Methods and analysis The study will be carried out in four steps: (1) a literature review to identify indicators of the appropriateness of oral anticoagulant prescriptions and their conditions of appropriateness; (2) a Delphi consensus method to assess the potential utility and operational implementation of the selected indicators; (3) techniques of medical data search to implement indicators from the hospital information system and; (4) a cross-sectional study to assess the ability of indicators to detect inappropriate oral anticoagulant prescriptions, performance of medical data search techniques for tracking or retrieving information and the ability of tools to be transferred into other institutions. The fourth step will include up to 80 patient hospital stays for each indicator, depending on the prevalence of inappropriate prescriptions estimated in interim analyses. Ethics and dissemination This work addresses the current lack of quality indicators of the appropriateness of oral anticoagulant prescriptions. We aim to develop and validate such indicators for integrating them into hospital clinical practice, as part of a structured approach to improve quality and safety of care. As each hospital information system is different, we will propose tools transferable to other healthcare institutions to allow an automated construction of these indicators. The PACHA study protocol was approved by institutional review boards and ethics committees (CPP Sud-Ouest et Outre Mer III—DC 2016/119; CPP Ile-de-France II—CDW_2016_0014). Registration details Clinical Trial.gov registration: NCT02898090. PMID:28860229

An Integrative Review of Postoperative Accelerated Recovery Protocols.

PubMed

Oliveira, Ramon AntÔnio; Guatura, Gabrielle Meriche GalvÃo Bento da Silva; Peniche, Aparecida de Cássia Giani; Costa, Ana Lúcia Siqueira; Poveda, Vanessa de Brito

2017-10-01

We undertook an integrative literature review of articles pertaining to perioperative nursing care provided to patients using postoperative accelerated recovery protocols. To select the articles, we searched the MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature, and LiteraturaLatino-Americana e do Caribe em Ciências da Saúde databases. We identified 329 studies, 13 of which met our inclusion criteria and described perioperative nursing care activities. Nursing activities noted in these articles were hypothermia prevention and maintenance of normothermia, restriction of IV fluids, assessment of vital signs, management of symptoms and pain, support of early ambulation, care for tubes and drains, oral administration of carbohydrate-rich foods, assessment of ability to tolerate diet, and encouragement to resume activities of daily living. There was a lack of research on this topic by nursing professionals; additional research by nursing professionals is needed regarding nurses' roles in providing this care. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

[The Effect of Dongchimi Juice Containing Kimchi Lactobacillus on the Oral Health of Patients at a Long-Term Care Hospital: Comparison with Chlorhexidine Solution].

PubMed

Lee, Seung Ah; Lee, Dongsuk

2017-08-01

The aim of this study was to identify the effect of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent and to compare it with that of chlorhexidine solution (0.12% dilution). This study employed a pretest-posttest experimental design in which a single group of patients was exposed to two different treatments over a period of time. The study included 32 patients hospitalized at a long-term care hospital in Korea. Data were collected between August 12, 2016 and September 28, 2016. The patients first used chlorhexidine solution as an oral care agent for 1 week. After an interval of 2 weeks, they used Dongchimi juice for 1 week. Each agent was applied 2 times a day depending on the protocol. The oral status of the patients was measured using Beck's Oral Exam Guide (OEG) scores. The number of pathogens in the oral cavity was counted by culture, and the patients' subjective satisfaction score for each oral agent was measured using a visual analogue scale. T-test and Mann-Whitney test were performed to identify significant differences between Dongchimi juice and chlorhexidine solution by using PASW Statistics for Windows, Version 18.0 (SPSS Inc., Chicago, IL, USA). The OEG score was not statistically different with the use of chlorhexidine solution and Dongchimi juice. However, decreasing number of pathogens and the subjective satisfaction score were higher with Dongchimi juice than with the chlorhexidine solution. These findings support the use of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent for Korean patients. © 2017 Korean Society of Nursing Science

Facilitating the transition of patients with special health care needs from pediatric to adult oral health care.

PubMed

Nowak, Arthur J; Casamassimo, Paul S; Slayton, Rebecca L

2010-11-01

Without guidelines or policies in dentistry for transitioning adolescents with special heath care needs from pediatric to adult oral health care, little is known about traditional support services. The authors surveyed pediatric dentists about their transition of adolescent patients with and without special health care needs (SHCNs) to adult care. In 2009, the authors e-mailed a pilot-tested survey modified from a survey used for U.S. pediatricians to 4,000 pediatric dentists. The survey included demographic questions and questions regarding services and barriers associated with the transition of patients to adult care. Responses were obtained from 1,686 (42.2 percent response) pediatric dentists who were mostly in group or solo private practices and were younger, in that most had completed their education in the preceding 15 years. More than one-half practiced in suburban settings, and most worked with both dental hygienists and dental assistants. Most assisted patients with SHCNs with their transitions to adult care, and the predominant barrier to transitioning to adult care was availability of general dentists and specialists who were willing to accept these new patients. Pediatric dentists' answers paralleled those of pediatricians for the most part in terms of services provided and barriers to transition. Most responding dentists helped adolescents with and without SHCNs make the transition into adult care, but the major barrier was the availability of general dentists and specialists. With an office protocol in place that includes trained staff members, transitioning patients (especially those with SHCNs) to adult care can be facilitated to provide the appropriate oral health and support services.

Biophysical Approaches for Oral Wound Healing: Emphasis on Photobiomodulation

PubMed Central

Khan, Imran; Arany, Praveen

2015-01-01

Significance: Oral wounds can lead to significant pain and discomfort as well as affect overall general health due to poor diet and inadequate nutrition. Besides many biological and pharmaceutical methods being investigated, there is growing interest in exploring various biophysical devices that utilize electric, magnetic, ultrasound, pressure, and light energy. Recent Advances: Significant insight into mechanisms of these biophysical devices could provide a clear rationale for their clinical use. Preclinical studies are essential precursors in determining physiological mechanisms and elucidation of causal pathways. This will lead to development of safe and effective therapeutic protocols for clinical wound management. Critical Issues: Identification of precise events initiated by biophysical devices, specifically photobiomodulation—the major focus of this review, offers promising avenues in improving oral wound management. The primary phase responses initiated by the interventions that distinctly contribute to the therapeutic response must be clearly delineated from secondary phase responses. The latter events are a consequence of the wound healing process and must not be confused with causal mechanisms. Future Direction: Clinical adoption of these biophysical devices needs robust and efficacious protocols that can be developed by well-designed preclinical and clinical studies. Elucidation of the precise molecular mechanisms of these biophysical approaches could determine optimization of their applications for predictive oral wound care. PMID:26634185

Branched Nerve Allografts to Improve Outcomes in Facial Composite Tissue Transplantation

DTIC Science & Technology

2017-12-01

Ethicon, Inc. Somervile, N.J.). Postoperatively, animals were recovered per standard protocol in the animal care facility.  Experimental Design ...official Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No...a human xenograft with or without oral Tacrolimus. Electrophysiologic assessments were performed pre -operatively and at the study endpoint (24 weeks

A clinical and pharmacoeconomic justification for intravenous acetylcysteine: a US perspective.

PubMed

Culley, Colleen M; Krenzelok, Edward P

2005-01-01

Paracetamol (acetaminophen) poisoning remains the most common exposure reported to US poison information centres and the leading cause of poisoning-related fatalities, despite the availability of an effective antidote, acetylcysteine. Oral acetylcysteine solution has been approved for the management of acetaminophen poisoning in the US for four decades. Until the recent approval of intravenous acetylcysteine in the US, it was necessary to compound the oral solution for intravenous administration. The effectiveness and tolerability of oral and intravenous acetylcysteine for the prevention of hepatotoxicity induced by paracetamol poisoning are well established in the literature. Intravenous acetylcysteine may be preferred over oral administration based on improved tolerability, ease of administration and the shortened course of therapy (20 hours intravenous vs 72 hours oral). The two intravenous acetylcysteine regimens documented in the literature, 48 hours and 20 hours, have similar efficacy when started within 8-10 hours of ingestion. Although there are no legal concerns with continuing the routine compounding of the oral solution to an intravenous product, new standards for pharmacy compounding of sterile preparations set forth by the US Pharmacopoeia highlight that the risk of compounding products for intravenous use must be assessed carefully. Changing the route of administration of a sterile oral solution to an intravenous preparation, when a commercial sterile and pyrogen-free product is available, may not be advisable. The best cost-containment strategies must be used for introduction of the more costly sterile, pyrogen-free intravenous acetylcysteine formulation by hospitals and healthcare systems. The intravenous acetylcysteine product is more cost effective when given for 20 hours than other treatment protocols based on the costs of acetylcysteine and hospitalisation. If used per protocol, the 20-hour intravenous acetylcysteine regimen may decrease hospital length of stay, thereby, offsetting the increased drug cost. Data conflict on the efficacy and administration of intravenous acetylcysteine for off-label uses, such as radiographic contrast media-induced nephropathy prevention and reperfusion in orthotopic liver transplantation. The costs for the intravenous formulation for these indications is significantly higher than use of the oral formulation for oral administration in radiographic contrast media-induced nephropathy prevention and compounded for intravenous use in orthotopic liver transplantation. The oral solution should be retained by healthcare systems for oral and inhalation applications, such as respiratory conditions, oral administration for radiographic contrast media nephropathy prevention, or the use of the 72-hour oral protocol to treat paracetamol poisoning, when the intravenous preparation cannot be used.

Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

PubMed

Yi Mohammadi, Joanna Jin; Franks, Kay; Hines, Sonia

2015-10-01

The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia.More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. Dementia poses a significant challenge for health and social policy in Australia. The quality of life of individuals, their families and friends is impacted by dementia. Older people with dementia often have other health comorbidities resulting in the need for a higher level of care. From 2009 to 2010, 53% of permanent residents in Residential Aged Care Facilities (RACFs) had dementia on admission. Older Australians are retaining more of their natural teeth, therefore residents entering RACFs will have more of their natural teeth and require complex dental work than they did in previous generations. Data from the Australian Institute of Health and Welfare showed that more than half the residents in RACFs are now partially dentate with an average of 12 teeth each. Furthermore, coronal and root caries are significant problems, especially in older Australians who are cognitively impaired.Residents in aged care facilities frequently have poor oral health and hygiene with moderate to high levels of oral disease and overall dental neglect. This is reinforced by aged care staff who acknowledge that the demands of feeding, toileting and behavioral issues amongst residents often take precedence over oral health care regimens. Current literature shows that there is a general reluctance on the part of aged care staff to prioritize oral care due to limited knowledge as well as existing psychological barriers to working on another person's mouth. Although staff routinely deal with residents' urinary and faecal incontinence, deep psychological barriers exist when working on someone's mouth due to their own personal values of oral health or their views that residents should be looking after their own teeth or dentures. Furthermore, residents with behavioral issues associated with dementia frequently have their oral hygiene neglected as they may be resistant and violent towards receiving oral care from aged care staff. Studies have shown that residents with dementia will often refuse to open their mouth or partake in oral hygiene care by aged care staff. The aged care staff in return often do not pursue an oral care regimen for these "difficult" residents, perpetuating the cycle of oral neglect and resultant disease.Dental hygienists are qualified oral health professionals who are specifically trained to develop individualized oral health care plans and preventative programs to reduce oral health disease in the community. Residents with dementia in aged care facilities have the right to live their lives comfortably and free of oral discomfort or pain. A Victorian study conducted by Hopcraft et al. investigated the ability of a dental hygienist to undertake a dental examination/screening for residents in aged care facilities, to develop a preventative and periodontal treatment plan and to refer patients appropriately to a dentist. Results from this study demonstrated that there was an excellent agreement between the dentist and dental hygienist regarding the decision to refer residents to a dentist for treatment, demonstrating high sensitivity (99.6%) and high specificity (82.9%). Residents from 31 Victorian RACFs (n=510) were examined by a single experienced dental epidemiologist and one of four dental hygienists using a simple mouth mirror and probe. Hopcraft et al. concluded that hygienists should be utilized more widely in providing holistic oral health care to residents in aged care facilities.Recently, Lewis et al. discussed the need to develop models of care to improve access to dental care for frail and functionally dependent elderly people in aged care facilities, with the model of care involving dental hygienists/oral health therapists having merit.The concept of professional oral care involves an oral health professional such as a dental hygienist or oral health therapist supervising or assisting residents with their oral care. Oral care involves the mechanical removal of plaque and food debris using a toothbrush, interproximal brush and floss.In 2014, Morino et al. explored the efficacy of short term professional oral care from dental hygienists once a week after breakfast for one month. In this study, the dental hygienists did not perform dental scaling but brushed subjects' teeth using a toothbrush and interdental brush. Dental plaque scores decreased significantly (Fisher's two-tailed tests, p<0.05) in the professional oral health intervention group. Interestingly, the positive effects of this short term intervention were sustained for the following three months (Wilcoxon test, p<0.05).A pilot study in Arkansas was conducted by Amerine et al. and utilized the dental hygienist as the "oral health champion" in the residential aged care facility using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI) scores to measure oral health. The results from this study showed improvements in three measured areas (tongue health, denture status and oral cleanliness) in the dental hygiene champion group. These findings suggest that the presence of a dental hygiene champion in long term care facilities may positively impact the oral health of residents requiring assistance with their oral care. However, the authors noted further research in this concept is required.Van Der Putten GJ et al. explored the effectiveness of a supervised implementation of an oral health care guideline in care homes. In each ward of the care homes, a nurse who acted as the ward oral health care organiser (WOO) was appointed. The dental hygienist and an investigator would attend the RACFs every six weeks to support them. The dental hygienist would train the WOO, and the WOO would train the ward nurses and nurse assistants. Participants were allocated into an intervention or a control group. The intervention group received supervised oral care. Statistically significant differences in mean dental and denture plaque scores at six months in both groups occurred (student t-test, p < 0.0001). This research study implemented an intervention using the train-the-trainer approach and although improvements in dental and denture plaque scores were seen in the six-month period, the long-term effects of this intervention are unknown. Further studies exploring the long-term effects of staff training on oral health education are needed as well as ongoing staff training in aged care facilities.A systematic review on oral health and aspiration pneumonia conducted by Vander Maarel-Wierink et al. has suggested that, in the frail elderly, the best intervention to reduce the incidence of aspiration pneumonia is brushing of teeth after each meal, cleaning dentures once a day, and receiving professional oral health care once a week.The need to advocate for a new model of geriatric dentistry is critical. A holistic multi-disciplinary approach to health care for residents entering aged care homes is imperative to achieve better oral health and comfort for residents, especially with Australia's ageing dentate population. A dental examination and assessment on admission to a RACF should be conducted by a Registered Nurse (RN), followed by an oral health professional such as a dentist, dental hygienist or oral health therapist. Current practice in the majority of Australian government funded nursing homes is that the RN or the Assistant in Nursing (AIN) conduct the oral health assessment as part of the aged care funding instrument (ACFI). Ongoing oral health care supported by an oral health professional is important throughout the individual's residency and eventual palliation whilst in an aged care facility.No systematic reviews conducted on the impact of professional oral care on the oral health of elderly people living in residential aged care facilities could be located, despite extensive searching of Medline, CINAHL, EMBASE, Web of Science, Cochrane Central Register of Trials and Dentistry & Oral Sciences Source (DOSS) databases. A JBI systematic review was conducted in 2004, titled, "Oral hygiene care for adults with dementia in residential aged care facilities"; however, this review examined the prevalence, incidence and increments of oral diseases; the use of assessment tools to evaluate oral health; preventative oral hygiene care strategies; and the provision of dental treatment and so had a different clinical focus. Twenty studies were included for analysis in the review conducted by Weening-Verbree et al, The studies in this review addressed oral health knowledge of aged care staff and mostly were conducted as an educational session delivered by dental hygienists or dentists.Overall, the current evidence available on interventions to improve oral health for residents living in aged care facilities is inadequate and should be explored further.

Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review.

PubMed

Oates, Lloyd L; Price, Christopher I

2017-01-01

Older patients in hospital may be unable to maintain hydration by drinking, leading to intravenous fluid replacement, complications and a longer length of stay. We undertook a systematic review to describe clinical assessment tools which identify patients at risk of insufficient oral fluid intake and the impact of simple interventions to promote drinking, in hospital and care home settings. MEDLINE, CINAHL, and EMBASE databases and two internet search engines (Google and Google Scholar) were examined. Articles were included when the main focus was use of a hydration/dehydration risk assessment in an adult population with/without a care intervention to promote oral hydration in hospitals or care homes. Reviews which used findings to develop new assessments were also included. Single case reports, laboratory results only, single technology assessments or non-oral fluid replacement in patients who were already dehydrated were excluded. Interventions where nutritional intake was the primary focus with a hydration component were also excluded. Identified articles were screened for relevance and quality before a narrative synthesis. No statistical analysis was planned. From 3973 citations, 23 articles were included. Rather than prevention of poor oral intake, most focused upon identification of patients already in negative fluid balance using information from the history, patient inspection and urinalysis. Nine formal hydration assessments were identified, five of which had an accompanying intervention/ care protocol, and there were no RCT or large observational studies. Interventions to provide extra opportunities to drink such as prompts, preference elicitation and routine beverage carts appeared to support hydration maintenance, further research is required. Despite a lack of knowledge of fluid requirements and dehydration risk factors amongst staff, there was no strong evidence that increasing awareness alone would be beneficial for patients. Despite descriptions of features associated with dehydration, there is insufficient evidence to recommend a specific clinical assessment which could identify older persons at risk of poor oral fluid intake; however there is evidence to support simple care interventions which promote drinking particularly for individuals with cognitive impairment. PROSPERO 2014:CRD42014015178.

Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

PubMed

Movahed, Reza; Teschke, Marcus; Wolford, Larry M

2013-12-01

Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Oral health and oral implant status in edentulous patients with implant-supported dental prostheses who are receiving long-term nursing care.

PubMed

Isaksson, Rita; Becktor, Jonas P; Brown, Andrew; Laurizohn, Christer; Isaksson, Sten

2009-12-01

The aim of this study was to investigate oral health and oral implant status in a group of edentulous patients receiving long-term residential or nursing care (LTC), all of whom had implant-supported fixed or removable dental prostheses. A dental examination was performed on a total of 3310 patients receiving LTC and from this population 35 edentulous patients in whom dental implants had been placed formed the cohort for this study. All examinations were performed by a specialist in hospital dentistry and took place in the patients' own home environment. Oral health was assessed by means of a protocol which evaluated oral hygiene status, possible oral mucosal inflammation and oral mucosal friction levels. Any problems with the implant-supported prosthesis, implant mobility or other complications were also assessed. In addition, patients were asked about any oral symptoms and their usual oral hygiene procedures. About half of the subjects (17/35) were registered as having no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral hygiene. Twenty-one of the 35 patients depended on help from the nursing personnel for their daily oral hygiene procedures. Obvious problems with food impaction were noted in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full arch-fixed prostheses and three implant-borne overdentures. There was no evidence of mobility or fractures of either the implants or the prostheses. Fifteen implants showed some exposed screw threads. Pus was exuding from one implant site and general peri-implant gingival hyperplasia was noted in two patients. Twenty-four patients were completely satisfied with the function and appearance of their implant-supported prostheses. Two patients were totally dissatisfied. This study indicates that oral implant therapy can be considered as a treatment of choice in elderly patients, even if oral hygiene is sub-optimal.

Oral hygiene in intensive care unit patients with photodynamic therapy: study protocol for randomised controlled trial.

PubMed

Da Collina, Gabriela Alves; Tempestini-Horliana, Anna Carolina Ratto; da Silva, Daniela de Fátima Teixeira; Longo, Priscila Larcher; Makabe, Maria Luisa Faria; Pavani, Christiane

2017-08-22

In intensive care units (ICUs), nosocomial infections are prevalent conditions and they have been related to high mortality indexes. Some studies have suggested that inefficient oral hygiene and ventilator-associated pneumonia (VAP) are related. Nowadays, in the Brazilian public health system there is no well-defined protocol for oral hygiene in an ICU. Due to the drawbacks of the use of antibiotics, photodynamic therapy (PDT) has emerged as an interesting technique in order to reduce antimicrobial-resistant pathogens. Methylene blue (MB) is the most common chemical agent for PDT in Brazil. However, new formulations for improved effectiveness are still lacking. The objective of this study is to evaluate the use of an MB mouthwash as an effective oral-hygiene procedure in an ICU and to show that oral hygiene using PDT with MB mouthwash may reduce VAP frequency to rates similar to, or higher than, chlorhexidine. Phase 1 will evaluate the most effective cleaning procedure, while phase 2 will correlate oral hygiene to VAP incidence. At the start of phase 1, the ICU patients will be randomly allocated into three different groups (10 patients/group): the efficacy of chlorhexidine, classical MB-PDT, and mouthwash MB-PDT will all be measured for the quantification of viable bacteria, both pre- and post-treatment, by a Reverse Transcription Polymerase Chain Reaction (RT-PCR). In phase 2, the most effective procedure found in phase 1 and a mechanical cleaning with filtered water will be carried out daily, once a day, over 5 days, with a total of 52 ICU patients randomly allocated into the two groups. The clinical records will be evaluated in order to find any pneumonic diagnoses. Since a variety of bacterial species are related to VAP, a universal primer for bacteria will be used in order to quantify the total bacteria count in the participants' samples. In order to quantify only the living bacteria before DNA extraction, the samples will be treated with propidium monoazide. This will infiltrate the dead bacteria and will intercalate the DNA bases, avoiding their DNA amplification. This will be the first trial to evaluate MB-PDT in a mouthwash formula that can increase the effectiveness due to the control of MB aggregation. The results of this study will be able to generate an easy and low-cost protocol to be used in an ICU for the Brazilian public health system. This protocol was approved by the Research Ethics Committee of the Conjunto Hospitalar do Mandaqui (1.317.834, CAAE: 49273515.9.3001.5551) and it was registered in Registro Brasileiro de Ensaios Clínicos (ReBEC number: RBR-94bvrc;). First received: 12 July 2015; 1st version 6 June 2016. Data will be published in a peer-reviewed journal.

Preservation of nutritional-status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis.

PubMed

Sorrentino, Paolo; Castaldo, Giuseppe; Tarantino, Luciano; Bracigliano, Alessandra; Perrella, Alessandro; Perrella, Oreste; Fiorentino, Francesco; Vecchione, Raffaela; D' Angelo, Salvatore

2012-04-01

Refractory ascites in liver-cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritional-support could improve outcomes in cirrhotic patients. Cirrhotic patients undergoing serial large-volume paracentesis for refractory-ascites were enrolled and randomized into three groups. Group A received post-paracentesis intravenous nutritional-support in addition to a balanced oral diet and a late-evening protein snack, group B received the same oral nutritional-protocol as the first group but without parenteral support, and group C (the control group) received a low-sodium or sodium-free diet. Clinical, anthropometric and laboratory nutritional parameters and biochemical tests of liver and renal function were reported for 12 months of follow-up. We enrolled 120 patients, who were randomized into three groups of equal size. Patients on the nutritional-protocol showed better preservation of clinical, anthropometric and laboratory nutritional parameters that were associated with decreased deterioration of liver function compared with patients on the low-sodium or sodium-free diet (group C). Groups A and B had lower morbidity and mortality rates than the control group (C). Mortality rates were significantly better in patients who were treated with parenteral-nutritional-support than for the other two groups. In patients who were on the nutritional-protocol, there was a reduction in the requirement of taps for the treatment of refractory ascites. Post-paracentesis parenteral-nutritional-support with a balanced oral diet and an evening protein snack appears to be the best care protocol for patients with liver-cirrhosis that has been complicated by refractory-ascites. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

Evaluation of the Effectiveness of Two Morphine Protocols to Treat Neonatal Abstinence Syndrome in a Level II Nursery in a Community Hospital.

PubMed

DeAtley, Heather N; Burton, Amanda; Fraley, Michelle DeLuca; Haltom, Joan

2017-07-01

The authors sought to evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. A single-center, retrospective chart review was conducted at a Level II nursery in a community hospital in Kentucky. Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included. The protocol 1 group consisted of 33 neonates who received an initial dose of morphine 0.04 mg/kg/dose administered orally every 4 hours (January 1-December 31, 2014), and the protocol 2 group consisted of 26 neonates who received an initial dose of morphine 0.06 mg/kg/dose administered orally every 3 hours (January 1-November 30, 2015), after a change in the protocol for managing NAS was implemented on January 1, 2015. Data were reviewed and compared between the two protocol groups to determine the impact that the dosage change had on length of hospital stay and morphine treatment duration. The average length of stay decreased by 7 days in the protocol 2 group compared with the protocol 1 group (21 vs 28.65 days). The average duration of treatment decreased by 7 days in the protocol 2 group compared with the protocol 1 group (18.3 vs 25.4 days). These differences between groups were not statistically significant, however, because the population size was not large enough to achieve adequate power. These results indicate that protocol 2 displayed the potential to decrease length of stay and duration of treatment compared with protocol 1 at this facility; however, balancing higher starting doses with the risk of oversedation will continue to challenge the health care team. Concern for oversedation when using the higher starting dose in protocol 2 has prompted further research (e.g., protocol 3, initial morphine 0.05 mg/kg/dose every 3 hrs). Continued research is also necessary with larger patient populations to enable generalizability to other institutions. © 2017 Pharmacotherapy Publications, Inc.

The Key Points of Maintenance Therapy for Dental Implants: A Literature Review.

PubMed

Pirc, Miha; Dragan, Irina F

2017-04-01

Dental implants require lifelong maintenance and care. Success is defined by biologic factors (presence of inflamed soft tissues surrounding dental implants and radiographic changes in the crestal bone levels) and mechanical factors (stability of the implant fixture and implant supported restoration, etc). Most implant failures are initiated by incipient stages of inflammatory processes, which lead to peri-mucositis and peri-implantitis. The evidence regarding the value of maintenance protocol regarding implants is sparse compared with the one for teeth. This article addresses the existing literature on processes for oral hygiene for implant care.

Oral care with vancomycin paste for reduction in incidence of alpha-hemolytic streptococcal sepsis.

PubMed

Barker, G J; Call, S K; Gamis, A S

1995-05-01

alpha-Hemolytic streptococcal (AHS) sepsis is increasing in oncology patients receiving myelosuppressive chemotherapy. In response to a high rate of AHS sepsis in this population at our institution, an oral care protocol was instituted, including vancomycin 0.5% in flavored methylcellulose (vanc paste) applied orally t.i.d. at the oncologists' discretion. A retrospective cohort study of 239 neutropenic episodes among 42 children receiving myelosuppressive chemotherapy between 1988 and 1991 compared the incidence of septicemia based on the prophylactic use of vanc paste. A total of 236 consecutive neutropenic episodes were evaluable, 121 with vanc paste and 115 without. AHS sepsis occurred in one child using vanc paste and in six children not using vanc paste (p = 0.06). Excluding staph-only positive blood cultures, which would not be reduced with a topical oral antibiotic drug, there were 6 and 13 positive blood cultures in the vanc-paste and nonvanc-paste patients, respectively (p = 0.09). There was no increase in incidence of gram-negative bacteremia among vanc-paste recipients. Vancomycin resistance was not encountered. This analysis suggests that vanc paste effectively reduces AHS sepsis, does not increase gram-negative bacteremia, and is not associated with vancomycin resistance. A multicentered, placebo-controlled, double-blind study is currently planned.

Preventing Caries in Preschoolers: Successful Initiation of an Innovative Community-Based Clinical Trial in Navajo Nation Head Start

PubMed Central

Quissell, David O.; Bryant, Lucinda L.; Braun, Patricia A.; Cudeii, Diana; Johs, Nikolas; Smith, Vongphone L.; George, Carmen; Henderson, William G.; Albino, Judith

2014-01-01

Navajo Nation children have the greatest prevalence of early childhood caries in the United States. This protocol describes an innovative combination of community-based participatory research and clinical trial methods to rigorously test a lay native Community Oral Health Specialists-delivered oral health intervention, with the goal of reducing the progression of disease and improving family knowledge and behaviors. Methods/Design This cluster-randomized trial designed by researchers at the Center for Native Oral Health Research at the University of Colorado in conjunction with members of the Navajo Nation community compares outcomes between the manualized 2-year oral health fluoride varnish-oral health promotion intervention and usual care in the community (child-caregiver dyads from 26 Head Start classrooms in each study arm; total of 1016 dyads). Outcome assessment includes annual dental screening and an annual caregiver survey of knowledge, attitudes and behaviors; collection of cost data will support cost-benefit analyses. Discussion The study protocol meets all standards required of randomized clinical trials. Aligned with principles of community-based participatory research, extended interaction between members of the Navajo community and researchers preceded study initiation, and collaboration between project staff and a wide variety of community members informed the study design and implementation. We believe the benefits of adding CBPR methods to those of randomized clinical studies outweigh the barriers and constraints, especially in studies of health disparities and in challenging settings. When done well, this innovative mix of methods will increase the likelihood of valid results that communities can use. PMID:24469238

Comparative effectiveness of vildagliptin in combination with other oral anti-diabetes agents in usual-care conditions: the EDGE-Latin America study.

PubMed

Mendivil, Carlos O; Márquez-Rodríguez, Eduardo; Angel, Iván D; Paz, Gustavo; Rodríguez, Cruz; Almada, Jorge; Szyskowsky, Ofelia

2014-09-01

To assess the proportion of patients on vildagliptin add-on dual therapy who respond to treatment over a 12 month follow-up, relative to comparator oral anti-diabetes dual therapy, in a usual care setting. Participants were patients with type 2 diabetes (T2DM) aged 18 years and older from 311 centers in Argentina, Colombia, Ecuador, Mexico and Venezuela. Patients were taking monotherapy with an oral anti-diabetes drug (OAD), and were prescribed a new add-on OAD based on the judgment of their personal physician. According to this choice, patients were assigned to one of the two cohorts: vildagliptin or comparator OADs. The primary endpoint was the proportion of patients achieving an A1c drop >0.3% without edema, hypoglycemia, weight gain or discontinuation due to gastrointestinal (GI) events. The secondary endpoint was the proportion of patients with baseline A1c ≥7% who reached the goal of an A1c <7% without hypoglycemia or weight gain. The per-protocol population (a subset of the intention-to-treat population that excluded patients with pre-specified protocol deviations) comprised 3773 patients, 3002 in the vildagliptin cohort and 771 in the comparator cohort. The proportion of patients reaching the primary endpoint was higher in the vildagliptin cohort (60.3%) than the comparator cohort (50.7%), OR 1.48 (95% CI: 1.25-1.73). The same was observed for the secondary endpoint (44.8 versus 33.1%) OR 1.64 (95% CI: 1.37-1.98). The incidence of adverse events was low and similar between treatment cohorts. In a usual care setting, patients treated with a vildagliptin combination succeeded in lowering A1c to <7%, without weight gain, hypoglycemia or peripheral edema more often than patients treated with comparator combinations, without increased risk of adverse events. Key limitations are the observational nature of the study and its relatively limited 12 month timeframe.

Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

PubMed Central

Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

2013-01-01

Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P < 0.001) and intraoral incisions (P < 0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health. PMID:23444246

Ambulatory oral surgery: 1-year experience with 11680 patients from Zagreb district, Croatia.

PubMed

Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

2013-02-01

To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Sociodemographic and clinical data on 11680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P<0.001) and intraoral incisions (P<0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P<0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients' awareness of the importance of oral health.

Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery.

PubMed

Yeung, Sophia E; Hilkewich, Leslee; Gillis, Chelsia; Heine, John A; Fenton, Tanis R

2017-07-01

Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional ( n = 46) and ERAS ( n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg -1 · d -1 ; ERAS group: 0.54 g · kg -1 · d -1 ; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables ( P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS ( P = 0.049) and fewer total infectious complications ( P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of ≥60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: -6.8, -2.0 d; P < 0.001). Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS. This trial was registered at clinicaltrials.gov as NCT02940665. © 2017 American Society for Nutrition.

Successful introduction and audit of a step-down oral antibiotic strategy for low risk paediatric febrile neutropaenia in a UK, multicentre, shared care setting.

PubMed

Dommett, R; Geary, J; Freeman, S; Hartley, J; Sharland, M; Davidson, A; Tulloh, R; Taj, M; Stoneham, S; Chisholm, J C

2009-11-01

Patients with febrile neutropaenia (FN) can be stratified according to their risk of significant complications, allowing reduced intensity therapy for low risk (LR) episodes. Serious events are very rare in low risk episodes making randomised trials difficult. Introduction of new evidence-based guidelines followed by re-auditing of the outcome is an alternative strategy. New guidelines for the management of LR FN were implemented in 4 specialist paediatric oncology centres (POCs) and in their associated shared care units (POSCUs). All patients commenced empirical intravenous antibiotic therapy and after 48h those with blood culture negative episodes designated LR were eligible for discharge on oral co-amoxiclav. Prospective data collection on FN episodes in all treatment centres was undertaken over a 1-year period. Seven hundred and sixty two eligible episodes of FN were recorded in 368 patients; 213 episodes were initiated in POCs and 549 episodes were initiated in POSCUs. In 40% of episodes no clinical or microbiological focus of infection was found. At 48h, 212 (27%) episodes were classified as LR and 143 of these (19%) were managed on the LR protocol. There was a low hospital readmission rate (8/143 episodes; 5.6%), no intensive care admissions and no deaths in LR episodes. Almost all LR episodes (209/212) occurred in the shared care setting. Rapid step-down to oral antibiotics was a feasible and safe management strategy for LR FN in the shared care setting in England.

A Real-time Ventilator Management Dashboard: Toward Hardwiring Compliance with Evidence-based Guidelines

PubMed Central

Starmer, John; Giuse, Dario

2008-01-01

Care of mechanically ventilated patients requires coordination between multiple caregivers, necessitating the availability of accurate and timely information on patient status. Researchers have documented positive effects of several interventions on the rates of developing ventilator associated complications, such as providing regular oral care and elevating the head of the bed. Informatics tools, such as electronic whiteboards, reminders, and alerts have been shown to aid in clinician compliance with guidelines or protocols. The purpose of this project was to design and implement a real-time ventilator management dashboard to show patient status with respect to elements important for ventilator management and infection prevention in the adult Intensive Care Units at Vanderbilt University Medical Center. PMID:18998939

AN OBSERVATIONAL STUDY OF SOCIAL CONTROL, MOOD, AND SELF-EFFICACY IN COUPLES DURING TREATMENT FOR HEAD AND NECK CANCER

PubMed Central

BADR, HODA; YEUNG, CHI; LEWIS, MEGAN A.; MILBURY, KATHRIN; REDD, WILLIAM H.

2014-01-01

OBJECTIVE Head and neck cancer (HNC) patients experience debilitating side effects, including abnormally reduced salivation and difficulty swallowing. Intensive self-care protocols are prescribed to control side effects and minimize discomfort, but non-adherence rates are high. Although spouses are in a prime position to encourage adherence, studies have yet to examine how spouse social control (i.e., attempts to influence patient behavior to support adherence) affects HNC patient mood and self-efficacy for engaging in these self-care routines. METHODS One-hundred twenty-five HNC couples where the patient (86% male) was undergoing radiotherapy were recorded in the laboratory as they discussed a cancer-related issue that the patient identified as being a topic of concern. RESULTS Sixty-eight couples discussed side-effects and spouses engaged in social control in 61 of these discussions. Although oral complications and pain were frequently identified by patients as being topics of concern, dental/oral care and pain management were some of the least likely self-care behaviors to be targeted by spouses, who focused primarily on encouraging patients to maintain their weight and hydration. Although spouses engaged in an almost equal number of positive and negative control attempts, only positive control was significantly (p<.05) associated with patient positive mood and self-efficacy. CONCLUSION HNC couples may benefit from programs that emphasize the regular practice of self-care routines to control oral side effects, pain, and nutrition/hydration problems. Likewise, programs that encourage spouses to maximize their use of positive social control may also boost patients’ mood during treatment and empower them to engage in recommended self-care behaviors. PMID:25471820

Access and management of HIV-related diseases in resource-constrained settings: a workshop report.

PubMed

Dimba, Eao; Yengopal, V; Joshua, E; Thavarajah, R; Balasundaram, S

2016-04-01

With advancement of medical interventions, the lifespan of people living with HIV has increased globally. However, low- and middle-income countries (LMICs) which bear the greatest burden of the HIV pandemic face a constant challenge in addressing the treatment needs of immune-suppressed patients. An analysis of the current management protocols and access to medication in resource-poor settings was conducted at this workshop, with emphasis on the situation in resource-poor settings. The participants developed a consensus document based on the need to respond to the constantly changing HIV pandemic. Provision of oral health care must be guided by interconnecting principles based on population based strategies that address upstream determinants of health. Basic oral health coverage in developing countries can only be realized with a strong foundation at the primary health level. Early diagnosis of HIV-related comorbidities including the adverse effects of ARVs is essential for the improvement of treatment outcomes. Standardization of oral health care delivery mechanisms will facilitate evaluation at national and regional levels. Oral health care workers have a moral obligation to participate in sustained campaigns to reduce the social stigma associated with HIV/AIDS in their work places at every stage of the referral chain. Future research also needs to realign itself towards prevention using the common risk factor approach, which has a broader impact on non-communicable diseases, which are increasingly affecting patients with HIV/AIDS as their life expectancies increase. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Opinion of dentists and gynecologists on the link between oral health and preterm low birth weight: "Preconception care - treat beyond the box".

PubMed

Ganganna, Aruna; Devishree, G

2017-01-01

Periodontal diseases are known to set an inflammatory response at the systemic level which can adversely affect the pregnancy outcomes, and many patients are unaware of this association. Health-care providers play a vital role in educating patients toward maintaining good oral health; hence, our study was planned to evaluate the knowledge, attitude, and practices of dentists' and gynecologists' concerning this link. In addition, referral to the dentists' during the preconception period was also emphasized. This was a cross-sectional questionnaire survey conducted among dentists and gynecologists' in the city of Mysore. The participants were divided into two groups and were asked specific questions about the association between oral health and preterm low birth weight (PTLB). Group I constituted the dentists possessing both graduate and postgraduate degree and Group II were the gynecologists'. Seventy-nine percent of the total participants agreed about the link between periodontal health and PTLB. Dentists were more aware of the periodontal changes during pregnancy and stressed on frequent dental checkup during pregnancy. Preconception care was a neglected part of the protocol by the gynecologists', and only 12% of them referred patients to a dentist in the preconception period. Factors significantly associated with knowledge in logistic regression analyses were older age, dentists and the years of experience (>5 years). Knowledge about oral health is important, to maintain good general health; hence, health workers should not miss opportunities to contribute to this health promotion. An integrated work by the dentists and gynecologists may reduce the adverse pregnancy outcomes associated with periodontal diseases.

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

PubMed Central

2011-01-01

Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. Methods/Design This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid. The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference. Discussion Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient. PMID:21281464

State of the evidence base for medically necessary oral health care.

PubMed

Patton, L L; White, B A; Field, M J

2001-09-01

The purpose of this article was to highlight the recent call for an evidence-based approach to public policy decision making with respect to funding dental services and the need this creates for enhanced clinical research activities. Systematic reviews on topics of importance to oral health care practitioners are being conducted and published by various national and international groups. Recent activities to assess evidence to support medically necessary dental services were reviewed. An Institute of Medicine Committee on Medicare Coverage Extensions found little published scientific evidence that directly assessed the effectiveness of dental services in preventing or managing systemic health outcomes for patients with head and neck cancer, lymphoma, leukemia, organ transplantation, and heart valve repair or replacement. The scientific community must strive to meet the challenge of conducting well-designed randomized, controlled trials that test the impact of dental treatment interventions on systemic health to meet the growing need for evidence to support or refute widely accepted dental treatment protocols for medically complex patients.

Efficacy of orally administered prednisolone versus partial endodontic treatment on pain reduction in emergency care of acute irreversible pulpitis of mandibular molars: study protocol for a randomized controlled trial.

PubMed

Kérourédan, Olivia; Jallon, Léonard; Perez, Paul; Germain, Christine; Péli, Jean-François; Oriez, Dominique; Fricain, Jean-Christophe; Arrivé, Elise; Devillard, Raphaël

2017-03-28

Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars. This study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h. This randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions. ClinicalTrials.gov, identifier: NCT02629042 . Registered on 7 December 2015. (Version n°1.1 28 July 2015).

Sharing Annotated Audio Recordings of Clinic Visits With Patients—Development of the Open Recording Automated Logging System (ORALS): Study Protocol

PubMed Central

Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn

2017-01-01

Background Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. Objective The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. Methods We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth’s Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. Results We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a US-wide network of primary care practices (www.iorahealth.com), has indicated a willingness to implement ORALS on a larger scale upon completion of this development project. Conclusions Upon the completion of this project we will have developed a novel recording system that will be ready for large-scale testing. Our long-term goal is for ORALS to seamlessly fit into a clinic’s and patient’s daily routine, increasing levels of patient engagement and transparency of care. PMID:28684387

Brief oral health promotion intervention among parents of young children to reduce early childhood dental decay.

PubMed

Arrow, Peter; Raheb, Joseph; Miller, Margaret

2013-03-20

Severe untreated dental decay affects a child's growth, body weight, quality of life as well as cognitive development, and the effects extend beyond the child to the family, the community and the health care system. Early health behavioural factors, including dietary practices and eating patterns, can play a major role in the initiation and development of oral diseases, particularly dental caries. The parent/caregiver, usually the mother, has a critical role in the adoption of protective health care behaviours and parental feeding practices strongly influence children's eating behaviours. This study will test if an early oral health promotion intervention through the use of brief motivational interviewing (MI) and anticipatory guidance (AG) approaches can reduce the incidence of early childhood dental decay and obesity. The study will be a randomised controlled study with parents and their new-born child/ren who are seen at 6-12 weeks of age by a child/community health nurse. Consenting parents will complete a questionnaire on oral health knowledge, behaviours, self-efficacy, oral health fatalism, parenting stress, prenatal and peri-natal health and socio-demographic factors at study commencement and at 12 and 36 months. Each child-parent pair will be allocated to an intervention or a standard care group, using a computer-generated random blocks. The standard group will be managed through the standard early oral health screening program; "lift the lip". The intervention group will be provided with tailored oral health counselling by oral health consultants trained in MI and AG.Participating children will be examined at 24, and 36 months for the occurrence of dental decay and have their height and weight recorded. Dietary information obtained from a food frequency chart will be used to determine food and dietary patterns. Data analysis will use intention to treat and per protocol analysis and will use tests of independent proportions and means. Multivariate statistical tests will also be used to take account of socio-economic and demographic factors in addition to parental knowledge, behaviour, self-efficacy, and parent/child stress. The study will test the effects of an oral health promotion intervention to affect oral health and general health and have the potential to demonstrate the "common risk factor" approach to health promotion. Australian New Zealand Clinical Trials Registry: http://ACTRN12611000997954.

IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care.

PubMed

Clarkson, Jan E; Ramsay, Craig R; Averley, Paul; Bonetti, Debbie; Boyers, Dwayne; Campbell, Louise; Chadwick, Graham R; Duncan, Anne; Elders, Andrew; Gouick, Jill; Hall, Andrew F; Heasman, Lynne; Heasman, Peter A; Hodge, Penny J; Jones, Clare; Laird, Marilyn; Lamont, Thomas J; Lovelock, Laura A; Madden, Isobel; McCombes, Wendy; McCracken, Giles I; McDonald, Alison M; McPherson, Gladys; Macpherson, Lorna E; Mitchell, Fiona E; Norrie, John Dt; Pitts, Nigel B; van der Pol, Marjon; Ricketts, David Nj; Ross, Margaret K; Steele, James G; Swan, Moira; Tickle, Martin; Watt, Pauline D; Worthington, Helen V; Young, Linda

2013-10-26

Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0-3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI.Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases.The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits. IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making. Protocol ID: ISRCTN56465715.

IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care

PubMed Central

2013-01-01

Background Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. Methods/Design This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI. Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits. Discussion IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making. Trial registration Protocol ID: ISRCTN56465715 PMID:24160246

Oral carcinogenesis is not achieved in different carcinogen-treated PAI-1 transgenic and wild-type mouse models.

PubMed

Avgoustidis, Dimitris; Nisyrios, Themistoklis; Nkenke, Emeka; Lijnen, Roger; Ragos, Vassilis; Perrea, Despina; Donta, Ismini; Vaena, Apostolia; Yapijakis, Christos; Vairaktaris, Eleftherios

2012-01-01

In an effort to assess the role of plasminogen activator inhibitor-1 (PAI-1) in oral squamous cancer development and progression, two different carcinogen treatment protocols were conducted. Protocol I included mice from a PAI-1 transgenic (Tg) breed (n=56) and their wild-type (WT) counterparts (n=56), divided into one control group and two main experimental groups, treated with 7,12-dimethylbenz[a]anthracene (DMBA) for 8 and 16 weeks, respectively. Protocol II included the same number and types of animals and groups, which were similarly treated with 4-Nitroquinoline 1-oxide (4-NQO) in drinking water. Two drugs that affect plasma PAI-1 levels, enalapril and pravastatin, were administered to certain subgroups of animals in both protocols. None of the animals developed macroscopically-visible oral cancer lesions. Eleven animals under Protocol I and 52 animals under Protocol II died. Skin lesions were noted only in DMBA-treated animals (n=9). Almost all animals administered with 4-NQO developed alopecia and lost weight, while two of them developed stomach tumours, and one female mouse developed a large ovarian cyst. Transgenic mice may respond differently when used in well-established carcinogen models and oral carcinogenesis is hard to achieve in these rodents.

Assessment and prevention of behavioural and social risk factors associated with oral cancer: protocol for a systematic review of clinical guidelines and systematic reviews to inform Primary Care dental professionals.

PubMed

Mathur, Sweta; Conway, David I; Worlledge-Andrew, Heather; Macpherson, Lorna M D; Ross, Alastair J

2015-12-22

Tobacco and alcohol are recognised as the major risk factors for both oral cavity (mouth) and oropharyngeal (throat) cancers, with increasing acceptance of the role of human papillomavirus (HPV) in the aetiology of oropharyngeal cancers. In addition, there is a significant increased risk for oral cancer among lower socioeconomic groups, males and older age groups. There is a growing evidence for the potential role of primary care professionals in smoking cessation and reducing alcohol-related harm. However, there are uncertainties about the best approaches/strategies to assess risk factors associated with oral cancer, effective components of preventive interventions for behaviour change and implementation strategies in primary care dental settings. Thus, in order to contribute to the prevention of oral cancer effectively, dental professionals need to assess patients on the major risk factors (tobacco, alcohol and HPV/sexual behaviours) and deliver appropriate prevention, taking into account the patient's sociodemographic context. The study aims to synthesise evidence on the best practice for undertaking an assessment of major behavioural risk factors associated with oral cancer and delivering effective behaviour change preventive interventions (e.g. advice, counselling, patient recall, signposting/referral to preventive services) by dental professionals in primary care dental settings. The study involves a systematic review and evidence appraisal. We will search for clinical guidelines and systematic reviews from the following databases: Cochrane Library, Ovid MEDLINE, EMBASE, Web of Science, PsychINFO, PubMed, TRIP and Google Scholar. We will also search websites of professional organisations/agencies and bibliographies/reference lists of selected papers. Quality will be assessed with the AGREE II (Appraisal of Guidelines for Research & Evaluation II) instrument for included clinical guidelines and the AMSTAR (A Measurement Tool to Assess Systematic Reviews) and ROBIS instruments for included systematic reviews. The best practice evidence will be assessed via a narrative synthesis of extracted data, considering publication quality. This systematic review will synthesise evidence on the best practice for oral cancer risk factor assessment and prevention and evaluate the relationship between available clinical guidelines and the review evidence base. This collation of evidence will be useful for making recommendations for future intervention, research and guideline development. PROSPERO CRD42015025289.

Older people's perceptions of the quality of oral care in short-term care units: A cross-sectional study.

PubMed

Andersson, Maria; Wilde-Larsson, Bodil; Carlsson, Eva; Persenius, Mona

2018-06-01

There is a lack of knowledge about oral care among older people living in short-term care (STC) units and how the quality of oral care provided by nursing staff is perceived by the older people. To (i) describe person-related conditions among older people in STC, (ii) describe and compare perceptions of the quality of oral care (including perceptions of care received and the subjective importance of such care), within and between older people who have the ability to perform oral self-care and those who are dependent on help with oral care and (iii) examine the relationship between person-related conditions and the quality of oral care. A cross-sectional study was conducted with 391 older people in STC units in Sweden based on self-reported questionnaire and clinical assessments. The older people were assessed as having normal oral health (2%), moderate oral health problems (78%) or severe oral health problems (20%). When comparing older people's perceptions of quality of oral care in terms of perceived reality and subjective importance, significant differences appeared within and between groups. Psychological well-being had a significant relationship with perception of the quality of oral care (both perceived reality and subjective importance), and gender and oral health status had a significant relationship with subjective importance. Older people's perceptions of areas for improvement regarding quality of oral care is a new and important knowledge for nursing staff in STC units. Older people want personalised information regarding oral health and oral care. Registered Nurses who take the responsibility in nursing care for older people's oral health may avoid unnecessary suffering by older people caused by oral health problems. Older people's perspective is an important component for quality work and might lead to improvements in the quality of oral care in STC. © 2018 John Wiley & Sons Ltd.

CareTrack Kids—part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review

PubMed Central

Hooper, Tamara D; Hibbert, Peter D; Mealing, Nicole; Wiles, Louise K; Jaffe, Adam; White, Les; Cowell, Christopher T; Runciman, William B; Goldstein, Stan; Hallahan, Andrew R; Wakefield, John G; Murphy, Elisabeth; Lau, Annie; Wheaton, Gavin; Williams, Helena M; Hughes, Clifford; Braithwaite, Jeffrey

2015-01-01

Introduction Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care delivered. This paper describes a study protocol to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. Methods and analysis A random sample of 6000–8000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against a set of indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Medical records of children aged <16 years who presented with at least one of the study conditions during 2012 and 2013 will be reviewed. Ethics and dissemination Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service and Women's and Children's Hospital Network (South Australia). An application is under review for the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and offer oral presentations to researchers, clinicians and policymakers at national and international conferences. PMID:25854977

Factors associated with a positive willingness to practise oral health care in the future amongst oral healthcare and nursing students.

PubMed

Haresaku, S; Monji, M; Miyoshi, M; Kubota, K; Kuroki, M; Aoki, H; Yoshida, R; Machishima, K; Makino, M; Naito, T

2018-06-06

The purpose of this study was to identify the weak points in the knowledge and attitudes of first-year oral health care and nursing students towards oral health care and to identify the factors associated with their positive willingness to practise oral health care after becoming a health professional in order to develop oral healthcare curricula. The subjects were 88 first-year dental students (DSs), 64 dental hygiene students (DHSs) and 119 nursing students (NSs) enrolled in schools in Japan, as of April 2017. A questionnaire was distributed to subjects in each school to assess their knowledge and attitudes towards oral health care. Less than half knew that oral health care was also provided in cancer hospitals, hospices, acute care hospitals, maternity wards and psychiatric wards. Only 46.2% knew that oral health care was effective in the prevention of aspiration pneumonia. The level of knowledge and attitudes in NSs regarding oral health care were likely to be lowest amongst the student groups. Only NSs' high interest towards oral health care was associated with their positive willingness to practise oral health care in the future although oral health students' high perceptions and interest regarding oral health care were associated with the willingness. This study showed oral healthcare and nursing students' weak points regarding their attitudes and knowledge of oral health care at early stages. Oral health academic staff and professionals should develop effective oral healthcare curricula for oral healthcare students and help nursing staff develop a collaborative nursing oral healthcare curriculum to motivate nursing students. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients

PubMed Central

Hafner, Gert; Neuhuber, Andreas; Hirtenfelder, Sylvia; Schmedler, Brigitte

2007-01-01

Aspiration in critically ill patients frequently causes severe co-morbidity. We evaluated a diagnostic protocol using routine FEES in critically ill patients at risk to develop aspiration following extubation. We instructed intensive care unit physicians on specific risk factors for and clinical signs of aspiration following extubation in critically ill patients and offered bedside FEES for such patients. Over a 45-month period, we were called to perform 913 endoscopic examinations in 553 patients. Silent aspiration or aspiration with acute symptoms (cough or gag reflex as the bolus passed into the trachea) was detected in 69.3% of all patients. Prolonged non-oral feeding via a naso-gastric tube was initiated in 49.7% of all patients. In 13.2% of patients, a percutaneous endoscopic gastrostomy was initiated as a result of FEES findings, and in 6.3% an additional tracheotomy to prevent aspiration had to be initiated. In 59 out of 258 patients (22.9%), tracheotomies were closed, and 30.7% of all 553 patients could be managed with the immediate onset of an oral diet and compensatory treatment procedures. Additional radiological examinations were not required. FEES in critically ill patients allows for a rapid evaluation of deglutition and for the immediate initiation of symptom-related rehabilitation or for an early resumption of oral feeding. PMID:17968575

Protocol for the management of psychiatric patients with psychomotor agitation.

PubMed

Vieta, Eduard; Garriga, Marina; Cardete, Laura; Bernardo, Miquel; Lombraña, María; Blanch, Jordi; Catalán, Rosa; Vázquez, Mireia; Soler, Victòria; Ortuño, Noélia; Martínez-Arán, Anabel

2017-09-08

Psychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode. Spanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement. The protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in the least invasive and coercive manner, ensuring their own safety and that of others around them. Establishing specialized teams in agitation and providing them with continued training on the identification of agitation, patient management and therapeutic alternatives might reduce the burden of PMA for both the patient and the healthcare system.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

PubMed

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Optimization of the protocols for the use of contrast agents in PET/CT studies.

PubMed

Pelegrí Martínez, L; Kohan, A A; Vercher Conejero, J L

The introduction of PET/CT scanners in clinical practice in 1998 has improved care for oncologic patients throughout the clinical pathway, from the initial diagnosis of disease through the evaluation of the response to treatment to screening for possible recurrence. The CT component of a PET/CT study is used to correct the attenuation of PET studies; CT also provides anatomic information about the distribution of the radiotracer. CT is especially useful in situations where PET alone can lead to false positives and false negatives, and CT thereby improves the diagnostic performance of PET. The use of intravenous or oral contrast agents and optimal CT protocols have improved the detection and characterization of lesions. However, there are circumstances in which the systematic use of contrast agents is not justified. The standard acquisition in PET/CT scanners is the whole body protocol, but this can lead to artifacts due to the position of patients and respiratory movements between the CT and PET acquisitions. This article discusses these aspects from a constructive perspective with the aim of maximizing the diagnostic potential of PET/CT and providing better care for patients. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer.

PubMed

Shida, Dai; Tagawa, Kyoko; Inada, Kentaro; Nasu, Keiichi; Seyama, Yasuji; Maeshiro, Tsuyoshi; Miyamoto, Sachio; Inoue, Satoru; Umekita, Nobutaka

2017-02-16

Enhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified. We evaluated 122 consecutive resections for obstructive colorectal cancer performed between July 2008 and November 2012 at Tokyo Metropolitan Bokutoh Hospital. Patients with rupture or impending rupture and those who received simple colostomy were excluded. The first set of 42 patients was treated based on traditional protocols, and the latter 80 according to modified ERAS protocols. The main endpoints were length of postoperative hospital stay, postoperative short-term morbidity, rate of readmission within 30 days, and mortality. Differences in modified ERAS protocols relative to traditional care include intensive preoperative counseling (by both surgeons and anesthesiologists), perioperative fluid management (avoidance of sodium/fluid overload), shortening of postoperative fasting period and early provision of oral nutrition, intraoperative warm air body heating, enforced postoperative mobilization, stimulation of gut motility, early removal of urinary catheter, and a multidisciplinary team approach to care. Median (interquartile range) postoperative hospital stay was 10 (10-14.25) days in the traditional group, and seven (7-8.75) days in the ERAS group, showing a 3-day reduction in hospital stay (p < 0.01). According to the Clavien-Dindo classification, overall incidences of grade 2 or higher postoperative complications for the traditional and ERAS groups were 15 and 10% (p = 0.48), and 30-day readmission rates were 0 and 1.3% (p = 1.00), respectively. As for mortality, one patient in the traditional group died and none in the ERAS group (p = 0.34). Modified ERAS protocols for obstructive colorectal cancer reduced hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible for patients with obstructive colorectal cancer.

Current protocols in the management of oral submucous fibrosis: An update.

PubMed

Arakeri, Gururaj; Rai, Kirthi Kumar; Boraks, George; Patil, Shekar Gowda; Aljabab, Abdulsalam S; Merkx, M A W; Carrozzo, Marco; Brennan, Peter A

2017-07-01

Oral submucous fibrosis (OSMF) is a debilitating condition of oral cavity which has significant potential for malignant transformation. In spite of over 20 years of research, the pathogenesis of the condition is still obscure and no single management modality is effective. Many OSMF treatment protocols have been proposed to alleviate the signs and symptoms of the disorder and there is overwhelming evidence that as areca nut is primary cause, stopping its use may have a considerable effect on symptoms rather than reversing pre-existing fibrosis. We present a review of the current protocols for managing OSMF. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Standardization of Nanoparticle Characterization: Methods for Testing Properties, Stability, and Functionality of Edible Nanoparticles.

PubMed

McClements, Jake; McClements, David Julian

2016-06-10

There has been a rapid increase in the fabrication of various kinds of edible nanoparticles for oral delivery of bioactive agents, such as those constructed from proteins, carbohydrates, lipids, and/or minerals. It is currently difficult to compare the relative advantages and disadvantages of different kinds of nanoparticle-based delivery systems because researchers use different analytical instruments and protocols to characterize them. In this paper, we briefly review the various analytical methods available for characterizing the properties of edible nanoparticles, such as composition, morphology, size, charge, physical state, and stability. This information is then used to propose a number of standardized protocols for characterizing nanoparticle properties, for evaluating their stability to environmental stresses, and for predicting their biological fate. Implementation of these protocols would facilitate comparison of the performance of nanoparticles under standardized conditions, which would facilitate the rational selection of nanoparticle-based delivery systems for different applications in the food, health care, and pharmaceutical industries.

A pacifier-activated music player with mother's voice improves oral feeding in preterm infants.

PubMed

Chorna, Olena D; Slaughter, James C; Wang, Lulu; Stark, Ann R; Maitre, Nathalie L

2014-03-01

We conducted a randomized trial to test the hypothesis that mother's voice played through a pacifier-activated music player (PAM) during nonnutritive sucking would improve the development of sucking ability and promote more effective oral feeding in preterm infants. Preterm infants between 34 0/7 and 35 6/7 weeks' postmenstrual age, including those with brain injury, who were taking at least half their feedings enterally and less than half orally, were randomly assigned to receive 5 daily 15-minute sessions of either PAM with mother's recorded voice or no PAM, along with routine nonnutritive sucking and maternal care in both groups. Assignment was masked to the clinical team. Ninety-four infants (46 and 48 in the PAM intervention and control groups, respectively) completed the study. The intervention group had significantly increased oral feeding rate (2.0 vs. 0.9 mL/min, P < .001), oral volume intake (91.1 vs. 48.1 mL/kg/d, P = .001), oral feeds/day (6.5 vs. 4.0, P < .001), and faster time-to-full oral feedings (31 vs. 38 d, P = .04) compared with controls. Weight gain and cortisol levels during the 5-day protocol were not different between groups. Average hospital stays were 20% shorter in the PAM group, but the difference was not significant (P = .07). A PAM using mother's voice improves oral feeding skills in preterm infants without adverse effects on hormonal stress or growth.

A Pacifier-Activated Music Player With Mother’s Voice Improves Oral Feeding in Preterm Infants

PubMed Central

Chorna, Olena D.; Slaughter, James C.; Wang, Lulu; Stark, Ann R.

2014-01-01

OBJECTIVES: We conducted a randomized trial to test the hypothesis that mother’s voice played through a pacifier-activated music player (PAM) during nonnutritive sucking would improve the development of sucking ability and promote more effective oral feeding in preterm infants. METHODS: Preterm infants between 34 0/7 and 35 6/7 weeks’ postmenstrual age, including those with brain injury, who were taking at least half their feedings enterally and less than half orally, were randomly assigned to receive 5 daily 15-minute sessions of either PAM with mother’s recorded voice or no PAM, along with routine nonnutritive sucking and maternal care in both groups. Assignment was masked to the clinical team. RESULTS: Ninety-four infants (46 and 48 in the PAM intervention and control groups, respectively) completed the study. The intervention group had significantly increased oral feeding rate (2.0 vs 0.9 mL/min, P < .001), oral volume intake (91.1 vs 48.1 mL/kg/d, P = .001), oral feeds/day (6.5 vs 4.0, P < .001), and faster time-to-full oral feedings (31 vs 38 d, P = .04) compared with controls. Weight gain and cortisol levels during the 5-day protocol were not different between groups. Average hospital stays were 20% shorter in the PAM group, but the difference was not significant (P = .07). CONCLUSIONS: A PAM using mother’s voice improves oral feeding skills in preterm infants without adverse effects on hormonal stress or growth. PMID:24534413

Brief oral health promotion intervention among parents of young children to reduce early childhood dental decay

PubMed Central

2013-01-01

Background Severe untreated dental decay affects a child’s growth, body weight, quality of life as well as cognitive development, and the effects extend beyond the child to the family, the community and the health care system. Early health behavioural factors, including dietary practices and eating patterns, can play a major role in the initiation and development of oral diseases, particularly dental caries. The parent/caregiver, usually the mother, has a critical role in the adoption of protective health care behaviours and parental feeding practices strongly influence children’s eating behaviours. This study will test if an early oral health promotion intervention through the use of brief motivational interviewing (MI) and anticipatory guidance (AG) approaches can reduce the incidence of early childhood dental decay and obesity. Methods The study will be a randomised controlled study with parents and their new-born child/ren who are seen at 6–12 weeks of age by a child/community health nurse. Consenting parents will complete a questionnaire on oral health knowledge, behaviours, self-efficacy, oral health fatalism, parenting stress, prenatal and peri-natal health and socio-demographic factors at study commencement and at 12 and 36 months. Each child–parent pair will be allocated to an intervention or a standard care group, using a computer-generated random blocks. The standard group will be managed through the standard early oral health screening program; “lift the lip”. The intervention group will be provided with tailored oral health counselling by oral health consultants trained in MI and AG. Participating children will be examined at 24, and 36 months for the occurrence of dental decay and have their height and weight recorded. Dietary information obtained from a food frequency chart will be used to determine food and dietary patterns. Data analysis will use intention to treat and per protocol analysis and will use tests of independent proportions and means. Multivariate statistical tests will also be used to take account of socio-economic and demographic factors in addition to parental knowledge, behaviour, self-efficacy, and parent/child stress. Discussion The study will test the effects of an oral health promotion intervention to affect oral health and general health and have the potential to demonstrate the “common risk factor” approach to health promotion. Trial registration Australian New Zealand Clinical Trials Registry: http://ACTRN12611000997954 PMID:23509932

A qualitative analysis of the nutritional requirements of palliative care patients.

PubMed

Muir, C I; Linklater, G T

2011-10-01

The National Health Servive (NHS) Quality Improvement Scotland developed nutritional Clinical Standards to address the problem of malnutrition in hospitals. NHS palliative care units are obliged to incorporate these standards into nutritional aspects of care. The nutritional needs of this patient population are under-researched. The present study aimed to explore patients' views of nutrition, to begin to understand their concerns and to determine whether such standards meet the needs of patients in the palliative care setting. A qualitative study was conducted in 2009 in an NHS Palliative Care Unit. Six inpatients were involved in one-to-one interviews, which were audiotaped and transcribed verbatim. The transcripts were subject to qualitative data analysis in accordance with a previous framework. A recurring theme that emerged was that of change and uncertainty. Four main areas subject to change were: disease state, symptoms, oral dietary intake and weight. Each change could exert control over, or be controlled by, the patient. When patients were eventually unable to exert control, they accepted the change, either willingly or enforced, thereby unintentionally setting their own targets. The present study enables a deeper understanding of the concerns that palliative care patients have regarding their oral dietary intake and weight. Their 'malnutrition' not only refers to physical malnutrition alone, but also incorporates psychological and social 'malnutrition'. When applying standards or protocols regarding nutritional care, these wider issues must be taken into account to meet patients' nutritional needs. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

Feasibility of implementing oral health guidelines in residential care settings: views of nursing staff and residential care workers.

PubMed

Hilton, Shaylee; Sheppard, Justine Joan; Hemsley, Bronwyn

2016-05-01

To determine the views of nurses and on the feasibility of implementing current evidence-based guidelines for oral care, examining barriers and facilitators to implementation. This mixed-methods study involved an online survey of 35 nurses and residential care workers, verified and expanded upon by one focus group of six residential care workers. Results reflected that nurses and residential care workers (a) have little or no training in recommended oral care techniques, and (b) lack access to the equipment and professional supports needed to provide adequate oral care. Basic oral care might be performed less than once per day in some settings and patients with problematic behaviours, dysphagia, or sensitivities associated with poor oral health might be less likely to receive oral care. While lack of time was highlighted as a barrier in the survey findings, focus group members considered that time should not be a barrier to prioritising oral care practices on a daily basis in residential care settings. There are several important discrepancies between the recommendations made in evidence-based guidelines for oral care and the implementation of such practices in residential care settings. Nursing and residential care staff considered adequate oral care to be feasible if access, funding and training barriers are removed and facilitators enhanced. Copyright © 2015 Elsevier Inc. All rights reserved.

Dental care protocol based on visual supports for children with autism spectrum disorders

PubMed Central

Mastroberardino, Stefano; Campus, Guglielmo; Olivari, Benedetta; Faggioli, Raffaella; Lenti, Carlo; Strohmenger, Laura

2015-01-01

Background Subjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments. Material and Methods 83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in order to undergo: an oral examination (stage 1), a professional oral hygiene session (stage 2), sealants (stage 3), and, if necessary, a restorative treatment (stage 4). Each stage came after a visual training, performed by a psychologist (stage 1) and by parents at home (stages 2, 3 and 4). Association between acceptance rates at each stage and gender, intellectual level, verbal fluency and cooperation grade was tested with chi-square test if appropriate. Results Seventy-seven (92.8%) subjects overcame both stage 1 and 2. Six (7.2%) refused stage 3 and among the 44 subjects who need restorative treatments, only three refused it. The acceptance rate at each stage was statistically significant associated to the verbal fluency (p=0.02; p=0.04; p=0.01, respectively for stage 1, 3 and 4). In stage 2 all subjects accepted to move to the next stage. The verbal/intellectual/cooperation dummy variable was statistically associated to the acceptance rate (p<0.01). Conclusions The use of visual supports has shown to be able to facilitate children with ASDs to undergo dental treatments even in non-verbal children with a low intellectual level, underlining that behavioural approach should be used as the first strategy to treat patients with ASDs in dental setting. Key words:Autism spectrum disorders, behaviour management, paediatric dentistry, visual learning methods. PMID:26241453

Does enhancing personal care assistants' own oral health influence their attitudes and practices towards oral care for residents - a pilot study.

PubMed

Knevel, Rjm; Foley, J; Gussy, M; Karimi, L

2016-11-01

To investigate whether, within a residential care facility, increasing personal care assistants' (PCAs) awareness of their own oral health status and self-care skills would alter existing attitudes and behavioural intentions related to the oral health care of residents. PCAs (n = 15) in the dementia care unit of a residential care facility in Melbourne, Australia, were invited to participate in a small research project that appeared to test the effectiveness of a work-place oral health educational programme in enhancing their own oral health whilst masking the actual outcome of interest, namely its effect on PCAs oral healthcare attitudes and practices towards the residents. Post-intervention, the self-reported confidence of the PCAs to identify their personal risk for oral health problems, identifying common oral health conditions and determining the factors contributing to their personal oral health was increased significantly (P < 0.05). Post-intervention, the self-reported confidence of the PCAs to feeling confident to identify factors that could contribute to poor oral health of residents, identify resident's higher risk for poor oral health and feeling confident in identifying common oral health conditions in residents was also increased significantly (P < 0.05). The results of this pilot study show that the educational intervention to increase the personal care assistants' (PCAs) awareness of their own oral health status and self-care skills increased the confidence of the carers to identify oral health risks in the residents, as well as increasing their self-reported confidence in providing oral care to residents. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of oral healthcare education on knowledge, attitude and skills of care home nurses: a systematic literature review.

PubMed

de Lugt-Lustig, Kersti H M E; Vanobbergen, Jacques N O; van der Putten, Gert-Jan; De Visschere, Luc M J; Schols, Jos M G A; de Baat, Cees

2014-02-01

To systematically review the literature on the effect of providing oral healthcare education to care home nurses on their oral healthcare knowledge and attitude and their oral hygiene care skills. A literature search was obtained for relevant articles on oral healthcare education of nurses in care homes, using five electronic retrieval systems and databases. The search was limited to human studies, articles published in English and articles published during the period January 1990 to December 2011. The methodological quality of an article was assessed on the basis of criteria published by the Cochrane Collaboration. For articles not meeting all methodological quality criteria, relevance criteria were used to determine how much scientific evidence could be assigned to the study findings. In accordance with the methodological quality criteria, two randomized controlled trials were included. Additionally, four studies were included after determining the scientific evidence of the study findings. The studies included revealed some scientific evidence and indications that an oral healthcare education programme for care home nurses may improve the nurses' oral healthcare knowledge and attitude. Any effect of oral healthcare education to care home nurses' oral hygiene care skills could not be determined. Oral healthcare education may have a positive effect on care home nurses' oral healthcare knowledge and attitude and on care home residents' oral hygiene, whereas any effect on care home nurses' oral hygiene care skills could not be found. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Needs and barriers to improve the collaboration in oral anticoagulant therapy: a qualitative study

PubMed Central

2011-01-01

Background Oral anticoagulant therapy (OAT) involves many health care disciplines. Even though collaboration between care professionals is assumed to improve the quality of OAT, very little research has been done into the practice of OAT management to arrange and manage the collaboration. This study aims to identify the problems in collaboration experienced by the care professionals involved, the solutions they proposed to improve collaboration, and the barriers they encountered to the implementation of these solutions. Methods In the Netherlands, intensive follow-up of OAT is provided by specialized anticoagulant clinics (ACs). Sixty-eight semi-structured face-to-face interviews were conducted with 103 professionals working at an AC. These semi-structured interviews were transcribed verbatim and analysed inductively. Wagner's chronic care model (CCM) and Cabana's framework for improvement were used to categorize the results. Results AC professionals experienced three main bottlenecks in collaboration: lack of knowledge (mostly of other professionals), lack of consensus on OAT, and limited information exchange between professionals. They mentioned several solutions to improve collaboration, especially solutions of CCM's decision support component (i.e. education, regular meetings, and agreements and protocols). Education is considered a prerequisite for the successful implementation of other proposed solutions such as developing a multidisciplinary protocol and changing the allocation of tasks. The potential of the health care organization to improve collaboration seemed to be underestimated by professionals. They experienced several barriers to the successful implementation of the proposed solutions. Most important barriers were the lack motivation of non-AC professionals and lack of time to establish collaboration. Conclusions This study revealed that the collaboration in OAT is limited by a lack of knowledge, a lack of consensus, and a limited information exchange. Education was identified as the best way to improve collaboration and considered a prerequisite for a successful implementation of other proposed solutions. Hence, the implementation sequence is of importance in order to improve the collaboration successfully. First step is to establish alignment regarding collaboration with all involved professionals to encounter the lack of motivation of non-AC professionals and lack of time. PMID:22192088

Strengthening of Oral Health Systems: Oral Health through Primary Health Care

PubMed Central

Petersen, Poul Erik

2014-01-01

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

Ventilator-associated pneumonia risk decreased by use of oral moisture gel in oral health care.

PubMed

Takeyasu, Yoshihiro; Yamane, Gen-Yuki; Tonogi, Morio; Watanabe, Yutaka; Nishikubo, Shuichi; Serita, Ryohei; Imura, Kumiko

2014-01-01

Although oral health care has a preventive effect against ventilator-associated pneumonia (VAP), the most effective method of oral health care in this respect remains to be established. The objective of this single-center, randomized, controlled trial was to investigate the relationship between VAP and various methods of oral health care. All patients included in the study (n=142) were on mechanical ventilation with oral intubation at the intensive care unit of the Tokyo Dental College Ichikawa General Hospital. They were divided into two groups, one receiving standard oral health care (Standard group), and the other receiving oral health care using an oral moisture gel instead of water (Gel group). After removal of the intubation tube, biofilm on cuff of the tube was stained with a disclosing agent to determine the contamination level. Factors investigated included sex, age, number of remaining teeth, intubation time, fever ≥38.5°C, VAP, cuff contamination level, and time required for one oral health care session. No VAP occurred in either group during the study period. The level of cuff contamination was significantly lower in the Gel group than the Standard group, and the time required for one session of oral health care was shorter (p<0.001). Multivariate analysis revealed use of the oral moisture gel as a factor affecting cuff contamination level. Use of an oral moisture gel decreased invasion of the pharynx by bacteria and contaminants together with biofilm formation on the intubation tube cuff. These results suggest that oral health care using an oral moisture gel is effective in preventing cuff contamination.

The association between chronic care management and the quality of thrombosis care

PubMed Central

Drewes, H.W.; Baan, C.A.; Westert, G.P.; Meijboom, B.R.; Lambooij, M.

2010-01-01

Introduction The oral anticoagulant therapy (OAT), used to prevent thrombosis, is associated with substantial avoidable hospitalization. Aim Identify the associations between chronic care management and the quality of OAT as suggested by the chronic care model (CCM) of Wagner. Methods Regression analysis with data of 61 thrombosis clinics and inductive analysis with 63 interviews with health care professionals of 23 thrombosis clinics. Results Results show substantial differences between regions in the quality of thrombosis care and the CCM activities. However, the variation in quality of care was not associated with the differences in CCM activities. The inductive analysis indicates that there are problems in the cooperation between caregivers. Several preferred CCM activities (e.g., multidisciplinary protocol) as well as the barriers to implement these activities (e.g., conflicting interests) were put forward by the health care professionals. Conclusion It can be concluded that there is variation in quality of thrombosis care between regions. This variation could not be explained by the observed differences in CCM activities. However, fragmentation is a major source of inefficiency according to health care professionals. The paper concludes with suggestions to improve chronic care management for thrombosis.

Natural history of dental plaque accumulation in mechanically ventilated adults: a descriptive correlational study.

PubMed

Jones, Deborah J; Munro, Cindy L; Grap, Mary Jo

2011-12-01

The purpose of this study was to describe the pattern of dental plaque accumulation in mechanically ventilated adults. Accumulation of dental plaque and bacterial colonisation of the oropharynx is associated with a number of systemic diseases including ventilator associated pneumonia. Data were collected from mechanically ventilated critically ill adults (n=137), enrolled within 24 hours of intubation. Dental plaque, counts of decayed, missing and filled teeth and systemic antibiotic use was assessed on study days 1, 3, 5 and 7. Dental plaque averages per study day, tooth type and tooth location were analysed. Medical respiratory, surgical trauma and neuroscience ICU's of a large tertiary care centre in the southeast United States. Plaque: all surfaces >60% plaque coverage from day 1 to day 7; molars and premolars contained greatest plaque average >70%. Systemic antibiotic use on day 1 had no significant effect on plaque accumulation on day 3 (p=0.73). Patients arrive in critical care units with preexisting oral hygiene issues. Dental plaque tends to accumulate in the posterior teeth (molars and premolars) that may be hard for nurses to visualise and reach; this problem may be exacerbated by endotracheal tubes and other equipment. Knowing accumulation trends of plaque will guide the development of effective oral care protocols. Published by Elsevier Ltd.

Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis.

PubMed

Baptist, Joanna; Shakya, Shrijana; Ongole, Ravikiran

2016-12-01

Oral submucous fibrosis (OSF) causes progressive debilitating symptoms, such as oral burning sensation (stomatopyrosis) and limited mouth opening. The standard of care (SOC) protocol includes habit cessation, intralesional steroid and hyaluronidase injections, and mouth opening exercises. The objective of the study was to evaluate efficacy of rebamipide in alleviating burning sensation of the oral mucosa in OSF in comparison with SOC intralesional steroid injections. Twenty OSF patients were divided into two groups [rebamipide (100 mg TID for 21 days) and betamethasone (4 mg/mL biweekly for 4 weeks)] of 10 each by random sampling. Burning sensation was assessed every week for 1 month. Burning sensation scores were analyzed using repeated measures analysis of variance (ANOVA) and paired t-test. Change in burning sensation score was significant (p < 0.05) in the first four visits. However, score between the 4th and 5th visit was not statistically significant (p > 0.05). Our study has shown that rebamipide can be considered as an effective modality to manage burning sensation in patients suffering from OSF. Considering stomatopyrosis and trismus as a major cause for inability to eat in OSF, use of newer adjunctive modalities, such as rebamipide will ease patients suffering and also encourage them to consume food.

Oral intradialytic nutritional supplement use and mortality in hemodialysis patients.

PubMed

Weiner, Daniel E; Tighiouart, Hocine; Ladik, Vladimir; Meyer, Klemens B; Zager, Philip G; Johnson, Douglas S

2014-02-01

Hemodialysis patients have high mortality rates, potentially reflecting underlying comorbid conditions and ongoing catabolism. Intradialytic oral nutritional supplements may reduce this risk. Retrospective propensity-matched cohort. Maintenance hemodialysis patients treated at Dialysis Clinic Inc facilities who were initiated on a nutritional supplement protocol in September to October 2010 were matched using a propensity score to patients at facilities at which the protocol was not used. Prescription of the protocol, whereby hemodialysis patients with serum albumin levels ≤3.5g/dL would initiate oral protein supplementation during the dialysis procedure. Sensitivity analyses matched on actual supplement intake during the first 3 study months. Covariates included patient and facility characteristics, which were used to develop the propensity scores and adjust multivariable models. All-cause mortality, ascertained though March 2012. Of 6,453 eligible patients in 101 eligible hemodialysis facilities, the protocol was prescribed to 2,700, and 1,278 of these were propensity matched to controls. Mean age was 61 ± 15 (SD) years and median dialysis vintage was 34 months. There were 258 deaths among protocol assignees versus 310 among matched controls during a mean follow-up of 14 months. In matched analyses, protocol prescription was associated with a 29% reduction in the hazard of all-cause mortality (HR, 0.71; 95% CI, 0.58-0.86); adjustment had minimal impact on models. In time-dependent models incorporating change in albumin level, protocol status remained significant but was attenuated in models incorporating a 30-day lag. Similar results were seen in sensitivity analyses of 439 patients receiving supplements who were propensity-matched to controls, with 116 deaths among supplement users versus 140 among controls (HR, 0.79; 95% CI, 0.60-1.05), achieving statistical significance in adjusted models. Observational design, potential residual confounding. Prescription of an oral nutritional supplement protocol and use of oral protein nutritional supplements during hemodialysis are associated with reduced mortality among in-center maintenance hemodialysis patients, an effect likely not mediated by change in serum albumin levels. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

The Oral Health Self-Care Behavior and Dental Attitudes among Nursing Home Personnel

PubMed Central

Wiener, R. Constance; Meckstroth, Richard

2014-01-01

The need for nursing home care will increase for the next several decades. Rural areas will be impacted in particular, as many older adults live in rural areas. Daily oral infection control changes when a person moves from independent living to institutional living. Oral care to dependent individuals is influenced by many factors. The purpose of this study is to determine the association of oral health self-care behavior with dental attitudes in nursing home personnel in a rural state. A survey was provided to attendees at an oral health conference. Questions were asked to determine dental knowledge, oral health self-care behavior, and dental care attitudes. Of 128 long term care health care facilities’ personnel invited, there were 31 attendees, and 21 of the attendees participated (67.7%). Nursing home personnel had a high level of dental knowledge. Oral health self-care behavior was independently influenced by dental knowledge (β=0.17; p=0.0444) and dental attitudes (β=0.55; p=.0081). Further investigation is needed to determine if oral health self-care attitudes and oral self-care behavior of nursing home personnel are factors in the provision of quality daily oral infection control for dependent nursing home residents living in rural areas. PMID:25349776

Oral health assessment and mouth care for children and young people receiving palliative care. Part two.

PubMed

Sargeant, S; Chamley, C

2013-04-01

This is the second part of a two-part article on oral health assessment and mouth care for children and young people receiving palliative care. This article covers basic oral hygiene and management of oral health problems: oral candidiasis, coated tongue/dirty mouth, dry mouth, hypersalivation, ulceration, painful mouth, stomatitis and mucositis. The article also covers treating patients who are immunocompromised and the need to educate families and carers in the basic principles of oral care, including the importance of preventing cross-infection. Part one outlined oral assessment and discussed the adaptation of the Nottingham Oral Health Assessment Tool (Freer 2000).

Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review

PubMed Central

Kent, Angelle; Kobagi, Nadia; Huynh, Kha Tu; Clarke, Alix; Yoon, Minn N.

2017-01-01

Background Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two major barriers to providing appropriate oral care are residents’ responsive behaviors to oral care and residents’ lack of ability or motivation to perform oral care on their own. Objectives To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents’ responsive behaviors to oral care, or enable/motivate residents to perform their own oral care. Materials and methods We searched the databases Medline, EMBASE, Evidence Based Reviews–Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science for intervention studies assessing the effectiveness of eligible strategies. Two reviewers independently (a) screened titles, abstracts and retrieved full-texts; (b) searched key journal contents, key author publications, and reference lists of all included studies; and (c) assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results. Results We included three one-group pre-test, post-test studies, and one cross-sectional study. Methodological quality was low (n = 3) and low moderate (n = 1). Two studies assessed strategies to enable/motivate nursing home residents to perform their own oral care, and to studies assessed strategies to prevent or overcome responsive behaviors to oral care. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems. Conclusions Potentially promising strategies are available that nursing home care providers can apply to prevent/overcome residents’ responsive behaviors to oral care or to enable/motivate residents to perform their own oral care. However, studies assessing these strategies have a high risk for bias. To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies. PMID:28609476

Prophylaxis for mucositis induced by ambulatory chemotherapy: systematic review.

PubMed

Manzi, Natália de Melo; Silveira, Renata Cristina de Campos Pereira; dos Reis, Paula Elaine Diniz

2016-04-01

The aim of this study was to perform a systematic review of clinical trials covering interventions used as prophylaxis for oral mucositis induced by ambulatory antineoplastic chemotherapy. Oral mucositis in patients undergoing chemotherapy is a side effect that can impact the quality of treatment and can interfere with eating and therapeutic adherence. Quantitative systematic review. Relevant databases were searched, from January 2002-July 2013, by using the combination of the keywords mucositis, stomatitis, neoplasms, antineoplastic agents, drug therapy, prevention and control and chemotherapy. Two researchers independently read the titles and abstracts from every cross-reference. The quality of the included studies was analysed by the Jadad Scale and the Cochrane Collaboration Risk of Bias Tool. Data were extracted from the selected studies with a data collection form developed specifically for this purpose. Of the 23 controlled clinical trials that were identified in this study, five articles evaluated the use of oral cryotherapy to prevent oral mucositis and three studies analysed the prophylactic use of glutamine. Interventions of protocols for oral care, palifermin, allopurinol and chlorhexidine were evaluated by two articles each. Interventions of zinc sulphate, amifostine, chewing gum, sucralfate, recombination human intestinal trefoil factor, kefir and vitamin E were evaluated by one article each. There is strong evidence that cryotherapy can prevent oral mucositis arising from ambulatory treatment with 5-flurouracil chemotherapy. Other interventions, although showing positive results in preventing oral mucositis, require further study to confirm their conclusions. © 2015 John Wiley & Sons Ltd.

A practical and successful desensitization protocol for immediate hypersensitivity reactions to iron salts.

PubMed

Demir, Semra; Olgac, Muge; Unal, Derya; Gelincik, Asli; Colakoglu, Bahauddin; Buyukozturk, Suna

2014-01-01

Orally administered iron salts (OAS) are widely used in the management of iron deficiency anemia and hypersensitivity reactions to OAS are not common. If an offending drug is the sole option or is significantly more effective than its alternatives, it can be readministered by desensitization. The oral desensitization protocols for iron published so far concern either desensitization that was completed only over a long period or did not attain the recommended therapeutic dose. We aimed to develop a more effective protocol. We report here on 2 patients who experienced hypersensitivity reactions to OAS. After confirming the diagnosis, both patients were desensitized to oral ferrous (II) glycine sulfate complex according to a 2-day desensitization protocol. A commercial suspension of oral ferrous glycine sulfate, which contains 4 mg of elemental iron in 1 ml, was preferred. We started with a dose as low as 0.1 ml from a 1/100 dilution (0.004 mg elemental iron) of the original suspension and reached the maximum effective dose in 2 days. Both patients were successfully desensitized and they went on to complete the 6-month iron treatment without any adverse effects. Although hypersensitvity reactions to iron are not common, there is no alternative for iron administration. Therefore, desensitization has to be the choice. This easy desensitization protocol seems to be a promising option. © 2014 S. Karger AG, Basel.

Efficacy of oral health promotion in primary care practice during early childhood: creating positive changes in parent's oral health beliefs and behaviors.

PubMed

Mattheus, Deborah J

2014-06-01

Nurse practitioners frequently provide care to children suffering from poor oral health. Creative approaches to impacting dental disease are needed due to the current lack of traditional dental providers. This study investigated the effects of oral health promotion provided by primary care providers on parental oral health beliefs and behaviors. Participants receiving standard oral care during two well child visits and two additional enhanced oral health visits (n=44) were compared to participants receiving standard oral care during two well child visits alone (n=40). Results revealed changes in parent's perception of the importance of oral care for their children's primary teeth compared to general healthcare needs (p<0.05), response to brushing their children's teeth (p<0.0001), confidence in brushing their teeth (p<0.05) and frequency of brushing (p<0.0001) in both groups. This small but important study shows that oral health programs in primary care can produce changes that can improve oral health outcomes. Parents and children exposed to oral health programs during their frequent well child care visits in the first years of life may help decrease the rate of early childhood caries and improve their quality of life.

Validity of patient-reported swallowing and speech outcomes in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer.

PubMed

Rinkel, R N P M; Verdonck-de Leeuw, I M; de Bree, R; Aaronson, N K; Leemans, C R

2015-04-01

The objective of this study was to test the construct validity of the patient-reported outcomes Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI) in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer. The study sample consisted of patients treated for oral or oropharyngeal cancer. Outcome measures were the SWAL-QOL and the SHI, and the Functional Rehabilitation Outcomes Grade (FROG), a test to measure oral and shoulder function. Spearman's rank correlation coefficient was used to test associations between the SHI and SWAL-QOL scales, and the FROG scales. During a study period of 3 months, 38 patients (21 males, 17 females; mean age 54 years) were included who visited the outpatient clinic for follow-up care 6-155 months after surgical treatment (n = 14) or combined surgery and radiotherapy (n = 24) for oral (n = 21) or oropharyngeal cancer (n = 17). Most SWAL-QOL and SHI scales (except the SWAL-QOL Fatigue scale) correlated significantly with one or more FROG oral function scales. None of the SWAL-QOL and SHI scales correlated significantly with the FROG shoulder function scale. These results support the construct validity of the SWAL-QOL and SHI questionnaires for assessing speech and swallowing problems in daily life that are moderately but significantly related to oral function. A multidimensional assessment protocol is recommended for use in clinical practice and for research purposes for measuring oral function and swallowing- and speech-related problems in daily life among head and neck cancer patients.

Electric versus manual tooth brushing among neuroscience ICU patients: is it safe?

PubMed

Prendergast, Virginia; Hagell, Peter; Hallberg, Ingalill Rahm

2011-04-01

Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU). As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission. Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial η(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001). In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients.

Dental aspects of cardiac transplantation.

PubMed

Golder, D T; Drinnan, A J

1993-06-01

This article does not cover all possible dental situations, but it is hoped that it will provide a framework on which a medical or dental consultant can develop his or her own comprehensive oral evaluation protocol for use in the screening of prospective cardiac transplant patients. It is always important for the dental consultant to remember a prospective recipient patient's primary health concern--that is, end-stage cardiac disease. The consultant should remember that many of the usual considerations for dental treatment planning must be modified and the significance of dental health placed into its proper perspective in the overall care of the cardiac transplant patient.

Occurrence of oral health problems and planned measures in dependent older people in nursing care.

PubMed

Rantzow, Veronica; Andersson, Pia; Lindmark, Ulrika

2018-06-26

The aim of the study was to describe oral health problems and planned measures in older people receiving nursing care. Poor oral health conditions have a negative impact on the quality of life of older people. Therefore, oral care is an important task in daily nursing activities. Data were obtained from the web-based Swedish national quality register Senior Alert. Data regarding oral health status and planned measures in individuals ≥65 years from one county in Sweden between July 2014 and June 2015 were included. The Revised Oral Assessment Guide - the Jönköping (ROAG-J), was used routinely by nursing staff in nursing care facilities to measure oral health status. Oral assessments were made on 2567 individuals (65.7% women). The most common oral health problem was related to "Teeth" (43.0%), which indicates deficient oral hygiene and/or broken teeth. At least one measure was planned in all the participants. The most common planned measures were "Moistening of the mouth" (16.6%), followed by "Brushing - assistance or complete help" (13.5%). Oral health problems were common, and planned measures did not seem to be sufficient to address the identified problems. The results indicate that greater priority should be given to the oral health care of older people in nursing care. The study highlights the importance of not only identifying oral health problems but also having knowledge and strategies for oral health care. Collaboration is needed to support nurses in caring for the oral health care of older people in nursing homes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Treatment and prevention of cancer treatment related oral mucositis].

PubMed

Ruiz-Esquide, Gonzalo; Nervi, Bruno; Vargas, Alex; Maíz, Alberto

2011-03-01

One of the most common and troublesome complications of modern intensive anticancer treatments is oral mucositis. The purpose of this review is to summarize current evidence and clinical guidelines regarding its prevention and therapy. The use of keratinocyte growth factor-1, supplementary glutamine and other recently developed treatment modalities are discussed. The injury of the oral mucosa caused by antineoplastic agents promotes the local expression of multiple pro-inflammatory and pro-apoptotic molecules and eventually leads to the development of ulcers. Such lesions predispose patients to several infectious and nutritional complications. Also, they lead to modification of treatment schedules, potentially affecting overall prognosis. Local cryotherapy with ice chips and phototherapy with low energy laser may be useful as preventive measures. Mouthwashes with allopurinol and phototherapy with low energy laser can be used as treatment. In radiotherapy, special radiation administration techniques should be used to minimize mucosal injury. Pain control should always be optimized, with the use of patient controlled analgesia and topical use of morphine. Supplemental glutamine should not be used outside of research protocols. Lastly, thorough attention should be paid to general care and hygiene measures.

Effects of combination oral care on oral health, dry mouth and salivary pH of intubated patients: A randomized controlled trial.

PubMed

Jang, Chun Sun; Shin, Yong Soon

2016-10-01

Intubated patients are at risk of oral health problems. Although a variety of oral care regimens for intubated patients have been studied, there is a lack of research on the effects of combination oral care that includes tooth brushing, chlorhexidine and cold water. This open-labelled, randomized, controlled trial aimed to evaluate the effects of combination oral care on oral health status. Participants aged 20 years and older were recruited on the first day after intubation through convenience sampling in a medical intensive care unit. Random assignment was performed using an internet randomization service. The primary outcome was oral health status. Data were collected during May and June 2013. Participants were randomized to one of two groups (23 intervention and 21 control). The final analysis included 18 patients with combination oral care and 17 in the control group. The intervention group had better oral health (effect size = 1.56), less dry mouth and higher salivary pH than the control group. Any additional burden of providing combination oral care to patients who are mechanically ventilated is worthwhile in terms of clinical outcomes. © 2016 John Wiley & Sons Australia, Ltd.

Oral care experiences and challenges in children with autism spectrum disorders.

PubMed

Stein, Leah I; Polido, José C; Najera, Sandy Oliver Lopez; Cermak, Sharon A

2012-01-01

The purpose of this study was to investigate the differences between children with autism spectrum disorders (ASD) and their typically developing peers in relation to aspects of oral care. Participants included 396 parents of ASD children or typically developing 2- to 18-year-olds. Parents completed a 37-item questionnaire designed by authors to elicit information about oral care in the home and dental office. Descriptive, bivariate, and multivariate regression analyses were conducted to examine the association between diagnostic group and oral care variables. Significantly more parents of ASD children than parents of typically developing children reported difficulty across almost all oral care variables explored, including oral care in the home, oral care at the dentist, and access to oral care. Following multivariate regression to control for possible confounders-including age, gender, Hispanic status, and paternal education level-all previously significant variables remained significant. This study indicates that children with autism spectrum disorders experience greater difficulties and barriers to care in both the home and dental office settings than their typically developing peers.

Delivery of oral health care through the Ryan White CARE Act to people infected with HIV.

PubMed

Schneider, D A; Hardwick, K S; Marconi, K M; Niemcryk, S J; Bowen, G S

1993-01-01

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 was passed by Congress "to improve the quality and availability of care for individuals and families with HIV disease." The act targets those individuals infected with HIV who lack financial resources to pay for care. While provision of oral health care is not mandated by the legislation, many oral health services are supported through five different programs receiving CARE Act funding. Legislative mandates, program guidance materials, grant applications, and other related materials were reviewed to analyze oral health care services supported or proposed through the CARE Act. In fiscal year 1991, an estimated $5.8 million of the total CARE Act funds ($229.6 million) were used for oral health care, and there is evidence that oral health concerns will receive increasing attention by grantees in future years. Opportunities exist for local oral health professionals to become involved in CARE Act programs and in the priority development process. It is possible that CARE Act grantees will serve as catalysts for the development of partnerships between private practitioners and public sector programs--relationships that could lead to improved access and quality of care for people with HIV infection.

A Deconstructive Pedagogy

ERIC Educational Resources Information Center

Uba, Laura

2008-01-01

This article describes a four-pronged pedagogical protocol for teaching undergraduates how to deconstruct statements, including a list of deconstructive considerations students learn to apply. The protocol also encourages oral participation in class discussions. Three assessment measures demonstrate the protocol's effectiveness: (1) a qualitative…

Oral health and cardiovascular care: Perceptions of people with cardiovascular disease

PubMed Central

Salamonson, Yenna; Ajwani, Shilpi; Bhole, Sameer; Bishop, Joshua; Lintern, Karen; Nolan, Samantha; Rajaratnam, Rohan; Redfern, Julie; Sheehan, Maria; Skarligos, Fiona; Spencer, Lissa; Srinivas, Ravi

2017-01-01

Main objective The aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health. Method A needs assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis. Results Results suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants. Relevance to clinical practice The lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in their practice. Affordable and accessible dental care services for people with cardiovascular disease should be considered and offered by health services in Australia. PMID:28727751

Implementation of a timed, electronic, assessment-driven potassium-replacement protocol.

PubMed

Zielenski, Christopher; Crabtree, Adam; Le, Tien; Marlatt, Alyse; Ng, Dana; Tran, Alan

2017-06-15

The adherence to and effectiveness and safety of a timed, electronic, assessment-driven potassium-replacement protocol (TARP) were compared with an electronic nurse-driven replacement protocol (NRP) are reported. A retrospective observational study was conducted in a community hospital evaluating protocol adherence, effectiveness, and safety for 2 potassium-replacement protocols. All adults on medical units with an order for potassium replacement per protocol during the 3-month trial periods were reviewed. All patients requiring potassium replacement per protocol were included in the analysis. Adherence to the protocol was assessed by evaluating the dose of potassium administered and performance of reassessments. Effectiveness of the protocol was assessed by evaluating the time to achieve target potassium levels. Safety was assessed by evaluating the route of administration and occurrence of hyperkalemia. A total of 300 patients treated using potassium-replacement protocols required potassium replacement during the study period, with 148 patients in the NRP group requiring 491 instances of potassium replacement. In the TARP group a total of 564 instances requiring potassium replacement corresponded to 152 patients. Of the 491 instances requiring replacement in the NRP group, the correct dose was administered and reassessment performed 117 times (23.8%). Overall adherence ( p < 0.05), correct dose given ( p < 0.05), average time from blood draw to potassium replacement ( p < 0.0001), use of oral replacement ( p < 0.05), and time to achieve target potassium level within 12 hours ( p < 0.05) were significantly improved in the TARP group. The TARP improved the effectiveness and safety of potassium-replacement therapy over the traditional NRP without negatively affecting timeliness of care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Enhanced recovery pathways in gynecologic oncology.

PubMed

Nelson, Gregg; Kalogera, Eleftheria; Dowdy, Sean C

2014-12-01

Many commonplace perioperative practices are lacking in scientific evidence and may interfere with the goal of optimizing patient recovery. Individual components of perioperative care have therefore been scrutinized, resulting in the creation of so-called "enhanced recovery" pathways (ERP), with the goal of hastening surgical recovery through attenuation of the stress response. In this review we examine the evidence for ERP in gynecologic oncology using data from our specialty and general surgery. We performed a systematic literature search on ERP in gynecologic oncology in June 2014 using PubMed/MEDLINE, EMBASE, and The Cochrane Library. All study types were included. References were hand reviewed to ensure completeness. The Enhanced Recovery After Surgery (ERAS) Society was contacted to identify any unpublished protocols. Seven investigations were identified that examined the role of ERP in gynecologic oncology. Common interventions included allowing oral intake of fluids up to 2 hours before induction of anesthesia, solids up to 6 hours before anesthesia, carbohydrate supplementation, intra- and postoperative euvolemia, aggressive nausea/vomiting prophylaxis, and oral nutrition and ambulation the day of surgery. In addition, bowel preparations, the NPO after midnight rule, nasogastric tubes, and intravenous opioids were discontinued. While no randomized data are available in gynecologic oncology, significant improvements in patient satisfaction, length of stay (up to 4 days), and cost (up to $7600 in savings per patient) were observed in ERP cohorts compared to historical controls. Morbidity, mortality, and readmission rates were no different between groups. Enhanced recovery is a safe perioperative management strategy for patients undergoing surgery for gynecologic malignancies, reduces length of stay and cost, and is considered standard of care at a growing number of institutions. Our specialty would benefit from a formalized ERP such as ERAS which audits compliance to protocol care elements to optimize patient outcomes and value. Copyright © 2014 Elsevier Inc. All rights reserved.

Geriatric Oral Health: A Review Article

PubMed Central

Razak, P Abdul; Richard, K M Jose; Thankachan, Rekha P; Hafiz, K A Abdul; Kumar, K Nanda; Sameer, K M

2014-01-01

Oral health is not separate from general health, but maintaining oral health is definitely difficult and different in old age. Even though, few elderly have physical and/or mental situation that call for particular interest in the dental workplace, one should not presume that all elderly community shares these circumstances. In order to achieve health, it is necessary to know few aspects of old age. In due course of old age body tissues get harder, collection of waste products in body cells and loss of lubrication leads to impaired functions of various organs. The design and implementation of comprehensive preventive dentistry protocols for elders presents the dental profession with many challenges. Although a specific protocol must be tailored to meet the unique needs of the individual patient, there are certain factors common to elderly segment of the population that may influence these protocols. PMID:25628498

A scoping review and research synthesis on financing and regulating oral care in long-term care facilities.

PubMed

MacEntee, Michael I; Kazanjian, Arminee; Kozak, Jean-Francois; Hornby, Kathy; Thorne, Sally; Kettratad-Pruksapong, Matana

2012-06-01

Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long-term care (LTC) facilities. We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health-related services. The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients.

PubMed

Gupta, A; Gupta, A; Singh, T K; Saxsena, A

2016-01-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

[An evaluation of the implementation of the 'Guidelines for oral care for patients dependent on care'].

PubMed

Hoeksema, A R; Meijer, H J A; Vissink, A; Raghoebar, G M; Visser, A

2016-05-01

75% of older people being admitted to a nursing home are found to have oral care problems that have not been treated. Moreover, the Healthcare Inspectorate [in the Netherlands] reports that oral care for patients who depend on care in nursing homes is inadequate. The 'Guidelines for oral care for patients dependent on care in nursing homes', developed in 2007, appears to have been inadequately implemented. The goal of this research was to gain insight into the implementation of these guidelines in healthcare organisations. To that end, a questionnaire was distributed among the staff of 74 nursing homes. An analysis of the data revealed that people are -familiar with the guidelines and that oral care providers are often available. Oral care providers, however, often do not have access to reasonable dental care facilities. Patients are, moreover, generally not screened and/or monitored in accordance with the guidelines. Finally, it seems that the instruction of nurses and care-providers is insufficient. Research supports the conclusion that the nursing home staff is well-acquainted with the 'Guidelines for oral care for patients dependent on care' but that implementation of the guidelines in daily practice leaves much to be desired.

Medical health care professionals' assessments of oral health needs in children with disabilities: a qualitative study.

PubMed

Hallberg, Ulrika; Klingberg, Gunilla

2005-10-01

Good collaboration between medical and dental care is essential to provide not only good oral health care, but also more holistic care for children with disabilities. The aim was to explore and describe medical health care professionals' assessments and considerations of orofacial problems and treatment needs in children with disabilities and in their families. In-depth interviews focusing on orofacial function were carried out with 17 medical health care employees. Interviews were transcribed verbatim and analysed in open and focused (selective) coding processes according to grounded theory. A core category was identified and named focusing on basic needs, showing that oral health care assessment was not on the agenda of medical health care professionals, but was instead viewed as a responsibility of parents or dentists. This study shows that oral health issues are not fully integrated in the medical care of children with disabilities. The omission of oral health issues from the medical agenda implies a risk of oral health problems in children with disabilities. To put the oral cavity and oral health on the medical agenda, dentists need to influence the undergraduate training of medical professionals and to initiate co-operation with the medical care system.

Perceptions of Oral Health, Preventive Care, and Care-Seeking Behaviors among Rural Adolescents

ERIC Educational Resources Information Center

Dodd, Virginia J.; Logan, Henrietta; Brown, Cameron D.; Calderon, Angela; Catalanotto, Frank

2014-01-01

Background: An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural…

Knowledge, perceived skills and activities of nursing staff to support oral home care among older domiciliary care clients.

PubMed

Salmi, Riikka; Tolvanen, Mimmi; Suhonen, Riitta; Lahti, Satu; Närhi, Timo

2018-04-25

Increasing number of older adults lives in their own homes, but needs help in many daily routines. Domiciliary care nursing staff (DCNS) is often needed to support oral home care. However, information of nursing staff's knowledge, skills and activity in this task is sparse. The study aimed to assess DCNS knowledge, perceived skills and activities to support oral home care of older domiciliary care clients. The study was conducted among DCNS in one of the largest cities in Finland. All DCNS members (n = 465) received a questionnaire with 14 multiple choice and open questions regarding the perceived skills, knowledge and activities of oral health guidance of older domiciliary care clients. In total, 115 (25%) DCNS members returned the questionnaires. Frequencies, percentages, means and standard deviations were used to describe the samples and study variables. DCNS was categorised according to age and working years for group comparisons, which were assessed with chi-squared test. Knowledge concerning oral health was mostly on a high level. Around 50% of DCNS considered their knowledge regarding dental prosthesis hygiene as sufficient. Of the DCNS, 67% informed that they had received education on oral health care. However, over 50% of the DCNS had a need for further education in issues related to oral home care. DCNS were active in supporting most oral and prosthesis hygiene means, yet less in guidance concerning toothbrushing. Activity to support cleaning the interdental spaces was the weakest, in which only 12% of the respondents considered having average or excellent skills. Younger DCNS had better knowledge on oral home care due to recent education, but older staff members were more skilful in performing oral hygiene measures. There is a need for structured instructions and training on oral home care for DCNS. Oral home care should be taken into account more often and regularly. © 2018 Nordic College of Caring Science.

[Community coordination of dental care needs in a home medical care support ward and at home].

PubMed

Sumi, Yasunori; Ozawa, Nobuyoshi; Miura, Hiroko; Miura, Hisayuki; Toba, Kenji

2011-01-01

The purpose of this study was to ascertain the current statuses and problems of dental home care patients by surveying the oral care status and needs of patients in the home medical care support ward at the National Center for Geriatrics and Gerontology. Patients that required continuous oral management even after discharge from the hospital were referred to local dental clinics to receive home dental care. We investigated the suitability and problems associated with such care, and identified the dental care needs of home patients and the status of local care coordination, including those in hospitals. The subjects were 82 patients. We ascertained their general condition and oral status, and also investigated the problems associated with patients judged to need specialized oral care by a dentist during oral treatment. Patients who required continuous specialized oral care after discharge from hospital were referred to dental clinics that could provide regular care, and the problems at the time of referral were identified. Dry mouth was reported by many patients. A large number of patients also needed specialized dental treatment such as the removal of dental calculus or tooth extraction. Problems were seen in oral function, with 38 of the patients (46%) unable to gargle and 23 (28%) unable to hold their mouths open. About half of the patients also had dementia, and communication with these patients was difficult. Of the 43 patients who were judged to need continuing oral care after discharge from hospital, their referral to a dental clinic for regular care was successful for 22 (51%) patients and unsuccessful for 21 (49%) patients. The reasons for unsuccessful referrals included the fact that the family, patient, nurse, or caregiver did not understand the need for specialized oral care. The present results suggest the need for specialized oral treatment in home medical care. These findings also suggest that coordinating seamless dental care among primary physicians, intermediates, and transferring care after hospital discharge to regular dentists is difficult.

Evaluation of Different Methods for Removing Oral Biofilm in Patients Admitted to the Intensive Care Unit

PubMed Central

Oliveira, Maria Sonia; Borges, Alvaro Henrique; Mattos, Fernanda Zanol; Semenoff, Tereza Aparecida Della Vedove; Segundo, Alex Semenoff; Tonetto, Mateus Rodrigues; Bandeca, Matheus Coêlho; Porto, Alessandra Nogueira

2014-01-01

Background: The present study aimed to evaluate the different methods for removing oral biofilm in combination with 0.12% chlorhexidine, in patients admitted to the intensive care unit (ICU) of the General University Hospital. Materials and Methods: Initially, the patients were included in the study and underwent periodontal evaluation by means of the visible plaque index (VPI) and gingival bleeding index (GBI). The removal of visible biofilm, by a professional, was carried out using a toothbrush and dental floss, followed by the application of a 0.12% chlorhexidine solution. The patients were included in this randomized and controlled study into four groups (total n = 48), as follows: Chlorhexidine and gauze 12/12 h; chlorhexidine and gauze 24/24 h; chlorhexidine and brushing 12/12 h; chlorhexidine and brushing 24/24 h. The patients underwent the biofilm removal protocol for 7 days and then were subjected to a new clinical evaluation as to VPI and GBI. Data analysis was performed through stratification and arrangement of the records, in order to carry out the associations with health indicators used in the study, and the statistical tests used were Kappa and t-test for independent and paired samples. Results: A decrease in the VPI and GBI values when comparing baseline to the final evaluation for all groups was observed. Conclusion: Based on the methodology, it was possible to concluded that chlorhexidine associated with the mechanical action of the toothbrush or gauze in the times 12 h and 24 h in the ICU environment presented the same results as regards amount of visible biofilm. How to cite the article: Oliveira MS, Borges AH, Mattos FZ, Semenoff TA, Segundo AS, Tonetto MR, Bandeca MC, Porto AN. Evaluation of different methods for removing oral biofilm in patients admitted to the intensive care unit. J Int Oral Health 2014;6(3):61-4. PMID:25083034

The Oral Health Care Manager in a Patient-Centered Health Facility.

PubMed

Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

2016-06-01

The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

Protocols and Hospital Mortality in Critically ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

PubMed Central

Sevransky, Jonathan E.; Checkley, William; Herrera, Phabiola; Pickering, Brian W.; Barr, Juliana; Brown, Samuel M; Chang, Steven Y; Chong, David; Kaufman, David; Fremont, Richard D; Girard, Timothy D; Hoag, Jeffrey; Johnson, Steven B; Kerlin, Mehta P; Liebler, Janice; O'Brien, James; O'Keefe, Terence; Park, Pauline K; Pastores, Stephen M; Patil, Namrata; Pietropaoli, Anthony P; Putman, Maryann; Rice, Todd W.; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Martin, Greg S

2015-01-01

Objective Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized intensive care units have superior patient outcomes compared with less highly protocolized intensive care units. Design Observational study in which participating intensive care units completed a general assessment and enrolled new patients one day each week. Setting and Patients 6179 critically ill patients across 59 intensive care units in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study Interventions: None Measurements and Main Results The primary exposure was the number of intensive care unit protocols; the primary outcome was hospital mortality. 5809 participants were followed prospectively and 5454 patients in 57 intensive care units had complete outcome data. The median number of protocols per intensive care unit was 19 (IQR 15 to 21.5). In single variable analyses, there were no differences in intensive care unit and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in intensive care units with a high vs. low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p=0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between intensive care units with high vs. low numbers of protocols for lung protective ventilation in ARDS (47% vs. 52%; p=0.28) and for spontaneous breathing trials (55% vs. 51%; p=0.27). Conclusions Clinical protocols are highly prevalent in United States intensive care units. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality. PMID:26110488

Rapid Bioavailability and Disposition protocol: A novel higher throughput approach to assess pharmacokinetics and steady-state brain distribution with reduced animal usage.

PubMed

Fu, Tingting; Gao, Ruina; Scott-Stevens, Paul; Chen, Yan; Zhang, Chalmers; Wang, Jianfei; Summerfield, Scott; Liu, Houfu; Sahi, Jasminder

2018-05-29

Besides routine pharmacokinetic (PK) parameters, unbound brain-to-blood concentration ratio (K p,uu ) is an index particularly crucial in drug discovery for central nervous system (CNS) indications. Despite advantages of K p,uu from steady state after constant intravenous (i.v.) infusion compared with one- or multiple time points after transient dosing, it is seldom obtained for compound optimization in early phase of CNS drug discovery due to requirement of prerequisite PK data to inform the study design. Here, we designed a novel rat in vivo PK protocol, dubbed as Rapid Bioavailability and Disposition (RBD), which combined oral (p.o.) dosing and i.v. infusion to obtain steady-state brain penetration, along with blood clearance, oral exposure and oral bioavailability for each discovery compound, within a 24 hour in-life experiment and only a few (e.g., 3) animals. Protocol validity was verified through simulations with a range of PK parameters in compartmental models as well as data comparison for nine compounds with distinct PK profiles. PK parameters (K p,brain , CL b and oral AUC) measured from the RBD protocol for all compounds, were within two-fold and/or statistically similar to those derived from conventional i.v./p.o. crossover PK studies. Our data clearly indicates that the RBD protocol offers reliable and reproducible data over a wide range of PK properties, with reduced turnaround time and animal usage. Copyright © 2017. Published by Elsevier B.V.

Team approach concept in management of oro-facial clefts: a survey of Nigerian practitioners.

PubMed

Akinmoladun, Victor I; Obimakinde, Obitade S

2009-05-10

Cleft palate craniofacial teams have evolved across the globe in the last 20 years in compliance with the interdisciplinary concept of management of oro-facial clefts. An interdisciplinary care allows a coordinated treatment protocol for the patient. The objective of this study was to evaluate oro-facial cleft care in Nigeria with particular emphasis on the compliance of the practitioners to the team approach concept. A snapshot survey was conducted among specialists that attended the Pan African Congress on Cleft Lip and Palate, at the International Institute of Tropical Agriculture, Nigeria in February 2007. Sixty three respondents successfully completed and returned the questionnaire for analysis. Mean age of respondents was 43.5 years and the range was 38-62 years.Male to female ratio was 2.7:1. Oral and Maxillofacial Surgeons and Plastic Surgeons constituted the majority of respondents (38.1% and 22.2%) respectively. Only 47.6% (n = 30) of the specialists belonged to cleft teams. Majority of Oral and Maxillofacial Surgeons and Plastic Surgeons belonged to cleft teams (70% and 63.3% respectively) while speech pathologists and orthodontists were less represented (20% and 36.7% respectively) in teams. Findings from this study suggests that interdisciplinary care for the cleft patient does not appear to have been fully embraced in Nigeria. This may be a result of several reasons ranging from non availability of the requisite specialists, the relatively young age of cleft care practice in this part of the world to the poor state of infrastructure.

Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

PubMed Central

Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

2015-01-01

Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. PMID:26515687

Assessment of Oral Status in Pediatric Patients with Special Health Care Needs receiving Dental Rehabilitation Procedures under General Anesthesia: A Retrospective Analysis.

PubMed

Solanki, Neeraj; Kumar, Anuj; Awasthi, Neha; Kundu, Anjali; Mathur, Suveet; Bidhumadhav, Suresh

2016-06-01

Dental problems serve as additional burden on the children with special health care needs (CSHCN) because of additional hospitalization pressure, they face for the treatment of various serious medical problems. These patients have higher incidence of dental caries due to increased quantity of sugar involved in the drug therapies and lower salivary flow in the oral cavity. Such patients are difficult to treat with local anesthesia or inhaled sedatives. Single-sitting dental treatment is possible in these patients with general anesthesia. Therefore, we conducted this retrospective analysis of oral health status of CSHCN receiving various dental treatments in a given population. A total of 200 CSHCN of age 14 years or less reporting in the pediatric wing of the general hospital from 2005 to 2014 that underwent comprehensive dental treatment under general anesthesia were included in the study. Patients with history of any additional systemic illness, any malignancy, any known drug allergy, or previous history of any dental treatment were excluded from the study. Complete mouth rehabilitation was done in these patients under general anesthesia following standard protocols. Data regarding the patient's disability, type, duration, and severity of disability was collected and analyzed. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Chi-square test, Student's t-test, and one-way analysis of variance were used to assess the level of significance. Statistically significant results were obtained while analyzing the subject's decayed missing filled/decayed extracted filled teeth indices divided based on age. Significant difference was observed only in cases where patients underwent complete crown placement even when divided based on type of disability. While analyzing the prevalence, statistically significant results were observed in patients when divided based on their age. In CSHCN, dental pathologies and caries indices are increased regardless of the type or extent of disability. Children with special health care needs should be given special oral health care, and regular dental checkup should be conducted as they are more prone to have dental problems.

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

PubMed

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

Perceptions of Oral Health, Preventive Care, and Care-Seeking Behaviors Among Rural Adolescents

PubMed Central

Dodd, Virginia J.; Logan, Henrietta; Brown, Cameron D.; Calderon, Angela; Catalanotto, Frank

2015-01-01

BACKGROUND An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. METHODS Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. RESULTS Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. CONCLUSIONS Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being “free” or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. PMID:25388597

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

PubMed

Dodd, Virginia J; Logan, Henrietta; Brown, Cameron D; Calderon, Angela; Catalanotto, Frank

2014-12-01

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. © 2014, American School Health Association.

Evaluating student learning outcomes in oral health knowledge and skills.

PubMed

Lewis, Adrienne; Edwards, Suzanne; Whiting, Glenda; Donnelly, Frank

2018-06-01

To evaluate whether a set of oral health resources designed for workforce training was relevant for students undertaking an entry-level nursing or aged care qualification. Oral health is one of the most neglected aspects of nursing care experienced by older people. Despite efforts to improve aged care worker oral health knowledge and skills, one-off training and rapid staff turnover have hindered the success of workplace programmes. Inadequate oral health content in entry-level nursing and aged care qualifications has perpetuated this. Kirkpatrick's training and evaluation model was used to evaluate the resources developed by a project called Building Better Oral Health Communities. Students used them as prescribed study materials and completed pre- and postintervention questionnaires. Educators were interviewed to obtain their feedback. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were collated according to relevance to learning, presentation style and interest. Evaluation showed high levels of student and educator satisfaction. Student learning outcomes demonstrated consistently positive attitudes and significant self-reported improvements in oral health knowledge and skills. Irrespective of course type, students gained similar levels of oral health knowledge and skills following use of the resources. Nurses and care workers must be able to provide consistent standards of oral health care as a fundamental part of caring for patients. Validated as an effective learning and teaching package, it is recommended that these resources be used to strengthen the oral health content of entry-level nursing and aged care qualifications. Building the oral health capacity of nurses and care workers is one way of reversing oral health neglect and improving the quality of care provided to older people. © 2017 John Wiley & Sons Ltd.

Professional oral hygiene as a therapeutic option for pediatric patients with plasma cell gingivitis: preliminary results of a prospective case series.

PubMed

Arduino, Paolo G; D'Aiuto, Francesco; Cavallito, Claudio; Carcieri, Paola; Carbone, Mario; Conrotto, Davide; Defabianis, Patrizia; Broccoletti, Roberto

2011-12-01

Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG. All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain). A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003). Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG.

Oral health and access to dental care: a qualitative exploration in rural Quebec.

PubMed

Emami, Elham; Wootton, John; Galarneau, Chantal; Bedos, Christophe

2014-01-01

We sought to explore how rural residents perceive their oral health and their access to dental care. We conducted a qualitative research study in rural Quebec. We used purposeful sampling to recruit study participants. A trained interviewer conducted audio-recorded, semistructured interviews until saturation was reached. We conducted thematic analysis to identify themes. This included interview debriefing, transcript coding, data display and interpretation. Saturation was reached after 15 interviews. Five main themes emerged from the interviews: rural idyll, perceived oral health, access to oral health care, cues to action and access to dental information. Most participants noted that they were satisfied with the rural lifestyle, and that rurality per se was not a threat to their oral health. However, they criticized the limited access to dental care in rural communities and voiced concerns about the impact on their oral health. Participants noted that motivation to seek dental care came mainly from family and friends rather than from dental care professionals. They highlighted the need for better education about oral health in rural communities. Residents' satisfaction with the rural lifestyle may be affected by unsatisfactory oral health care. Health care providers in rural communities should be engaged in tailoring strategies to improve access to oral health care.

Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour.

PubMed

Ab Malik, Normaliza; Mohamad Yatim, Saari; Lam, Otto L T; Jin, Lijian; McGrath, Colman

2018-04-01

This study aimed to examine "intention to" and "performance of" oral hygiene care to stroke patients using the Theory of Planned Behavior. A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected. The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β = 0.21, p < 0.001), subjective norms (β = 0.38, p < 0.001), perceived behavior control (β = 0.04, p < 0.001); after controlling for personal and environmental factors. Approximately two-thirds (63.4%, 493) reported the performance of some form of oral hygiene care for patients. This behavior was associated with general intention scores (OR =1.13, 95%CI =1.05-1.22, p <0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care. The Theory of Planned Behavior provides understanding of "intention to" and "performance of" oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation. Implications for Rehabilitation Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia). Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation. A large-scale national survey was conducted to understand "intentions to" and "performance of" oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model. These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.

Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

PubMed

Nakajima, Nobuhisa

2017-06-01

Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p < 0.001). 2) Severe cases of dry mouth (Grade-2&3) were noted in 20.0% and 64.8% in good and poor oral intake groups, respectively ( p < 0.0001). Candidiasis complication rate was significantly higher in poor oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

One for all: A standardized protocol for ex vivo culture of limbal, conjunctival and oral mucosal epithelial cells into corneal lineage.

PubMed

Dhamodaran, Kamesh; Subramani, Murali; Matalia, Himanshu; Jayadev, Chaitra; Shetty, Rohit; Das, Debashish

2016-04-01

Autologous transplantation of ex vivo cultured cells the treatment of choice for patients with limbal stem cell deficiency. The most commonly used cell sources for transplantation limbal, conjunctival or oral mucosal tissue. Protocols vary for culturing each tissue type, and there are no comparative studies on transplantation outcomes using these different culture techniques. To overcome this limitation, we devised a simple protocol that can uniformly promote growth and differentiation of cells from a limbal, conjunctival or oral mucosal biopsy into the corneal lineage. Biopsies were cultured as explants on de-epithelialized human amniotic membrane in the presence of recombinant epidermal growth factor and insulin. Cultured cells were characterized using immunohistochemistry and quantitative reverse transcriptase polymerase chain reaction for stem/progenitor markers (ABCG2 and P63α) and differentiation markers (CK3, CK12, CK4, CK13, CK15 and CONNEXIN 43). Fluorescence-activated cell sorter analysis was performed for ABCG2. The results revealed that cells of all three biopsies differentiated into the corneal lineage. Positivity of CK3/12, CK4, CK12 and CONNEXIN 43 immunostaining and the relative mRNA expression of CK3, CK4, CK12, CK13, CK15 and CONNEXIN 43 could be detected in the cultured biopsies. Unlike tissue-specific protocols, our protocol can unequivocally promote differentiation of cells from a limbal, conjunctival or oral mucosal biopsy into the corneal lineage. This simple standardized protocol can be adapted for ocular surface reconstruction using stem cell transplantation. Copyright © 2016 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children.

PubMed

Braun, P A; Quissell, D O; Henderson, W G; Bryant, L L; Gregorich, S E; George, C; Toledo, N; Cudeii, D; Smith, V; Johs, N; Cheng, J; Rasmussen, M; Cheng, N F; Santo, W; Batliner, T; Wilson, A; Brega, A; Roan, R; Lind, K; Tiwari, T; Shain, S; Schaffer, G; Harper, M; Manson, S M; Albino, J

2016-10-01

The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health-focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health-related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739). © International & American Associations for Dental Research 2016.

Correlates of Unmet Dental Care Need Among HIV-Positive People Since Being Diagnosed with HIV

PubMed Central

Jeanty, Yves; Cardenas, Gabriel; Fox, Jane E.; Pereyra, Margaret; Diaz, Chanelle; Bednarsh, Helene; Reznik, David A.; Abel, Stephen N.; Bachman, Sara S.; Metsch, Lisa R.

2012-01-01

Objectives We analyzed the characteristics of people living with HIV/AIDS (PLWHA) who reported unmet oral health needs since testing positive and compared those characteristics with people reporting no unmet health needs. We also identified barriers to accessing oral health care for PLWHA. Methods We collected data from 2,469 HIV-positive patients who had not received oral health care in the previous 12 months and who had accessed care at Health Resources and Service Administration-funded Special Projects of National Significance Innovations in Oral Health Care Initiative demonstration sites. The outcome of interest was prior unmet oral health needs. We explore barriers to receiving oral health care, including cost, access, logistics, and personal factors. Bivariate tests of significance and generalized estimating equations were used in analyses. Results Nearly half of the study participants reported unmet dental care needs since their HIV diagnosis. People reporting unmet needs were more likely to be non-Hispanic white, U.S.-born, and HIV-positive for more than one year, and to have ever used crack cocaine or crystal methamphetamine. The top three reported barriers to oral care were cost, access to dental care, and fear of dental care. Additional reported barriers were indifference to dental care and logistical issues. Conclusion Innovative strategies are needed to increase access to and retention in oral health care for PLWHA. Key areas for action include developing strategies to reduce costs, increase access, and reduce personal barriers to receiving dental care, particularly considering the impact of poor oral health in this population. PMID:22547873

The Hospice Patient's Right to Oral Care: Making Time for the Mouth.

PubMed

Soileau, Kristi; Elster, Nanette

2018-04-01

The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.

Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol.

PubMed

Jingu, Akiko; Fukuda, Junya; Taketomi-Takahashi, Ayako; Tsushima, Yoshito

2014-10-06

Adverse reactions to iodinated and gadolinium contrast media are an important clinical issue. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions, some patients may have reactions to contrast media in spite of premedication (breakthrough reaction; BTR).The purpose of this study was to assess the frequency, type and severity of BTR when following an oral steroid premedication protocol. All iodinated and gadolinium contrast-enhanced radiologic examinations between August 2011 and February 2013 for which the premedication protocol was applied in our institution were assessed for BTRs. The protocol was applied to a total of 252 examinations (153 patients, ages 15-87 years; 63 males, 90 females). Of these, 152 were for prior acute adverse reactions to contrast media, 85 were for a history of bronchial asthma, and 15 were for other reasons. There were 198 contrast enhanced CTs and 54 contrast enhanced MRIs. There were nine BTR (4.5%) for iodinated contrast media, and only one BTR (1.9%) for gadolinium contrast media: eight were mild and one was moderate. No patient who had a mild index reaction (IR) had a severe BTR. Incidence of BTRs when following the premedication protocol was low. This study by no means proves the efficacy of premedication, but provides some support for following a premedication protocol to improve safety of contrast-enhanced examinations when prior adverse reactions are mild, or when there is a history of asthma.

Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol

PubMed Central

2014-01-01

Background Adverse reactions to iodinated and gadolinium contrast media are an important clinical issue. Although some guidelines have proposed oral steroid premedication protocols to prevent adverse reactions, some patients may have reactions to contrast media in spite of premedication (breakthrough reaction; BTR). The purpose of this study was to assess the frequency, type and severity of BTR when following an oral steroid premedication protocol. Methods All iodinated and gadolinium contrast-enhanced radiologic examinations between August 2011 and February 2013 for which the premedication protocol was applied in our institution were assessed for BTRs. Results The protocol was applied to a total of 252 examinations (153 patients, ages 15–87 years; 63 males, 90 females). Of these, 152 were for prior acute adverse reactions to contrast media, 85 were for a history of bronchial asthma, and 15 were for other reasons. There were 198 contrast enhanced CTs and 54 contrast enhanced MRIs. There were nine BTR (4.5%) for iodinated contrast media, and only one BTR (1.9%) for gadolinium contrast media: eight were mild and one was moderate. No patient who had a mild index reaction (IR) had a severe BTR. Conclusion Incidence of BTRs when following the premedication protocol was low. This study by no means proves the efficacy of premedication, but provides some support for following a premedication protocol to improve safety of contrast-enhanced examinations when prior adverse reactions are mild, or when there is a history of asthma. PMID:25287952

Listening to Parents: A Qualitative Look at the Dental and Oral Care Experiences of Children with Autism Spectrum Disorder.

PubMed

Lewis, Charlotte; Vigo, Lynn; Novak, Louise; Klein, Eileen J

2015-01-01

Children with autism spectrum disorder (ASD) experience various barriers to optimal dental and oral care. The purpose of this study was to conduct focus groups of parents of children with autism spectrum disorder and subsequent qualitative analysis of the interviews in order to better understand problems in dental and oral care encountered by children with ASD. Four focus groups, comprised of parents of children with ASD, ranging in age from three to 17 years old, were assembled. We took a semi-structured approach, facilitating discussion about home oral hygiene and professional dental care. Audiotapes were transcribed and independently coded by four investigators who then jointly identified themes. There were three overarching, interrelated themes: (1) There is variability between children with ASD in how they tolerate dental and oral care and in what facilitates such care. (2) Parents want more extensive dental care for their children with ASD. (3) Each child's dental and oral care should be individualized based on parents' input about the unique characteristics and needs of their child. There is no "one size fits all" approach to dental and oral care for children with autism spectrum disorder. Parents are valuable partners in informing the unique dental and oral care needs of their child with ASD.

Increasing Access to Oral Health Care for People Living with HIV/AIDS in Rural Oregon

PubMed Central

Jones, Jill; Mofidi, Mahyar; Bednarsh, Helene; Gambrell, Alan; Tobias, Carol R.

2012-01-01

Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs. PMID:22547878

NATURAL HISTORY OF DENTAL PLAQUE ACCUMULATION IN MECHANICALLY VENTILATED ADULTS: A DESCRIPTIVE CORRELATIONAL STUDY

PubMed Central

Jones, Deborah J.; Munro, Cindy L.; Grap, Mary Jo

2011-01-01

Summary Objective The purpose of this study was to describe the pattern of dental plaque accumulation in mechanically ventilated adults. Accumulation of dental plaque and bacterial colonization of the oropharynx is associated with a number of systemic diseases including ventilator associated pneumonia. Research Methodology/Design Data were collected from mechanically ventilated critically ill adults (n=137), enrolled within 24 hours of intubation. Dental plaque, counts of decayed, missing and filled teeth and systemic antibiotic use was assessed on study days 1, 3, 5 and 7. Dental plaque averages per study day, tooth type and tooth location were analyzed. Setting Medical Respiratory, Surgical Trauma and Neuroscience ICU’s of a large tertiary care center in the southeast United States. Results Plaque: All surfaces > 60% plaque coverage from day 1 to day 7; Molars and Premolars contained greatest plaque average >70%. Systemic antibiotic use on day 1 had no significant effect on plaque accumulation on day 3 (p=0.73). Conclusions Patients arrive in critical care units with preexisting oral hygiene issues. Dental plaque tends to accumulate in the posterior teeth (molars and premolars) that may be hard for nurses to visualize and reach; this problem may be exacerbated by endotracheal tubes and other equipment. Knowing accumulation trends of plaque will guide the development of effective oral care protocols. PMID:22014582

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand

PubMed Central

2013-01-01

Background Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance. Methods/design The participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui. This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm. Discussion The development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976. PMID:24330669

Reducing disease burden and health inequalities arising from chronic disease among indigenous children: an early childhood caries intervention in Aotearoa/New Zealand.

PubMed

Broughton, John R; Maipi, Joyce Te H; Person, Marie; Thomson, W Murray; Morgaine, Kate C; Tiakiwai, Sarah-Jane; Kilgour, Jonathan; Berryman, Kay; Lawrence, Herenia P; Jamieson, Lisa M

2013-12-13

Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance. The participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm. The development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.

Use of laser photomodulation in the evolution of oral mucositis associated to cyclophosphamide, methotrexate, 5-fluouracil - CMF in 5 fluouracil + adriamycin + cyclophosphamide - FAC chemotherapy protocols in patients with breast cancer

NASA Astrophysics Data System (ADS)

de Fátima Lima Ferreira, Maria; de Carvalho, Fabiola Bastos; de Oliveira, Susana C. P. S.; Monteiro, Juliana S. C.; Santos, Gustavo M. P.; Gesteira, Maria F. M.; Maia, Tereza Cristina Teixeira; Pinheiro, Antônio L. B.

2013-03-01

The aim of this study was to evaluate the efficacy of the laser photobiomodulation (FBML) in prevention and treatment of oral mucositis induced by chemotherapy protocols CMF (cyclophosphamide, methotrexate, 5-Fluouracil) and FAC (5 Fluouracil + Adriamycin + Cyclophosphamide) in cancer patients breast. We selected 28 patients treated at the Center for High Complexity (CACON), who underwent 6 cycles of 21 days of treatment, with diagnosis of infiltrating ductal carcinoma (ICD C50.9). Were randomly divided into three groups: Group A - eight patients (Protocol FAC + Dental protocol of CACON + Laser), Group B - 6 patients (Protocol CMF + Dental protocol of CACON + Laser), Group C - was divided into two sub-groups: Group C1 with 8 patients (Control Group 1: FAC + Dental protocol o CACON) and group C2 with 6 patients (control group 2: Protocol CMF + Dental protocol of CACON). Patients in Group A and B were use of preventive FBML 24 hours before the start of chemotherapy cycle, then every 48 hours and was extended up to one week following completion of chemotherapy. The groups A and B, presented oral mucositis grade 0 (64.29%) p = 0.07, grade I (7.14%), grade II (14.29%), grade III (7.14 %), grade IV (7.14%) compared to group C, who presented mucositis grade 0 (35.71%) in the initial evaluation with p = 0.10, grade I (21.43%), grade II (28.57%), grade III (14.29%), grade IV (0.00%), patients who used the FBML as a preventive and therapeutic showed a reduction and pain relief in 42.86%. It is concluded that the low power laser when used preventively or as therapy and showed immediate relief of pain and accelerate tissue repair.

Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study

PubMed Central

2011-01-01

Introduction Today, we frequently find patients taking oral anticoagulant therapy (OAT), a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications. Materials and methods A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76) undergoing OAT for more than 5 years were managed with a standardized management protocol and a 2-months follow-up. The aim of the present study was to apply a protocol, which could provide a safe intra- and postoperative management of patients on OAT. Results Among the 193 patients, only 2 had postoperative complications. Conclusions We think that the protocol used in the present study can be used for complete safety in the treatment of this type of patients. PMID:21771331

Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices.

PubMed

Byrnes, Matthew C; Schuerer, Douglas J E; Schallom, Marilyn E; Sona, Carrie S; Mazuski, John E; Taylor, Beth E; McKenzie, Wendi; Thomas, James M; Emerson, Jeffrey S; Nemeth, Jennifer L; Bailey, Ruth A; Boyle, Walter A; Buchman, Timothy G; Coopersmith, Craig M

2009-10-01

To determine a) if a checklist covering a diverse group of intensive care unit protocols and objectives would improve clinician consideration of these domains and b) if improved consideration would change practice patterns. Pre- and post observational study. A 24-bed surgical/burn/trauma intensive care unit in a teaching hospital. A total of 1399 patients admitted between June 2006 and May 2007. The first component of the study evaluated whether mandating verbal review of a checklist covering 14 intensive care unit best practices altered verbal consideration of these domains. Evaluation was performed using real-time bedside audits on morning rounds. The second component evaluated whether the checklist altered implementation of these domains by changing practice patterns. Evaluation was performed by analyzing data from the Project IMPACT database after patients left the intensive care unit. Verbal consideration of evaluable domains improved from 90.9% (530/583) to 99.7% (669/671, p < .0001) after verbal review of the checklist was mandated. Bedside consideration improved on the use of deep venous thrombosis prophylaxis (p < .05), stress ulcer prophylaxis (p < .01), oral care for ventilated patients (p < 0.01), electrolyte repletion (p < .01), initiation of physical therapy (p < .05), and documentation of restraint orders (p < .0001). Mandatory verbal review of the checklist resulted in a greater than two-fold increase in transferring patients out of the intensive care unit on telemetry (16% vs. 35%, p < .0001) and initiation of physical therapy (28% vs. 42%, p < .0001) compared with baseline practice. A mandatory verbal review of a checklist covering a wide range of objectives and goals at each patient's bedside is an effective method to improve both consideration and implementation of intensive care unit best practices. A bedside checklist is a simple, cost-effective method to prevent errors of omission in basic domains of intensive care unit management that might otherwise be forgotten in the setting of more urgent care requirements.

Preventive oral health practices of school pupils in Southern Nigeria.

PubMed

Folayan, Morenike O; Khami, Mohammad R; Onyejaka, Nneka; Popoola, Bamidele O; Adeyemo, Yewande Isabella

2014-07-07

One of the goals of the World Health Organisation goal is to ensure increased uptake of preventive oral self-care by 2020. This would require the design public health programmes that will ensure children place premium on preventive oral health care uptake. One effort in that direction is the need for countries to define baseline measures on use of preventive oral self-care measures by their population as well as identify factors that impact on its use. This study aims to determine the prevalence and the impact of age and sex on the use of recommended oral self-care measures by pupils in Southern Nigeria. Pupils age 8 to 16 years (N = 2,676) in two urban sites in Southern Nigeria completed a questionnaire about recommended oral self-care (use of fluoridated toothpaste, flossing, regularity of consuming sugary snacks between main meals), time of the last dental check-up and cigarette smoking habit. Chi square was used to test association between age (8-10years, 11-16 years), sex, and use of recommended oral self-care. Logistic regression analysis was used to determine the predictors of use of recommended oral self-care. Only 7.8% of the study population practiced the recommended oral self-care. Older adolescents had an 8.0% increased odds (OR: 1.08; CI:0.81-1.43; p = 0.61) and males had a 20.0% decreased odds (OR: 0.80; CI:0.60-1.06; p = 0.12) of practicing recommended oral self-care though observed differences were not statistically significant. Very few respondents (12.7%) had visited the dental clinic for a check-up in the last one year. Majority of the respondents (92.2%) were non-smokers. The use of a combination of oral self-care approaches was very low for this study population. Age and sex were predictive factors for the use of components of the oral self-care measures but not significant predictors of use of recommended oral self-care. Future studies would be required to understand 'why' and 'how' age and sex impacts on the use of caries preventive oral self-care measures to be able to design effective prevention educational programmes for the study population.

Preventive oral health practices of school pupils in Southern Nigeria

PubMed Central

2014-01-01

Background One of the goals of the World Health Organisation goal is to ensure increased uptake of preventive oral self-care by 2020. This would require the design public health programmes that will ensure children place premium on preventive oral health care uptake. One effort in that direction is the need for countries to define baseline measures on use of preventive oral self-care measures by their population as well as identify factors that impact on its use. This study aims to determine the prevalence and the impact of age and sex on the use of recommended oral self-care measures by pupils in Southern Nigeria. Methods Pupils age 8 to 16 years (N = 2,676) in two urban sites in Southern Nigeria completed a questionnaire about recommended oral self-care (use of fluoridated toothpaste, flossing, regularity of consuming sugary snacks between main meals), time of the last dental check-up and cigarette smoking habit. Chi square was used to test association between age (8-10years, 11–16 years), sex, and use of recommended oral self-care. Logistic regression analysis was used to determine the predictors of use of recommended oral self-care. Results Only 7.8% of the study population practiced the recommended oral self-care. Older adolescents had an 8.0% increased odds (OR: 1.08; CI:0.81–1.43; p = 0.61) and males had a 20.0% decreased odds (OR: 0.80; CI:0.60-1.06; p = 0.12) of practicing recommended oral self-care though observed differences were not statistically significant. Very few respondents (12.7%) had visited the dental clinic for a check-up in the last one year. Majority of the respondents (92.2%) were non-smokers. Conclusions The use of a combination of oral self-care approaches was very low for this study population. Age and sex were predictive factors for the use of components of the oral self-care measures but not significant predictors of use of recommended oral self-care. Future studies would be required to understand ‘why’ and ‘how’ age and sex impacts on the use of caries preventive oral self-care measures to be able to design effective prevention educational programmes for the study population. PMID:25001584

Access to Oral Health Care: A National Crisis and Call for Reform.

PubMed

Bersell, Catherine H

2017-02-01

Purpose: According to the report Healthy People 2020, oral health is integral to overall health and access to dental services is essential to promoting and maintaining good oral health. Yet, those who need dental care the most are often the least likely to receive it. The dental hygiene profession is poised to play a pivotal role in the resolution of oral health disparities. The purpose of this manuscript is to examine the critical issue of access to oral health care in the United States from various perspectives and consider potential implications for dental professionals and the oral health care system. This report focuses on major underserved and vulnerable populations and highlights several barriers that significantly affect the ability to access and navigate the oral health care system. These include low socioeconomic status; the shortage and maldistribution of dentists; a lack of professional training regarding current evidence-based oral health guidelines; deficient continuity of care due to inadequate interdisciplinary collaboration; low oral health literacy; and patient perceptions and misconceptions about preventive dental care. This report also contains an update on provider participation in Medicaid; the state of children's oral health; and emerging workforce models, state initiatives, and legislative reforms. Recommendations increasing access to care require local, state, and federal stakeholders to combine forces that take advantage of the existing dental hygiene workforce, utilize innovative delivery models, improve license reciprocity, reduce prohibitive supervision, and expand the dental hygiene scope of practice. The major focus of future research will be on the implementation of mid-level oral health care providers. Dental hygienists are an integral part of the access to care solution and have a great opportunity to lead the call to action and fulfill the American Dental Hygienists' Association's mandate that oral health care is the right of all people. Copyright © 2017 The American Dental Hygienists’ Association.

Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians.

PubMed

Chung, J P; Mojon, P; Budtz-Jørgensen, E

2000-01-01

Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized in 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 caregivers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority.

Oral Health Equity and Unmet Dental Care Needs in a Population-Based Sample: Findings From the Survey of the Health of Wisconsin

PubMed Central

Wisk, Lauren E.; Walsh, Matthew; McWilliams, Christine; Eggers, Shoshannah; Olson, Melissa

2015-01-01

Objectives. We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. Methods. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. Results. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Conclusions. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing). PMID:25905843

Oral health equity and unmet dental care needs in a population-based sample: findings from the Survey of the Health of Wisconsin.

PubMed

Malecki, Kristen; Wisk, Lauren E; Walsh, Matthew; McWilliams, Christine; Eggers, Shoshannah; Olson, Melissa

2015-07-01

We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing).

Oral Rehabilitation and Management of Mentally Retarded

PubMed Central

Khetan, Jitendra; Gupta, Sarika; Tomar, Deepak; Singh, Meenakshi

2015-01-01

High level of periodontal problems of dental caries are frequently observed in mentally handicapped children. This group of patients presents various problems when they face dental treatments. Identification of such population and providing them affordable oral health care is the new concept. A systematic method for identification and screening of persons with mental retardation has been developed and is being followed. Cost and fear are the most commonly cited barriers to dental care. Physical or mental may lead to deterioration in self-care, and oral care state have a low priority. Risk factors are inter-related and are often barriers to oral health. With advancements in today’s world sufficient information and support is available for each and every individual to lead a healthy life which include the access to the oral health care. Factors such as fear, anxiety and dental phobia plays a vital role in acceptance of dental care and also the delaying of dental care. Lack of knowledge of oral and dental disease, awareness or oral need, oral side-effects of medication and organization of dental services are highlighted in the literature. All health personnel should receive training to support the concept of primary oral health care. Training about dealing with such mentally handicapped people should be addressed urgently among the health professionals. PMID:25738098

Oral rehabilitation and management of mentally retarded.

PubMed

Solanki, Jitender; Khetan, Jitendra; Gupta, Sarika; Tomar, Deepak; Singh, Meenakshi

2015-01-01

High level of periodontal problems of dental caries are frequently observed in mentally handicapped children. This group of patients presents various problems when they face dental treatments. Identification of such population and providing them affordable oral health care is the new concept. A systematic method for identification and screening of persons with mental retardation has been developed and is being followed. Cost and fear are the most commonly cited barriers to dental care. Physical or mental may lead to deterioration in self-care, and oral care state have a low priority. Risk factors are inter-related and are often barriers to oral health. With advancements in today's world sufficient information and support is available for each and every individual to lead a healthy life which include the access to the oral health care. Factors such as fear, anxiety and dental phobia plays a vital role in acceptance of dental care and also the delaying of dental care. Lack of knowledge of oral and dental disease, awareness or oral need, oral side-effects of medication and organization of dental services are highlighted in the literature. All health personnel should receive training to support the concept of primary oral health care. Training about dealing with such mentally handicapped people should be addressed urgently among the health professionals.

Confronting Oral Health Disparities Among American Indian/Alaska Native Children: The Pediatric Oral Health Therapist

PubMed Central

Nash, David A.; Nagel, Ron J.

2005-01-01

American Indian and Alaska Native (AIAN) children are disproportionately affected by oral disease compared with the general population of American children. Additionally, AIAN children have limited access to professional oral health care. The Indian Health Service (IHS) and AIAN tribal leaders face a significant problem in ensuring care for the oral health of these children. We discuss the development and deployment of a new allied oral health professional, a pediatric oral health therapist. This kind of practitioner can effectively extend the ability of dentists to provide for children not receiving care and help to confront the significant oral health disparities existing in AIAN children. Resolving oral health disparities and ensuring access to oral health care for American Indians and Alaska Natives is a moral issue—one of social justice. PMID:16006412

An interprofessional educational approach to oral health care in the geriatric population.

PubMed

Bonwell, Patricia Brown; Parsons, Pamela L; Best, Al M; Hise, Sabrina

2014-01-01

An interprofessional educational approach was used to provide five in-service training sessions for all direct health care providers in a long-term care facility, and one half-day seminar/live webinar for community-licensed health care professionals. Content included presentations by five disciplines: (a) periodontist: oral-systemic relationship, (b) oral pathologist: oral pathology, (c) pharmacist: oral health-pharmacological link, (d) dietitian: oral health-dietary link, and (e) occupational therapist: providing and practicing proper oral hygiene. Significant improvement in posttest scores for the five in-service training sessions and the half-day seminar/live webinar was revealed in t-test results, representing an increase in knowledge gained. Approximately 80% of the 145 participants indicated that they would make a change in patient care. Findings indicate that the in-service training sessions and half-day seminar/live webinar supported development of the geriatric work force by utilizing an interprofessional educational approach which will assist in meeting the oral health care needs of the geriatric population.

Providers' preferences for pediatric oral health information in the electronic health record: a cross-sectional survey.

PubMed

Shea, Christopher M; Turner, Kea; White, B Alex; Zhu, Ye; Rozier, R Gary

2018-01-11

The majority of primary care physicians support integration of children's oral health promotion and disease prevention into their practices but can experience challenges integrating oral health services into their workflow. Most electronic health records (EHRs) in primary care settings do not include oral health information for pediatric patients. Therefore, it is important to understand providers' preferences for oral health information within the EHR. The objectives of this study are to assess (1) the relative importance of various elements of pediatric oral health information for primary care providers to have in the EHR and (2) the extent to which practice and provider characteristics are associated with these information preferences. We surveyed a sample of primary care physicians who conducted Medicaid well-child visits in North Carolina from August - December 2013. Using descriptive statistics, we analyzed primary care physicians' oral health information preferences relative to their information preferences for traditional preventive aspects of well-child visits. Furthermore, we analyzed associations between oral health information preferences and provider- and practice-level characteristics using an ordinary least squares regression model. Fewer primary care providers reported that pediatric oral health information is "very important," as compared to more traditional elements of primary care information, such as tracking immunizations. However, the majority of respondents reported some elements of oral health information as being very important. Also, we found positive associations between the percentage of well child visits in which oral health screenings and oral health referrals are performed and the reported importance of having pediatric oral health information in the EHR. Incorporating oral health information into the EHR may be desirable for providers, particularly those who perform oral health screenings and dental referrals.

The practical oral care video--evaluation of a dental awareness month initiative.

PubMed

Chalmers, J M; Robinson, J; Nankivell, N

2005-06-01

A collaborative effort for the Australian Dental Association's Dental Awareness Month in 2002 included the production of 'Practical Oral Care - a video for residential care staff'. This evaluation of the project aimed to profile the video purchasers, evaluate the usefulness and appropriateness of the video and accompanying booklet using a mailed questionnaire, and elicit appropriate and practical themes for future geriatric oral health promotion and research. A national mail-out of evaluation questionnaires was undertaken to all purchasers of the video. Of the 792 purchasers at the time of the project, 294 questionnaires were returned with 83.7 per cent from residential aged care facilities, 12.6 per cent from dental professionals and 3.7 per cent from health educators. The great majority of purchasers agreed or strongly agreed that the booklet was practical and useful, video was the best format, video length was appropriate, content was realistic, the video assisted staff to identify residents at risk for dental problems and better meet their oral care needs, and improved awareness about oral care issues. Analysis of purchasers' comments highlighted the need for the production of videos on more specific practical oral care issues with behaviourally difficult residents and residents with dementia, to be supplemented with a self-directed learning package. The Practical Oral Care video was a successful national collaborative geriatric oral health promotion initiative and provided the opportunity to increase awareness about oral care issues in residential care.

Preventive Effect on Post-Operative Pneumonia of Oral Health Care among Patients Who Undergo Esophageal Resection: A Multi-Center Retrospective Study.

PubMed

Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Oho, Takahiko; Umeda, Masahiro

2016-08-01

Post-operative pneumonia is a frequent and possibly fatal complication of esophagectomy and is likely caused by aspiration of oropharyngeal fluid that contains pathogenic micro-organisms. We conducted a multi-center retrospective study to investigate the preventive effect of oral health care on post-operative pneumonia among patients with esophageal cancer who underwent esophagectomy. A total of 280 patients underwent esophagectomy at three university hospitals. These patients were divided retrospectively into those who received pre-operative oral care from dentists and dental hygienists (oral care group; n = 173) and those who did not receive such care (control group; n = 107). We evaluated the correlations between the occurrence of post-operative pneumonia and 18 predictive variables (patient factors, tumor factors, treatment factors, and pre-operative oral care) using the χ(2) test and logistic regression analysis. The differences of mean hospital days and mortality rate in both groups were analyzed by the Student t-test. Age, post-operative dysphagia, and absence of pre-operative oral care were correlated significantly with post-operative pneumonia in the univariable analysis. Multivariable analysis revealed that diabetes mellitus, post-operative dysphagia, and the absence of pre-operative oral care were independent risk factors for post-operative pneumonia. The mean hospital stay and mortality rate did not differ between the oral care and control groups. Pre-operative oral care may be an effective and easy method to prevent post-operative pneumonia in patients who are undergoing esophagectomy.

[Effects of an Oral Care Program on the Swallowing Function in Post-Operative Patients With Oral Cancer].

PubMed

Hsiang, Ching-Chi; Hwu, Yueh-Juen

2017-04-01

Oral cancer is the fourth leading cause of death among men in Taiwan. Dysphagia, choking, and aspiration pneumonia are often noted in post-operative patients with oral cancer. Improving patients' swallowing function is an urgent problem that cannot be neglected. To investigate the effects of an oral care program on the swallowing function of post-operative patients with oral cancer. A quasi-experimental research design was conducted and post-operative patients with oral cancer were recruited. The experimental group (n = 20) received 12 weeks of the oral care program intervention, while the control group (n = 20) received standard post-operative care. The modified barium swallow (MBS) study and self-rated degree of dysphagia were compared between the two groups after the intervention period. Post-intervention scores on the MBS test and for the self-rated degree of dysphagia were significantly better in the experimental group than in the control group (p < .001). Performing the oral care program was found to improve the swallowing function of post-operative patients with oral cancer. The results of the present study provide a reference for healthcare providers to improve quality of care.

Prevalence and predictors of difficulty accessing the mouths of intubated critically ill adults to deliver oral care: An observational study.

PubMed

Dale, Craig M; Smith, Orla; Burry, Lisa; Rose, Louise

2018-04-01

Oral care of intubated patients is essential to the prevention of infection and patient discomfort. However, barriers to oral access and delivery of oral care have received little attention. To determine prevalence and predictors of oral access difficulty. A prospective, observational, multi-center study. Four intensive care units in Toronto, Canada. Adult patients orally intubated for ≥48 h. We screened consecutive admissions once a week to identify eligible participants. We observed each patient and asked the patient's nurse about presence or absence of difficulty accessing the mouth to deliver oral care across three categories: (1) visualizing inside the mouth; (2) obtaining patient cooperation, or (3) inserting instruments for delivery of oral care. We asked nurses to identify presence of patient behaviors contributing to oral access difficulty and perceived level of difficulty on a Likert response scale. We examined patient and treatment characteristics associated with extreme difficulty (i.e., difficulty in all 3 categories) using a generalized estimating equation regression model. A total of 428 patients were observed, 58% admitted with a medical diagnosis. More than half (57%) had ≥2 oral devices up to maximum of 4. Oral care difficulty was identified in 83% of patients and rated as moderate to high for 217 (51%). Difficulty concerned visibility (74%), patient cooperation (55%), and space to insert instruments (53%). Patient behaviors contributing difficulty included coughing/gagging (60%), mouth closing (49%), biting (45%) and localizing (27%) during care. Variables associated with extreme difficulty included neurological (OR 1.92, 95% CI 1.42-2.60) or trauma admission (OR 1.83, 95% CI 1.16-2.89), lack of pain assessment or treatment in the 4 h prior to oral care (OR 1.43, 95% CI 1.14-1.80), more oral devices (OR 1.40, 95% CI 1.05-1.87), and duration of intubation (OR 1.05, 95% CI 1.01-1.10). Absence of documented agitation in the 4 h prior to oral care was associated with less difficulty (OR 0.68, 95% CI 0.54-0.86). Oral care is complex and difficulties are experienced in a vast majority of intubated patients. Some difficulties are amenable to correction such as pain management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Non-dental primary care providers' views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study.

PubMed

Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

2015-10-29

To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Qualitative study with semistructured interviews and thematic analysis. Four remote communities in outback Queensland, Australia. 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Dental hygiene intervention to prevent nosocomial pneumonias.

PubMed

Barnes, Caren M

2014-06-01

Nosocomial and ventilator associated pneumonias that plague critically ill, elderly and long-term care residents could be reduced with effective oral hygiene practices facilitated collaboratively between nurses and dental hygienists. Nosocomial pneumonias, specifically aspiration pneumonias and ventilator-associated pneumonias in the elderly and infirm have become a major health care issue, The provision of oral care in hospital and hospital-like facilities presents challenges that can prevent patients from receiving optimal oral care One sequela can be aspiration pneumonia which ranks first in mortality and second in morbidity among all nosocomial infections. Since aspiration pneumonia is linked to the colonization of oral bacteria in dental plaque and biofilm, it is time to look for creative solutions to integrating the expertise of dental hygienists into health care teams in these institutional settings. A comprehensive review of the literature was conducted regarding the etiology and prevalence of health care related pneumonias. Evidence describing the challenges and barriers that the nurses, nursing staff, and dental hygienists face in the provision of oral care in hospitals and long-term care facilities is provided. Intercollaborative solutions to providing optimal oral care in hospitals and long-term care facilities are suggested. Dental hygienists have the expertise and practice experience to provide oral care in hospitals, long-term care and residential facilities. They can contribute to solving oral care challenges through intercollaboration with other health care team members. Yet, there are long-standing systemic barriers that must be addressed in order to provide this optimal care. Dental hygienists becoming better assimilated within the total health care team in hospital and residential facilities can positively impact the suffering, morbidity and mortality associated with aspiration pneumonias. Copyright © 2014 Elsevier Inc. All rights reserved.

Eating disorder professionals' perceptions of oral health knowledge.

PubMed

Johnson, L B; Boyd, L D; Rainchuso, L; Rothman, A; Mayer, B

2017-08-01

The aim of this study was to assess the oral health knowledge among professionals who specialize in treating eating disorders, and identify to what extent their education, and training addresses oral health care delivery, and recommendations for individuals with eating disorders. Participants for this study were licensed behavioural and medical providers specializing in eating disorder treatment (n = 107), and recruited through professional eating disorder organizations. Participants completed an anonymous, online questionnaire (33 items) assessing level of oral health-related education, knowledge and treatment recommendations within the participant's respective eating disorder discipline. The majority of respondents (85%) were formally trained in eating disorders, and of those trained, 64.4% were not satisfied with the level of oral health education during formal education, and 19.5% report no oral health education. Respondents consider their knowledge of risk of oral disease for their clients/patients as average or above (84%), and ranked tooth erosion as the greatest reason for oral care (63%) while dry mouth led in the rankings for least significant reason for oral care (33%). Referral for oral care was found to be more common after reports of complication (55%). According to these findings, eating disorder professionals regard oral health care for their clients as significant, and may be unaware of associated oral risk factors, current oral care standards and long-term oral effects of disordered eating apart from enamel erosion. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Service-Learning Project to Eliminate Barriers to Oral Care for Children with Special Health Care Needs

ERIC Educational Resources Information Center

DeMattei, Ronda R.; Allen, Jessica; Goss, Breanna

2012-01-01

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental…

Does oral care contribute to brain activation?: One case of functional near-infrared spectroscopy study in patients with a persistent disturbance of consciousness.

PubMed

Fujii, Wataru; Kanamori, Daisuke; Nagata, Chisato; Sakaguchi, Kiyomi; Watanabe, Risa

2014-08-01

We used functional near-infrared spectroscopy (fNIRS) to measure cerebral blood flow during oral care in a patient with persistent disturbance of consciousness. We experienced that cerebral blood flow to frontal area increased during oral care, suggesting that oral care may have a potential role in rehabilitation for the brain.

Development of an oral care guide for patients undergoing autologous stem cell transplantation.

PubMed

Salvador, Prisco T

2006-01-01

Nurses identified oral mucositis as a recurring issue in clinical practice. To meet this challenge, a group of nurses took a leadership role in developing an oral care guide. The University Health Network Nursing Research Utilization Model and the Neuman Systems Model served as conceptual frameworks. A flowchart was developed to ensure a coordinated and continuous provision of oral care. Educational presentations were conducted to familiarize nurses and members of the multidisciplinary team of the practice changes. The introduction of the oral care regimen as primary prevention, plus systematic oral assessment and monitoring had the potential to reduce the occurrence and severity of oral mucositis in patients undergoing autologous stem cell transplantation.

A Consensus-Based Set of Measures for Oral Health Care.

PubMed

Baâdoudi, F; Trescher, A; Duijster, D; Maskrey, N; Gabel, F; van der Heijden, G J M G; Listl, S

2017-04-01

Increasingly more responsive and accountable health care systems are demanded, which is characterized by transparency and explicit demonstration of competence by health care providers and the systems in which they work. This study aimed to establish measures of oral health for transparent and explicit reporting of routine data to facilitate more patient-centered and prevention-oriented oral health care. To accomplish this, an intermediate objective was to develop a comprehensive list of topics that a range of stakeholders would perceive as valid, important, and relevant for describing oral health and oral health care. A 4-stage approach was used to develop the list of topics: 1) scoping of literature and its appraisal, 2) a meeting of experts, 3) a 2-stage Delphi process (online), and 4) a World Café discussion. The aim was to create consensus through structured conversations via a range of stakeholders (general dental practitioners, patients, insurers, and policy makers) from the Netherlands, Germany, the United Kingdom, Ireland, Hungary, and Denmark. The study was part of the ADVOCATE project, and it resulted in a list of 48 topics grouped into 6 clusters: 1) access to dental care, 2) symptoms and diagnosis, 3) health behaviors, 4) oral treatments, 5) oral prevention, and 6) patient perception. All topics can be measured, as they all have a data source with defined numerators and denominators. This study is the first to establish a comprehensive and multiple-stakeholder consented topic list designed for guiding the implementation of transparent and explicit measurement of routine data of oral health and oral health care. Successful measurement within oral health care systems is essential to facilitate learning from variation in practice and outcomes within and among systems, and it potentiates improvement toward more patient-centered and prevention-oriented oral health care.

An Effective Oral Motor Intervention Protocol for Infants and Toddlers with Low Muscle Tone.

ERIC Educational Resources Information Center

Kumin, Libby; Von Hagel, Kimberly Chapman; Bahr, Diane Chapman

2001-01-01

Parents were trained to provide infants (n=4) with low muscle tone secondary to Down Syndrome with a home intervention oral motor training program. Four case studies indicate that all four children demonstrated improved oral motor function for eating, drinking, and speaking. (Contains references.) (DB)

Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

PubMed

Ogunbodede, E O; Kida, I A; Madjapa, H S; Amedari, M; Ehizele, A; Mutave, R; Sodipo, B; Temilola, S; Okoye, L

2015-07-01

Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations. © International & American Associations for Dental Research 2015.

Comprehension of Japanese oral care-related terms among caregivers and nurses, as assessed using a newly developed instrument.

PubMed

Shibata, Satoko; Stegaroiu, Roxana; Nakazawa, Akari; Ohuchi, Akitsugu

2017-03-01

(i) To assess comprehension of oral care-related terms among caregivers and nurses working at long-term care facilities, using a newly developed test; (ii) to analyse the effect of participant characteristics on their comprehension. Effective mutual communication between dental professionals and caregivers/nurses is essential for providing information on daily oral care for institutionalised elders. A 36-item word-knowledge test in Japanese was developed to assess comprehension of oral care-related terms. The test was administered to a convenience sample of 236 nursing staff (198 caregivers and 38 nurses) at six long-term care facilities in Niigata City, Japan, and its reliability and validity were verified. Associations of participant characteristics with their responses were investigated by multiple regression analysis. Mean percentage of correct responses (accuracy rate) for nursing staff was approximately 62% (highest for oral care products and lowest for prosthodontic terms). Test internal reliability was high (Cronbach's alpha >0.8). Concurrent validity (test ability to distinguish between characteristically different groups) was confirmed. Mean accuracy rate was significantly higher among nurses (78.5 ± 19.3%) than among caregivers (58.7 ± 22.8%), and among respondents with interest in oral care (64.2 ± 21.1%) than among those with no such interest (51.5 ± 28.9%). The word-knowledge test was valid and reliable for nursing staff of six long-term care facilities in Niigata City. Their comprehension was low for perioral and intraoral structures, related symptom and disease names, and prosthodontics terms related to oral care. Understanding of oral care-related terms among the nursing staff was related to their occupation and interest in oral care. © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial.

PubMed

van der Heijden, Amber A W A; de Bruijne, Martine C; Feenstra, Talitha L; Dekker, Jacqueline M; Baan, Caroline A; Bosmans, Judith E; Bot, Sandra D M; Donker, Gé A; Nijpels, Giel

2014-06-25

The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€ 758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Current Controlled trials: ISRCTN66124817.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial

PubMed Central

2014-01-01

Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. Methods In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Results Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Conclusions Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Trial registration Current Controlled trials: ISRCTN66124817. PMID:24966055

Influence of Institutional Guidelines on Oral Hygiene Practices in Intensive Care Units.

PubMed

Kiyoshi-Teo, Hiroko; Blegen, Mary

2015-07-01

Maintaining oral hygiene is a key component of preventing ventilator-associated pneumonia; however, practices are inconsistent. To explore how characteristics of institutional guidelines for oral hygiene influence nurses' oral hygiene practices and perceptions of that practice. Oral hygiene section of a larger survey study on prevention of ventilator-associated pneumonia. Critical care nurses at 8 hospitals in Northern California that had more than 1000 ventilator days in 2009 were recruited to participate in the survey. Twenty-one questions addressed oral hygiene practices and practice perceptions. Descriptive statistics, analysis of variance, and Spearman correlations were used for analyses. A total of 576 critical care nurses (45% response rate) responded to the survey. Three types of institutional oral hygiene guidelines existed: nursing policy, order set, and information bulletin. Nursing policy provided the most detail about the oral hygiene care; however, adherence, awareness, and priority level were higher with order sets (P < .05). The content and method of disseminating these guidelines varied, and nursing practices were affected by these differences. Nurses assessed the oral cavity and used oral swabs more often when those practices were included in institutional guidelines. The content and dissemination method of institutional guidelines on oral hygiene do influence the oral hygiene practices of critical care nurses. Future studies examining how institutional guidelines could best be incorporated into routine workflow are needed. ©2015 American Association of Critical-Care Nurses.

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care.

PubMed

Harnagea, Hermina; Lamothe, Lise; Couturier, Yves; Esfandiari, Shahrokh; Voyer, René; Charbonneau, Anne; Emami, Elham

2018-02-15

Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training non-dental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector.

Oral hygiene and mouth care for older people in acute hospitals: part 1.

PubMed

Steel, Ben J

2017-10-31

The oral health of older people in acute hospitals has rarely been studied. Hospital admission provides a prime opportunity for identification and rectification of problems, and oral health promotion. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presents the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. Searches of electronic databases and the websites of relevant professional health service bodies in the UK were undertaken to identify articles and guidelines. The literature shows a high prevalence of oro-dental disease in this population, with many known detrimental effects, combined with suboptimal oral hygiene and mouth care provision in acute hospitals. Several guidelines exist, although the emphasis on oral health is weaker than other aspects of hospital care. Older adults admitted to acute hospitals have a high burden of oro-dental disease and oral and mouth care needs, but care provision tends to be suboptimal. The literature is growing, but this area is still relatively neglected. Great potential exists to develop oral and mouth care in this context. The second part of this article explores clinical recommendations. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Squamous cell carcinoma of dogs and cats: an ideal test system for human head and neck PDT protocols

NASA Astrophysics Data System (ADS)

Lucroy, Michael D.

2006-02-01

Photodynamic therapy (PDT) is ideally suited for the treatment of head and neck cancer (HNC) in humans. Developing useful PDT protocols for HNC is challenging due to the expense of Phase I and II clinical trials. Moreover, the often-poor predictive value of murine models means that photosensitizers may proceed far into development before problems are noted. Dogs and cats with spontaneous oral squamous cell carcinoma (SCC) share striking similarities with humans affected with oral SCC. These similarities include viral and environmental tobacco smoke as risk factors, location-dependent prognoses, and relative resistance to chemotherapy. The relatively large oral cancers encountered in veterinary patients allow for light and drug dosimetry that are directly applicable to humans. The irregular shape of oral SCC allows a rigorous evaluation of novel photodynamic therapy protocols under field conditions. Because spontaneous tumors in dogs and cats arise in an outbred animal population it is possible to observe an intact host response to PDT. The shorter lifespan of dogs and cats allows rapid accrual of endpoint data. External beam radiation therapy and chemotherapy are commonplace in veterinary medicine, making dogs and cats with spontaneous SCC a useful resource to study the interactions with PDT and other cancer treatment modalities. Our preliminary results demonstrate that PDT is well-tolerated by dogs with oral cancer, and a Phase II clinical trial of zinc-phthalocyanine-based photodynamic therapy is underway in dogs with oral SCC. The usefulness of 5-aminolevulinic acid methyl ester-based PDT is being investigated in cats with oral SCC.

Oral health and care in the intensive care unit: state of the science.

PubMed

Munro, Cindy L; Grap, Mary Jo

2004-01-01

Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia. The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults. Most research in oral care has been directed toward patients' comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported. Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.

Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

PubMed

Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

Wanting better: a qualitative study of low-income parents about their children's oral health.

PubMed

Lewis, Charlotte W; Linsenmayer, Kristi A; Williams, Alexis

2010-01-01

Using qualitative methods, the purpose of this study was to understand low-income parents' experiences and how these influenced their oral health-related behavior toward their children. Twenty-eight parents were recruited from 7 sites that serve low-income families. Interviews, which were audiotaped and transcribed, were comprised of mostly open-ended questions. Transcripts were analyzed for common themes. Parents' experiences influenced their oral health-related beliefs, intentions, and behaviors. Finding dentists who accept Medicaid was the greatest barrier to realizing intended preventive dental care. Physicians appeared to have relatively little impact on these families' oral health care, even though parents believed that oral health is part of overall health care. WIC (the Supplemental Nutrition Program for Women, Infants and Children) played an important role in facilitating oral health knowledge and access to dental care. Most low-income parents had received little attention to their own oral health, yet wanted better for their children. This motivated the high value placed on their children's preventive oral health. Parents faced challenges finding dental care for their children. Difficulty finding a regular source of dental care for low-income adults, however, was nearly universal. The authors identified strategies, which emerged from their interviews, to improve the oral health knowledge and dental care access for these low-income families.

Dental attendance among adult Finns after a major oral health care reform.

PubMed

Raittio, Eero; Kiiskinen, Urpo; Helminen, Sari; Aromaa, Arpo; Suominen, Anna Liisa

2014-12-01

Between 2001 and 2002, all age limits restricting the availability of subsidized private dental care and Public Dental Services (PDS) were abolished in Finland. In addition, the reform aimed to address income- and residence-related disparities in access to subsidized oral health care services. The aim of this study was to analyse how dental attendance and factors associated with it changed after the reform. We carried out three consecutive surveys on the use of oral health care services and perceived oral health. The surveys were conducted in 2001 (n = 2837), in 2004 (n = 2420) and in 2007 (n = 2296), and the study population comprised Finnish adults born in 1970 or earlier. Logistic regression analyses were used to examine factors associated with the use of the services. The percentage of respondents who attended dental care regularly or had used oral health care services over the past 12 months rose between 2001 and 2007. In particular, there was an increase in the proportion of subjects who used PDS. The average number of visits to a private dentist decreased between 2001 and 2007. In the regression analyses, the use of services was associated with older age, perceived lack of need for care, perceived toothache during the past 12 months, perceived good oral health, lower number of missing teeth and regular dental visiting habits. The use of private dental care services was associated with perceived good oral health and perceived lack of need for care, higher household income and older age in all three study years while the use of PDS was associated with younger age, perceived good oral health and perceived lack of need for care only in 2001. The use of oral health care services rose and age did not seem to be a barrier to the use of oral health care services after the reform, as was the aim of the reform. No change in the association of household income with the use of oral health care services was seen after the OHCR. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Understanding oral health beliefs and practices among Cantonese-speaking older Australians.

PubMed

Mariño, Rodrigo; Minichiello, Victor; Macentee, Michael I

2010-03-01

The present study was conducted to explore how older immigrants from Hong Kong or Southern China manage their oral health in Melbourne. We used six focus groups involving 50 Cantonese-speaking immigrants who were 55 years and over and living in Melbourne. Four major themes relevant to oral health care emerged from the discussion: (i) traditional Chinese health beliefs; (ii) traditional medicine and oral health; (iii) attitudes towards dentists; and (iv) access to oral health-care services. Language, communication and cost of dentistry were identified as major barriers to oral health care. Older Chinese immigrants in Melbourne have concerns about oral health care that are similar to other ethnic groups, they want more oral health-related support from government, and many of they return to China or Hong Kong for dental treatment.

Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO): study protocol for a randomized controlled trial.

PubMed

Kaasch, Achim J; Fätkenheuer, Gerd; Prinz-Langenohl, Reinhild; Paulus, Ursula; Hellmich, Martin; Weiß, Verena; Jung, Norma; Rieg, Siegbert; Kern, Winfried V; Seifert, Harald

2015-10-09

Current guidelines recommend that patients with Staphylococcus aureus bloodstream infection (SAB) are treated with long courses of intravenous antimicrobial therapy. This serves to avoid SAB-related complications such as relapses, local extension and distant metastatic foci. However, in certain clinical scenarios, the incidence of SAB-related complications is low. Patients with a low-risk for complications may thus benefit from an early switch to oral medication through earlier discharge and fewer complications of intravenous therapy. The major objective for the SABATO trial is to demonstrate that in patients with low-risk SAB a switch from intravenous to oral antimicrobial therapy (oral switch therapy, OST) is non-inferior to a conventional course of intravenous therapy (intravenous standard therapy, IST). The trial is designed as randomized, parallel-group, observer-blinded, clinical non-inferiority trial. The primary endpoint is the occurrence of a SAB-related complication (relapsing SAB, deep-seated infection, and attributable mortality) within 90 days. Secondary endpoints are the length of hospital stay; 14-day, 30-day, and 90-day mortality; and complications of intravenous therapy. Patients with SAB who have received 5 to 7 full days of adequate intravenous antimicrobial therapy are eligible. Main exclusion criteria are polymicrobial bloodstream infection, signs and symptoms of complicated SAB (deep-seated infection, hematogenous dissemination, septic shock, and prolonged bacteremia), the presence of a non-removable foreign body, and severe comorbidity. Patients will receive either OST or IST with a protocol-approved antimicrobial and are followed up for 90 days. Four hundred thirty patients will be randomized 1:1 in two study arms. Efficacy regarding incidence of SAB-related complications is tested sequentially with a non-inferiority margin of 10 and 5 percentage points. The SABATO trial assesses whether early oral switch therapy is safe and effective for patients with low-risk SAB. Regardless of the result, this pragmatic trial will strongly influence the standard of care in SAB. ClinicalTrials.gov NCT01792804 registered 13 February 2013; German Clinical trials register DRKS00004741 registered 4 October 2013, EudraCT 2013-000577-77 . First patient randomized on 20 December 2013.

Wound-healing outcomes using standardized assessment and care in clinical practice.

PubMed

Bolton, Laura; McNees, Patrick; van Rijswijk, Lia; de Leon, Jean; Lyder, Courtney; Kobza, Laura; Edman, Kelly; Scheurich, Anne; Shannon, Ron; Toth, Michelle

2004-01-01

Wound-healing outcomes applying standardized protocols have typically been measured within controlled clinical trials, not natural settings. Standardized protocols of wound care have been validated for clinical use, creating an opportunity to measure the resulting outcomes. Wound-healing outcomes were explored during clinical use of standardized validated protocols of care based on patient and wound assessments. This was a prospective multicenter study of wound-healing outcomes management in real-world clinical practice. Healing outcomes from March 26 to October 31, 2001, were recorded on patients in 3 long-term care facilities, 1 long-term acute care hospital, and 12 home care agencies for wounds selected by staff to receive care based on computer-generated validated wound care algorithms. After diagnosis, wound dimensions and status were assessed using a tool adapted from the Pressure Sore Status Toolfor use on all wounds. Wound, ostomy, and continence nursing professionals accessed consistent protocols of care, via telemedicine in home care or paper forms in long-term care. A physician entered assessments into a desktop computer in the wound clinic. Based on evidence that healing proceeds faster with fewer infections in environments without gauze, the protocols generally avoided gauze dressings. Most of the 767 wounds selected to receive the standardized-protocols of care were stage III-IV pressure ulcers (n = 373; mean healing time 62 days) or full-thickness venous ulcers (n = 124; mean healing time 57 days). Partial-thickness wounds healed faster than same-etiology full-thickness wounds. These results provide benchmarks for natural-setting healing outcomes and help to define and address wound care challenges. Outcomes primarily using nongauze protocols of care matched or surpassed best previously published results on similar wounds using gauze-based protocols of care, including protocols applying gauze impregnated with growth factors or other agents.

Oral Health Care Delivery Within the Accountable Care Organization.

PubMed

Blue, Christine; Riggs, Sheila

2016-06-01

The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

Does oral care contribute to brain activation?: One case of functional near-infrared spectroscopy study in patients with a persistent disturbance of consciousness

PubMed Central

Fujii, Wataru; Kanamori, Daisuke; Nagata, Chisato; Sakaguchi, Kiyomi; Watanabe, Risa

2014-01-01

Key Clinical Message We used functional near-infrared spectroscopy (fNIRS) to measure cerebral blood flow during oral care in a patient with persistent disturbance of consciousness. We experienced that cerebral blood flow to frontal area increased during oral care, suggesting that oral care may have a potential role in rehabilitation for the brain. PMID:25356272

Comparison of wiping and rinsing techniques after oral care procedures in critically ill patients during endotracheal intubation and after extubation: A prospective cross-over trial.

PubMed

Muramatsu, Keita; Matsuo, Koichiro; Kawai, Yusuke; Yamamoto, Tsukasa; Hara, Yoshitaka; Shimomura, Yasuyo; Yamashita, Chizuru; Nishida, Osamu

2018-06-26

Endotracheal intubation of critically ill patients increases the risk of aspiration pneumonia, which can be reduced by regular oral care. However, the rinsing of the residual oral contaminants after mechanical cleaning carries the risk of aspirating the residue during the intubation period. Removing the contaminants by wiping with mouth wipes could be an alternative to rinsing with water because of no additional fluid. This study tested: (i) the amount of oral bacteria during endotracheal intubation and after extubation; and (ii) the changes in the bacterial count during oral care procedures. Thirty-five mechanically ventilated patients in the intensive care unit were enrolled. The amount of bacteria on the dorsal tongue surface was counted before and following oral care and then after the elimination of contaminants either by rinsing with water and suctioning or by wiping with mouth wipes. The oral bacterial amount was compared statistically between the intubation and extubation status and among set time points during the oral care procedure. The oral bacterial count was significantly decreased after extubation. During the oral care procedure, the oral bacterial amount was significantly lower after eliminating the contaminants either by rinsing or wiping, with no remarkable difference between the elimination techniques. The findings suggest that the oral bacterial amount is elevated during endotracheal intubation, which could increase the risk of aspiration pneumonia. The significant reduction in the bacterial count by wiping indicates that it might be a suitable alternative to rinsing for mechanically ventilated patients. © 2018 Japan Academy of Nursing Science.

Development of a neuro early mobilisation protocol for use in a neuroscience intensive care unit.

PubMed

Brissie, Megan A; Zomorodi, Meg; Soares-Sardinha, Sharmila; Jordan, J Dedrick

2017-10-01

Through evaluation of the literature and working with a team of multidisciplinary healthcare providers, our objective was to refine an interprofessional Neuro Early Mobilisation Protocol for complex patients in the Neuroscience Intensive Care Unit. Using the literature as a guide, key stakeholders, from multiple professions, designed and refined a Neuro Early Mobilisation Protocol. This project took place at a large academic medical center in the southeast United States classified as both a Level I Trauma Center and Comprehensive Stroke Center. Goals for protocol development were to: (1) simplify the protocol to allow for ease of use, (2) make the protocol more generalizable to the patient population cared for in the Neuroscience Intensive Care Unit, (3) receive feedback from those using the original protocol on ways to improve the protocol and (4) ensure patients were properly screened for inclusion and exclusion in the protocol. Using expert feedback and the evidence, an evidence-based Neuro Early Mobilisation Protocol was created for use with all patients in the Neuroscience Intensive Care Unit. Future work will consist of protocol implementation and evaluation in order to increase patient mobilisation in the Neuroscience Intensive Care Unit. Copyright © 2017 Elsevier Ltd. All rights reserved.

Increasing Access to Oral Health Care for People Living with HIV/AIDS in the U.S.: Baseline Evaluation Results of the Innovations in Oral Health Care Initiative

PubMed Central

Fox, Jane E.; Tobias, Carol R.; Bachman, Sara S.; Reznik, David A.; Rajabiun, Serena; Verdecias, Niko

2012-01-01

Objectives We provide an overview of the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative, describe the models developed by the 15 demonstration sites and associated evaluation center, and present initial descriptive data about the characteristics of the multisite evaluation study sample. Methods Baseline data were collected from May 2007–August 2009 for 2,469 adults living with HIV/AIDS who had been without dental care, except for emergency care, for 12 months or longer. Variables included sociodemographic characteristics, HIV status, medical care, history of dental care and oral health symptoms, oral health practices, and physical and mental health quality of life. Descriptive statistics of baseline variables were calculated. Results The study sample included 2,469 adults who had been HIV-positive for a decade; most were engaged in HIV care. The majority (52.4%) of patients had not seen a dentist in more than two years; 48.2% reported an unmet oral health-care need since testing positive for HIV, and 63.2% rated the health of their teeth and gums as “fair” or “poor.” Conclusions This study is the largest to examine oral health care among people living with HIV/AIDS in more than a decade. The need for access to oral health care among members of this HIV-positive patient sample is greater than in the general population, following previous trends. Findings from our study reinforce the necessity for continued federal and statewide advocacy and support for oral health programs targeting people living with HIV/AIDS; findings can be extended to other vulnerable populations. PMID:22547872

Patient Perspectives on Improving Oral Health-Care Practices Among People Living with HIV/AIDS

PubMed Central

Rajabiun, Serena; Fox, Jane E.; McCluskey, Amanda; Guevara, Ernesto; Verdecias, Niko; Jeanty, Yves; DeMayo, Michael; Mofidi, Mahyar

2012-01-01

This qualitative study explored the impact on oral health-care knowledge, attitudes, and practices among 39 people living with HIV/AIDS (PLWHA) participating in a national initiative aimed at increasing access to oral health care. Personal values and childhood dental experiences, beliefs about the importance of oral health in relation to HIV health, and concerns for appearance and self-esteem were found to be determinants of oral health knowledge and practice. Program participation resulted in better hygiene practices, improved self-esteem and appearance, relief of pain, and better physical and emotional health. In-depth exploration of the causes for these changes revealed a desire to continue with dental care due to the dental staff and environmental setting, and a desire to maintain overall HIV health, including oral health. Our findings emphasize the importance of addressing both personal values and contextual factors in providing oral health-care services to PLWHA. PMID:22547879

Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis.

PubMed

Venn, Emilee C; Preisner, Karolina; Boscan, Pedro L; Twedt, David C; Sullivan, Lauren A

2017-01-01

To compare 2 treatment protocols (standard in-hospital versus modified outpatient) in affecting the duration of treatment or survival of dogs with parvoviral enteritis. Prospective, randomized study. University teaching hospital. Client-owned dogs with naturally acquired parvovirus were randomized to receive either an inpatient (n = 20) or outpatient (n = 20) treatment protocol. Both groups received intravenous (IV) fluid resuscitation and correction of hypoglycemia at hospital admission. Following stabilization, basic inpatient interventions included administration of IV fluids, administration of cefoxitin (22 mg/kg IV q 8 h), and maropitant (1 mg/kg IV q 24 h). Basic outpatient interventions (provided in-hospital) included administration of subcutaneous (SC) fluid (30 mL/kg q 6 h), administration of maropitant (1 mg/kg SC q 24 h) and cefovecin (8 mg/kg SC once). Using daily electrolyte and glucose evaluations, dextrose and potassium supplementation was provided intravenously (inpatients) or orally (outpatients) as indicated. Rescue criteria were used in both groups for analgesia and nausea. All dogs were syringe fed a commercial canine convalescence diet (1 mL/kg PO q 6 h) until voluntary appetite returned. Protocol success, defined as survival to hospital discharge, was 90% (18/20) for the inpatient group compared to 80% (16/20) for the outpatient group (P = 0.66). There was no difference detected in duration of hospitalization for inpatient dogs (4.6 ± 2 days) versus outpatient dogs (3.8 ± 1.8 days, P = 0.20). Metabolic disturbances were frequent in the outpatient group, with 50% of dogs requiring dextrose supplementation and 60% of dogs requiring potassium supplementation. An outpatient protocol may be a reasonable alternative for dogs that cannot receive standard in-hospital treatment for parvoviral enteritis. Diligent supportive care and monitoring are still required to optimize treatment of dogs with parvoviral enteritis in an outpatient setting. © Veterinary Emergency and Critical Care Society 2016.

Mobile microscopy as a screening tool for oral cancer in India: A pilot study.

PubMed

Skandarajah, Arunan; Sunny, Sumsum P; Gurpur, Praveen; Reber, Clay D; D'Ambrosio, Michael V; Raghavan, Nisheena; James, Bonney Lee; Ramanjinappa, Ravindra D; Suresh, Amritha; Kandasarma, Uma; Birur, Praveen; Kumar, Vinay V; Galmeanu, Honorius-Cezar; Itu, Alexandru Mihail; Modiga-Arsu, Mihai; Rausch, Saskia; Sramek, Maria; Kollegal, Manohar; Paladini, Gianluca; Kuriakose, Moni; Ladic, Lance; Koch, Felix; Fletcher, Daniel

2017-01-01

Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings.

Team approach concept in management of oro-facial clefts: a survey of Nigerian practitioners

PubMed Central

Akinmoladun, Victor I; Obimakinde, Obitade S

2009-01-01

Background Cleft palate craniofacial teams have evolved across the globe in the last 20 years in compliance with the interdisciplinary concept of management of oro-facial clefts. An interdisciplinary care allows a coordinated treatment protocol for the patient. The objective of this study was to evaluate oro-facial cleft care in Nigeria with particular emphasis on the compliance of the practitioners to the team approach concept. Methods A snapshot survey was conducted among specialists that attended the Pan African Congress on Cleft Lip and Palate, at the International Institute of Tropical Agriculture, Nigeria in February 2007. Result Sixty three respondents successfully completed and returned the questionnaire for analysis. Mean age of respondents was 43.5 years and the range was 38–62 years. Male to female ratio was 2.7:1. Oral and Maxillofacial Surgeons and Plastic Surgeons constituted the majority of respondents (38.1% and 22.2%) respectively. Only 47.6% (n = 30) of the specialists belonged to cleft teams. Majority of Oral and Maxillofacial Surgeons and Plastic Surgeons belonged to cleft teams (70% and 63.3% respectively) while speech pathologists and orthodontists were less represented (20% and 36.7% respectively) in teams. Conclusion Findings from this study suggests that interdisciplinary care for the cleft patient does not appear to have been fully embraced in Nigeria. This may be a result of several reasons ranging from non availability of the requisite specialists, the relatively young age of cleft care practice in this part of the world to the poor state of infrastructure. PMID:19426559

Barriers of delivering oral health care to older people experienced by dentists: a systematic literature review.

PubMed

Bots-VantSpijker, Pieternella C; Vanobbergen, Jacques N O; Schols, Jos M G A; Schaub, Rob M H; Bots, Casper P; de Baat, Cees

2014-04-01

To identify barriers of delivering oral health care to older people experienced by dentists. A comprehensive literature search was carried out for studies published in the period January 1990-December 2011, using free text and MESH term search strategies for PubMed (Medline), EMBASE and CINAHL. The initial search identified 236 potentially relevant publications: PubMed (Medline; n = 127), EMBASE (n = 108) and CINAHL (n = 1). After screening of titles and abstracts, 14 publications were revealed as relevant for further review. Seven articles, focusing on dentists delivering oral health care to older people in care homes, were suitable for this review, and seven articles did not meet the previously determined quality criteria. One of these articles also focused on barriers experienced by dentists working in their own practice and delivering oral health care to community-dwelling older people. The most common barriers of delivering oral health care to older people were identified respectively as: the lack of adequate equipment in a care home and no area for treatment available (n = 4) and the lack of adequate reimbursement for working in a care home (n = 5). In addition, the inadequate training and experience in delivering oral health care to older care home residents (n = 2) were mentioned. Four publications indicated the loss of time from private practice as a barrier to deliver oral health care in a care home. We suggest that additional research should be initiated to investigate more in detail the barriers dentists experience in delivering oral health care to older people in their own dental practices. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

An investigation into the variability of primary care oral surgery contracts and tariffs in England and Wales (2014/2015).

PubMed

Hierons, R J; Gerrard, G; Jones, R

2017-06-09

Primary care oral surgery services vary markedly throughout the country but until now there has been a paucity of data on these services. The British Association of Oral Surgeons (BAOS) primary care group (the authors) were tasked to gather data around primary care oral surgery contracts and tariffs and provide evidence-based recommendations on the commissioning of these services. Following a freedom of information (FOI) request, data were obtained for 27 English local area teams and seven Welsh local health boards. The data demonstrated both regional and national variability with respect to primary care oral surgery contracts, concerning both contract type and level of remuneration. These differences are discussed and the authors make recommendations for standardising oral surgery contracts and tariffs.

Immunocytochemistry associated with oral exfoliative cytology: methodological analysis..

PubMed

da Silva, Alessandra Dutra; Lima, Celina Faig; Maraschin, Bruna Jalfim; Laureano, Natália Koerich; Daroit, Natália Batista; Brochier, Fernanda; Sant'Ana Filho, Manoel; Visioli, Fernanda; Rados, Pantelis Varvaki

2015-04-01

To evaluate different immunocytochemical protocol variations to find the most effective protocol for the analysis of involucrin, epidermal growth factor receptor (EGFR), and E-cadherin antibodies. Exfoliative cytology is a noninvasive method used to monitor and screen for early changes in the oral mucosa of patients exposed to carcinogens such as tobacco and alcohol. It has been postulated that its association with immunocytochemistry may improve the effectiveness of the screening process. Four graduate students from Porto Alegre in southern Brazil had oral smears collected from the border of the tongue using a cytobrush. The following variables were analyzed: cell membrane permeability, antigen retrieval method (microwave oven or water bath), antibody incubation time (overnight or 1 hour), detection system used (Envision or LSAB), and chromogen incubation time (10 seconds or 5 minutes). Best results were obtained with the following combinations: (1) for involucrin: water bath, 1-hour incubation for primary antibody, Envision, and chromogen incubation for 10 seconds; (2)for EGFR: microwave, overnight incubation, LSAB, and chromogen incubation for 5 minutes; and (3) for E-cadherin: water bath, over-night incubation, Envision, and chromogen incubation for 5 minutes. Our findings suggest that each antibody requires a specific immunocytochemical protocol to guarantee optimal results with oral smears.

Overview of methods in economic analyses of behavioral interventions to promote oral health

PubMed Central

O’Connell, Joan M.; Griffin, Susan

2016-01-01

Background Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE. Objective To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health. Methods We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described. Discussion Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly. PMID:21656966

Overview of methods in economic analyses of behavioral interventions to promote oral health.

PubMed

O'Connell, Joan M; Griffin, Susan

2011-01-01

Broad adoption of interventions that prove effective in randomized clinical trials or comparative effectiveness research may depend to a great extent on their costs and cost-effectiveness (CE). Many studies of behavioral health interventions for oral health promotion and disease prevention lack robust economic assessments of costs and CE. To describe methodologies employed to assess intervention costs, potential savings, net costs, CE, and the financial sustainability of behavioral health interventions to promote oral health. We provide an overview of terminology and strategies for conducting economic evaluations of behavioral interventions to improve oral health based on the recommendations of the Panel of Cost-Effectiveness in Health and Medicine. To illustrate these approaches, we summarize methodologies and findings from a limited number of published studies. The strategies include methods for assessing intervention costs, potential savings, net costs, CE, and financial sustainability from various perspectives (e.g., health-care provider, health system, health payer, employer, society). Statistical methods for estimating short-term and long-term economic outcomes and for examining the sensitivity of economic outcomes to cost parameters are described. Through the use of established protocols for evaluating costs and savings, it is possible to assess and compare intervention costs, net costs, CE, and financial sustainability. The addition of economic outcomes to outcomes reflecting effectiveness, appropriateness, acceptability, and organizational sustainability strengthens evaluations of oral health interventions and increases the potential that those found to be successful in research settings will be disseminated more broadly.

Effectiveness of a Caregiver Education Program on Providing Oral Care to Individuals with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Fickert, Nancy A.; Ross, Diana

2012-01-01

Caregivers who work in community living arrangements or intermediate care facilities are responsible for the oral hygiene of individuals with intellectual and developmental disabilities. Oral hygiene training programs do not exist in many organizations, despite concerns about the oral care of this population. The purpose of this study was to…

Exploring the Efficacy of Behavioral Skills Training to Teach Basic Behavior Analytic Techniques to Oral Care Providers

ERIC Educational Resources Information Center

Graudins, Maija M.; Rehfeldt, Ruth Anne; DeMattei, Ronda; Baker, Jonathan C.; Scaglia, Fiorella

2012-01-01

Performing oral care procedures with children with autism who exhibit noncompliance can be challenging for oral care professionals. Previous research has elucidated a number of effective behavior analytic procedures for increasing compliance, but some procedures are likely to be too time consuming and expensive for community-based oral care…

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.

PubMed

Childers, Christopher P; Siletz, Anaar E; Singer, Emily S; Faltermeier, Claire; Hu, Q Lina; Ko, Clifford Y; Golladay, Gregory J; Kates, Stephen L; Wick, Elizabeth C; Maggard-Gibbons, Melinda

2018-01-01

Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/ Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.

The elderly as a market--challenges to evidence.

PubMed

Ellwood, Roger P

2014-02-01

To review the role of the oral care industry in the oral health of elders and opportunities for partnership with other key stakeholders. The elder population is growing at a faster rate than any other segment of the population. This is coupled with a greater probability of maintaining the dentition into later life and an increase in complex restorative work. If an elder's situation changes, they are highly vulnerable to a rapid onset of oral disease that can be devastating and extremely difficult to address. This manuscript reviews the role of the oral care industry in understanding this population as a market and the different approaches that might be used in promoting health. Two key market segments were identified, the vulnerable elders with high levels of chronic oral disease, systemic complications, medications and often inability to maintain good standards of oral hygiene and a wealthier, health and beauty conscious group with a keen interest in maintaining a healthy, aesthetically pleasing and functional dentition throughout their lives. It is likely that within current healthcare models, the oral care of elders will be unsustainable, with a smaller working population funding ever-increasing health care needs. 'Home care' combined with effective professional preventive and effective therapeutic options are essential. Partnerships between the oral care industry and oral care providers, to deliver education and engagement of care workers, medical practitioners, pharmacists and social services, are essential over the next few decades. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients.

PubMed

Arduino, P G; Lopetuso, E; Carcieri, P; Giacometti, S; Carbone, M; Tanteri, C; Broccoletti, R

2012-05-01

The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. Patients received oral hygiene instruction followed by non-surgical periodontal therapy including oral hygiene instructions in a 3-week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient-related outcomes (visual analogue score of pain). A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). Professional oral hygiene procedures and non-surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival-related pain, in female patients affected by MMP with specific gingival localization. © 2011 John Wiley & Sons A/S.

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society.

PubMed

Dort, Joseph C; Farwell, D Gregory; Findlay, Merran; Huber, Gerhard F; Kerr, Paul; Shea-Budgell, Melissa A; Simon, Christian; Uppington, Jeffrey; Zygun, David; Ljungqvist, Olle; Harris, Jeffrey

2017-03-01

Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

Administrative Challenges to the Integration of Oral Health With Primary Care

PubMed Central

Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal

2017-01-01

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce. PMID:27218701

A model for community-based pediatric oral heath: implementation of an infant oral care program.

PubMed

Ramos-Gomez, Francisco J

2014-01-01

The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0-5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC), and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance "in health" not in "disease modality". IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the "age-one visit". This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients.

PubMed

Duvan, Candan Iltemir; Berker, Bulent; Turhan, Nilgun Ozturk; Satiroglu, Hakan

2008-01-01

To compare oral contraceptive (OC) pretreatment plus microdose GnRH-a in flare-up protocol and non-OC microdose GnRH-a in flare-up protocol among poor responder ICSI patients. A retrospective analysis of poor responder ICSI patients. Patients were divided into two groups according to used microdose protocol. Precycle treatment with OC followed by follicular phase administration of 40 microg s.c. leuprolide acetate (LA) every 12 h beginning on after 2 day pill-free period and rFSH administration was begun on the third day of LA administration (OC-Group, n=26). Alternatively on day 2 after menses, patients were administered similar stimulation regime (non-OC Group, n=27). There were no significant differences between groups in the number of oocytes, peak estradiol levels, endometrial thickness, fertilization rates and embryo quality. Implantations and pregnancy rates per embryo transfer were similar. OC pretreatment plus microdose GnRHa in flare-up protocol does not offer advantages over non-OC microdose GnRHa in flare-up protocol among poor responder ICSI patients.

Developments in oral health policy in the Nordic countries since 1990.

PubMed

Widström, Eeva; Ekman, Agneta; Aandahl, Liljan S; Pedersen, Maria Malling; Agustsdottir, Helga; Eaton, Kenneth A

2005-01-01

There is a number of systems for the provision of oral health care, one of which is the Nordic model of centrally planned oral health care provision. This model has historically been firmly based on the concept of a welfare state in which there is universal entitlement to services and mutual responsibility and agreement to financing them. This study reports and analyses oral health care provision systems and developments in oral health policy in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) since 1990. Descriptions of and data on the oral health care provision systems in the Nordic countries were obtained from the Chief Dental Officers of the five countries, and contemporary scientific literature was appraised using cross-case analyses to identify generalisable features. It was found that in many respects the system in Iceland did not follow the 'Nordic' pattern. In the other four countries, tax-financed public dental services employing salaried dentists were complemented by publicly subsidised private services. Additional, totally private services were also available to a variable extent. Recently, the availabilty of publicly subsidised oral health care has been extended to cover wider groups of the total population in Finland and Sweden and, to a smaller extent, in Denmark. Concepts from market-driven care models have been introduced. In all five countries, relative to the national populations and other parts of the world, there were high numbers of dentists, dental hygienists and technicians. Access to oral health care services was good and utilisation rates generally high. In spite of anticipated problems with increasing health care costs, more public funds have recently been invested in oral health care in three of the five countries. The essential principles of the Nordic model for the delivery of community services, including oral health care, i.e. universal availability, high quality, finance through taxation and public provision, were still adhered to in spite of attempts at privatisation during the 1990 s. It appeared that, in general, the populations of the Nordic countries still believed that there was a need for health and oral health care to be paid for from public funds.

Oral Health Care Receipt and Self-Rated Oral Health for Diverse Asian American Subgroups in New York City

PubMed Central

Jung, Molly; Kwon, Simona C.; Edens, Neile; Northridge, Mary E.; Trinh-Shevrin, Chau

2017-01-01

Objectives. To identify determinants of receipt of annual oral health examinations and self-rated oral health among diverse Asian American subgroups. Methods. We used data from the Community Health Resources and Needs Assessment, a community-based survey of Asian American immigrant adults conducted in the New York City metropolitan region from 2013 to 2016 (n = 1288). We used multivariable logistic regression models to assess determinants of oral health care receipt and self-rated oral health. Results. Failure to receive an annual oral health examination was common in this sample (41.5%) and was more frequent for participants who were younger and male and those who had poorer English fluency and lower educational attainment. Not having dental insurance versus having private dental insurance resulted in 2 to 3 times the odds of nonreceipt of oral health care and poor self-rated oral health. Conclusions. Nonreceipt of annual oral health examinations and poor self-rated oral health were common across Asian American subgroups. Facilitating dental insurance sign-up and providing in-language services may improve oral health care access and ultimately oral health among Asian American immigrants. PMID:28661810

Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project.

PubMed

McNally, Mary; Martin-Misener, Ruth; McNeil, Karen; Brillant, Martha; Moorhouse, Paige; Crowell, Sandra; Matthews, Debora; Clovis, Joanne

2015-03-01

Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a "champion" was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Appraisal of the sensitising potential of orally and dermally administered mercaptobenzothiazole by a biphasic protocol of the local lymph node assay.

PubMed

Ahuja, Varun; Wanner, Reinhard; Platzek, Thomas; Stahlmann, Ralf

2009-10-01

Mercaptobenzothiazole (MBT) is used while manufacturing natural rubber products. Our study deals with assessing its allergenic potential following dermal and oral routes of exposure, using a biphasic local lymph node assay (LLNA). Female Balb/c mice were treated with MBT (dermally 3, 10, 30% concentrations in DMSO; orally 1, 10, 100 mg/kg doses in corn oil) on the back (dermal study) or through oral administration (oral study) on days 1-3 followed by auricular application of 3, 10 and 30% concentrations, respectively, on days 15-17. End points determined on day 19 included ear thickness, ear punch weight, lymph node weight, lymph node cell count, and lymphocyte subpopulations (CD4+, CD8+, CD45+). After dermal application of 3% or 10% solution, a significant increase in cell count and lymph node weight along with significant decrease in CD8+ cells was observed. After initial oral administration of 1 mg/kg, we noticed a significant amplification in cell count. Following oral administration of 10 mg/kg, we observed a similar increase in cell count and lymph node weight. The results of our study show that the modified biphasic LLNA protocol can be used to study the sensitising potential of a compound also following the oral route of exposure.

Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence.

PubMed

Carvalho, Caroline Gomes; Medeiros-Filho, João Batista; Ferreira, Meire Coelho

2018-02-22

Oncological treatment can cause changes in the oral cavity compromising oral functions. The aim of the study was, based on a systematic review, to draft a guide directed at the team of health professionals involved in the oral care of oncological patients. A systematic search of the literature was performed for articles published between 2000 and April 2017. Searches were made of electronic databases and hand search. The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and RCTs published in English, involving pediatric and adult oncological patients and focused on the prevention and treatment of oral complications as well as studies addressing the maintenance of oral health. Among the 1237 studies identified, 129 were pre-selected and 54 were selected to form the basis for the clinical guide. The studies analyzed stress the need for oral assessments as well as preventive and curative actions prior to oncological treatment. To minimize the severity of oral problems, the studies emphasize daily oral care, the treatment of xerostomia with saliva substitute and hydration, and low-level laser therapy, nystatin, acyclovir, respectively, for the prevention and treatment of oral mucositis, oral candidiasis, and infection by herpes simplex virus. Thus, the guide produced addresses oral assessments and professional and home care before, during, and after oncological treatment. The guide drafted has the function of assisting health professionals involved in the oral care of patients with cancer, enabling the prevention or treatment of oral complications stemming from oncological treatment.

Southern Nevada assisted living residents' perception of their oral health status and access to dental care.

PubMed

Dounis, Georgia; Ditmyer, Marcia M; McCants, Robert; Lee, Yoonah; Mobley, Connie

2012-06-01

Oral health is an integral component of general health, and quality of life. The purpose of this study was to determine the perceptions of oral health status and acces\\s to dental care by Southern Nevada Assisted Living Facilities Residents. A cross-sectional questionnaire study design was used to survey residents between 34 and 99 years old residing in Assisted Living Facilities. Seventy respondents (42 males and 28 females) completed a survey that included personal oral hygiene, access to care, and demographic information. Data analyses included descriptive statistics and chi-square. Mean age was 75.78 years, and the majority had a college education (n = 41). Four currently smoked cigarettes. Twenty-nine (males = 14; females = 15) reported having dental insurance. Eleven respondents had seen a dentist twice a year, while 33 reported a visit less than 6 months. Forty-one reported the facility did not provide oral health care with majority (n = 64) indicating that accessing oral health care was difficult. Self-rated response to oral hygiene, a majority (n = 64) reported their oral hygiene as fair and five reported their oral hygiene as poor. Assisted living residents in Southern Nevada reported difficulty accessing dental services within and outside of the facility. Oral care models to address this unique population should be explored. © 2010 The Gerodontology Society and John Wiley & Sons A/S.

An exploratory qualitative study of Otago adolescents' views of oral health and oral health care.

PubMed

Fitzgerald, Ruth P; Thomson, W Murray; Schafer, Cyril T; Loose, Moragh A T H

2004-09-01

To investigate Otago adolescents' views of oral health and oral health care, in order to increase understanding of the influences on their use or non-use of free care. The study employed a qualitative approach, using focus groups and grounded theory analysis. Participants ranged in age from 13 to 18, and included both genders and a variety of educational attainments, ethnicities and family incomes. Focus groups were conducted in schools, training centres, a place of employment, a CYF (Child, Youth and Family) Home, and a University Hall of Residence. While aware of the normative pressure to attend for free dental care and engage in oral health care, Otago adolescents consider doing so to be "just so gay". They exhibit strongly held preconceptions about the expense of dentistry and the respective competence of dentists and dental therapists. The dental surgery environment was viewed as a major disincentive. Adolescent oral health beliefs centred on two models: the medicalised, pragmatic view of oral health (which valued the function of teeth); and the cosmetic view of oral health (which valued the aesthetics of teeth); or a combination of these two models. In both models, media advertising for oral health care products was a significant source of oral health information. The preferred oral health behaviour associated with the medicalised model was frequent use of chewing gum and rapid toothbrushing, and, for the cosmetic model frequent use of chewing gum and breath fresheners. These findings support the international literature on the use/non-use of dental services even when the financial barriers to seeking such services has been removed. New Zealand dental care has developed without reference to the changing norms of youth culture, and the conventional dental practice setting is not viewed by adolescents as being inviting or appropriate. Increasing the uptake of free oral health care by that group will require some innovative approaches.

Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253.

PubMed

Shiboski, C H; Chen, H; Ghannoum, M A; Komarow, L; Evans, S; Mukherjee, P K; Isham, N; Katzenstein, D; Asmelash, A; Omozoarhe, A E; Gengiah, S; Allen, R; Tripathy, S; Swindells, S

2014-06-01

To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding. Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values. Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/mm(3). Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2-4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22-48) and the specificity 85% (95%CI 81-88). We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding.

Icing oral mucositis: Oral cryotherapy in multiple myeloma patients undergoing autologous hematopoietic stem cell transplant.

PubMed

Chen, Joey; Seabrook, Jamie; Fulford, Adrienne; Rajakumar, Irina

2017-03-01

Background Up to 70% of patients receiving hematopoietic stem cell transplant develop oral mucositis as a side effect of high-dose melphalan conditioning chemotherapy. Oral cryotherapy has been documented to be potentially effective in reducing oral mucositis. The aim of this study was to examine the effectiveness of the cryotherapy protocol implemented within the hematopoietic stem cell transplant program. Methods A retrospective chart review was conducted of adult multiple myeloma patients who received high-dose melphalan conditioning therapy for autologous hematopoietic stem cell transplant. Primary endpoints were incidence and severity of oral mucositis. Secondary endpoints included duration of oral mucositis, duration of hospital stay, parenteral narcotics use and total parenteral nutrition use. Results One hundred and forty patients were included in the study, 70 patients in both no cryotherapy and cryotherapy groups. Both oral mucositis incidence and severity were found to be significantly lower in the cryotherapy group. Fifty (71.4%) experienced mucositis post cryotherapy compared to 67 (95.7%) in the no cryotherapy group (p < 0.001). The median oral mucositis severity, assessed using the WHO oral toxicity scale from grade 0-4, experienced in the no group was 2.5 vs. 2 in the cryotherapy group (p = 0.03). Oral mucositis duration and use of parenteral narcotics were also significantly reduced. Duration of hospital stay and use of parenteral nutrition were similar between the two groups. Conclusion The cryotherapy protocol resulted in a significantly lower incidence and severity of oral mucositis. These results provide evidence for the continued use of oral cryotherapy, an inexpensive and generally well-tolerated practice.

Why do we need an oral health care policy in Canada?

PubMed

Leake, James L

2006-05-01

Although health care is a right of citizenship, severe inequities in oral health and access to care persist. This paper provides information on the financing, organization and delivery of oral health services in Canada. It concludes that dental care has largely fallen out of consideration as health care. The increasing costs of dental insurance and disparities in oral health and access to care threaten the system"s sustainability. The legislation that allows the insured to receive tax-free care and requires all taxpayers to subsidize that expenditure is socially unjust. Unless an alternative direction is taken, dentistry will lose its relevance as a profession working for the public good and this will be followed by further erosion of public support for dental education and research. However, never before have we had the opportunity presented by high levels of oral health, the extensive resources already allocated to oral health care, plus the support of other organizations to allow us to consider what else we might do. One of the first steps would be to establish new models for the delivery of preventive measures and care that reach out to those who do not now enjoy access.

A pilot study: dose adaptation of capecitabine using mobile phone toxicity monitoring - supporting patients in their homes.

PubMed

Weaver, Andrew; Love, Sharon B; Larsen, Mark; Shanyinde, Milensu; Waters, Rachel; Grainger, Lisa; Shearwood, Vanessa; Brooks, Claire; Gibson, Oliver; Young, Annie M; Tarassenko, Lionel

2014-10-01

Real-time symptom monitoring using a mobile phone is potentially advantageous for patients receiving oral chemotherapy. We therefore conducted a pilot study of patient dose adaptation using mobile phone monitoring of specific symptoms to investigate relative dose intensity of capecitabine, level of toxicity and perceived supportive care. Patients with breast or colorectal cancer receiving capecitabine completed a symptom, temperature and dose diary twice a day using a mobile phone application. This information was encrypted and automatically transmitted in real time to a secure server, with moderate levels of toxicity automatically prompting self-care symptom management messages on the screen of the patient's mobile phone or in severe cases, a call from a specialist nurse to advise on care according to an agreed protocol. Patients (n = 26) completed the mobile phone diary on 92.6 % of occasions. Twelve patients had a maximum toxicity grade of 3 (46.2 %). The average dose intensity for all patients as a percentage of standard dose was 90 %. In eight patients, the dose of capecitabine was reduced, and in eight patients, the dose of capecitabine was increased. Patients and healthcare professionals involved felt reassured by the novel monitoring system, in particular, during out of hours. It is possible to optimise the individual dose of oral chemotherapy safely including dose increase and to manage chemotherapy side effects effectively using real-time mobile phone monitoring of toxicity parameters entered by the patient.

Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners.

PubMed

Clark, Carol A; Kent, Kathleen A; Jackson, Richard D

2016-01-01

Oral health is essential to overall health at any age, although in children it is particularly important because poor oral health can have a deleterious effect on deciduous and permanent dentition. For decades, oral health providers have urged primary care providers to incorporate oral health assessment, risk factor identification, parent education, and preventive therapy into routine well-child visits. Despite recommendations from various professional associations and governmental organizations, the incidence of dental disease in young children remains relatively unchanged. Although the literature has clearly demonstrated that preventive care treatments, such as the application of fluoride varnish performed in the primary care setting, improve oral health in children, very few primary care providers include oral health services in their well-child visits. The purpose of this article is to reduce the barriers and knowledge gaps identified in recent pediatric oral health research and educate primary care nurse practitioners on the application of fluoride varnish to reduce the risk of the development of dental caries in young children. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Integrated nutritional intervention in the elderly after hip fracture. A process evaluation.

PubMed

Breedveld-Peters, José J L; Reijven, Petronella L M; Wyers, Caroline E; van Helden, Svenhjalmar; Arts, J J Chris; Meesters, Berry; Prins, Martin H; van der Weijden, Trudy; Dagnelie, Pieter C

2012-04-01

Within a multicentre randomized controlled trial aimed at improving the nutritional status and increase the speed of recovery of elderly hip fracture patients, we performed a process evaluation to investigate the feasibility of the intervention within the present Dutch health care system. Patients in the intervention group received nutritional counseling during 10 contacts. Oral nutritional supplements were advised as needed until three months after hip fracture surgery. The intervention was evaluated with respect to dieticians' adherence to the study protocol, content of nutritional counseling, and patients' adherence to recommendations given. We included 66 patients (mean age of 76, range 55-92 years); 74% women. Eighty-three percent of patients received all 10 contacts as planned, but in 62% of the patients one or more telephone calls had to be replaced by face to face contacts. Nutritional counseling was complete in 91% of contacts. Oral nutritional supplementation was needed for a median period of 76 days; 75% of the patients took the oral nutritional supplements as recommended. Nutritional counseling in elderly hip fracture patients through face to face contacts and telephone calls is feasible. However, individual tailoring of the intervention is recommended. The majority of hip fracture patients needed >2 months oral nutritional supplements to meet their nutritional requirements. The trial was registered at clincialtrails.gov as NCT00523575. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Oral health assessment and mouth care for children and young people receiving palliative care. Part one.

PubMed

Sargeant, Stephanie; Chamley, Carol

2013-03-01

This is the first part of two articles exploring oral health problems and treatments for children receiving palliative care, successful management of which can improve considerably the quality of life for this group of children and young people. Part one includes an adapted oral health assessment tool for use in children and young people with complex and palliative healthcare needs that has the potential to help nurses identify and monitor oral health problems and prevent or minimise oral problems from developing. Part two--to be published next month--focuses on basic oral hygiene and the management of specific oral health problems.

Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review.

PubMed

Poudel, Prakash; Griffiths, Rhonda; Wong, Vincent W; Arora, Amit; Flack, Jeff R; Khoo, Chee L; George, Ajesh

2018-05-02

People with uncontrolled diabetes are at greater risk for several oral health problems, particularly periodontal (gum) disease. Periodontal disease also impacts diabetes control. Good oral hygiene and regular dental visits are recommended to prevent and manage oral health problems. Several studies have been conducted to assess the oral health knowledge, attitudes, and practices of people with diabetes yet a review of these findings has not yet been undertaken. The aim of this systematic review was to synthesize current evidence on the knowledge, attitudes and practices of people with diabetes in relation to their oral health care. A systematic search of all literature was carried out in five databases using key search terms. The inclusion criteria were: 1) published in the English language; 2) from 2000 to November, 2017; 3) conducted on persons with any type of diabetes and of all ages; 4) explored at least one study outcome (knowledge or attitude or practices toward oral health care); and 5) used quantitative methods of data collection. No restrictions were placed on the quality and setting of the study. A total of 28 studies met the inclusion criteria. The studies included a total of 27,894 people with diabetes and were conducted in 14 countries. The review found that people with diabetes have inadequate oral health knowledge, poor oral health attitudes, and fewer dental visits. They rarely receive oral health education and dental referrals from their care providers. Provision of oral health education by diabetes care providers and referral to dentists when required, was associated with improved oral health behaviours among patients. Overall, people with diabetes have limited oral health knowledge and poor oral health behaviours. It is therefore essential to educate patients about their increased risk for oral health problems, motivate them for good oral health behaviours and facilitate access to dental care.

Assessment of oral storytelling abilities of Latino junior high school students with learning handicaps.

PubMed

Goldstein, B C; Harris, K C; Klein, M D

1993-02-01

This study investigated the relationship between reading comprehension and oral storytelling abilities. Thirty-one Latino junior high school students with learning handicaps were selected as subjects based on learning handicapped designation, home language, and language proficiency status. Reading comprehension was measured by the Reading Comprehension subtest of the Peabody Individual Achievement Test. Storytelling was measured by (a) the Oral Production subtest of the Language Assessment Scales using the standard scoring protocol and (b) a story structure analysis. A comparison of the standard scoring protocol and reading comprehension revealed no relationship, while the comparison of the story structure analysis and reading comprehension revealed a significant correlation. The implications of these results for language assessment of bilingual students are discussed.

Dental and Oral Problem Patterns and Treatment Seeking Behavior of Geriatric Population

PubMed Central

AlZarea, Bader K.

2017-01-01

Background: The manifestations of oral changes and disorders affecting the geriatric population are different from the rest of the population. Inaccessibility to dental care is a compelling impediment to avail oral health services. Objective: The aims were to assess the dental and oral problems and to find out the determinants of oral health seeking behaviour among elderly population of Al-Jouf province, Saudi Arabia. Methods: The present cross sectional study included geriatric patients of 60 years and above, who visited the College of Dentistry, Al-Jouf University. A simple pre-structured questionnaire was filled by the patients, which comprised of demographic details and the different oral complaints of elderly and the type of health care utilized for those complaints. Results: Out of total 892 elderly persons included, 51.79% were males and 48.21 were females. The most common oral problem was missing tooth (78.69%) followed by gum problems (74.21%). 39.5% males and 28.0% females visited general dental practitioners for oral health care. Majority of the participants (32.8%) suggested accessibility as a basic factor in determining the health care source. The difference in the distribution of male and females or association between the type of care and gender and distribution for choosing a health care source was found to be statistically significant (p < 0.05). Conclusion: Inaccessibility to dental care emerged as an important barrier to avail oral health services. Adequate access to medical and dental care can reduce premature morbidity and mortality, preserve function, and enhance overall quality of life. PMID:28553412

Oral hygiene and mouth care for older people in acute hospitals: part 2.

PubMed

Steel, Ben J

2017-11-30

Acute hospital admission provides an excellent opportunity to address poor oral health in older people, a group rarely seen by dental professionals and for who oral health activity in hospital is inconsistent and generally suboptimal. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presented the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. The second article explores clinical recommendations. A change in philosophy is needed to embed oral care as an essential component of holistic practice. More research is needed to determine the best ways to assess and treat oro-dental problems in older people, and promote and restore their oral health in hospitals. Great potential exists to innovate and develop new ways of providing care to this group. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Improving residents' oral health through staff education in nursing homes.

PubMed

Le, Phu; Dempster, Laura; Limeback, Hardy; Locker, David

2012-01-01

This study assessed the efficacy of oral care education among nursing home staff members to improve the oral health of residents. Nursing home support staff members (NHSSMs) in the study group received oral care education at baseline between a pretest and posttest. NHSSMs' oral care knowledge was measured using a 20-item knowledge test at baseline, posteducation, and at a 6-month follow-up. Residents' oral health was assessed at baseline and again at a 6-month follow-up using the Modified Plaque Index (PI) and Modified Gingival Index (GI). Among staff members who received the oral care education (n = 32), posttest knowledge statistically significantly increased from the pretest level (p < .05). Thirty-nine control residents of the nursing homes and 41 study residents participated. Among residents in the study group, PI decreased at 6 months compared to baseline (p < .05), but there was no statistically significant difference in their GI measurements between baseline and 6-month follow-up (p= .07). © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Oral health and dental care during pregnancy.

PubMed

Steinberg, Barbara J; Hilton, Irene V; Iida, Hiroko; Iada, Hiroko; Samelson, Renee

2013-04-01

Current research shows that women tend to receive less dental care than usual when they are pregnant. In 2012, the first national consensus statement on oral health care during pregnancy was issued, emphasizing both the importance and safety of routine dental care for pregnant women. This article reviews the current recommendations for perinatal oral health care and common oral manifestations during pregnancy. Periodontal disease and its association with preterm birth and low birth weight are also discussed, as is the role played by dental intervention in these adverse outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

Primary health care approach. Its relevance to oral health in Nigeria.

PubMed

Ndiokwelu, E

2002-09-01

This article discusses the concept of Primary Health Care--an idea which started with the World Health Assembly agreement in 1977 to work resolutely towards the goal of Health for All. This decision was followed by the historic international conference on Primary Health Care at Alma Ata in 1978. Many countries including Nigeria, adopted the primary health care strategy to achieve health for all by the year 2000 (now 2000 and beyond). Since health needs to be seen and dealt with in a holistic manner, oral health is an integral part of health. Strategies for achieving health for all implicitly and must of necessity involve oral health. This article has tried to show the relevance of the strategy of primary health care to oral health. It concludes that primary health care approach is very relevant to oral health in Nigeria.

Writing Interview Protocols and Conducting Interviews: Tips for Students New to the Field of Qualitative Research

ERIC Educational Resources Information Center

Jacob, Stacy A.; Furgerson, S. Paige

2012-01-01

Students new to doing qualitative research in the ethnographic and oral traditions, often have difficulty creating successful interview protocols. This article offers practical suggestions for students new to qualitative research for both writing interview protocol that elicit useful data and for conducting the interview. This piece was originally…

"Everybody brush!": protocol for a parallel-group randomized controlled trial of a family-focused primary prevention program with distribution of oral hygiene products and education to increase frequency of toothbrushing.

PubMed

Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R Michael; Huebner, Colleen E; Ludwig, Sharity; Allen, Gary; Scott, JoAnna

2015-05-22

Twice daily toothbrushing with fluoridated toothpaste is the most widely advocated preventive strategy for dental caries (tooth decay) and is recommended by professional dental associations. Not all parents, children, or adolescents follow this recommendation. This protocol describes the methods for the implementation and evaluation of a quality improvement health promotion program. The objective of the study is to show a theory-informed, evidence-based program to improve twice daily toothbrushing and oral health-related quality of life that may reduce dental caries, dental treatment need, and costs. The design is a parallel-group, pragmatic randomized controlled trial. Families of Medicaid-insured children and adolescents within a large dental care organization in central Oregon will participate in the trial (n=21,743). Families will be assigned to one of three groups: a test intervention, an active control, or a passive control condition. The intervention aims to address barriers and support for twice-daily toothbrushing. Families in the test condition will receive toothpaste and toothbrushes by mail for all family members every three months. In addition, they will receive education and social support to encourage toothbrushing via postcards, recorded telephone messages, and an optional participant-initiated telephone helpline. Families in the active control condition will receive the kit of supplies by mail, but no additional instructional information or telephone support. Families assigned to the passive control will be on a waiting list. The primary outcomes are restorative dental care received and, only for children younger than 36 months old at baseline, the frequency of twice-daily toothbrushing. Data will be collected through dental claims records and, for children younger than 36 months old at baseline, parent interviews and clinical exams. Enrollment of participants and baseline interviews have been completed. Final results are expected in early summer, 2017. If proven effective, this simple intervention can be sustained by the dental care organization and replicated by other organizations and government. ClinicalTrials.gov NCT02327507; http://clinicaltrials.gov/ct2/show/NCT02327507 (Archived by WebCite at http://www.webcitation.org/6YCIxJSor).

Provider Compliance And Competence With Oral Cancer Screenings In The U.S. Army

DTIC Science & Technology

2016-05-01

irritation, poor dental hygiene, and marijuana use have been implicated in oral cancer development. Currently these causations remain unproven (9...assumed that, since oral cancer screening protocols were not required to be taught in dental school prior to 2010, 35 some providers would benefit ...felt that it would not, or had no opinion. It appears that Army providers and patients may benefit from increased oral cancer screening training. Of

Contemporary management of cleft lip and palate in the United Kingdom. Have we reached the turning point?

PubMed

Colbert, S D; Green, Ben; Brennan, P A; Mercer, N

2015-09-01

Babies born with clefts of the lip, and the alveolus or palate, or both, require multidisciplinary, highly specialised treatment from birth to early adulthood. We review the contemporary management of clefts and outline the current treatment protocol adopted by cleft networks in the United Kingdom. We also look at the level of evidence and the restructuring of services that has defined current practice. In light of the recent Cleft Care UK study, we ask whether it is now time to adopt a new philosophy towards the surgical techniques that are used. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Access to special care dentistry, part 7. Special care dentistry services: seamless care for people in their middle years--part 1.

PubMed

Lewis, D; Fiske, J; Dougall, A

2008-09-27

Children and older people have been relatively well served by specialist dental care. Despite increasing disability amongst people in their middle years, there have been no or few dedicated dental teams with responsibility for provision of their oral care. This article explores the ethos and practicality of seamless care across the age groups and the primary/secondary care interface, with a focus on embedding oral health into general healthcare plans through the multidisciplinary team approach. The article explores four conditions--rheumatoid arthritis, Huntingdon's disease, multiple sclerosis and diabetes. It considers the features of each condition and how they can impact on both oral health and the delivery of dental services. It also considers the elements of care that contribute to a holistic and seamless approach to oral care services.

A randomized trial of protocol-based care for early septic shock.

PubMed

Yealy, Donald M; Kellum, John A; Huang, David T; Barnato, Amber E; Weissfeld, Lisa A; Pike, Francis; Terndrup, Thomas; Wang, Henry E; Hou, Peter C; LoVecchio, Frank; Filbin, Michael R; Shapiro, Nathan I; Angus, Derek C

2014-05-01

In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary. In 31 emergency departments in the United States, we randomly assigned patients with septic shock to one of three groups for 6 hours of resuscitation: protocol-based EGDT; protocol-based standard therapy that did not require the placement of a central venous catheter, administration of inotropes, or blood transfusions; or usual care. The primary end point was 60-day in-hospital mortality. We tested sequentially whether protocol-based care (EGDT and standard-therapy groups combined) was superior to usual care and whether protocol-based EGDT was superior to protocol-based standard therapy. Secondary outcomes included longer-term mortality and the need for organ support. We enrolled 1341 patients, of whom 439 were randomly assigned to protocol-based EGDT, 446 to protocol-based standard therapy, and 456 to usual care. Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids, vasopressors, inotropes, and blood transfusions. By 60 days, there were 92 deaths in the protocol-based EGDT group (21.0%), 81 in the protocol-based standard-therapy group (18.2%), and 86 in the usual-care group (18.9%) (relative risk with protocol-based therapy vs. usual care, 1.04; 95% confidence interval [CI], 0.82 to 1.31; P=0.83; relative risk with protocol-based EGDT vs. protocol-based standard therapy, 1.15; 95% CI, 0.88 to 1.51; P=0.31). There were no significant differences in 90-day mortality, 1-year mortality, or the need for organ support. In a multicenter trial conducted in the tertiary care setting, protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes. (Funded by the National Institute of General Medical Sciences; ProCESS ClinicalTrials.gov number, NCT00510835.).

Infection control in healthcare settings: perspectives for mfDNA analysis in monitoring sanitation procedures.

PubMed

Valeriani, Federica; Protano, Carmela; Gianfranceschi, Gianluca; Cozza, Paola; Campanella, Vincenzo; Liguori, Giorgio; Vitali, Matteo; Divizia, Maurizio; Romano Spica, Vincenzo

2016-08-09

Appropriate sanitation procedures and monitoring of their actual efficacy represent critical points for improving hygiene and reducing the risk of healthcare-associated infections. Presently, surveillance is based on traditional protocols and classical microbiology. Innovation in monitoring is required not only to enhance safety or speed up controls but also to prevent cross infections due to novel or uncultivable pathogens. In order to improve surveillance monitoring, we propose that biological fluid microflora (mf) on reprocessed devices is a potential indicator of sanitation failure, when tested by an mfDNA-based approach. The survey focused on oral microflora traces in dental care settings. Experimental tests (n = 48) and an "in field" trial (n = 83) were performed on dental instruments. Conventional microbiology and amplification of bacterial genes by multiple real-time PCR were applied to detect traces of salivary microflora. Six different sanitation protocols were considered. A monitoring protocol was developed and performance of the mfDNA assay was evaluated by sensitivity and specificity. Contaminated samples resulted positive for saliva traces by the proposed approach (CT < 35). In accordance with guidelines, only fully sanitized samples were considered negative (100 %). Culture-based tests confirmed disinfectant efficacy, but failed in detecting incomplete sanitation. The method provided sensitivity and specificity over 95 %. The principle of detecting biological fluids by mfDNA analysis seems promising for monitoring the effectiveness of instrument reprocessing. The molecular approach is simple, fast and can provide a valid support for surveillance in dental care or other hospital settings.

[Effects of special mouth care with an aroma solution on oral status and oral cavity microorganism growth in elderly stroke patients].

PubMed

Lee, Eun-Hye; Park, Hyojung

2015-02-01

This study was conducted to examine the effect of oral care with an aroma solution on oral status and oral cavity microorganism growth in elderly patients with stroke. A non-equivalent control group, with a pretest-posttest design was used in this study. The participants were assigned to the experimental group (n=30) that received oral care with an aroma solution or the control group (n=31) that received 0.9% saline solution. To identify the effect of the experimental treatments, objective/subjective assessments of oral status and oral cavity microorganism growth were performed using the oral assessment guide, oral perception guide, and oral swab culture. Data were analyzed using Chi-square test, Fisher's exact test, and t-test with the SPSS version 21.0 program. The objective oral status was significantly lower in the experimental group than in the control group (t= -3.64, p<.001). There was no significant difference between the subjective oral status of the experimental group and control groups (t= -1.24, p=.109). Oral microorganism growth was significantly lower in the experimental group than in the control group (t= -7.39, p<.001). These findings indicate that special mouth care using an aroma solution could be an effective oral health nursing intervention for elderly patients with stroke.

Preventive oral health intervention among old home care clients.

PubMed

Nihtilä, Annamari; Tuuliainen, Eveliina; Komulainen, Kaija; Autonen-Honkonen, Kirsi; Nykänen, Irma; Hartikainen, Sirpa; Ahonen, Riitta; Tiihonen, Miia; Suominen, Anna Liisa

2017-09-01

poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene. to investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over. the intervention group comprised 151 patients (84.4 ± 5.6 years) and the control group 118 patients (84.7 ± 5.2 years). An interview and a clinical examination were carried out before a tailored intervention of oral and denture hygiene. The participants in both groups were re-interviewed and re-examined after 6 months. the intervention significantly reduced the number of plaque covered teeth and improved denture hygiene. In addition, functional ability and cognitive function were significantly associated with better oral hygiene. the intervention had a positive effect on oral hygiene, however the number of teeth with plaque remained high, even after the intervention. Multiple approaches based on individual needs are required to improve the oral health of vulnerable older adults, including integrating dental preventive care into daily care plan carried out by home care nurses. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com

Restoration of Oral Function for Adult Edentulous Patients with Ectodermal Dysplasia: A Prospective Preliminary Clinical Study.

PubMed

Wu, Yiqun; Wang, Xu Dong; Wang, Feng; Huang, Wei; Zhang, Zhiyong; Zhang, Zhiyuan; Kaigler, Darnell; Zou, Duohong

2015-10-01

Therapy with zygomatic implants (ZIs) or conventional implants (CIs) has proven to be an effective method to restore oral function for systemically healthy patients. However, it is still a major challenge to fully restore oral function to edentulous adult patients with ectodermal dysplasia (ED). The aim of this study was to determine an effective treatment protocol for restoring oral function using ZIs and CIs to edentulous adult ED patients. Ten edentulous adult ED patients were treated in this study. The treatment protocol involved the following: (1) bone augmentation in the region of the anterior teeth; (2) placement of two ZIs and four CIs in the maxilla, and four CIs in the mandible; (3) fabrication of dental prosthesis; and (4) psychological and oral education. Following treatment of these patients, implant success rates, biological complications, patient satisfaction, and psychological changes were recorded. Although there was evidence of bone graft resorption in the maxilla, bone augmentation of the mandible was successful in all patients. Nine CIs in the maxilla failed and were removed. All ZIs were successful, and the CIs success rates were 77.50% in the maxilla and 100% in the mandible, with a mean of 88.75%. The mean peri-implant bone resorption for the CIs ranged from 1.3 ± 0.4 mm to 1.8 ± 0.6 mm, and four cases exhibited gingival hyperplasia in the maxilla and mandible. One hundred percent of the patients were satisfied with the restoration of their oral function, and >50% of the patients exhibited enhanced self-confidence and self-esteem. This study demonstrates that oral function can be restored in edentulous adult ED patients using a comprehensive and systematic treatment protocol involving psychological and oral education, bone augmentation, implant placement, and denture fabrication. Despite these positive outcomes, bone augmentation remains challenging in the anterior region of the maxilla for edentulous adult ED patients. © 2015 Wiley Periodicals, Inc.

The cumulative effect of multiple critical care protocols on length of stay in a geriatric trauma population.

PubMed

Frederickson, Tiffany A; Renner, Catherine Hackett; Swegle, James R; Sahr, Sheryl M

2013-01-01

The elderly individuals are the most rapidly growing cohort within the US population, and a corresponding increase is being seen in elderly trauma patients. Elderly patients are more likely to have a hospital length of stay (LOS) in excess of 10 days. They account for 60% of total ICU days. Length of stay is frequently used as a proxy measure for improvement in injury outcomes, changes in quality of care, and hospital outcomes. Patient care protocols are typically created from evidence-based guidelines that serve to reduce variation in care from patient to patient. Patient care protocols have been found to positively impact patient care with reduced duration of mechanical ventilation, shorter LOS in the ICU and shorter overall hospitalization time, reduced mortality, and reduced health care costs. The following study was designed to assess the impact of the implementation of 4 patient care protocols within an elderly trauma population. We hypothesized that the implementation of these protocols would have a beneficial impact on patient care that could be measured by a decrease in hospital LOS. An archival, retrospective pretest/posttest study was performed on elderly trauma patients. The new protocols helped guide practical changes in care that resulted in a 32% decrease in LOS for our elderly trauma patients which exceeds the 25% decrease found in other studies. Additionally, the "Other" category for each variable was less frequently used in the post-protocol phase than in the pre-protocol phase, suggesting a spillover effect on the level of detail recorded in the patient chart. With less variation in practices in the post-protocol phase, Injury Severity score, and admission systolic blood pressure emerged as significant predictors of LOS.

Visionaries or dreamers? The story of infant oral health.

PubMed

Nowak, Arthur J; Quiñonez, Rocio B

2011-01-01

To review the early history of the promotion of oral health for infants and toddlers, the impact of the AAPD guideline on infant oral health care and ways to maximize health outcomes. Review of the literature. Concepts on primary prevention and early intervention were reported as early as the 19th century. Progress to positively impact the oral health of children has been made. Nevertheless, the advice of early scholars and clinicians that oral care and prevention must begin early with the caregivers and the emergence of the infant's first tooth have not been fully embraced by the profession. A historical perspective on oral health care for infants and toddlers has been presented. There is a need to move away from the surgical approach of managing oral disease and embrace the concepts of primary care beginning perinatally while more broadly addressing social determinants of health.

Caregivers' health literacy and their young children's oral-health-related expenditures.

PubMed

Vann, W F; Divaris, K; Gizlice, Z; Baker, A D; Lee, J Y

2013-07-01

Caregivers' health literacy has emerged as an important determinant of young children's health care and outcomes. We examined the hypothesis that caregivers' health literacy influences children's oral-health-care-related expenditures. This was a prospective cohort study of 1,132 child/caregiver dyads (children's mean age = 19 months), participating in the Carolina Oral Health Literacy Project. Health literacy was measured by the REALD-30 (word recognition based) and NVS (comprehension based) instruments. Follow-up data included child Medicaid claims for CY2008-10. We quantified expenditures using annualized 2010 fee-adjusted Medicaid-paid dollars for oral-health-related visits involving preventive, restorative, and emergency care. We used descriptive, bivariate, and multivariate statistical methods based on generalized gamma models. Mean oral-health-related annual expenditures totaled $203: preventive--$81, restorative--$99, and emergency care--$22. Among children who received services, mean expenditures were: emergency hospital-based--$1282, preventive--$106, and restorative care--$343. Caregivers' low literacy in the oral health context was associated with a statistically non-significant increase in total expenditures (average annual difference = $40; 95% confidence interval, -32, 111). Nevertheless, with both instruments, emergency dental care expenditures were consistently elevated among children of low-literacy caregivers. These findings provide initial support for health literacy as an important determinant of the meaningful use and cost of oral health care.

Oral health challenges facing Dubai children with Autism Spectrum Disorder at home and in accessing oral health care.

PubMed

Mansoor, D; Al Halabi, M; Khamis, A H; Kowash, M

2018-06-01

To investigate the challenges faced by Autism Spectrum Disorder (ASD) children and their families in Dubai from three different perspectives of dental care: oral care at home, oral care at the dentist and access to oral care, and to compare the results to their normally developing peers. A case-control comparative study of 84 ASD and 53 healthy children attending special needs centres and schools in Dubai including siblings of the autistic children. Data collection was by a survey questionnaire completed by parents or guardians. More parents of ASD children compared to parents of healthy children reported difficulties across almost all oral care variables explored. The majority of ASD children's parents (83.3%) reported that their children need assistance in brushing their teeth compared with 15.4% of the healthy controls (p-value < 0.001). The ASD children's uncooperative behaviour increased during dental visits and significantly more parents (37%) rated their child's experience as negative compared with 9.5% among the parents of control children (p-value=0.006). The autistic children had visited a dentist mostly for extractions. This study indicates that autistic children in Dubai experience more challenges and barriers to oral care than their typically developing healthy peers.

The impact of an oral hygiene education module on patient practices and nursing documentation.

PubMed

Coke, Lola; Otten, Karine; Staffileno, Beth; Minarich, Laura; Nowiszewski, Candice

2015-02-01

Oral hygiene is inconsistent among patients with cancer and is a national patient care issue. To promote comfort and nutritional status, oral hygiene for patients with cancer is important. The purpose of this study was to develop an evidence-based oral hygiene educational module (EM) for nursing and patient care technician (PCT) staff to promote consistent oral hygiene patient education; evaluate patient understanding of oral hygiene practices post-EM; and determine staff documentation frequency of oral hygiene care. Pre- and post-EM data were collected using a developed oral hygiene assessment tool; nursing documentation data were collected by chart review. Post-EM data were collected eight weeks post-EM. Data were analyzed using frequencies and the Mann-Whitney U test. Twenty-two patient documentation pairs were collected. Compared to pre-EM, admission teaching, patient education, and patient oral hygiene practices improved post-EM. Post-EM oral hygiene documentation and PCT teaching increased.

Disparities in children's oral health and access to dental care.

PubMed

Mouradian, W E; Wehr, E; Crall, J J

Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.

Current Trend of Antimicrobial Prescription for Oral Implant Surgery Among Dentists in India.

PubMed

Datta, Rahul; Grewal, Yasmin; Batth, J S; Singh, Amandeep

2014-12-01

The aim of our study was to evaluate antimicrobial prescription behaviour amongst dentists performing oral implant surgery in India. Dentists performing oral implant surgery from different parts of India were personally approached during various national events such as conferences and academic meetings and information regarding their prescription habits for antimicrobial agents in routine oral implant surgery was collected using a structured questionnaire. Out of a total sample of 332 dentists, 85.5 % prescribed 17 different groups or combinations of antibiotics routinely for oral implant surgery in the normal healthy patient. Majority preferred the peri-operative protocol of drug therapy (72.2 %) with variable and prolonged duration of therapy after surgery, ranging from 3 to 10 days. An antimicrobial mouthwash was routinely prescribed by all the doctors (14.5 %) not in favour of prescribing antimicrobials in a normal healthy patient. Our findings suggest that there is a trend of antimicrobial agent misuse by dentists performing oral implant surgery in India, both in terms of drugs used and the protocols prescribed. The majority of these dentists prescribed a variety of antimicrobial agents for prolonged durations routinely even in the normal, healthy patients.

Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

PubMed

Mehta, Nishant; Rajpurohit, Ladusingh; Ankola, Anil; Hebbal, Mamata; Setia, Priyanka

2015-05-01

To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

Oral health status and need for oral care of care-dependent indwelling elderly: from admission to death.

PubMed

Hoeksema, Arie R; Peters, Lilian L; Raghoebar, Gerry M; Meijer, Henny J A; Vissink, Arjan; Visser, Anita

2017-09-01

The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in all new long-stay patients (n = 725) admitted to a nursing home between January 2009 and December 2013. All patients were followed from admission until death or until they left the nursing home. At admission, dementia patients were significantly older than somatic patients; median [IQR] ages were, respectively, 85 [79-89] and 81 [76-87] (p = 0.001). In addition, edentulous patients were significantly older than patients with remaining teeth, 83 [79-89] versus 80 [74-86] (p = 0.001) years. Thirty percent of the admitted patients died within 12 months after admission. A small minority (20%) of the patients had their own teeth. In this group, poor oral hygiene (72%), caries (70%), and broken teeth (62%) were frequently observed. Edentulous patients were significantly more cooperative with treatment than patients with remaining teeth (64 versus 27%). Finally, significantly less professional dental care was given to edentulous patients when compared to patients with remaining teeth (median 90 [IQR 60-180] versus 165 [75-375] min). When compared to edentulous elderly patients, patients with remaining teeth were younger at admittance, were more often non-cooperative, and had a poorer oral health and higher need for dental care. It is important that health care workers ensure adequate oral health and dental care to frail elderly, especially for elderly with remaining teeth.

Ethical considerations in community oral health.

PubMed

Naidoo, Sudeshni

2015-05-01

As the public's oral health care needs increase in complexity, there is renewed attention to the ethical dimensions of community oral health decision making and the development of public health ethics in teaching and research in dentistry. Despite their reduction globally, oral diseases persist with a particular distribution pattern that is a reflection of the increasingly widespread inequality in access to community oral health preventive and dental care. This is due to differences in the appropriateness, availability, accessibility, and acceptability of oral health education and the care provided. This article provides an overview of community oral health from an ethical perspective, including the importance of equity, human rights, and social justice in providing oral health care to the underserved. The need for a paradigm shift from highly technical and individualistic dental training curricula is discussed, together with the need to instill a holistic approach to ethical and social responsibility in new dental graduates. It concludes with some possible strategies, using the overarching principles of ethics and bioethics that are applicable to practice among vulnerable populations.

Giving low priority to oral health care. Voices from people with disabilities in a grounded theory study.

PubMed

Hallberg, Ulrika; Klingberg, Gunilla

2007-10-01

Our knowledge of how people with disabilities look upon oral health and dental care is limited. The aim of this study was thus to explore how the people with disabilities experience the encounter with dental health care. With a focus on dental care and oral health, qualitative interviews with 16 informants with cognitive and/or physical disabilities were analysed in accordance with the qualitative method of grounded theory. A core category identified and labeled "giving low priority to oral health care" was found to be related to four other categories: "being afraid of losing control", "having difficulties complying with instructions", "having a desire for continuity", and "wishing to be just like everyone else". The results show that oral health and dental care are important, but are not considered a priority by the people with disabilities. General health issues have much higher priority but do not include oral health, which consequently can affect oral health negatively. Of several factors identified that could be improved to make dental visits more pleasant for patients are enhancing a sense of control in the patient and improving continuity.

Mobile microscopy as a screening tool for oral cancer in India: A pilot study

PubMed Central

Skandarajah, Arunan; Sunny, Sumsum P.; Gurpur, Praveen; Reber, Clay D.; D’Ambrosio, Michael V.; Raghavan, Nisheena; James, Bonney Lee; Ramanjinappa, Ravindra D.; Suresh, Amritha; Kandasarma, Uma; Birur, Praveen; Kumar, Vinay V.; Galmeanu, Honorius-Cezar; Itu, Alexandru Mihail; Modiga-Arsu, Mihai; Rausch, Saskia; Sramek, Maria; Kollegal, Manohar; Paladini, Gianluca; Kuriakose, Moni; Koch, Felix; Fletcher, Daniel

2017-01-01

Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings. PMID:29176904

Women's oral health: growing evidence for enhancing perspectives.

PubMed

Halpern, Leslie R; Kaste, Linda M; Briggs, Charlotte; DiPietro, Luisa A; Erwin, Katherine; Frantsve-Hawley, Julie; Gordon, Sara; Heaton, Brenda; Henshaw, Michelle M; Joskow, Renée; Reisine, Susan T; Sinkford, Jeanne C

2013-04-01

Women's health, including oral health, is an evolving science with foundation knowledge from many disciplines. Key milestones, particularly in the last decade, provide a roadmap towards the necessary inclusion of gender into dental practice. Such focus is especially important for the evolving role of oral health care providers as primary health care providers. Continued progress of the vibrant incorporation of evidence-based women's oral health into the standard practice of oral health care is encouraged. This expanded preface provides an introduction to this DCNA issue, a brief history and timeline of major women's oral health events, and resources for further consideration. Copyright © 2013. Published by Elsevier Inc.

Role of oral candidiasis in TB and HIV co-infection: AIDS Clinical Trial Group Protocol A5253

PubMed Central

Shiboski, C. H.; Chen, H.; Ghannoum, M. A.; Komarow, L.; Evans, S.; Mukherjee, P. K.; Isham, N.; Katzenstein, D.; Asmelash, A.; Omozoarhe, A. E.; Gengiah, S.; Allen, R.; Tripathy, S.; Swindells, S.

2014-01-01

SUMMARY OBJECTIVE To evaluate the association between oral candidiasis and tuberculosis (TB) in human immunodeficiency virus (HIV) infected individuals in sub-Saharan Africa, and to investigate oral candidiasis as a potential tool for TB case finding. METHODS Protocol A5253 was a cross-sectional study designed to improve the diagnosis of pulmonary TB in HIV-infected adults in high TB prevalence countries. Participants received an oral examination to detect oral candidiasis. We estimated the association between TB disease and oral candidiasis using logistic regression, and sensitivity, specificity and predictive values. RESULTS Of 454 participants with TB culture results enrolled in African sites, the median age was 33 years, 71% were female and the median CD4 count was 257 cells/mm3. Fifty-four (12%) had TB disease; the prevalence of oral candidiasis was significantly higher among TB cases (35%) than among non-TB cases (16%, P < 0.001). The odds of having TB was 2.4 times higher among those with oral candidiasis when controlling for CD4 count and antifungals (95%CI 1.2–4.7, P = 0.01). The sensitivity of oral candidiasis as a predictor of TB was 35% (95%CI 22–48) and the specificity 85% (95%CI 81–88). CONCLUSION We found a strong association between oral candidiasis and TB disease, independent of CD4 count, suggesting that in resource-limited settings, oral candidiasis may provide clinical evidence for increased risk of TB and contribute to TB case finding. PMID:24903939

No role for human papillomavirus infection in oral cancers in a region in southern India.

PubMed

Laprise, Claudie; Madathil, Sreenath A; Allison, Paul; Abraham, Priya; Raghavendran, Anantharam; Shahul, Hameed P; ThekkePurakkal, Akhil-Soman; Castonguay, Geneviève; Coutlée, François; Schlecht, Nicolas F; Rousseau, Marie-Claude; Franco, Eduardo L; Nicolau, Belinda

2016-02-15

Oral cancer is a major public health issue in India with ∼ 77,000 new cases and 52,000 deaths yearly. Paan chewing, tobacco and alcohol use are strong risk factors for this cancer in India. Human papillomaviruses (HPVs) are also related to a subset of head and neck cancers (HNCs). We examined the association between oral HPV and oral cancer in a sample of Indian subjects participating in a hospital-based case-control study. We recruited incident oral cancer cases (N = 350) and controls frequency-matched by age and sex (N = 371) from two main referral hospitals in Kerala, South India. Sociodemographic and behavioral data were collected by interviews. Epithelial cells were sampled using Oral CDx® brushes from the oral cancer site and the normal mucosa. Detection and genotyping of 36 HPV genotypes were done using a polymerase chain reaction protocol. Data collection procedures were performed by qualified dentists via a detailed protocol with strict quality control, including independent HPV testing in India and Canada. HPV DNA was detected in none of the cases or controls. Associations between oral cancer and risk factors usually associated with HPV infection, such as oral sex and number of lifetime sexual partners, were examined by logistic regression and were not associated with oral cancer. Lack of a role for HPV infection in this study may reflect cultural or religious characteristics specific to this region in India that are not conducive to oral HPV transmission. A nationwide representative prevalence study is needed to investigate HPV prevalence variability among Indian regions. © 2015 UICC.

Significant unmet oral health needs of homebound elderly adults.

PubMed

Ornstein, Katherine A; DeCherrie, Linda; Gluzman, Rima; Scott, Elizabeth S; Kansal, Jyoti; Shah, Tushin; Katz, Ralph; Soriano, Theresa A

2015-01-01

To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health. Cross-sectional analysis. Participants' homes in New York City. Homebound elderly adults (N = 125). A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index. Participants who reported a high level of unmet oral health needs were more likely to be nonwhite, although this effect was not significant in multivariate analysis. Individual medical diagnoses and the presence of multiple comorbidities were not associated with unmet oral health needs. The oral health status of homebound elderly adults was poor regardless of their medical diagnoses. High unmet oral health needs combined with strong desire to receive dental care suggests there is a need to improve access to dental care for this growing population. In addition to improving awareness of geriatricians and primary care providers who care for homebound individuals, the medical community must partner with the dental community to develop home-based programs for older adults. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Oral health need and access to dental services: evidence from the National Survey of Children's Health, 2007.

PubMed

Bell, Janice F; Huebner, Colleen E; Reed, Sarah C

2012-04-01

This study examines associations between parents' report of their children's oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1-17 years, using data from the 2007 National Survey of Children's Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.

Oral status, cognitive function and dependency among New Zealand nursing home residents.

PubMed

Thomson, William M; Smith, Moira B; Ferguson, Catherine Anna; Kerse, Ngaire M; Peri, Kathryn; Gribben, Barry

2018-04-23

To investigate clinical oral disease and its association with cognitive function and dependency among older New Zealanders in residential aged care. National survey of oral health in aged residential care throughout New Zealand. We classified residents into 1 of 3 levels of care: "low dependency care (or assisted living)"; "high dependency care"; or "specialist dementia care/psychogeriatric care." The Abbreviated Mental Test characterised cognitive function as "unimpaired" (scores of 7-10), "moderately impaired" (4-6) or "severely impaired" (0-3). Intra-oral examinations were conducted, along with a computer-assisted personal interview. Most of the 987 clinically examined participants were either at low or high dependency care level, with another 1 in 6 in psychogeriatric care. Almost half overall had severely impaired cognitive function. Just under half of the sample had 1 or more natural teeth remaining. Negative binomial regression modelling showed that the number of carious teeth was lower among women and higher among those who were older, those with more teeth and in those with severely impaired cognitive function. Oral debris scores (representing plaque biofilm and other soft deposits on teeth) were higher in men, those with more teeth, and in those with severely impaired cognitive function. Impaired cognitive function is a risk indicator for both dental caries and oral debris in aged residential care. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

[Therapeutic effect of rebamipide for oral mucositis associated with FEC therapy for breast cancer].

PubMed

Enami, Akiko; Masuda, Norikazu; Yamamura, Jun; Mizutani, Makiko; Yasojima, Hiroyuki; Shikata, Ayako; Masaoka, Miyuki; Takada, Seiko; Bamba, Nao; Yamamoto, Mie; Abe, Megumi; Makihara, Katsuya

2014-11-01

No guidelines for supportive drug therapy have been established for oral mucositis occurring during cancer chemotherapy. We retrospectively examined the progression of oral mucositis in 91 patients with breast cancer who received the 5-fluorouracil, epirubicin, and cyclophosphamide (FEC)-100 regimen between September 2007 and August 2008. Daily rebamipide was administered to patients with oral mucositis as per hospital protocol to evaluate the hypothesized preventive and mucosal protective effects of rebamipide(Mucosta®). Oral mucositis was observed in 43 patients (47%)during 4 courses of FEC. The median age of the patients was 55 years(range, 32-76 years). Of the 91 patients, 49 patients who did not receive rebamipide during the 4 FEC courses were classified as group A, 14 patients who received rebamipide before the start of FEC were classified as group B, and 28 patients who received rebamipide after developing oral mucositis were classified as group C. The incidence of oral mucositis at the start of FEC with or without rebamipide administration was observed in 5 patients in group B (36%) and 38 patients in groups A and C (49%) (p=0.3472). The mucositis grade was G1 in 4 patients and G2 in 1 patient in group B, and G1 in 20 patients and G2 plus G3 in 18 patients in groups A and C (p=0.2467). In group C, the grade decreased in 25 patients (89%) and did not occur (G0) in 17 patients (61%) during the next course, and 15 patients (54%) continued to the final course without any occurrence of mucositis. These results suggest that rebamipide is effective for the treatment of oral mucositis. Although significant differences were not observed in the groups, rebamipide has the potential to prevent development of oral mucositis and alleviate its symptoms, and seems promising as a new supportive drug therapy. We hope to verify the preventive and protective effects of rebamipide by conducting a prospective, randomized trial while treating oral mucositis with basic oral care and appropriate interventions provided by a multidisciplinary team.

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

PubMed Central

Berker, Bulent; Turhan, Nilgun Ozturk; Satiroglu, Hakan

2008-01-01

Purpose To compare oral contraceptive (OC) pretreatment plus microdose GnRH-a in flare-up protocol and non-OC microdose GnRH-a in flare-up protocol among poor responder ICSI patients. Methods A retrospective analysis of poor responder ICSI patients. Patients were divided into two groups according to used microdose protocol. Precycle treatment with OC followed by follicular phase administration of 40 μg sc leuprolide acetate (LA) every 12 h beginning on after 2 day pill-free period and rFSH administration was begun on the third day of LA administration (OC-Group, n = 26). Alternatively on day 2 after menses, patients were administered similar stimulation regime (non-OC Group, n = 27). Results There were no significant differences between groups in the number of oocytes, peak estradiol levels, endometrial thickness, fertilization rates and embryo quality. Implantations and pregnancy rates per embryo transfer were similar. Conclusion OC pretreatment plus microdose GnRHa in flare-up protocol does not offer advantages over non-OC microdose GnRHa in flare-up protocol among poor responder ICSI patients. PMID:18253823

Effect of Oral Health Care Program on Oral Health Status of Elderly People Living in Nursing Homes: a Quasi-experimental Study.

PubMed

Ildarabadi, Es-Hagh; Armat, Mohammad Reza; Motamedosanaye, Vahideh; Ghanei, Farzaneh

2017-12-01

Oral health of elderly people plays a major role in their overall health and quality of life, and is an integral part of personal care. The aim of this study was to evaluate the effect of implementing the oral health care program (OHCP) on oral health status of elderly people resident in nursing homes. This quasi-experimental study was carried out using a pretest-posttest design on 101 elderly people (46 in the intervention group and 55 in the control group) resident in two randomly selected nursing homes in Mashhad, Iran. In the intervention group, the OHCP was carried out by caregivers for 8 weeks. The control group received routine care. Using the oral health assessment tool, the oral health status of elderly people was assessed in both groups at three times; onset of the study, 4th, and 8th week after the start of the study. The oral health status of the elderly people in both groups was not statistically significantly different at baseline, but it changed significantly at the 4 th , and 8 th weeks (p<.001). The implementation of the OHCP for elderly people resident in nursing homes may improve their oral health status after 4 weeks. It is recommended that OHCP be included in care plans of all nursing homes to improve the elderly people's oral health status.

Ten Years of a National Oral Health Policy in Brazil: Innovation, Boldness, and Numerous Challenges.

PubMed

Pucca, G A; Gabriel, M; de Araujo, M E; de Almeida, F C S

2015-10-01

Brazil is the only country in the world to propose a universal health care system with the aim of guaranteeing delivery of all levels of health care, free of charge, to a population of over 200 million inhabitants by means of a unified health system ("Sistema Único de Saúde" [SUS]). The national policy of oral health, also known as Smiling Brazil ("Brasil Sorridente"), was implemented in 2004. Oral health was designated as 1 of the 4 priority areas of the SUS, transforming oral health care in Brazil, with the objective that the SUS achieve the integrality of care envisaged at its creation. The aim of this article is to share part of this experience in order to prompt reflection about the inclusion of oral health care in other health care systems around the world. The most significant results of Smiling Brazil can be seen in 3 areas: (1) oral health epidemiological indicators, (2) financial investment and professional development, and (3) the building of an oral health care network throughout the 10 y of the policy. The "Discovery!" article presented here portrays 10 y of evolution; however, it is important to point out that this is a process undergoing construction and that the oral health care network needs to be further expanded, refined, and solidified so that over time and through changes in the political parties in power, Smiling Brazil prevails as a perennial policy and not merely an action by a single government. © International & American Associations for Dental Research 2015.

Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial.

PubMed

Liang, Xiao; Ying, Hanning; Wang, Hongwei; Xu, Hongxia; Liu, Minjun; Zhou, Haiyan; Ge, Huiqing; Jiang, Wenbin; Feng, Lijun; Liu, Hui; Zhang, Yingchun; Mao, Zhiying; Li, Jianhua; Shen, Bo; Liang, Yuelong; Cai, Xiujun

2018-06-01

Enhanced recovery after surgery (ERAS), with several evidence-based elements, has been shown to shorten length of hospital stay and reduce perioperative hospital costs in many operations. This randomized clinical trial was performed to compare complications and hospital stay of laparoscopic liver resection between ERAS and traditional care. A randomized controlled trial was performed for laparoscopic liver resection from August 2015 to August 2016. Patients were randomly divided into ERAS group and traditional care group. The primary outcome was length of hospital stay (LOS) after surgery. Second outcomes included postoperative complications, hospital cost, and 30-day readmissions. Elements used in ERAS group included more perioperative education, nurse navigators, nutrition support for liver diseases, respiratory therapy, oral carbohydrate 2 h before operation, early mobilization and oral intake, goal-directed fluid therapy, less drainages, postoperative nausea and vomiting (PONV) prophylaxis and multimodal analgesia. The study included 58 (two conversion to laparotomy) patients in ERAS group and 61 (three conversion to laparotomy) patients in the traditional care group. Postoperative LOS was significantly shorter in the ERAS group than traditional care group (5 vs. 8 days; p < 0.001). ERAS program significantly reduced the hospital costs (CNY 45413.1 vs. 55794.1; p = 0.006) and complications (36.2 vs. 55.7%; p = 0.033). Duration till first flatus and PONV were significantly reduced in ERAS group. Pain control was better in ERAS (Visual analogue scale (VAS) POD1 (≥ 4) 19.0 vs. 39.3%, p = 0.017; VAS POD1 2.5 vs. 3.1, p = 0.010). There was no difference in the rate of 30-day readmissions (6.9 vs. 8.2%; p = 1.000). ERAS protocol is feasible and safe for laparoscopic liver resection. Patients in ERAS group have less pain and complications.

School-Based Educational Intervention to Improve Children's Oral Health-Related Knowledge.

PubMed

Blake, Holly; Dawett, Bhupinder; Leighton, Paul; Rose-Brady, Laura; Deery, Chris

2015-07-01

To evaluate a brief oral health promotion intervention delivered in schools by a primary care dental practice, aimed at changing oral health care knowledge and oral health-related behaviors in children. Cohort study with pretest-posttest design. Three primary schools. One hundred and fifty children (aged 9-12 years). Children received a 60-minute theory-driven classroom-based interactive educational session delivered by a dental care professional and received take-home literature on oral health. All children completed a questionnaire on oral health-related knowledge and self-reported oral health-related behaviors before, immediately after, and 6 weeks following the intervention. Children's dental knowledge significantly improved following the intervention, with improvement evident at immediate follow-up and maintained 6 weeks later. Significantly more children reported using dental floss 6 weeks after the intervention compared with baseline. No significant differences were detected in toothbrushing or dietary behaviors. School-based preventative oral health education delivered by primary care dental practices can generate short-term improvements in children's knowledge of oral health and some aspects of oral hygiene behavior. Future research should engage parents/carers and include objective clinical and behavioral outcomes in controlled study designs. © 2014 Society for Public Health Education.

The potential oral health impact of cost barriers to dental care: findings from a Canadian population-based study

PubMed Central

2014-01-01

Background Prior to the 2007/09 Canadian Health Measures Survey, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care. Methods A secondary data analysis of the 2007/09 Canadian Health Measures Survey was undertaken using a sample of 5,586 Canadians aged 6 to 79. Chi square tests were conducted to test the association between reporting cost barriers to care and oral health outcomes. Logistic regressions were conducted to identify predictors of reporting cost barriers. Results Individuals who reported cost barriers to dental care had poorer oral health and more treatment needs compared to their counterparts. Conclusions Avoiding dental care and/or foregoing recommended treatment because of cost may contribute to poor oral health. This study substantiates the potential likelihood of progressive dental problems caused by an inability to treat existing conditions due to financial barriers. PMID:24962622

Provision of mouth-care in long-term care facilities: an educational trial.

PubMed

MacEntee, M I; Wyatt, C C L; Beattie, B L; Paterson, B; Levy-Milne, R; McCandless, L; Kazanjian, A

2007-02-01

This randomized clinical trial aimed to assess the effectiveness of a pyramid-based education for improving the oral health of elders in long-term care (LTC) facilities. Fourteen facilities matched for size were assigned randomly to an active or control group. At baseline in each facility, care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial. Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice. The residents in the facilities at baseline and after 3 months were examined clinically to measure their oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties. Clinical measures after 3 months were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents. A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities.

The importance of oral health in long-term care.

PubMed

Haumschild, Mary S; Haumschild, Ryan J

2009-11-01

Emerging evidence has shown a strong link between the effects of chronic oral inflammation and general health. The mouth is the visible gateway to the rest of the body and reflects what is happening deep inside. Periodontal disease has been linked to systemic disease; likewise, systemic disease can have an impact on oral health. In fact, there are over 100 systemic diseases that have oral manifestations, such as cardiovascular disease, stroke, respiratory infections, pancreatic cancer, diabetes, and nutritional problems. This is a bidirectional relationship and the link is inflammation. Oral health problems can have an adverse effect on the quality of life and are more prevalent in older adults, but are not caused by aging. Approximately 75% of baby boomers will enter long-term care facilities with the majority of their natural teeth and this trend is expected to continue. Studies indicate that residents with good oral care require less health care dollar expenditures. Therefore, dental professionals, such as the dental hygienist, should be part of the multidisciplinary team to assist in providing expert regular dental care and training to caregivers and other health care professionals in long-term care facilities.

An oral health survey of vulnerable older people in Belgium.

PubMed

De Visschere, Luc; Janssens, Barbara; De Reu, Griet; Duyck, Joke; Vanobbergen, Jacques

2016-11-01

The aim of this study was to gain insight in the oral health of persons aged 65 years or more. Data were obtained from 652 vulnerable older persons (≥65) by means of a clinical oral examination. Additional demographic data were gathered including age, gender, residence, and care dependency. The mean age of the total study sample was 83 (7.7) years and 71 % was female. Nearly 33 % of the sample was living at home with support, and 67 % was residing in nursing homes. The number of occluding pairs was low and the proportion of edentulous people was highest among persons with the highest care dependency. The mean Decay-missing-filled teeth index (DMFT) was 20.3 (9.0). A prosthetic treatment need and inadequate oral hygiene levels were observed in 40 % and more than 60 % of the subjects, respectively. The highest treatment need was observed in the oldest age group and the highest mean dental plaque in older persons with the highest care dependency. The oral health in frail older people in Belgium is poor. The restorative and prosthetic treatment need is high and oral hygiene levels are problematic. Age, residence, and care dependency seemed to have some influence on oral health parameters. In the long term, the most important future challenge of oral health care policies is to identify older adults before they begin to manifest such oral health deterioration. Regular dental visits should be strongly promoted by all (oral) health care workers during the lifespan of all persons including older adults.

The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities: An Institutional Ethnography.

PubMed

Caspar, Sienna; Ratner, Pamela A; Phinney, Alison; MacKinnon, Karen

2016-06-01

Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants' (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC. © The Author(s) 2016.

77 FR 32974 - Agency Information Collection Request. 30-Day Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-04

... Primary Care Physicians on Oral Health for the Office on Women's Health (OWH),--OMB No. 0990-NEW... care physicians regarding oral health. This survey will provide the agency with information on oral.... The study will explore physicians' level of understanding of oral disease and what constitutes health...

Comparative effectiveness and cost-effectiveness of Chuna manual therapy versus conventional usual care for nonacute low back pain: study protocol for a pilot multicenter, pragmatic randomized controlled trial (pCRN study).

PubMed

Shin, Byung-Cheul; Kim, Me-Riong; Cho, Jae-Heung; Jung, Jae-Young; Kim, Koh-Woon; Lee, Jun-Hwan; Nam, Kibong; Lee, Min Ho; Hwang, Eui-Hyoung; Heo, Kwang-Ho; Kim, Namkwen; Ha, In-Hyuk

2017-01-17

While Chuna manual therapy is a Korean manual therapy widely used primarily for low back pain (LBP)-related disorders in Korea, well-designed studies on the comparative effectiveness of Chuna manual therapy are scarce. This study is the protocol for a three-armed, multicenter, pragmatic randomized controlled pilot trial. Sixty severe nonacute LBP patients (pain duration of at least 3 weeks, Numeric Rating Scale (NRS) ≥5) will be recruited at four Korean medicine hospitals. Participants will be randomly allocated to the Chuna group (n = 20), usual care group (n = 20), or Chuna plus usual care group (n = 20) for 6 weeks of treatment. Usual care will consist of orally administered conventional medicine, physical therapy, and back pain care education. The trial will be conducted with outcome assessor and statistician blinding. The primary endpoint will be NRS of LBP at week 7 post randomization. Secondary outcomes include NRS of leg pain, the Oswestry Disability Index (ODI), the Patient Global Impression of Change (PGIC), the Credibility and Expectancy Questionnaire, lumbar range of motion (ROM), the EuroQol-5 Dimension (EQ-5D) health survey, the Health Utility Index III (HUI-III), and economic evaluation and safety data. Post-treatment follow-ups will be conducted at 1, 4, and 10 weeks after conclusion of treatment. This study will assess the comparative effectiveness of Chuna manual therapy compared to conventional usual care. Costs and effectiveness (utility) data will be analyzed for exploratory cost-effectiveness analysis. If this pilot study does not reach a definite conclusion due to its small sample size, these results will be used as preliminary results to calculate sample size for future large-scale clinical trials and contribute in the assessment of feasibility of a full-scale multicenter trial. Clinical Research Information Service (CRIS), KCT0001850 . Registered on 17 March 2016.

Implementing Evidenced Based Oral Care for Critically Ill Patients

DTIC Science & Technology

2016-02-28

Tacoma, WA 98402 N/A 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) TriService Nursing Research...determined if an evidence-based oral care program resulted in increased nurses ’ knowledge and improved oral care practices compliance. Design: The project...critical care nursing education was conducted over a two-week period using the conceptual underpinning of the Iowa Model, the Diffusion of Innovation

The importance and provision of oral hygiene in surgical patients.

PubMed

Ford, Samuel J

2008-10-01

The provision of mouth care on the general surgical ward and intensive care setting has recently gained momentum as an important aspect of patient care. Oropharyngeal morbidity can cause pain and disordered swallowing leading to reluctance in commencing or maintaining an adequate dietary intake. On the intensive care unit, aside from patient discomfort and general well-being, oral hygiene is integral to the prevention of ventilator-associated pneumonia. Chlorhexidine (0.2%) is widely used to decrease oral bacterial loading, dental bacterial plaque and gingivitis. Pineapple juice has gained favour as a salivary stimulant in those with a dry mouth or coated tongue. Tooth brushing is the ideal method of promoting oral hygiene. Brushing is feasible in the vast majority, although access is problematic in ventilated patients. Surgical patients undergoing palliative treatment are particularly prone to oral morbidity that may require specific but simple remedies. Neglect of basic aspects of patient care, typified by poor oral hygiene, can be detrimental to surgical outcome.

Oral Health Status of Older Adults in Sweden Receiving Elder Care: Findings From Nursing Assessments.

PubMed

Johansson, Isabelle; Jansson, Henrik; Lindmark, Ulrika

2016-01-01

Frail elderly people often have poor oral hygiene, contributing to oral health problems that can detract significantly from quality of life. The aim of this study was to describe oral health status of frail elderly individuals using the Revised Oral Assessment Guide-Jönköping (ROAG-J), a mouth assessment instrument that can be used in daily nursing care. Data were obtained from the Swedish Senior Alert quality registry in one Swedish municipality. ROAG-J assessments on admission to elder care and one subsequent occasion were used. ROAG-J measurements documented oral health in nine areas: voice, lips, oral mucosa, tongue, gums, teeth, saliva, swallowing, and presence of any prostheses or implants. Assessments were made by nursing staff during the course of daily nursing care. Individuals 65 years of age or older and receiving elder care services (N = 667) were involved; 1,904 assessments made between November 2011 and March 2014 were used for the analysis. On the basis of both assessments, less than one third of participants had oral health problems. No significant difference in any of the oral health variables was found between first and subsequent assessments. At first assessment, men and women differed in tongue health (p < .01); at the subsequent assessment, gender differences in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006) were observed. Most participants had good oral health. Assessments made by nursing staff using the ROAG-J demonstrate that this tool can be used in daily nursing care, where different, important oral conditions may be encountered. However, knowledge about oral health conditions and the ROAG-J instrument is important to ensure high validity. The ROAG-J enables nursing staff to detect problems in the mouth and to guide decisions related to oral health interventions.

[Oral communication between colleagues in geriatric care units].

PubMed

Maury-Zing, Céline

2014-01-01

Transmitting information orally between colleagues in gerontology care units. While the only certified method of transmitting nursing information is in writing, the oral tradition remains firmly rooted in the practice of health care providers. Professionals caring for elderly patients need to exchange information--whether it be considered important or trivial-, anywhere and at any time. In this article, professionals describe how they were able to identify which configurations of players and teams enable information to flow and benefit the care of elderly patients.

Oral health services within community-based organizations for young children with special health care needs.

PubMed

Cruz, Stephanie; Chi, Donald L; Huebner, Colleen E

2016-09-01

To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a nonfluoridated community. Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision. We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program. Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

Should we educate care staff to improve the oral health and oral hygiene of people with intellectual disability in residential care? Real world lessons from a randomized controlled trial.

PubMed

Mac Giolla Phadraig, Caoimhin; Guerin, Suzanne; Nunn, June

2015-01-01

This study assessed the impact of a multitiered oral health educational program on the oral health and oral hygiene of people with intellectual disabilities (ID). In a controlled pretest, posttest trial, with cluster randomization, a pyramidal training program was delivered to residential staff who cared for a randomly allocated, purposively stratified intervention group of people with ID living in community care homes. A control group lived in centers where staff received no training. Clinical measures were carried out pre- and posttest. Difference in Modified Gingival Index (MGI) and Plaque Index (PI) was measured posttest using ANCOVA. Seventy-six participants took part, representing 49.0% of the invited sample (n = 155). Fourteen did not receive clinical examination. There was one dropout 6-9 months later. A 10.5% and 8.5% reduction in mean MGI and PI was evident at posttest but did not show statistically significant difference, when controlling for baseline covariates (p > 0.05, ANCOVA). Mean MGI and PI scores were not significantly different among people with ID whose care staff had and had not received oral health training. Limitations are discussed. The results indicate that this program failed to significantly improve oral health or oral hygiene, despite the intervention being "educationally" successful. More research is needed. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

Promotion of oral health by community nurses.

PubMed

Garry, Brendan; Boran, Sue

2017-10-02

To explore the enablers and barriers perceived by community nurses in the promotion of oral health in an adult community trust directorate. Oral health care promotion in community care settings is being neglected. England and Wales have witnessed marked improvements in periodontal disease; however, no improvements have been seen in older people. A qualitative methodology was employed, where eight nurses from Band 5 to 7 were interviewed using a semi-structured approach. The data was analysed thematically. Data analysis was organised into four themes: professional self-concept and the development of knowledge, skills and attitudes necessary in the promotion of oral health; the impact an organisation has on the promotion of oral health and an exploration of the enablers and barriers identified by the community nurses while delivering care; the relationships between the nurse and patient and the potential impact on oral health promotion; the concept of self-regard in relation to the promotion of oral health and its overall impact. A commitment to improving oral health and requests for additional educational input were apparent. Organisational enablers and barriers were identified, alongside the crucial role a positive self-regard for oral health care may play in the promotion of oral health. Nurses need relevant education, organisational support, adequate resources and support from a multidisciplinary team to deliver optimal oral health promotion.

Short message service prompted mouth self-examination in oral cancer patients as an alternative to frequent hospital-based surveillance.

PubMed

Vaishampayan, Sagar; Malik, Akshat; Pawar, Prashant; Arya, Kavi; Chaturvedi, Pankaj

2017-01-01

Oral squamous cell carcinoma (OSCC) are amongst commonest cancer in the Indian sub-continent. After treatment, these patients require frequent followup to look for recurrences/second primary. Mouth Self Examination (MSE) has a great potential in all levels of prevention of oral cancer. However, the compliance to self-examination has been reported as poor. Mobile phone is a cheap and effective way to reach out to people. Short Message Service (SMS) is extremely popular can be a very effective motivational and interactive tool in health care setting. We aimed to identify in adequately treated OSCC patients, the influence of health provider initiated SMS on the compliance to the MSE and to establish the efficacy of MSE by comparing patients' MSE interpretation via replies to the SMS with that of the experts' opinion on clinical examination status during follow up. We conclude that MSE can be very useful in adequately treated OSCC patients for evaluating disease status. All treated OSCC patients must be adequately educated for MSE as an integral part of treatment & follow-up protocol by the health provider facility. Health provider generated SMS reminders do improve motivation and compliance towards MSE but don't seem to reduce dropouts in follow up for large and diverse population like that in India.

Promoting oral health among the inner city homeless: a community-academic partnership.

PubMed

Lashley, Mary

2008-09-01

Oral health care resources for the homeless are scarce, underfunded, and generally inadequate to meet the oral health needs of this population. The purpose of this program was to improve oral health among the urban homeless in a faith-based inner city mission through education, screening, and improved access to oral health care. The program provided for expanded delivery of oral health care services to the homeless while preparing students in the health professions for community-based practice with at-risk and vulnerable populations. By proactively addressing oral health needs through prevention and earlier diagnosis and treatment, morbidity, quality of life, and cost can be positively affected. Innovative, cross-disciplinary, community delivery models that involve key stakeholders at all levels are needed to address the oral health needs of the homeless and underserved adequately.

Capacity Building and Financing Oral Health in the African and Middle East Region.

PubMed

Mumghamba, E G; Joury, E; Fatusi, O; Ober-Oluoch, J; Onigbanjo, R J; Honkala, S

2015-07-01

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach. © International & American Associations for Dental Research 2015.

Lymphoscintigraphy and radioguided sentinel node biopsy in oral cavity squamous cell carcinoma: same day protocol.

PubMed

Vigili, Maurizio Giovanni; Tartaglione, Girolamo; Rahimi, Siavash; Mafera, Barbara; Pagan, Marco

2007-02-01

The routine use of a sentinel node biopsy (SNB) protocol in oral cavity squamous cell carcinomas (SCC) has been challenged on the basis of the elevated number of sentinel nodes (SNs) detected (>2.5) and on the multiply neck level involvement reported in several studies. These data limit the practical application of the protocol, because in such cases, it seems easier and safer to perform a selective neck dissection. The aim of our study is to perform radioguided surgery 1-3 h after lymphoscintigraphy (same day protocol) to detect the lymph nodes closest to the tumour site. In our study, 12 patients affected by cT1-2 N0 SCC of the oral cavity were submitted to a same day protocol of a lymphoscintigraphic examination (1-3 h before surgery) and a radioguided SNB. We used a hand-held gamma probe and performed an elective neck dissection on all patients. The SNs were found in all cases with 83% localised in the ipsilateral neck in only levels I-II. The mean number of SN detected was 2.1, with a mean pathological size of 13.8 mm measured on pathological specimen. Metastases were found in 5/12 cases (41.6%), on levels I, II and III and all were identified by step serial sectioning and routine H&E staining. This study confirms the accuracy of SNB in predicting the presence of occult metastases. This protocol is designed to detect SNs, which are almost always on neck level I and II, thereby limiting the number of nodes examined and the extension of the surgical approach.

A shorter and more specific oral sensitization-based experimental model of food allergy in mice.

PubMed

Bailón, Elvira; Cueto-Sola, Margarita; Utrilla, Pilar; Rodríguez-Ruiz, Judith; Garrido-Mesa, Natividad; Zarzuelo, Antonio; Xaus, Jordi; Gálvez, Julio; Comalada, Mònica

2012-07-31

Cow's milk protein allergy (CMPA) is one of the most prevalent human food-borne allergies, particularly in children. Experimental animal models have become critical tools with which to perform research on new therapeutic approaches and on the molecular mechanisms involved. However, oral food allergen sensitization in mice requires several weeks and is usually associated with unspecific immune responses. To overcome these inconveniences, we have developed a new food allergy model that takes only two weeks while retaining the main characters of allergic response to food antigens. The new model is characterized by oral sensitization of weaned Balb/c mice with 5 doses of purified cow's milk protein (CMP) plus cholera toxin (CT) for only two weeks and posterior challenge with an intraperitoneal administration of the allergen at the end of the sensitization period. In parallel, we studied a conventional protocol that lasts for seven weeks, and also the non-specific effects exerted by CT in both protocols. The shorter protocol achieves a similar clinical score as the original food allergy model without macroscopically affecting gut morphology or physiology. Moreover, the shorter protocol caused an increased IL-4 production and a more selective antigen-specific IgG1 response. Finally, the extended CT administration during the sensitization period of the conventional protocol is responsible for the exacerbated immune response observed in that model. Therefore, the new model presented here allows a reduction not only in experimental time but also in the number of animals required per experiment while maintaining the features of conventional allergy models. We propose that the new protocol reported will contribute to advancing allergy research. Copyright © 2012 Elsevier B.V. All rights reserved.

Oral Health: Brush Up on Dental Care Basics

MedlinePlus

... Mayo Clinic Staff Your smile depends on simple dental care habits, such as brushing and flossing. But ... your oral health. Oral health begins with clean teeth. Keeping the area where your teeth meet your ...

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

PubMed

Petrola, Krishna Andréia Feitosa; Bezerra, Ítalo Barroso; de Menezes, Érico Alexandro Vasconcelos; Calvasina, Paola; Saintrain, Maria Vieira de Lima; Pimentel G F Vieira-Meyer, Anya

2016-01-01

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

PubMed Central

Petrola, Krishna Andréia Feitosa; Bezerra, Ítalo Barroso; de Menezes, Érico Alexandro Vasconcelos; Calvasina, Paola; Saintrain, Maria Vieira de Lima; Pimentel G. F. Vieira-Meyer, Anya

2016-01-01

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly. Conclusions: No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil. PMID:27537330

How do nurses, midwives and health visitors contribute to protocol-based care? A synthesis of the UK literature.

PubMed

Ilott, Irene; Booth, Andrew; Rick, Jo; Patterson, Malcolm

2010-06-01

To explore how nurses, midwives and health visitors contribute to the development, implementation and audit of protocol-based care. Protocol-based care refers to the use of documents that set standards for clinical care processes with the intent of reducing unacceptable variations in practice. Documents such as protocols, clinical guidelines and care pathways underpin evidence-based practice throughout the world. An interpretative review using the five-stage systematic literature review process. The data sources were the British Nursing Index, CINAHL, EMBASE, MEDLINE and Web of Science from onset to 2005. The Journal of Integrated Care Pathways was hand searched (1997-June 2006). Thirty three studies about protocol-based care in the United Kingdom were appraised using the Qualitative Assessment and Review Instrument (QARI version 2). The literature was synthesized inductively and deductively, using an official 12-step guide for development as a framework for the deductive synthesis. Most papers were descriptive, offering practitioner knowledge and positive findings about a locally developed and owned protocol-based care. The majority were instigated in response to clinical need or service re-design. Development of protocol-based care was a non-linear, idiosyncratic process, with steps omitted, repeated or completed in a different order. The context and the multiple purposes of protocol-based care influenced the development process. Implementation and sustainability were rarely mentioned, or theorised as a change. The roles and activities of nurses were so understated as to be almost invisible. There were notable gaps in the literature about the resource use costs, the engagement of patients in the decision-making process, leadership and the impact of formalisation and new roles on inter-professional relations. Documents that standardise clinical care are part of the history of nursing as well as contemporary evidence-based care and expanded roles. Considering the proliferation and contested nature of protocol-based care, the dearth of literature about the contribution, experience and outcomes for nurses, midwives and health visitors is noteworthy and requires further investigation. (c) 2010 Elsevier Ltd. All rights reserved.

Boron biodistribution for BNCT in the hamster cheek pouch oral cancer model: Combined administration of BSH and BPA

DOE Office of Scientific and Technical Information (OSTI.GOV)

D.W. Nigg; William Bauer; Various Others

Sodium mercaptoundecahydro-closo-dodecaborate (BSH) is being investigated clinically for BNCT. We examined the biodistribution of BSH and BPA administered jointly in different proportions in the hamster cheek pouch oral cancer model. The 3 assayed protocols were non-toxic, and showed preferential tumor boron uptake versus precancerous and normal tissue and therapeutic tumor boron concentration values (70–85 ppm). All 3 protocols warrant assessment in BNCT studies to contribute to the knowledge of (BSH+BPA)-BNCT radiobiology for head and neck cancer and optimize therapeutic efficacy.

A literature review: polypharmacy protocol for primary care.

PubMed

Skinner, Mary

2015-01-01

The purpose of this literature review is to critically evaluate published protocols on polypharmacy in adults ages 65 and older that are currently used in primary care settings that may potentially lead to fewer adverse drug events. A review of OVID, CINAHL, EBSCO, Cochrane Library, Medline, and PubMed databases was completed using the following key words: protocol, guideline, geriatrics, elderly, older adult, polypharmacy, and primary care. Inclusion criteria were: articles in medical, nursing, and pharmacology journals with an intervention, protocol, or guideline addressing polypharmacy that lead to fewer adverse drug events. Qualitative and quantitative studies were included. Exclusion criteria were: publications prior to the year 1992. A gap exists in the literature. No standardized protocol for addressing polypharmacy in the primary care setting was found. Mnemonics, algorithms, clinical practice guidelines, and clinical strategies for addressing polypharmacy in a variety of health care settings were found throughout the literature. Several screening instruments for use in primary care to assess potentially inappropriate prescription of medications in the elderly, such as the Beers Criteria and the STOPP screening tool, were identified. However, these screening instruments were not included in a standardized protocol to manage polypharmacy in primary care. Polypharmacy in the elderly is a critical problem that may result in adverse drug events such as falls, hospitalizations, and increased expenditures for both the patient and the health care system. No standardized protocols to address polypharmacy specific to the primary care setting were identified in this review of the literature. Given the growing population of elderly in this country and the high number of medications they consume, it is critical to focus on the utilization of a standardized protocol to address the potential harm of polypharmacy in the primary care setting and evaluate its effects on patient outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

PubMed

Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Yamada, Shin-Ichi; Kurita, Hiroshi; Yamauchi, Chika; Shibuya, Yasuyuki; Kojima, Yuka; Nakahara, Hirokazu; Oho, Takahiko; Umeda, Masahiro

2017-08-01

The aim of this study was to investigate the effectiveness of oral care in prevention of postoperative pneumonia associated with esophageal cancer surgery.Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. However, the relationship between oral health status and postoperative pneumonia has not been well investigated.This study included 539 patients with esophageal cancer undergoing surgery at 1 of 7 university hospitals. While 306 patients received perioperative oral care, 233 did not. Various clinical factors as well as occurrence of postoperative pneumonia were retrospectively evaluated. Propensity-score matching was performed to minimize selection biases associated with comparison of retrospective data between the oral care and control groups. Factors related to postoperative pneumonia were analyzed by logistic regression analysis.Of the original 539 patients, 103 (19.1%) experienced postoperative pneumonia. The results of multivariate analysis of the 420 propensity score-matched patients revealed longer operation time, postoperative dysphagia, and lack of oral care intervention to be significantly correlated with postoperative pneumonia.The present findings demonstrate that perioperative oral care can reduce the risk of postoperative pneumonia in patients undergoing esophageal cancer surgery.

Efficiency and effectiveness of the use of an acenocoumarol pharmacogenetic dosing algorithm versus usual care in patients with venous thromboembolic disease initiating oral anticoagulation: study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Hemorrhagic events are frequent in patients on treatment with antivitamin-K oral anticoagulants due to their narrow therapeutic margin. Studies performed with acenocoumarol have shown the relationship between demographic, clinical and genotypic variants and the response to these drugs. Once the influence of these genetic and clinical factors on the dose of acenocoumarol needed to maintain a stable international normalized ratio (INR) has been demonstrated, new strategies need to be developed to predict the appropriate doses of this drug. Several pharmacogenetic algorithms have been developed for warfarin, but only three have been developed for acenocoumarol. After the development of a pharmacogenetic algorithm, the obvious next step is to demonstrate its effectiveness and utility by means of a randomized controlled trial. The aim of this study is to evaluate the effectiveness and efficiency of an acenocoumarol dosing algorithm developed by our group which includes demographic, clinical and pharmacogenetic variables (VKORC1, CYP2C9, CYP4F2 and ApoE) in patients with venous thromboembolism (VTE). Methods and design This is a multicenter, single blind, randomized controlled clinical trial. The protocol has been approved by La Paz University Hospital Research Ethics Committee and by the Spanish Drug Agency. Two hundred and forty patients with VTE in which oral anticoagulant therapy is indicated will be included. Randomization (case/control 1:1) will be stratified by center. Acenocoumarol dose in the control group will be scheduled and adjusted following common clinical practice; in the experimental arm dosing will be following an individualized algorithm developed and validated by our group. Patients will be followed for three months. The main endpoints are: 1) Percentage of patients with INR within the therapeutic range on day seven after initiation of oral anticoagulant therapy; 2) Time from the start of oral anticoagulant treatment to achievement of a stable INR within the therapeutic range; 3) Number of INR determinations within the therapeutic range in the first six weeks of treatment. Discussion To date, there are no clinical trials comparing pharmacogenetic acenocoumarol dosing algorithm versus routine clinical practice in VTE. Implementation of this pharmacogenetic algorithm in the clinical practice routine could reduce side effects and improve patient safety. Trial registration Eudra CT. Identifier: 2009-016643-18. PMID:23237631

[Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

PubMed

Saito, Hajime; Minamiya, Yoshihiro

2016-01-01

Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

Determinants of preventive oral health behaviour among senior dental students in Nigeria

PubMed Central

2013-01-01

Background To study the association between oral health behaviour of senior dental students in Nigeria and their gender, age, knowledge of preventive care, and attitudes towards preventive dentistry. Methods Questionnaires were administered to 179 senior dental students in the six dental schools in Nigeria. The questionnaire obtained information on age, gender, oral self-care, knowledge of preventive dental care and attitudes towards preventive dentistry. Attending a dental clinic for check-up by a dentist or a classmate within the last year was defined as preventive care use. Students who performed oral self-care and attended dental clinic for check-ups were noted to have complied with recommended oral self-care. Chi-square test and binary logistic regression models were used for statistical analyses. Results More male respondents agreed that the use of fluoride toothpaste was more important than the tooth brushing technique for caries prevention (P < 0.001). While the use of dental floss was very low (7.3%), more females were more likely to report using dental floss (p=0.03). Older students were also more likely to comply with recommended oral self-care (p<0.001). In binary regression models, respondents who were younger (p=0.04) and those with higher knowledge of preventive dental care (p=0.008) were more likely to consume sugary snacks less than once a day. Conclusion Gender differences in the awareness of the superiority of using fluoridated toothpaste over brushing in caries prevention; and in the use of dental floss were observed. While older students were more likely to comply with recommended oral self-care measures, younger students with good knowledge of preventive dental care were more likely to consume sugary snacks less than once a day. PMID:23777298

Determinants of preventive oral health behaviour among senior dental students in Nigeria.

PubMed

Folayan, Morenike O; Khami, Mohammad R; Folaranmi, Nkiru; Popoola, Bamidele O; Sofola, Oyinkan O; Ligali, Taofeek O; Esan, Ayodeji O; Orenuga, Omolola O

2013-06-18

To study the association between oral health behaviour of senior dental students in Nigeria and their gender, age, knowledge of preventive care, and attitudes towards preventive dentistry. Questionnaires were administered to 179 senior dental students in the six dental schools in Nigeria. The questionnaire obtained information on age, gender, oral self-care, knowledge of preventive dental care and attitudes towards preventive dentistry. Attending a dental clinic for check-up by a dentist or a classmate within the last year was defined as preventive care use. Students who performed oral self-care and attended dental clinic for check-ups were noted to have complied with recommended oral self-care. Chi-square test and binary logistic regression models were used for statistical analyses. More male respondents agreed that the use of fluoride toothpaste was more important than the tooth brushing technique for caries prevention (P < 0.001). While the use of dental floss was very low (7.3%), more females were more likely to report using dental floss (p=0.03). Older students were also more likely to comply with recommended oral self-care (p<0.001). In binary regression models, respondents who were younger (p=0.04) and those with higher knowledge of preventive dental care (p=0.008) were more likely to consume sugary snacks less than once a day. Gender differences in the awareness of the superiority of using fluoridated toothpaste over brushing in caries prevention; and in the use of dental floss were observed. While older students were more likely to comply with recommended oral self-care measures, younger students with good knowledge of preventive dental care were more likely to consume sugary snacks less than once a day.

Role and models for compensation of tobacco use prevention and cessation by oral health professionals.

PubMed

Crail, Jon; Lahtinen, Aira; Beck-Mannagetta, Johann; Benzian, Habib; Enmarks, Birgitta; Jenner, Tony; Knevel, Ron; Lulic, Martina; Wickholm, Seppo

2010-02-01

Appropriate compensation of tobacco use prevention and cessation (TUPAC) would give oral health professionals better incentives to provide TUPAC, which is considered part of their professional and ethical responsibility and improves quality of care. Barriers for compensation are that tobacco addiction is not recognised as a chronic disease but rather as a behavioural disorder or merely as a risk factor for other diseases. TUPAC-related compensation should be available to oral health professionals, be in appropriate relation to other dental therapeutic interventions and should not be funded from existing oral health care budgets alone. We recommend modifying existing treatment and billing codes or creating new codes for TUPAC. Furthermore, we suggest a four-staged model for TUPAC compensation. Stages 1 and 2 are basic care, stage 3 is intermediate care and stage 4 is advanced care. Proceeding from stage 1 to other stages may happen immediately or over many years. Stage 1: Identification and documentation of tobacco use is part of each patient's medical history and included into oral examination with no extra compensation. Stage 2: Brief intervention consists of a motivational interview and providing information about existing support. This stage should be coded/reimbursed as a short preventive intervention similar to other advice for oral care. Stage 3: Intermediate care consists of a motivational interview, assessment of tobacco dependency, informing about possible support and pharmacotherapy, if appropriate. This stage should be coded as preventive intervention similar to an oral hygiene instruction. Stage 4: Advanced care. Treatment codes should be created for advanced interventions by oral health professionals with adequate qualification. Interventions should follow established guidelines and use the most cost-effective approaches.

Collaborating for oral health in support of vulnerable older people: co-production of oral health training in care homes.

PubMed

Patel, Rakhee; Robertson, Claire; Gallagher, Jennifer E

2017-11-23

In recent years, the value of co-production has become embedded in the social care agenda. Care home residents are at significantly higher risk of dental diseases and often rely on the care team for support. It is therefore vital that staff are trained and confident in delivering evidence based oral care to their clients. Three London care homes co-produced a pilot oral health training programme, informed by in-depth interviews and group discussions. The initiative was evaluated using pre/post-questionnaires of carers and semi-structured interviews of managers and the dental teams. Two care homes were available for delivery of the programme, which resulted in training of 64% (n = 87) of care staff. The training programme involved videos and resources and was delivered flexibly with the support of an oral health educator and a dental therapist. There was an improvement in knowledge and self-reported confidence post-training; however, only 54% (n = 45) completed the post-training questionnaire. This study suggests that co-production of an oral care training package for care home staff, is possible and welcome, but challenging in this complex and changing environment. Further work is needed to explore the feasibility, sustainability and impact of doing so. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphpsphonates

PubMed Central

Bermúdez-Bejarano, Elena-Beatriz; Serrera-Figallo, María-Ángeles; Gutiérrez-Corrales, Aida; Romero-Ruiz, Manuel-María; Castillo-de-Oyagüe, Raquel; Gutiérrez-Pérez, José-Luis; Machuca-Portillo, Guillermo

2017-01-01

Introduction Chemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radiation therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug’s mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies. Objectives The objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ. Material and Methods A literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained. Results and Discussion The 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results. Key words:Bisphosphonates, bronj, therapeutic protocol, clinical result. PMID:27918742

Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research.

PubMed

Russell, Stefanie L; Mayberry, Linda J

2008-01-01

This article presents a review of the research relevant to oral health during pregnancy and includes nursing practice recommendations for referral of women to a dentist for safe and effective dental care during pregnancy. In recent years, research linking periodontitis to the risk for adverse birth outcomes has resulted in increased interest in the topic of oral health during pregnancy. The achievement of optimal oral health in pregnant women as its own benefit, however, has in the past been hampered by myths surrounding the safety of dental care during pregnancy. Many women also lack access to dental care and dental insurance, which interferes with their ability to receive adequate oral care during pregnancy. Intraoral changes that occur with pregnancy because of hormonal changes, combined with lack of routine exams and delays in treatment for oral disease, place pregnant women at higher risk for dental infections.

Oral health technicians in Brazilian primary health care: potentials and constraints.

PubMed

Aguiar, Dulce Maria Lucena de; Tomita, Nilce Emy; Machado, Maria de Fátima Antero Sousa; Martins, Cleide Lavieri; Frazão, Paulo

2014-07-01

Different perspectives on the role of mid-level workers in health care might represent a constraint to health policies. This study aimed to investigate how different agents view the participation of oral health technicians in direct activities of oral healthcare with the goal of understanding the related symbolic dispositions. Theoretical assumptions related to inter-professional collaboration and conflicts in the field of healthcare were used for this analysis. A researcher conducted 24 in-depth interviews with general dental practitioners, oral health technicians and local managers. The concepts of Pierre Bourdieu supported the data interpretation. The results indicated inter-professional relations marked by collaboration and conflict that reflect an action space related to different perspectives of primary care delivery. They also unveiled the symbolic devices related to the participation of oral health technicians that represent a constraint to the implementation of oral health policy, thus reducing the potential of primary health care in Brazil.

Exploring Current and Future Roles of Non-Dental Professionals: Implications for Dental Hygiene Education.

PubMed

Maxey, Hannah L; Farrell, Christine; Gwozdek, Anne

2017-09-01

The health care system is undergoing transformation in which oral health is not only valued as an aspect of overall health, but health care delivery systems are aligning to better deliver total patient care. As a result of this transformation, education for many non-dental professionals incorporates oral health content to prepare them to practice in comprehensive delivery models. While some non-dental professionals already incorporate oral health care in their service, many opportunities exist for expansion of oral health care delivery by other non-dental professionals, including radiologic technicians, nursing staff, and human services professionals. As non-dental professionals take on expanded roles in oral health care, the dental hygiene workforce must be prepared to practice in settings with new types of professionals. Dental hygiene curricula should prioritize interprofessional education to best prepare these students for practice in evolved delivery models. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Assessment of the oral health status of the medically compromised homebound geriatric patient: a descriptive pilot study.

PubMed

Paunovich, E

1994-01-01

This pilot study was designed to assess the oral health status of homebound elderly and determine their dental care needs. Fifty-one subjects enrolled in a hospital-based home care program were recruited for this study. Subjects were visited in their homes by both a dentist and a physician. Care plans and medications were reviewed for each subject. Initial assessments to receive informed written consent were conducted by the physician. Oral health assessments by the dentist included comprehensive examinations for soft tissue pathology, periodontal health, caries, restoration, and tooth condition, as well as existing prosthesis assessment, plaque index, and grip strength. A Physical Self-Maintenance Scale was administered in order to determine the level of dependence of this population for their oral hygiene self-care. The oral health status of these homebound elderly was found to be poor, with 84% of the subjects requiring dental care.

A service-learning project to eliminate barriers to oral care for children with special health care needs.

PubMed

DeMattei, Ronda R; Allen, Jessica; Goss, Breanna

2012-06-01

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.

Directly observed daily mouth care provided to care home residents in one area of Kent, UK.

PubMed

Zander, A; Boniface, D

2017-03-01

To gather accurate data on the daily mouth care provided in care homes including tooth brushing, oral health assessment, and recording of care provided. Direct observation and notes review. Both nursing and 'regular' care homes. 365 Residents living in 16 care homes and their carers underwent observation, notes review or data collection in some form. Provision of mouth morning care. Of 161 residents observed, most (93, 58%) did not have their teeth/dentures brushed. If performed, brushing was often carried out by the resident themselves (36 cases, 53%), rather than by a carer (32 cases, 44%). Carers used a toothbrush to clean inside a resident's mouth in just 7 cases (4.3% of all personal care routines observed). Smaller care homes were no more likely to brush residents teeth than larger care homes, and nursing homes were no more likely to brush teeth than other care homes. Of the 309 sets of notes available for review, 41 (13%) contained a dedicated oral health needs assessment, and 109 (35%) contained a daily oral care chart in some form. Mouth care was often recorded inaccurately (15% of cases). This is the first observational study in the UK to assess oral care actually provided to residents by carers in care homes. The findings reveal a substantially different picture of daily mouth care than was previously understood and suggest that many of the nation's care home residents may not be receiving adequate, or any, oral health care. Copyright© 2017 Dennis Barber Ltd

Integrating a Nurse-Midwife-Led Oral Health Intervention Into CenteringPregnancy Prenatal Care: Results of a Pilot Study.

PubMed

Adams, Sally H; Gregorich, Steven E; Rising, Sharon S; Hutchison, Margaret; Chung, Lisa H

2017-07-01

National and professional organizations recommend oral health promotion in prenatal care to improve women's oral health. However, few prenatal programs include education about oral health promotion. The objective of this study was to determine if women receiving a brief, low-cost, and sustainable educational intervention entitled CenteringPregnancy Oral Health Promotion had clinically improved oral health compared to women receiving standard CenteringPregnancy care. Women attending CenteringPregnancy, a group prenatal care model, at 4 health centers in the San Francisco Bay Area, participated in this nonrandomized controlled pilot study in 2010 to 2011. The intervention arm received the CenteringPregnancy Oral Health Promotion intervention consisting of two 15-minute skills-based educational modules addressing maternal and infant oral health, each module presented in a separate CenteringPregnancy prenatal care session. The present analysis focused on the maternal module that included facilitated discussions and skills-building activities including proper tooth brushing. The control arm received standard CenteringPregnancy prenatal care. Dental examinations and questionnaires were administered prior to and approximately 9 weeks postintervention. Primary outcomes included the Plaque Index, percent bleeding on probing, and percent of gingival pocket depths 4 mm or greater. Secondary outcomes were self-reported oral health knowledge, attitudes (importance and self-efficacy), and behaviors (tooth brushing and flossing). Regression models tested whether pre to post changes in outcomes differed between the intervention versus the control arms. One hundred and one women participated in the study; 49 were in the intervention arm, and 52 were in the control arm. The control and intervention arms did not vary significantly at baseline. Significant pre to post differences were noted between the arms with significant improvements in the intervention arm for the Plaque Index, bleeding on probing, and pocket depths 4 mm or greater. Providing brief oral health education and skills-building activities within prenatal care may be effective in improving women's oral health during pregnancy. These findings provide support for developing a full-scale randomized clinical trial of the CenteringPregnancy Oral Health Promotion intervention. © 2017 by the American College of Nurse-Midwives.

Utility of knowledge, attitude, and practice survey, and prevalence of dental caries among 11- to 13-year-old children in an urban community in India.

PubMed

Suprabha, Baranya Shrikrishna; Rao, Arathi; Shenoy, Ramya; Khanal, Sanskriti

2013-04-30

The school oral health education program is believed to be a cost-effective method for promoting oral health. The KAP (knowledge-attitude-practice) model of oral health education is often the foundation of most health education programs. To assess the existing knowledge, attitude, and oral health care practices among 11- to 13-year-old children and the association of knowledge with attitude, oral health care practices, and dental caries prevalence. Cross-sectional design, involving 858 children studying in class seven at various schools in the city of Mangalore, India. The children were selected using stratified random sampling method. Prevalence of dental caries was determined using decayed, missing, and filled permanent teeth (DMFT) index. A self-administered questionnaire on self-care practices in oral health, knowledge, and attitude toward oral health care was filled by children. The association of different variables with knowledge was analyzed using binary logistic regression analysis. The dental caries prevalence was 59.4%, and 54.5% had low knowledge. They lacked knowledge regarding use of fluoridated toothpaste and did not use them. Children with low knowledge had significantly higher odds of having DMFT ≥ 1, not using fluoridated toothpaste, and being afraid of going to the dentist due to possible pain. There was no association of other oral health care practices and attitudes with knowledge. Oral health care practices and attitudes are not fully explained by knowledge, and other models of health education need to be considered.

Cervical and facial infections - a real life threat

NASA Astrophysics Data System (ADS)

Rosu, S.; Fratila, M.

2014-03-01

Cervicofacial infections of dental origin are a difficult and complex issue of oral and maxillofacial surgery. Recognizing in due time the situations which are likely to develop a life-threatening condition and medical surgical prompt interventions significantly reduce the rate of the complications. Between January 2009 and March 2013, at the Clinic of Oral and Maxillofacial Surgery of the University of Medicine and Pharmacy "Victor Babes" Timisoara, 17 patients with severe cervicofacial infections were admitted in the emergency department as they needed a complex medical surgical treatment in accordance with protocol established together with the intensive-care department. Assessing the situations, we noticed a difficult, prolonged time of the recovery process which needed a hospitalization period of around 20 days. It recorded two deceased because of cervical necrotizing fasciitis and oral floor phlegmon, the most severe forms of the cervicofacial infections. The severity of the condition of the patients with cervicofacial infections must be figured and as quickly as possible an energetic therapeutic attitude must be adopted. The experience shows a frequent resistance to antibiotics like ampicillin, penicillin and oxacillin. The patients must be guided in due time to a clinic which has an intensive care department, where the surgical treatment must be administrated together with an intensive treatment for supporting the general condition. The reduction of the vital risk of the cervicofacial infections of dental origin will be done through an attentive assessment of the general and local condition (status) of the outpatients, before the dental extraction. The absence of a treatment adapted to the situation and to the clinic development, meaningfully increases the rate of the complications and the length of the hospitalization, the lethal evolution being not excluded.

Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia.

PubMed

Chin, May Chien; Sivasampu, Sheamini; Khoo, Ee Ming

2017-01-01

Use of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage. Data used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA. A weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector. Oral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.

Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

PubMed Central

Sivasampu, Sheamini; Khoo, Ee Ming

2017-01-01

Objective Use of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage. Methods Data used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA. Results A weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector. Conclusion Oral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system. PMID:28662193

Geography Matters: State-Level Variation in Children's Oral Health Care Access and Oral Health Status

PubMed Central

Fisher-Owens, Susan A.; Soobader, Mah-J; Gansky, Stuart A.; Isong, Inyang A.; Weintraub, Jane A.; Platt, Larry J.; Newacheck, Paul W.

2016-01-01

Objectives To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences Study Design Observational study using cross-sectional surveys Methods Using the 2007 National Survey of Children's Health, we examined state variation in parent's report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighborhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. Results Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ~¼ of the state variation in no preventive visit and ~½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. Conclusion Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health. PMID:26995567

Geography matters: state-level variation in children's oral health care access and oral health status.

PubMed

Fisher-Owens, S A; Soobader, M J; Gansky, S A; Isong, I A; Weintraub, J A; Platt, L J; Newacheck, P W

2016-05-01

To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. Observational study using cross-sectional surveys. Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Advances and challenges in oral health after a decade of the "Smiling Brazil" Program.

PubMed

Scherer, Charleni Inês; Scherer, Magda Duarte dos Anjos

2015-01-01

To analyze oral health work changes in primary health care after Brazil's National Oral Health Policy Guidelines were released. A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people's participation and social control; and intersectorial actions. Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Overcoming Historical Separation between Oral and General Health Care: Interprofessional Collaboration for Promoting Health Equity.

PubMed

Simon, Lisa

2016-09-01

Since the founding of dental schools as institutions distinct from medical schools, dentistry-its practice, service delivery, and insurance coverage, for example-and dental care have been kept separate from medical care in the United States. This separation is most detrimental to undeserved groups at highest risk for poor oral health. As awareness grows of the important links between oral and general health, physicians and dentists are collaborating to develop innovative service delivery and payment models that can reintegrate oral health care into medical care. Interprofessional education of medical and dental students can help produce clinicians who work together to the benefit of their patients. © 2016 American Medical Association. All Rights Reserved.

Oral Health Promotion and Smoking Cessation Program Delivered via Tobacco Quitlines: The Oral Health 4 Life Trial.

PubMed

McClure, Jennifer B; Bush, Terry; Anderson, Melissa L; Blasi, Paula; Thompson, Ella; Nelson, Jennifer; Catz, Sheryl L

2018-05-01

To assess the effects of a novel oral health promotion program (Oral Health 4 Life; OH4L) delivered through state-funded tobacco quitlines. Using a semipragmatic design to balance experimental control and generalizability, we randomized US quitline callers (n = 718) to standard care or standard care plus OH4L. We followed participants for 6 months to assess effects on professional dental care and smoking abstinence. We collected data between 2015 and 2017. Participants were racially diverse (42% non-White) and socioeconomically disadvantaged. Most (71%) reported fair or poor oral health, and all were overdue for routine dental care. At 6 months, professional dental care and abstinence did not significantly differ between arms, but abstinence favored the experimental arm and was significantly higher among experimental participants at 2 months in a complete case sensitivity analysis. OH4L was not effective for promoting dental care, but integrating oral health counseling with quitline counseling may offer some advantage for smoking cessation. Public Health Implications. We offer a model for conducting semipragmatic trials and partnering with tobacco quitlines to evaluate population-level public health interventions.

An Innovative Project Breaks Down Barriers to Oral Health Care for Vulnerable Young Children in Los Angeles County.

PubMed

Crall, James J; Illum, Jackie; Martinez, Ana; Pourat, Nadereh

2016-06-01

Despite the high rate of untreated tooth decay, many young children in California under six years of age have never been to a dentist. Numerous and complex barriers to access to oral health care for young children exist, and a multifaceted approach is required to improve receipt of preventive and treatment services that could improve the oral health of this population. This policy brief describes the UCLA-First 5 LA 21st Century Dental Homes Project, which was designed to improve oral health care for young children in 12 Federally Qualified Health Center (FQHC) clinic sites with co-located dental and primary care services and its accessibility in their service areas throughout Los Angeles County. The project funded infrastructure and staffing, provided technical assistance to improve operations, trained clinical personnel to provide oral health care to young children, implemented a quality improvement learning collaborative, trained parents and child care providers in oral hygiene and healthy habits, and disseminated information to promote effective policies. Early data on the project indicated twofold increases in delivery of both diagnostics and treatment visits for young children, and a threefold increase in preventive services for young children during the program.

Experimentally induced hyperchloremic and DL-lactic acidosis in calves: an attempt to study the effects of oral rehydration on acid-base status.

PubMed

Schwedhelm, L; Kirchner, D; Klaus, B; Bachmann, L

2013-04-01

Many diarrheic calves suffer from metabolic acidosis, which is commonly treated by oral rehydration therapy. Oral rehydration solutions can be prepared in water, milk, or milk replacer. Therefore, the aim of the study was to verify dietary effects of water- or milk replacer-based oral rehydration solutions on parameters of acid-base balance in calves with experimentally induced hyperchloremic and dl-lactate acidosis. In 12 calves, hyperchloremic or dl-lactate acidosis was induced by HCl or dl-lactic acid infusions according to protocols outlined in previous literature. Immediately after induction, the calves were fed with milk replacer or water- or milk replacer-based oral rehydration solutions, or remained fasting, respectively. Blood samples were taken to monitor acid-base status over an experimental period of 4h. Using the protocols, all calves revealed a manifest hyperchloremic or dl-lactate acidosis. Because of high infusion volumes, plasma volume was expanded and effects of feeding regimens on blood parameters were rare. Unexpected clinical aberrations occurred after repeated induction of dl-lactate acidosis: all calves developed a thrombophlebitis of the jugular vein, whereas HCl infusion had no effect on endothelium. Induction of acidosis via infusion is not suitable to study dietary effects. A protocol to induce acidosis and dehydration simultaneously is required to duplicate the metabolic conditions of diarrheic calves. In further investigations, attention should be focused on effects of d-lactate or its metabolites on endothelial tissue. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

A Dual Sugar Challenge Test for Lipogenic Sensitivity to Dietary Fructose

PubMed Central

Parker, Thomas S.; Levine, Daniel M.; Hellerstein, Marc K.

2011-01-01

Context: Increased hepatic de novo lipogenesis (DNL) in response to dietary sugar is implicated in dyslipidemia, fatty liver, and insulin resistance. Objective: The aim of the study was to develop a simple outpatient tolerance test for lipogenic sensitivity to dietary sugar. Design and Setting: In inpatients given repeated doses of fructose, protocol 1 compared the acute increase in DNL determined from the percentage of palmitate (“new palmitate”) and the percentage of isotopically labeled palmitate (“%DNL”) in very low-density lipoprotein triglyceride (TG). Protocol 2 compared the increase in new palmitate in outpatients given three different sugar beverages in a randomized crossover design. Participants: There were 15 lean and overweight volunteers in protocol 1 and 15 overweight volunteers in protocol 2. Interventions: In protocol 1, subjects received 1.4 g/kg fructose in divided oral doses over 6 h; in protocol 2, subjects received 0.5 g/kg fructose, 0.5 g/kg fructose plus 0.5g/kg glucose, or 1 g/kg fructose plus 1g/kg glucose each as a single oral bolus. Main Outcome Measures: We measured the increase in DNL by two methods. Results: After repeated doses of fructose, new palmitate was significantly correlated with the increase in %DNL (Δ, r = 0.814; P < 0.001) and with fasting insulin levels (area under the curve, r = 0.754; P = 0.001). After a single sugar dose, new palmitate showed a dose effect and was greater after fructose plus glucose. Very low-density lipoprotein TG and total TG significantly increased in both protocols. Conclusions: A single oral bolus of fructose and glucose rapidly increases serum TG and TG palmitate in overweight subjects. A dual sugar challenge test could prove useful to identify individuals at risk for carbohydrate-induced dyslipidemia and other adverse effects of increased DNL. PMID:21252253

The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock.

PubMed

Kellum, John A; Chawla, Lakhmir S; Keener, Christopher; Singbartl, Kai; Palevsky, Paul M; Pike, Francis L; Yealy, Donald M; Huang, David T; Angus, Derek C

2016-02-01

Septic shock is a common cause of acute kidney injury (AKI), and fluid resuscitation is a major part of therapy. To determine if structured resuscitation designed to alter fluid, blood, and vasopressor use affects the development or severity of AKI or outcomes. Ancillary study to the ProCESS (Protocolized Care for Early Septic Shock) trial of alternative resuscitation strategies (two protocols vs. usual care) for septic shock. We studied 1,243 patients and classified AKI using serum creatinine and urine output. We determined recovery status at hospital discharge, examined rates of renal replacement therapy and fluid overload, and measured biomarkers of kidney damage. Among patients without evidence of AKI at enrollment, 37.6% of protocolized care and 38.1% of usual care patients developed kidney injury (P = 0.90). AKI duration (P = 0.59) and rates of renal replacement therapy did not differ between study arms (6.9% for protocolized care and 4.3% for usual care; P = 0.08). Fluid overload occurred in 8.3% of protocolized care and 6.3% of usual care patients (P = 0.26). Among patients with severe AKI, complete and partial recovery was 50.7 and 13.2% for protocolized patients and 49.1 and 13.4% for usual care patients (P = 0.93). Sixty-day hospital mortality was 6.2% for patients without AKI, 16.8% for those with stage 1, and 27.7% for stages 2 to 3. In patients with septic shock, AKI is common and associated with adverse outcomes, but it is not influenced by protocolized resuscitation compared with usual care.

Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients.

PubMed

Zotti, Francesca; Dalessandri, Domenico; Salgarello, Stefano; Piancino, Mariagrazia; Bonetti, Stefano; Visconti, Luca; Paganelli, Corrado

2016-01-01

To evaluate the influence of an app-based approach in a protocol for domestic oral hygiene maintenance in a group of adolescent patients wearing fixed multibracket appliances. Eighty adolescent patients scheduled to start an orthodontic multibracket treatment were randomly divided into two groups of 40. Plaque index (PI), gingival index (GI), white spots (WS), and caries presence were recorded in all patients, and they were instructed regarding domestic oral hygiene maintenance on the day of braces application (t0) and every 3 months (t1, t2, t3, t4) during the first year of treatment. Study group (SG) patients were enrolled in a WhatsApp chat room-based competition and instructed to share monthly with the other participants two self-photographs (selfies) showing their oral hygiene status. SG patient participation in the chat room was regular and active throughout the observation period. At t2, t3, and t4, SG patients had significantly lower values of both PI and GI and a lower incidence of new WS and caries, compared with the control group. Integration of new "social" technologies in a standard oral hygiene motivation protocol is effective in improving compliance of adolescent patients and in improving their oral health status during orthodontic multibracket treatment.

Conservative Approach in Patients with Pemphigus Gingival Vulgaris: A Pilot Study of Five Cases

PubMed Central

Gambino, Alessio; Carbone, Mario; Arduino, Paolo G.; Carbone, Lucio; Broccoletti, Roberto

2014-01-01

Objectives. The aim of this pilot study was to describe the clinical efficacy of a conservative oral hygiene protocol in patients affected by gingival pemphigus vulgaris (PV) applied in a case series. Methods. Subjects suffering from PV with gingival localisation and slightly responsive to conventional treatment with systemic corticosteroids and immunosuppressive drugs were selected among individuals treated in the Unit of Oral Medicine Section of the University of Turin. Five subjects received nonsurgical periodontal therapy, over a 7-day period, including oral hygiene instructions; patients were instructed about domiciliary oral hygiene maintenance and instructions were reinforced at each visit and personalised if necessary. Clinical outcome variables were recorded at baseline (before starting) and 16 weeks after intervention, including full mouth plaque score (FMPS), bleeding scores (FMBS), probing pocket depth (PPD), oral pemphigus clinical score (OPCS), and patient related outcomes (visual analogue score of pain). Results. Five patients were treated and, after finishing the proposed therapy protocol, a statistical significant reduction was observed for FMBS (P = 0.043) and OPCS (P = 0.038). Conclusions. Professional oral hygiene procedures with nonsurgical therapy are related to an improvement of gingival status and a decrease of gingival bleeding in patients affected by PV with specific gingival localization. PMID:25505912

The oral healthcare manager in a patient-centered health facility

PubMed Central

Theile, Cheryl Westphal; Strauss, Shiela; Northridge, Mary Evelyn; Birenz, Shirley

2016-01-01

Background and Purpose Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral healthcare manager who can facilitate integration of oral and primary care in a variety of healthcare settings. Methods Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral healthcare manager who would address both oral healthcare and a patient’s related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral healthcare manager. Conclusion A healthcare provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive healthcare. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral healthcare manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. PMID:27236994

Virtual surgical planning for treatment of severe mandibular retrognathia with collapsed occlusion using contemporary surgical and prosthodontic protocols.

PubMed

Dhima, Matilda; Salinas, Thomas J; Rieck, Kevin L

2013-11-01

To meet functional and esthetic needs in an older adult for treatment of complex skeletal and dentoalveolar deformities using contemporary surgical and prosthodontic protocols. An older adult with dentoalveolar complex and skeletal deformity (mandibular retrognathia) was treated by a combination of virtual planning and current surgical and prosthodontic protocols. Treatment planning steps and sequencing are presented. Skeletal, soft tissue, and dental harmonies were attained without biological or mechanical complications. Definitive oral rehabilitation was completed with a maxillary complete denture and a mandibular metal ceramic fixed implant-retained prosthesis. A surgical and prosthodontic team approach in combination with technologic advances can predictably optimize esthetic and functional outcomes for patients with complex skeletal and dentoalveolar deformities. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Oral health in Libya: addressing the future challenges.

PubMed

Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

2014-01-01

Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health-related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management.

Oral health in Libya: addressing the future challenges

PubMed Central

Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

2014-01-01

Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health–related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management. PMID:24666627

Treatment of Chronic Myocardial Infarction in a Pig (Sus scrofa) Model with Extracellular Matrix and Stem Cells

DTIC Science & Technology

2015-08-13

amlodarone, aspirin , and clopldogrel according to protocol. Once the pigs were anesthetized a baseline echocardiogram was obtained. Under fluoroscopic...premedicated with oral amiodarone, aspirin , and clopidogrel according to protocol. Once the pigs were anesthetized a baseline echocardiogram was

Oral health-related quality of life in patients with stroke: a randomized clinical trial of oral hygiene care during outpatient rehabilitation.

PubMed

Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

2017-08-09

This study was to evaluate the effectiveness of oral hygiene care in improving oral health- and health-related quality of life (OHRQoL and HRQoL) among patients receiving outpatient stroke rehabilitation. Subjects were randomized to: (1) a conventional oral hygiene care programme (COHCP) comprising a manual toothbrush, and oral hygiene instruction, or (2) an advanced oral hygiene care programme (AOHCP) comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction. The interventional period lasted for 3 months, followed by a 3-month observational period. HRQoL was assessed by SF-12, and OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14), General Oral Health Assessment Index (GOHAI), and Oral Health Transitional Scale (OHTS). Participants in AOHCP group had significantly better OHRQoL at the end of clinical trial as assessed by OHTS (p < 0.01), and at the end of observational study as assessed by GOHAI (p < 0.05) than those in the COHCP. Participants in the AOHCP group had significantly better HRQoL as assessed by physical component summary score (PCS) the end of both 3 and 6 months (both p < 0.05). This study provided the evidence that the AOHCP was more effective than the COHCP within stroke rehabilitation in improving subjective health.

Position of the Academy of Nutrition and Dietetics: oral health and nutrition.

PubMed

Touger-Decker, Riva; Mobley, Connie

2013-05-01

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Primary Oral Health Care in India: Vision or Dream?

PubMed Central

Suresh, Kotumachagi S; Javanaiah, Nagarathna; Shantappa, Shruti; Srivastava, Pooja

2016-01-01

The contemporary approach to dental caries management in children focuses on prevention than treatment. Pediatricians, general dentists and pediatric dentists must be involved in a detailed preventive program, which includes prenatal counselling, treatment of expectant mothers at risk for dental caries, infant oral health care and the establishment of the dental home, so that dental disease can be prevented in infants, starting at a young age. Various health care system and organizations in India must join together to promote oral health care for all the children and specially focused toward children from disadvantaged background and children with special health care needs. How to cite this article Suresh KS, Kumar P, Javanaiah N, Shantappa S, Srivastava P. Primary Oral Health Care in India: Vision or Dream? Int J Clin Pediatr Dent 2016;9(3):228-232. PMID:27843255

Synthetic Hydroxyapatite as a Biomimetic Oral Care Agent.

PubMed

Enax, Joachim; Epple, Matthias

Human tooth enamel consists mostly of minerals, primarily hydroxyapatite, Ca10(PO4)6(OH)2, and thus synthetic hydroxyapatite can be used as a biomimetic oral care agent. This review describes the synthesis and characterization of hydroxyapatite from a chemist's perspective and provides an overview of its current use in oral care, with a focus on dentin hypersensitivity, caries, biofilm management, erosion, and enamel lesions. Reviews and original research papers published in English and German were included. The efficiency of synthetic hydroxyapatite in occluding open dentin tubules, resulting in a protection for sensitive teeth, has been well documented in a number of clinical studies. The first corresponding studies on caries, biofilm management and erosion have provided evidence for a positive effect of hydroxyapatite either as a main or synergistic agent in oral care products. However, more in situ and in vivo studies are needed due to the complexity of the oral milieu and to further clarify existing results. Due to its biocompatibility and similarity to biologically formed hydroxyapatite in natural tooth enamel, synthetic hydroxyapatite is a promising biomimetic oral care ingredient that may extend the scope of preventive dentistry.

Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

PubMed

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

Clinical Outcomes and Cost Effectiveness of Accelerated Diagnostic Protocol in a Chest Pain Center Compared with Routine Care of Patients with Chest Pain

PubMed Central

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

Aims The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Methods and Results Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14–0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. Conclusion An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources. PMID:25622029

ANALYSIS OF FLOW THROUGH A HUMAN ORAL MODEL FOR USE IN INHALATION TOXICOLOGY AND AEROSOL THERAPY PROTOCOLS

EPA Science Inventory

RATIONALE
Understanding the transport and deposition of inhaled aerosols is of fundamental importance to inhalation toxicology and aerosol therapy. Herein, we focus on the development of a computer based oral morphology and related computational fluid dynamics (CFD) studi...

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey.

PubMed

Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos

2017-01-01

Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level dental providers?

PubMed

Shaefer, H Luke; Miller, Matthew

2011-08-01

Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

Using focus groups to design systems science models that promote oral health equity.

PubMed

Kum, Susan S; Northridge, Mary E; Metcalf, Sara S

2018-06-04

While the US population overall has experienced improvements in oral health over the past 60 years, oral diseases remain among the most common chronic conditions across the life course. Further, lack of access to oral health care contributes to profound and enduring oral health inequities worldwide. Vulnerable and underserved populations who commonly lack access to oral health care include racial/ethnic minority older adults living in urban environments. The aim of this study was to use a systematic approach to explicate cause and effect relationships in creating a causal map, a type of concept map in which the links between nodes represent causality or influence. To improve our mental models of the real world and devise strategies to promote oral health equity, methods including system dynamics, agent-based modeling, geographic information science, and social network simulation have been leveraged by the research team. The practice of systems science modeling is situated amidst an ongoing modeling process of observing the real world, formulating mental models of how it works, setting decision rules to guide behavior, and from these heuristics, making decisions that in turn affect the state of the real world. Qualitative data were obtained from focus groups conducted with community-dwelling older adults who self-identify as African American, Dominican, or Puerto Rican to elicit their lived experiences in accessing oral health care in their northern Manhattan neighborhoods. The findings of this study support the multi-dimensional and multi-level perspective of access to oral health care and affirm a theorized discrepancy in fit between available dental providers and patients. The lack of information about oral health at the community level may be compromising the use and quality of oral health care among racial/ethnic minority older adults. Well-informed community members may fill critical roles in oral health promotion, as they are viewed as highly credible sources of information and recommendations for dental providers. The next phase of this research will involve incorporating the knowledge gained from this study into simulation models that will be used to explore alternative paths toward improving oral health and health care for racial/ethnic minority older adults.

Providing oral health care to underserved population of pregnant women: retrospective review of 320 patients treated in private practice setting.

PubMed

Kerpen, Steven J; Burakoff, Ronald

2013-01-01

This article aims to quantify the impact of a novel partnership between a fee-for-service private practice and a teaching hospital dental service intended to provide oral care to an underserved population of pregnant women. Further, it seeks to ascertain the oral needs of this high-risk and diverse population. Data is presented that suggests the dire need for oral care among this pregnant population and the efficacy of treating these women in a private practice setting.

A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation.

PubMed

Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

2017-06-01

The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation. Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored. Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01). Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nursing Administrators' Views on Oral Health in Long-Term Care Facilities: An exploratory study.

PubMed

Urata, Janelle Y; Couch, Elizabeth T; Walsh, Margaret M; Rowe, Dorothy J

2018-04-01

Purpose: To explore the knowledge, attitudes, and practices of supervising nurse administrators (SNAs) regarding the oral care provided to long-term care facility (LTCF) residents and the role of dental professionals in those facilities. Methods: The investigators of this study partnered with the National Association of Nursing Administrators to send this cross-sectional study consisting of a 35-item electronic survey to its members whose email addresses were in their database. Online software tabulated responses and calculated frequencies (percentages) of responses for each survey item. Results: Of the 2,359 potential participants, 171 (n=171) completed the survey for a 7% response rate. Only 25% of the respondents were familiar with the expertise of dental hygienists (DHs), however once informed, the majority were interested in having DHs perform oral health staff trainings, oral screenings, and dental referrals and initiate fluoride varnish programs. Most respondents correctly answered the oral health-related knowledge items, understood that oral health is important to general health, but reported that the LTCF residents' oral health was only "good" or "fair." Fewer than half, (48%) of the SNAs were "very satisfied" with the quality of oral care provided to the residents. While more than half reported that they had no dentist on staff or on-site dental equipment, 77% reported that they would consider on-site mobile oral care services. Oral health training for staff was provided primarily by registered nurses, however only 32% reported including identification of dental caries as part of the in-service training. Conclusion: This exploratory study lays the foundation for more extensive research investigating various strategies to improve the oral health of LTCF residents, including increased collaboration between DHs and SNAs. Copyright © 2018 The American Dental Hygienists’ Association.

Accessibility to oral health care for people on social assistance: a survey of social service providers from Public Welfare Centers in Flanders.

PubMed

Verheire, Fee; De Visschere, Luc; Fernandez, Carla; Lambert, Martijn; Marks, Luc

2018-05-09

The goals of the present study were as follows: (i) to explore the characteristics of the Flemish Public Centers for Social Welfare (PCSW) concerning oral health care; (ii) to explore possible barriers experienced by people on social assistance and oral health-care providers; and (iii) to explore the accessibility of general and oral health care for people on social assistance. The data of this cross-sectional study were obtained by a survey of social service providers working in a PCSW. For this purpose, a new questionnaire was developed. The survey was validated by means of a pilot study. All 306 PCSWs in Flanders were invited to participate in this survey, of which 192 (62.7%) responded. The findings demonstrate that for people on social assistance, financial limitations and low prioritisation of oral health are the main barriers to good oral health care. The study reveals that such individuals experience greater financial barriers and poorer access to a dentist than to a general medical practitioner. The study also reveals that dentists report financial concerns and administrative burdens as the main barriers in treating this subgroup. The responses of PCSWs demonstrate that local dentists are reluctant to treat this subgroup. Additional efforts are needed to improve the accessibility of oral health care for people on social assistance. Recommended improvements at the organisational level could improve increased education to target the population on the importance of oral health care. Administrative burden and financial concerns of the providers also need to be addressed to decrease their reluctance to work with those on social assistance. © 2018 FDI World Dental Federation.

Opinions of dentists on the barriers in providing oral health care to community-dwelling frail older people: a questionnaire survey.

PubMed

Bots-VantSpijker, Pieternella C; Bruers, Josef J M; Bots, Casper P; Vanobbergen, Jacques N O; De Visschere, Luc M J; de Baat, Cees; Schols, Jos M G A

2016-06-01

The aim of this study was to investigate to what extent dentists in the Netherlands experience barriers in providing oral health care to community-dwelling older people. As most publications on the barriers in providing oral health care to older people consist of surveys on oral health care in care homes, it was decided to investigate the barriers dentists experience in their own dental practices while providing oral health care to community-dwelling frail older people. A representative sample of 1592 of the approximately 8000 dentists in the Netherlands aged 64 or younger were invited to respond to a questionnaire online. The dentists were asked to respond to 15 opinions concerning oral healthcare provision to community-dwelling frail older people aged 75 years or more who experience problems in physical, psychological and social areas, as well as possible financial problems. The total response rate was 37% (n = 595; male=76%; average age 49). The majority of those who responded agreed that the reimbursement of oral health care to older people is poor. Two thirds of those who responded (66%) agreed that there are limited opportunities to refer the frail and elderly with complex oral healthcare problems to a colleague with specific knowledge and skills. Dentists experienced barriers in two domains; a lack of knowledge and practical circumstances. It was concluded that the dentist's gender, age, year of graduation and the number of patients aged 75 years or more treated weekly were in some respect, related to the barriers encountered. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.

PubMed

Deschepper, Mieke; Waegeman, Willem; Eeckloo, Kristof; Vogelaers, Dirk; Blot, Stijn

2018-05-09

Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population. In this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012-2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme). The study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32-2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51-6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96-2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90-1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2-49.1). These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.

Oral health management considerations for patients with sickle cell disease.

PubMed

Kawar, Nadia; Alrayyes, Sahar; Yang, Bin; Aljewari, Haider

2018-06-01

Sickle cell disease (SCD) can affect many systems in the body including the oral cavity. This necessitates modifications in oral health care management of these patients. The purpose of this paper is to make recommendations for management of SCD patients according to their oral health care needs based on the known findings. Copyright © 2018 Mosby, Inc. All rights reserved.

Oral Health Knowledge, Past Oral Health Behaviors, and Barriers to Preventive Oral Care of Head Start Parents

ERIC Educational Resources Information Center

Knowlden, Adam P.; Hill, Lawrence F.; Alles-White, Monica L.; Cottrell, Randall R.

2012-01-01

Tooth decay remains the most common chronic disease of childhood. The CincySmiles Foundation (CSF) developed an instrument to evaluate Head Start parents' knowledge of oral health care practices and to identify barriers Head Start parents face when seeking dental treatment for their children. Data from Head Start parents (n = 675) across 3…

Oral Health Services within Community-Based Organizations for Young Children with Special Health Care Needs

PubMed Central

Cruz, S; Chi, DL; Huebner, CE

2016-01-01

Purpose To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a non-fluoridated community. Methods Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision. Results We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program. Conclusions Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN. PMID:27028954

Should Dental Schools Train Dentists to Routinely Provide Limited Preventive Primary Medical Care? Two Viewpoints: Viewpoint 1: Dentists Should Be Trained to Routinely Provide Limited Preventive Primary Care and Viewpoint 2: Dentists Should Be Trained in Primary Care Medicine to Enable Comprehensive Patient Management Within Their Scope of Practice.

PubMed

Giddon, Donald B; Donoff, R Bruce; Edwards, Paul C; Goldblatt, Lawrence I

2017-05-01

This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.

Expanding oral care opportunities: direct access care provided by dental hygienists in the United States.

PubMed

Naughton, Doreen K

2014-06-01

Dental hygienists expand access to oral care in the United States. Many Americans have access to oral health care in traditional dental offices however millions of Americans have unmet dental needs. For decades dental hygienists have provided opportunities for un-served and under-served Americans to receive preventive services in a variety of alternate delivery sites, and referral to licensed dentists for dental care needs. Publications, state practice acts, state public health departments, the American Dental Hygienists' Association, and personal interviews of dental hygiene practitioners were accessed for information and statistical data. Dental hygienists in 36 states can legally provide direct access care. Dental hygienists are providing preventive services in a variety of settings to previously un-served and under-served Americans, with referral to dentists for dental needs. Dental hygienists have provided direct access to care in the United States for decades. The exact number of direct access providers in the United States is unknown. Limited research and anecdotal information demonstrate that direct access care has facilitated alternate entry points into the oral health systems for thousands of previously un-served and underserved Americans. Older adults, persons with special needs, children in schools, pregnant women, minority populations, rural populations, and others have benefited from the availability of many services provided by direct access dental hygienists. Legislatures and private groups are becoming increasingly aware of the impact that direct access has made on the delivery of oral health care. Many factors continue to drive the growth of direct access care. Additional research is needed to accumulate qualitative and quantitative outcome data related to direct access care provided by dental hygienists and other mid level providers of oral health services. Copyright © 2014 Elsevier Inc. All rights reserved.

No More Fighting and Biting During Mouth Care: Applying the Theoretical Constructs of Threat Perception to Clinical Practice

PubMed Central

Jablonski, Rita A.; Therrien, Barbara; Kolanowski, Ann

2012-01-01

The purpose of this article is to describe how the neurobiological principles of threat perception and fear response can support clinical approaches to prevent and reduce care-resistant behaviors during mouth care. Nursing home residents who exhibit care-resistant behavior are at risk for poor oral health because daily oral hygiene may not be consistently provided. Poor oral health predisposes these older people to systemic problems such as pneumonia, cerebral vascular accidents, and hyperglycemia. Care-resistant behavior is a fear-evoked response to nurses’ unintentionally threatening behavior during mouth care. Nurses can safely and effectively provide mouth care to persons with dementia who resist care by using personalized combinations of 15 threat reduction strategies. PMID:22216691

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

PubMed Central

Siletz, Anaar E.; Singer, Emily S.; Faltermeier, Claire; Hu, Q. Lina; Ko, Clifford Y.; Golladay, Gregory J.; Kates, Stephen L.; Wick, Elizabeth C.; Maggard-Gibbons, Melinda

2018-01-01

Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients. PMID:29468091

Care and consumption: A Latin American social medicine's conceptual framework to comprehend oral health inequalities.

PubMed

Abadía-Barrero, César Ernesto; Martínez-Parra, Adriana Gisela

2017-10-01

This article offers a conceptual framework that arises out of the Latin American Social Medicine/Collective Health (LASM/CH) tradition to comprehend inequalities in oral health. We conducted a dialogue between the LASM/CH proposal called social determination of health (in particular one of its nuclear categories 'ways of living together') and studies that address social inequalities and oral health. This dialogue allowed us to redefine oral health-disease-treatment as a process that either promotes or harms well-being and is modulated by different ways of living together where not only patients and professionals, but also governments, supranational bodies, and national and international markets represented by food, pharmaceutical, insurance, personal care, and cosmetic companies interact. The article proposes the cycle particular-consumption care/institutional-consumption care as the construct that allows investigators to think about how ways of living together relate to oral health inequalities. 'Particular-consumption care' includes ways and possibilities to access healthy foods and practice protective hygienic measures. 'Institutional-consumption care' refers to institutional responses related to supply, access to services, capabilities for resolution, and pedagogical practices.

When can oral health education begin? Relative effectiveness of three oral health education strategies starting pre-partum.

PubMed

Clifford, H; Johnson, N W; Brown, C; Battistutta, D

2012-06-01

To test the impact of oral health education provided to pregnant mothers on subsequent practices within the infant's family. A quasi-experimental intervention trial comparing the effectiveness of 'usual care' to one, or both, of two oral health education resources: a 'sample bag' of information and oral health care products; and/or a nine-minute "Healthy Teeth for Life" video on postnatal oral health issues. Women attending the midwife clinic at approximately 30 weeks gestation were recruited (n=611) in a public hospital providing free maternity services. Four months after the birth of their infant, relative to the usual care condition, each of the oral health education interventions had independent or combined positive impacts on mother's knowledge of oral health practices. However young, single, health care card-holder or unemployed mothers were less likely to apply healthy behaviours or to improve knowledge of healthy choices, as a result of these interventions. The video intervention provided the strongest and most consistent positive impact on mothers' general and infant oral health knowledge. While mothers indicated that the later stage of pregnancy was a good time to receive oral health education, many suggested that this should also be provided after birth at a time when teeth were a priority issue, such as when "baby teeth" start to erupt.

Oral health needs and barriers to dental care in hospitalized children.

PubMed

Nicopoulos, Martine; Brennan, Michael T; Kent, M Louise; Brickhouse, Tegwyn H; Rogers, Mary K; Fox, Philip C; Lockhart, Peter B

2007-01-01

The goal of this study was to examine the oral health status and utilization of dental care reported by hospitalized children. A bedside oral examination was performed on hospitalized children. Past dental treatment and current oral health needs were assessed. The mean age (+/- SD) of 120 enrolled patients was 6.7 (+/- 2.9) years (range 3 to 12); 60% were males. The age of the patients' first dental office visit was 3.5 +/- 1.8 years, with 28% having never seen a dentist. Unmet oral health needs (e.g., untreated dental caries) were noted in 42% of children, and soft tissue (mucosal) abnormalities in 59% of children. Children with chronic medical conditions reported barriers to receiving dental care more often (24%) than children with acute medical conditions (3.5%) (p=0.04). A high prevalance of unmet oral health needs and soft tissue abnormalities was identified in a hospitalized pediatric population. Children with chronic medical conditions were more likely to experience barriers to obtaining dental care.

Oral manifestations and dental management of a child with Zellweger syndrome.

PubMed

Lertsirivorakul, Jinda; Wongswadiwat, Malinee; Treesuwan, Panta

2014-01-01

Zellweger syndrome (ZS) is a rare autosomal recessive disorder, resulting from an impairment in peroxisome function. It is characterized by craniofacial dysmorphism and neurological abnormalities, and involves several systems, which may complicate dental and anesthesia management. The case of a 7-year-old girl diagnosed with ZS is described with emphasis on oral manifestations, oral rehabilitation under general anesthesia (GA), and home oral care. Apart from the unique features of ZS, she presented with clinodactyly, distinctive palatal vault, Class III malocclusion, missing teeth, microdontia, and delayed dental formation. Dental treatment under GA was conducted with concerns of risk of respiratory insufficiency. Oral home care by the parent and regular recall visits were essential to maintain good oral health. Children with ZS may survive into late childhood. They, however, present multiple health problems that are of special concern for not only the pediatric dentist but also the anesthesiologist. Collaboration with the medical team is essential for optimal care of these patients. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Measuring quality of life in cleft lip and palate patients: currently available patient-reported outcomes measures.

PubMed

Eckstein, Donna A; Wu, Rebecca L; Akinbiyi, Takintope; Silver, Lester; Taub, Peter J

2011-11-01

Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons. The authors performed a literature review to identify questionnaires validated in cleft lip and palate patients. Qualifying instruments were assessed for adherence to guidelines for development and validation by the scientific advisory committee and for content. The authors identified 44 measures used in cleft lip and palate studies. After 15 ad hoc questionnaires, eight generic instruments, 11 psychiatric instruments, and one non-English language questionnaire were excluded, nine measures remained. Of these, four were never validated in the cleft population. Analysis revealed one craniofacial-specific measure (Youth Quality of Life-Facial Differences), two voice-related measures (Patient Voice-Related Quality of Life and Cleft Audit Protocol for Speech-Augmented), and two oral health-related measures (Child Oral Health Impact Profile and Child Oral Health Quality of Life). The Youth Quality of Life-Facial Differences, Child Oral Health Impact Profile, and Child Oral Health Quality of Life questionnaires were sufficiently validated. None was created specifically for clefts, resulting in content limitations. There is a lack of comprehensive, valid, and reliable questionnaires for cleft lip and palate surgery. For thorough assessment of satisfaction, further research to develop and validate cleft lip and palate surgery-specific instruments is needed.

Protocol-based care: the standardisation of decision-making?

PubMed

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

PubMed Central

Scherer, Charleni Inês; Scherer, Magda Duarte dos Anjos

2016-01-01

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities. PMID:26815162

Oral health care utilization in children with disabilities.

PubMed

Leroy, Roos; Declerck, Dominique

2013-11-01

The objectives of this report were to survey the utilization of oral health care in children and adolescents with disabilities over a 7-year period and to compare these data with the utilization pattern of their peers without disabilities. For most countries, these data have not been published in the international literature so far. The cohort used was the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents. The database comprised prospective data on oral and general health care utilization and sociodemographic variables collected from 2002 up to 2008. Data were available from 326 children and adolescents with and 53,589 without disabilities. Dental attendance rates were low in both subgroups: only 50 % had a dental visit in four or more of the seven observation years. Emergency oral and medical care was recorded significantly more often in children with disabilities whereas radiographs, restorations, and orthodontic assessments and treatments more frequently in children without disabilities. The present study demonstrated that dental attendance rates in both subgroups were low and that in those who attended, preventive oral health care was only infrequently attested. Further research is needed to elucidate whether the lower number of radiographs and restorations and the higher number of emergency visits observed in the subgroup with disabilities reflect unmet oral treatment needs. Objective data on health care utilization are essential to enable governments and stakeholders to devise appropriate care and to optimize access to care for persons with disabilities.

Vietnamese Oral Health Beliefs and Practices: Impact on the Utilization of Western Preventive Oral Health Care.

PubMed

Nguyen, Kim Yen T; Smallidge, Dianne L; Boyd, Linda D; Rainchuso, Lori

2017-02-01

Purpose: Infrequent use of the Western health care by the Vietnamese may be explained by deeply-rooted traditional oral health beliefs and practices unique to the Asian culture. This study investigated Vietnamese oral health beliefs and practices and their relationship to the utilization of Western preventive oral health care services among Vietnamese-Americans. Methods: An exploratory, cross-sectional survey design with a convenience sample of 140 par-ticipants (n = 140) was used for this study. Participants were recruited on site of a Vietnamese-owned business, with questionnaires consisting of 28 questions that were distributed in hard copy by the principal investigator (PI) on multiple occasions and at various times of the day. Results: Spearman Rank Correlations tests showed participants who agreed with the statement, "Regular dental visits will help prevent dental problems," were more likely to utilize medical health services (p< 0.05) and visit a dentist if their "gums were bleeding" (p< 0.05). However, only 22.86% of the participants would visit a dentist if experiencing a toothache. Despite results showing a strong association between the use of medical health care services and the belief that dental visits can prevent future dental health problems, participants did not believe in seeking Western oral health care for all dental health issues. No statistical significance was found between age, gender, pri-mary language, years spent in the United States, education level, religion and the Vietnamese survey participants' individual oral beliefs and practices. Conclusion: The results suggest that Vietnamese Americans holding the belief that dental visits help prevent oral health problems, were more likely to utilize Western health care services. The study also supports existing literature that Vietnamese oral health beliefs and practices impact the use of Western health care services. Copyright © 2017 The American Dental Hygienists’ Association.

Oral health matters for the nutritional status of older persons-A population-based study.

PubMed

Lindmark, Ulrika; Jansson, Henrik; Lannering, Christina; Johansson, Linda

2018-03-01

To explore the association between oral health and nutritional status in the context of daily care for older people. Oral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people. A retrospective cross-sectional study. Data from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide-Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8 ± 7.9) had both oral and nutritional assessments registered by the nursing staff in daily care. Approximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one-third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished. There is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems. Nursing staff involved in care for older people should be aware of the importance of including regular oral health check-ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge. © 2017 John Wiley & Sons Ltd.

Theoretical and hands-on guidance from dental hygienists promotes good oral health in elderly people living in nursing homes, a pilot study.

PubMed

Seleskog, B; Lindqvist, L; Wårdh, I; Engström, A; von Bültzingslöwen, I

2018-04-12

Oral health in nursing homes for elderly is often unsatisfactory, and oral health education to nursing staff has not shown sufficient results why there is need for novel approaches. The aim of the study was to trial a new oral healthcare educational programme and to evaluate the effects on residents' oral health. In addition, attitudes among the nursing staff in the intervention nursing home were explored. In a controlled clinical trial, two comparable nursing homes were randomly assigned for intervention or control. Interventions included weekly theoretical and hands-on guidance from dental hygienists on oral hygiene procedures and discussions on oral care routines. The residents' oral health, measured by the Revised Oral Assessment Guide (ROAG), dental plaque and gingival bleeding were evaluated at baseline and after 3 months. Attitudes among the staff to oral health care were measured at the intervention nursing home. Revised Oral Assessment Guide gums and lips scores showed a tendency to decrease in the intervention group, but remained high in the control group. Plaque levels improved significantly after intervention, and a trend towards less gingival bleeding was observed. The intervention nursing staff seemed to be more aware of their own limitations concerning oral health care after intervention and valued more frequent contact with dental services to a greater extent. The oral healthcare situation for elderly people today is so complex that theoretical education at the group level regarding different aspects of oral health is not sufficient. Individual hands-on guidance by dental hygienists on a regular basis in everyday care may be a new approach. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effectiveness of a caregiver education program on providing oral care to individuals with intellectual and developmental disabilities.

PubMed

Fickert, Nancy A; Ross, Diana

2012-06-01

Caregivers who work in community living arrangements or intermediate care facilities are responsible for the oral hygiene of individuals with intellectual and developmental disabilities. Oral hygiene training programs do not exist in many organizations, despite concerns about the oral care of this population. The purpose of this study was to determine the effectiveness of a caregiver educational program. This study used a quasi-experimental one-group pretest/posttest design with repeated measures to describe the outcomes of an educational program. Program participants demonstrated oral hygiene skills on each other while being scored by a trained observer, after which they completed an oral hygiene compliance survey. After three months, a follow-up included the same posttest, demonstration of oral hygiene skills, and repeat of the compliance survey. Paired-sample t-tests of oral hygiene knowledge showed a statistically significant improvement from pretest to posttest and from pretest to three-month posttest. Oral hygiene skills and compliance improved. Results demonstrate evidence that caregiver education improves knowledge, skill, and compliance in oral hygiene. Further studies are required to demonstrate the value of providing oral hygiene education and training for caregivers of individuals with intellectual and developmental disabilities.

Predictors of the utilization of oral health services by children of low-income families in the United States: beliefs, cost, or provider?

PubMed

Kim, Young Ok Rhee; Telleen, Sharon

2004-12-01

This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on weekends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.

[Preoperative fluid management contributes to the prevention of intraoperative hypothermia].

PubMed

Yatabe, Tomoaki; Yokoyama, Masataka

2011-07-01

Intraoperative hypothermia causes several unfavorable events such as surgical site infection and cardiovascular events. Therefore, during anesthesia, temperature is routinely regulated, mainly by using external heating devices. Recently, oral amino acid intake and intravenous amino acid or fructose infusion have been reported to prevent intraoperative hypothermia during general and regional anesthesia. Diet (nutrient)-induced thermogenesis is considered to help prevent intraoperative hypothermia. Since the Enhanced Recovery After Surgery (ERAS) protocol has been introduced, it has been used in perioperative management in many hospitals. Prevention of intraoperative hypothermia is included in this protocol. According to the protocol, anesthesiologists play an important role in both intraoperative and perioperative management. Management of optimal body temperature by preoperative fluid management alone may be difficult. To this end, preoperative fluid management and nutrient management strategies such as preoperative oral fluid intake and carbohydrate loading have the potential to contribute to the prevention of intraoperative hypothermia.

Protocolized treatment is associated with decreased organ dysfunction in pediatric severe sepsis

PubMed Central

Balamuth, Fran; Weiss, Scott L.; Fitzgerald, Julie C.; Hayes, Katie; Centkowski, Sierra; Chilutti, Marianne; Grundmeier, Robert W.; Lavelle, Jane; Alpern, Elizabeth R.

2016-01-01

Objective To determine whether treatment with a protocolized sepsis guideline in the emergency department (ED) was associated with a lower burden of organ dysfunction (OD) by hospital day 2 compared to non-protocolized usual care in pediatric patients with severe sepsis. Design Retrospective cohort study Setting Tertiary care children’s hospital from January 1, 2012–March 31, 2014. Measurements and Main Results Subjects with international consensus defined severe sepsis and pediatric intensive care unit (PICU) admission within 24 hours of ED arrival were included. The exposure was the use of a protocolized ED sepsis guideline. The primary outcome was complete resolution of OD by hospital day 2. One hundred eighty nine subjects were identified during the study period. Of these, 121 (64%) were treated with the protocolized ED guideline and 68 were not. There were no significant differences between the groups in age, sex, race, number of comorbid conditions, ED triage level, or OD on arrival to the ED. Patients treated with protocolized ED care were more likely to be free of OD on hospital day 2 after controlling for sex, comorbid condition, indwelling central venous catheter, PIM-2 score, and timing of antibiotics and intravenous fluids (adjusted OR 4.2, 95% CI 1.7, 10.4). Conclusions Use of a protocolized ED sepsis guideline was independently associated with resolution of OD by hospital day 2 compared to non-protocolized usual care. These data indicate that morbidity outcomes in children can be improved with the use of protocolized care. PMID:27455114

Oral Health Care for Children in Countries Using Dental Therapists in Public, School-Based Programs, Contrasted with That of the United States, Using Dentists in a Private Practice Model

PubMed Central

Friedman, Jay W.; Nash, David A.

2013-01-01

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children’s access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, “A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States.” We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices. PMID:23865650

People living with HIV /AIDS (PLWHA) and HIV/AIDS associated oral lesions; a study in Malaysia

PubMed Central

2012-01-01

Background The continuous increase in number of people living with HIV/AIDS (PLWHA) represents a serious health and economic burden. HIV positive individuals with oral lesions have significantly lower oral health-related quality of life than HIV positive individuals without oral lesions. The objective of this study was to assess the knowledge, attitude and practices (KAP) within a cohort of HIV/AIDS positive patients towards HIV/AIDS associated oral lesions. Methods Two hundred seventy patients attending a national referral hospital of infectious disease in Malaysia were recruited for the study. The study involved the administration of a validated interview-based questionnaire designed to elicit knowledge, attitude and practices of these patients towards HIV associated oral lesions. The last part of the questionnaire assessed the training provided to the patients in relation to the oral lesions associated with the disease and the effectiveness of this training. Data analysis was carried out using SPSS version 18. Results Thirty seven percent of patients were reported as knowledgeable, while sixty four percent reported to have positive attitude towards the care of oral hygiene. Sixty six percent of the patients reported that they would seek professional care when experiencing oral lesion. Training was reported effective for 93% patients. Conclusions Patients were non-knowledgeable in relation to oral manifestations of the disease and one third of the participating patients showed negative attitudes towards oral health care and reported various measures to manage oral lesions rather than seeking professional care. Developing effective educational methodologies can empower patients with knowledge that may translate to positive attitudes and practices. PMID:23043358

Protocolized fluid therapy in brain-dead donors: The multi-center randomized MOnIToR trial

PubMed Central

Al-Khafaji, Ali; Elder, Michele; Lebovitz, Daniel J; Murugan, Raghavan; Souter, Michael; Stuart, Susan; Wahed, Abdus S.; Keebler, Ben; Dils, Dorrie; Mitchell, Stephanie; Shutterly, Kurt; Wilkerson, Dawn; Pearse, Rupert; Kellum, John A

2015-01-01

BACKGROUND Critical shortages of organs for transplantation jeopardize many lives. Observational data suggest that better fluid management for deceased organ donors could increase organ recovery. We conducted the first large multi-center randomized trial in brain-dead donors to determine whether protocolized fluid therapy increases organs transplanted. METHODS We randomly assigned donors to either protocolized or usual care in eight organ procurement organizations. A “protocol-guided fluid therapy” algorithm targeting cardiac index, mean arterial pressure and pulse pressure variation was used. Our primary outcome was the number of organs transplanted per donor and our primary analysis was intention-to-treat. Secondary analyses included: 1) modified intention-to-treat where only subjects able to receive the intervention were included, and 2) twelve-month survival in transplant recipients. The study was stopped early. RESULTS We enrolled 556 donors; 279 protocolized care, 277 usual care. Groups had similar characteristics at baseline. The study protocol could be implemented in 76% of subjects randomized to the intervention. There was no significant difference in mean number of organs transplanted per donor: 3.39 organs per donor, (95%CI: 3.14-3.63) with protocolized care, compared to usual care 3.29 (95%CI: 3.04-3.54) (mean difference, 0.1, 95%CI: -0.25 to 0.45; p=0.56). In modified intention-to-treat analysis the mean number of organs increased (3.52 organs per donor, 95%CI: 3.23-3.8) but was not statistically significant (mean difference, 0.23, 95%CI: -0.15-0.61; p=0.23). Among the 1430 recipients of organs from study subjects, with data available, 56 deaths (7.8%) occurred in the protocolized care arm and 56 (7.9%) in the usual care arm in the first year (Hazard Ratio: 0.97, p=0.86). CONCLUSIONS In brain-dead organ donors, protocol-guided fluid therapy compared to usual care may not increase the number of organs transplanted per donor. PMID:25583616

Receipt of preventive oral health care by U.S. children: a population-based study of the 2005-2008 medical expenditure panel surveys.

PubMed

Huebner, Colleen E; Bell, Janice F; Reed, Sarah C

2013-11-01

This study provides estimates of the annual use of preventive oral health care by U.S. children ages 6 months-17 years. We estimated the annual use of preventive oral health care with data from the Medical Expenditure Panel Survey for the years 2005 through 2008 (n = 18,218). Additionally, we tested associations between use of preventive oral health care and predisposing factors, enabling factors and health need within three age groups: young children, school-age children and youth. Overall, 21 % of the sample was reported to have received preventive oral health care in the prior year. More school-age children received preventive care than did young children or youth regardless of gender, race/ethnicity, health status, residence, or family size. Among the youngest children, low parental education and lack of health insurance were associated with lower odds of receiving preventive care. School-age children of racial and ethnic minority groups had a higher odds of receiving preventive care than did non-Hispanic Whites. Youth with special health care needs were less likely to receive care than their peers. Within each age group, use of preventive care increased significantly from 2005 to 2008. In the U.S. there has been an increase in use of pediatric preventive dental care. Continued effort is needed to achieve primary prevention. Outreach and education should include all parents and especially parents with low levels of education, parents of children with special health care needs and those without health insurance.

Comprehensive Oral Health Care to Reduce the Incidence of Severe Early Childhood Caries (s-ECC) in Urban China.

PubMed

Si, Yan; Guo, Yan; Yuan, Chao; Xu, Tao; Zheng, Shu Guo

2016-03-01

To explore the effectiveness of comprehensive oral health care to reduce the caries incidence for children with severe early childhood caries (s-ECC) in an urban area in China. A total of 357 children aged 3 to 4 years old and diagnosed with s-ECC were recruited in this randomised controlled, single-blinded clinical trial for 1 year. Children of two different kindergarten classes were enrolled in this study and randomly divided into a test group (205 children) and a control group (152 children). The test group received comprehensive oral health care, which included: oral health examination, oral health education, topical fluoride application and dental treatment, and the children in the control group only received the oral health examination. The evaluation of the oral health questionnaire for parents was also performed. An evaluation was carried out at the time of recruitment and 1 year later to explore the effectiveness of the comprehensive oral health care model. The differences in decayed teeth (dt), decayed tooth surfaces (ds), filled teeth (ft), filled tooth surfaces (fs) and the ratio of ft /(dt + ft) between the two groups were statistically significant (P < 0.001) at 1 year. The incidence of caries in the control group was higher than that of the test group (P = 0.02). The rate of awareness of oral health knowledge (P = 0.01) and the practice of good diet habits (P = 0.02) by parents in the test group were significantly higher than those in the control group. The present study demonstrated that the comprehensive oral health care program reduces and prevents caries amongst children with s-ECC.

Social inequalities in oral health and in use of oral health care services among adolescents in Uganda.

PubMed

Okullo, I; Astrøm, A N; Haugejorden, O

2004-09-01

The aim of this study was to describe clinical and self-perceived indicators of oral health status and the use of oral health care services by social and demographic characteristics. In 2001, a cross-sectional random sample survey was conducted in urban and rural settings in Uganda (Kampala and Lira, respectively), and 1146 secondary school students with a mean age of 15.8 years completed questionnaires in school. Dental caries was recorded by one examiner on a random subsample of 372 students. Logistic regression analyses revealed that being an urban resident was associated with higher odds for having dental caries (dmft > 0), seeking care because of toothache (delayed treatment demand) and being dissatisfied with one's own oral health status [adjusted odds ratio (OR) = 1.5-2.1]. Being an urban resident was associated with lower odds for oral health care attendance generally and for having missing teeth in particular (adjusted OR = 0.6-0.4). Students who had parents with a higher education and those with weak social ties were, respectively, less and more likely to be dissatisfied with their oral health status. As compared to caries-free participants, the odds for being dissatisfied with oral health and delayed treatment demand increased significantly with an increasing dmft score (adjusted OR = 2.1-3.2). Urban students were most likely to have a dmft > 0 and to rate their oral health status negatively. Having received dental care and the prevalence of missing teeth, and delayed treatment demand were, respectively, most and least prevalent among rural students. Dental caries at different diagnostic cut-off points and weak social ties affected self-reported oral health negatively, independently of social and demographic characteristics. Copyright 2004 BSPD and IAPD

Geriatric dentistry and prevention: research and public policy.

PubMed

Gershen, J A

1991-12-01

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral disease. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey

PubMed Central

Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos

2017-01-01

Background: Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Methods: Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Results: Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Interpretation: Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers. PMID:28401141

Laser phototherapy as topical prophylaxis against head and neck cancer radiotherapy-induced oral mucositis: comparison between low and high/low power lasers.

PubMed

Simões, Alyne; Eduardo, Fernanda P; Luiz, Ana Claudia; Campos, Luana; Sá, Pedro Henrique R N; Cristófaro, Márcio; Marques, Márcia M; Eduardo, Carlos P

2009-04-01

Oral mucositis is a dose-limiting and painful side effect of radiotherapy (RT) and/or chemotherapy in cancer patients. The purpose of the present study was to analyze the effect of different protocols of laser phototherapy (LPT) on the grade of mucositis and degree of pain in patients under RT. Thirty-nine patients were divided into three groups: G1, where the irradiations were done three times a week using low power laser; G2, where combined high and low power lasers were used three time a week; and G3, where patients received low power laser irradiation once a week. The low power LPT was done using an InGaAlP laser (660 nm/40 mW/6 J cm(-2)/0.24 J per point). In the combined protocol, the high power LPT was done using a GaAlAs laser (808 nm, 1 W/cm(2)). Oral mucositis was assessed at each LPT session in accordance to the oral-mucositis scale of the National Institute of the Cancer-Common Toxicity criteria (NIC-CTC). The patient self-assessed pain was measured by means of the visual analogue scale. All protocols of LPT led to the maintenance of oral mucositis scores in the same levels until the last RT session. Moreover, LPT three times a week also maintained the pain levels. However, the patients submitted to the once a week LPT had significant pain increase; and the association of low/high LPT led to increased healing time. These findings are desired when dealing with oncologic patients under RT avoiding unplanned radiation treatment breaks and additional hospital costs.

Oral paracetamol versus oral ibuprofen for closure of haemodynamically significant patent ductus arteriosus in preterm neonates (<32 weeks): a blinded, randomised, active-controlled, non-inferiority trial

PubMed Central

Kumar, Ashutosh; Sundaram, Venkataseshan; Yadav, Rahul; Oleti, Tejo Pratap; Murki, Srinivas; Krishna, Arun; Sundaram, Mangalabharathi; Saini, Shiv Sajan; Dutta, Sourabh

2017-01-01

Introduction Haemodynamically significant patent ductus arteriosus (hsPDA) is a common cause of mortality and morbidity in preterm infants. Existing medical therapies with ibuprofen or indomethacin have multiple adverse effects. Hence, an alternative drug like paracetamol given through oral route with less side effects need to be tested in an appropriate study design with least risk of bias to arrive at a conclusion. Methods and analysis Multisite, randomised, active-controlled, non-inferiority design. The primary objective is to study the efficacy of oral paracetamol for closure of hsPDA in comparison to oral ibuprofen in preterm neonates of <32 weeks’ gestation. Randomisation web-based and allocation concealment would be done; the treating team, investigators, outcome assessors and laboratory personnel would be blinded from the intervention. Echocardiography images would be coded for independent review. Closure of PDA by the end of last dose of study drug or earlier would be the study endpoint. A sample size of 196 neonates would be enrolled with a non-inferiority margin of 15%. Both intention-to-treat and per-protocol analysis will be done to assess the effect of contamination and protocol violations in the primary outcome. Ethics and dissemination The trial would follow international code of ethics for clinical trial. The trial protocol was approved by the Institute Ethics Committee of all three centres. All serious adverse events would be reported in detail to the Institute Ethics Committee. A written informed consent would be obtained from one of the parents. No plan has been made for dissemination. Trial registration number CTRI/2014/08/004805. PMID:29637155

Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.

PubMed

Maturo, Donna; Powell, Alexis; Major-Wilson, Hannah; Sanchez, Kenia; De Santis, Joseph P; Friedman, Lawrence B

2015-01-01

Advances in care and treatment of adolescents/young adults with HIV infection have made survival into adulthood possible, requiring transition to adult care. Researchers have documented that the transition process is challenging for adolescents/young adults. To ensure successful transition, a formal transition protocol is needed. Despite existing research, little quantitative evaluation of the transition process has been conducted. The purpose of the study was to pilot test the "Movin' Out" Transitioning Protocol, a formalized protocol developed to assist transition to adult care. A retrospective medical/nursing record review was conducted with 38 clients enrolled in the "Movin' Out" Transitioning Protocol at a university-based adolescent medicine clinic providing care to adolescents/young adults with HIV infection. Almost half of the participants were able to successfully transition to adult care. Reasons for failure to transition included relocation, attrition, lost to follow-up, and transfer to another adult service. Failure to transition to adult care was not related to adherence issues, X(2) (1, N=38)=2.49, p=.288; substance use, X(2) (1, N=38)=1.71, p=.474; mental health issues, X(2) (1, N=38)=2.23, p=.322; or pregnancy/childrearing, X(2) (1, N=38)=0.00, p=.627). Despite the small sample size, the "Movin' Out" Transitioning Protocol appears to be useful in guiding the transition process of adolescents/young adults with HIV infection to adult care. More research is needed with a larger sample to fully evaluate the "Movin' Out" Transitioning Protocol. Copyright © 2015 Elsevier Inc. All rights reserved.

A Curriculum for the New Dental Practitioner: Preparing Dentists for a Prospective Oral Health Care Environment

PubMed Central

Polverini, Peter J.

2012-01-01

The emerging concept of prospective health care would shift the focus of health care from disease management to disease prevention and health management. Dentistry has a unique opportunity to embrace this model of prospective and collaborative care and focus on the management of oral health. Academic dentistry must better prepare future dentists to succeed in this new health care environment by providing them with the scientific and technical knowledge required to understand and assess risk and practice disease prevention. Dental schools must consider creating career pathways for enabling future graduates to assume important leadership roles that will advance a prospective oral health care system. PMID:22390456

HIV patient retention: the implementation of a North Carolina clinic-based protocol.

PubMed

Keller, Jennifer; Heine, Amy; LeViere, Anna Finestone; Donovan, Jenna; Wilkin, Aimee; Sullivan, Kristen; Quinlivan, Evelyn Byrd

2017-05-01

Decreased visit attendance leads to poor health outcomes, decreased viral suppression, and higher mortality rates for persons living with HIV. Retention in care is an important factor in improving health status for people living with HIV but continues to be a challenge in clinical settings. This paper details the development and implementation of the NC-LINK Retention Protocol, a clinic-based protocol to locate and reengage out-of-care patients, as part of overall clinic retention efforts. The protocol was implemented as one of four interventions of the NC-LINK Systems and Linkages Project, a multi-site initiative funded by the HIV/AIDS Bureau and the Special Projects of National Significance. Lists of out-of-care patients who had not received HIV medical care in over nine months and did not have a future appointment were created each month. Patient navigators, case managers, and other staff then followed a standardized protocol to locate and reengage these patients in care. A total of 452 patients were identified for reengagement services. Of those, 194 (43%) returned to care, 108 (24%) had another definitive outcome (incarcerated, deceased, or relocated) and 150 (33%) were referred for additional follow-up to locate and reengage in care. In summary, 67% of patients were located through the efforts of the clinic staff. The results of this intervention indicate that it is possible to successfully integrate a protocol into the existing infrastructure of a clinic and reengage a majority of out-of-care patients into medical care.

Merging video coaching and an anthropologic approach to understand health care provider behavior toward hand hygiene protocols.

PubMed

Boudjema, Sophia; Tarantini, Clément; Peretti-Watel, Patrick; Brouqui, Philippe

2017-05-01

We used videorecordings of routine care to analyze health care providers' deviance from protocols and organized follow-up interviews that were conducted by an anthropologist and a nurse. After consent, health care workers were recorded during routine care by an automatic video remote control. Each participant was invited to watch her or his recorded behaviors on 2 different videos showing routine practices and her or his deviance from protocols, and to comment on them. After this step an in-depth interview based on preestablished guidelines was organized and explanations regarding the observed deviance was discussed. This design was intended to reveal the HCWs' subjectivity; that is, how they perceive hand hygiene issues in their daily routine, what concrete difficulties they face, and how they try to resolve them. We selected 43 of 250 videorecordings created during the study, which allowed us to study 15 out of 20 health care professionals. Twenty out of 43 videos showed 1 or more breaches in the hand hygiene protocol. The breaches were frequently linked to glove abuse. Deviance from protocols was explained by the health care workers as the result of an adaptive behavior; that is, facing work constraints that were disconnected from infection control protocols. Professional practices and protocols should be revisited to create simple messages that are adapted to the mandatory needs in a real life clinic environment. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

“Everybody Brush!”: Protocol for a Parallel-Group Randomized Controlled Trial of a Family-Focused Primary Prevention Program With Distribution of Oral Hygiene Products and Education to Increase Frequency of Toothbrushing

PubMed Central

2015-01-01

Background Twice daily toothbrushing with fluoridated toothpaste is the most widely advocated preventive strategy for dental caries (tooth decay) and is recommended by professional dental associations. Not all parents, children, or adolescents follow this recommendation. This protocol describes the methods for the implementation and evaluation of a quality improvement health promotion program. Objective The objective of the study is to show a theory-informed, evidence-based program to improve twice daily toothbrushing and oral health-related quality of life that may reduce dental caries, dental treatment need, and costs. Methods The design is a parallel-group, pragmatic randomized controlled trial. Families of Medicaid-insured children and adolescents within a large dental care organization in central Oregon will participate in the trial (n=21,743). Families will be assigned to one of three groups: a test intervention, an active control, or a passive control condition. The intervention aims to address barriers and support for twice-daily toothbrushing. Families in the test condition will receive toothpaste and toothbrushes by mail for all family members every three months. In addition, they will receive education and social support to encourage toothbrushing via postcards, recorded telephone messages, and an optional participant-initiated telephone helpline. Families in the active control condition will receive the kit of supplies by mail, but no additional instructional information or telephone support. Families assigned to the passive control will be on a waiting list. The primary outcomes are restorative dental care received and, only for children younger than 36 months old at baseline, the frequency of twice-daily toothbrushing. Data will be collected through dental claims records and, for children younger than 36 months old at baseline, parent interviews and clinical exams. Results Enrollment of participants and baseline interviews have been completed. Final results are expected in early summer, 2017. Conclusions If proven effective, this simple intervention can be sustained by the dental care organization and replicated by other organizations and government. Trial Registration Trial Registration: ClinicalTrials.gov NCT02327507; http://clinicaltrials.gov/ct2/show/NCT02327507 (Archived by WebCite at http://www.webcitation.org/6YCIxJSor). PMID:26002091

New Mexico community voices: policy reform to reduce oral health disparities.

PubMed

Powell, Wayne; Hollis, Christine; de la Rosa, Mario; Helitzer, Deborah L; Derksen, Daniel

2006-02-01

Using a socio-ecological framework to guide the initiative, New Mexico Community Voices developed, with state and local stakeholders, responsive oral health policies to address oral health disparities. Several policy objectives were achieved: increasing awareness of the public health importance of oral health; improving access to dental services for uninsured or underserved populations; enhancing dental services specialty care; and increasing sustainable oral health infrastructure through pipeline development of oral health providers to relieve service shortages and diversify the oral health workforce. Improving access to oral health and augmenting numbers of dental providers in rural areas were also successful. The governor has appointed the New Mexico Oral Health Advisory Council to address state oral health issues. The New Mexico partnerships have demonstrated how effective policy change can generate important incremental shifts in oral health care delivery and provide best practice models that diminish the oral health crisis faced by underserved populations.

The impact of integration of dental services on oral health in long-term care: qualitative analysis.

PubMed

Finkleman, Gary I; Lawrence, Herenia P; Glogauer, Michael

2012-06-01

To qualitatively analyse how integration of dental service in long-term care (LTC) impacts residents and their oral health. Few studies have attempted to merge inductive and deductive data to clarify the significance of the complex psychosocial environment in LTC facilities. Understanding the subjective oral health experience of LTC residents in their social setting is key to uncovering behavioural patterns that may be limiting the oral care provided to LTC residents. A cross-sectional study was performed involving 61 residents in three Ontario LTC facilities. Observations and reflective notes were recorded during open-ended interviews using a structured questionnaire to stimulate conversation topics. This ensured that each resident received the same prompting during the interview process. Inductive analysis was used to identify common patterns and themes within field notes and transcriptions. The major themes identified included oral hygiene, oral discomfort, general health, appearance, dental access, and denture related issues. Oral hygiene and discomfort were the dominating categories within the facilities. Two of the three LTC centres identified in this study failed to provide appropriate oral care for their residents. Future research needs to be directed at prospective studies assessing the effect of oral health education and mandatory dental examinations o entry within LTC centres utilising qualitative and quantitative analyses. © 2010 The Gerodontology Society and John Wiley & Sons A/S.

A Quality Improvement System to Manage Feeding Assistance Care in Assisted-Living.

PubMed

Simmons, Sandra F; Coelho, Chris S; Sandler, Andrew; Schnelle, John F

2018-03-01

To describe a feasible quality improvement system to manage feeding assistance care processes in an assisted living facility (ALF) that provides dementia care and the use of these data to maintain the quality of daily care provision and prevent unintentional weight loss. Supervisory ALF staff used a standardized observational protocol to assess feeding assistance care quality during and between meals for 12 consecutive months for 53 residents receiving dementia care. Direct care staff received feedback about the quality of assistance and consistency of between-meal snack delivery for residents with low meal intake and/or weight loss. On average, 78.4% of the ALF residents consumed more than one-half of each served meal and/or received staff assistance during meals to promote consumption over the 12 months. An average of 79.7% of the residents were offered snacks between meals twice per day. The prevalence of unintentional weight loss averaged 1.3% across 12 months. A quality improvement system resulted in sustained levels of mealtime feeding assistance and between-meal snack delivery and a low prevalence of weight loss among ALF residents receiving dementia care. Given that many ALF residents receiving dementia care are likely to be at risk for low oral intake and unintentional weight loss, ALFs should implement a quality improvement system similar to that described in this project, despite the absence of regulations to do so. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy.

PubMed

McCaul, Lorna K

2012-03-01

The incidence of head and neck cancer is rising. The attendant oral complications of cancer management make oral health maintenance a lifelong challenge for these patients. Holistic management in the context of a core multidisciplinary team is essential in optimizing outcomes. Predicting the risk of adverse oral outcomes is difficult. Effective communication between healthcare professionals in the core and extended teams and with the patient is essential. Primary care dental teams will be involved in the long-term management of oral care for head and cancer patients. A broad understanding of the management of head and neck cancer, consequences of treatment and the need for good communication is key to good quality patient care.

Rationale for the prevention of oral diseases in primary health care: an international collaborative study in oral health education.

PubMed

Bourgeois, Denis M; Phantumvanit, Prathip; Llodra, Juan Carlos; Horn, Virginie; Carlile, Monica; Eiselé, Jean-Luc

2014-10-01

Ensuring that members of society are healthy and reaching their full potential requires the prevention of oral diseases through the promotion of oral health and well-being. The present article identifies the best policy conditions of effective public health and primary care integration and the actors who promote and sustain these efforts. In this review, arguments and recommendations are provided to introduce an oral health collaborative promotion programme called Live.Learn.Laugh. phase 2, arising from an unique partnership between FDI World Dental Federation, the global company Unilever plc and an international network of National Dental Associations, health-care centres, schools and educators populations. © 2014 FDI World Dental Federation.

Outbreak of drug-resistant Acinetobacter baumannii ST219 caused by oral care using tap water from contaminated hand hygiene sinks as a reservoir.

PubMed

Umezawa, Kazuo; Asai, Satomi; Ohshima, Toshio; Iwashita, Hideo; Ohashi, Maya; Sasaki, Mika; Kaneko, Akihiro; Inokuchi, Sadaki; Miyachi, Hayato

2015-11-01

An outbreak of amikacin- and ciprofloxacin-resistant Acinetobacter baumannii ST219 in Tokai University hospital's emergency intensive care unit was caused by its colonization in water systems and subsequent spread through oral care using tap water. The outbreak was successfully controlled after replacement of the water system and implementation as of daily cleaning of water taps and oral care with a dry method. It is important to strictly manage the water system in critical care areas. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Health behavior models and oral health: a review.

PubMed

Hollister, M Catherine; Anema, Marion G

2004-01-01

Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner. Research regarding health behavior has explored the effectiveness and applicability of various health models in oral health behavior modification. The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health. This paper describes health behavior models that have been applied to oral health education, presents a critical analysis of the effectiveness of each model in oral health education, and provides examples of application to oral health education.

Oral hygiene practices and dental service utilization among pregnant women.

PubMed

Boggess, Kim A; Urlaub, Diana M; Massey, Katie E; Moos, Merry-K; Matheson, Matthew B; Lorenz, Carol

2010-05-01

Daily oral hygiene and regular dental visits are important components of oral health care. The authors' objective in this study was to examine women's oral hygiene practices and use of dental services during pregnancy. The authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic information, as well as data on oral hygiene practices and use of dental services during pregnancy. They used chi2 and multivariable logistic regression models to assess associations between oral hygiene practice and dental service use during pregnancy and to identify maternal predictor variables. Of the 599 participants, 83 percent (n=497) reported brushing once or twice per day. Twenty-four percent (n=141) reported flossing at least once daily; Hispanic women were more likely to floss than were white or African American women (28 percent [52 of 183] versus 22 percent [54 of 248] versus 19 percent [23 of 121], respectively, P<.001). Seventy-four percent (n=442) of the participants reported having received no routine dental care during pregnancy. Hispanic women were significantly less likely than were black or white women to receive routine dental care during pregnancy (13 percent versus 21 percent versus 36 percent, respectively, P<.001). The authors found that being older than 36 years, being of Hispanic race or ethnicity, having an annual income of less than $30,000, flossing infrequently and receiving no dental care when not pregnant were significantly associated with lack of routine dental care during pregnancy (adjusted odds ratios, 95 percent confidence intervals: 2.56 [1.33-4.92]; 2.19 [1.11-4.29]; 2.02 [1.12-3.65]; 1.86 [1.13-3.07]; and 4.35 [2.5-7.69], respectively). A woman's lack of receiving routine dental care when not pregnant was the most significant predictor of lack of receiving dental care during pregnancy. Racial, ethnic and economic disparities related to oral hygiene practices and dental service utilization during pregnancy exist. Medical and dental care providers who treat women of reproductive age and pregnant women need to develop policy strategies to address this population's access barriers to, and use of, dental care services.

Efficacy and Safety of Available Protocols for Aspirin Hypersensitivity for Patients Undergoing Percutaneous Coronary Intervention: A Survey and Systematic Review.

PubMed

Bianco, Matteo; Bernardi, Alessandro; D'Ascenzo, Fabrizio; Cerrato, Enrico; Omedè, Pierluigi; Montefusco, Antonio; DiNicolantonio, James J; Zoccai, Giuseppe Biondi; Varbella, Ferdinando; Carini, Giovanni; Moretti, Claudio; Pozzi, Roberto; Gaita, Fiorenzo

2016-01-01

The most suitable approach for patients with aspirin hypersensitivity undergoing percutaneous coronary intervention remains to be assessed. Pubmed, Google Scholar, and Cochrane were systematically searched for papers describing protocols about aspirin hypersensitivity in the percutaneous coronary intervention setting. Discharge from hospital with aspirin was the primary end point, whereas rates of adverse reactions being a secondary outcome. An online international survey was performed to critically analyze rates of aspirin hypersensitivity and its medical and interventional management. Eleven studies with 283 patients were included. An endovenous desensitization protocol was performed on one of them, with high efficacy rate (98%) and a low adverse reaction rate when compared with oral administration. No significant differences were reported among the oral protocols in terms of efficacy (less versus more fractionated [95.8% {95.4%-96.2%} versus 95.9% {95.2-96.5%}]), whereas higher incidence of rash and angioedema were reported for protocols with <6 doses escalation (2.6% [1.1%-4.1%] versus 2.6% [1.9%-3.2%]). In the survey, we collected answer from 86 physician of the 100 interviewed. Fifty-six percent of them managed aspirin hypersensitivity changing the therapeutic regimen (eg, clopidogrel monotherapy and indobufen). Despite the previous safety data, desensitization protocols were adopted by only 42% of surveyed cardiologist. Available protocols for aspirin hypersensitivity are effective and safe, representing a feasible approach for patients needing dual antiplatelet therapy. © 2016 American Heart Association, Inc.

Supporting Tablet Configuration, Tracking, and Infection Control Practices in Digital Health Interventions: Study Protocol.

PubMed

Furberg, Robert D; Ortiz, Alexa M; Zulkiewicz, Brittany A; Hudson, Jordan P; Taylor, Olivia M; Lewis, Megan A

2016-06-27

Tablet-based health care interventions have the potential to encourage patient care in a timelier manner, allow physicians convenient access to patient records, and provide an improved method for patient education. However, along with the continued adoption of tablet technologies, there is a concomitant need to develop protocols focusing on the configuration, management, and maintenance of these devices within the health care setting to support the conduct of clinical research. Develop three protocols to support tablet configuration, tablet management, and tablet maintenance. The Configurator software, Tile technology, and current infection control recommendations were employed to develop three distinct protocols for tablet-based digital health interventions. Configurator is a mobile device management software specifically for iPhone operating system (iOS) devices. The capabilities and current applications of Configurator were reviewed and used to develop the protocol to support device configuration. Tile is a tracking tag associated with a free mobile app available for iOS and Android devices. The features associated with Tile were evaluated and used to develop the Tile protocol to support tablet management. Furthermore, current recommendations on preventing health care-related infections were reviewed to develop the infection control protocol to support tablet maintenance. This article provides three protocols: the Configurator protocol, the Tile protocol, and the infection control protocol. These protocols can help to ensure consistent implementation of tablet-based interventions, enhance fidelity when employing tablets for research purposes, and serve as a guide for tablet deployments within clinical settings.

Access to oral health care and self-reported health status among low-income adults living with HIV/AIDS.

PubMed

Bachman, Sara S; Walter, Angela W; Umez-Eronini, Amarachi

2012-05-01

We identified factors associated with improved self-reported health status in a sample of people living with HIV/AIDS (PLWHA) following enrollment in oral health care. Data were collected from 1,499 enrollees in the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative. Data were gathered from 2007-2010 through in-person interviews at 14 sites; self-reported health status was measured using the SF-8™ Health Survey's physical and mental health summary scores. Utilization records of oral health-care services provided to enrollees were also obtained. Data were analyzed using general estimating equation linear regression. Between baseline and follow-up, we found that physical health status improved marginally while mental health status improved to a greater degree. For change in physical health status, a decrease in oral health problems and lack of health insurance were significantly associated with improved health status. Improved mental health status was associated with a decrease in oral health problems at the last available visit and no pain or distress in one's teeth or gums at the last available visit. For low-income PLWHA, engagement in a program to increase access to oral health care was associated with improvement in overall well-being as measured by change in the SF-8 Health Survey. These results contribute to the knowledge base about using the SF-8 to assess the impact of clinical interventions. For public health practitioners working with PLWHA, findings suggest that access to oral health care can help promote well-being for this vulnerable population.

Access to Oral Health Care and Self-Reported Health Status Among Low-Income Adults Living with HIV/AIDS

PubMed Central

Bachman, Sara S.; Walter, Angela W.; Umez-Eronini, Amarachi

2012-01-01

Objective We identified factors associated with improved self-reported health status in a sample of people living with HIV/AIDS (PLWHA) following enrollment in oral health care. Methods Data were collected from 1,499 enrollees in the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative. Data were gathered from 2007–2010 through in-person interviews at 14 sites; self-reported health status was measured using the SF-8™ Health Survey's physical and mental health summary scores. Utilization records of oral health-care services provided to enrollees were also obtained. Data were analyzed using general estimating equation linear regression. Results Between baseline and follow-up, we found that physical health status improved marginally while mental health status improved to a greater degree. For change in physical health status, a decrease in oral health problems and lack of health insurance were significantly associated with improved health status. Improved mental health status was associated with a decrease in oral health problems at the last available visit and no pain or distress in one's teeth or gums at the last available visit. Conclusion For low-income PLWHA, engagement in a program to increase access to oral health care was associated with improvement in overall well-being as measured by change in the SF-8 Health Survey. These results contribute to the knowledge base about using the SF-8 to assess the impact of clinical interventions. For public health practitioners working with PLWHA, findings suggest that access to oral health care can help promote well-being for this vulnerable population. PMID:22547877

Oral health knowledge, attitude, and self-care practices among pharmacists in Riyadh, Riyadh Province, Saudi Arabia

PubMed Central

Baseer, Mohammad Abdual; Mehkari, Mohammed Aleemullah; Al-Marek, Fahad AbdulMohsen Fahad; Bajahzar, Omar Ahmad

2016-01-01

Aim: Identifying and addressing gaps in the oral health knowledge, attitude, and practices of pharmacists is important before they can be considered as a member of the oral health promotion team. The aim of this study was to determine the prevailing oral health knowledge, attitude, and self-care practices among a sample of pharmacists from Riyadh, Riyadh Province, Saudi Arabia. Materials and Methods: A cross-sectional study involving 200 pharmacists working in community- and hospital-based pharmacies was conducted using a structured, self-administered, close-ended questionnaire. The responses were collected and descriptive statistics of the mean scores of knowledge, attitude, and self-care practices were calculated. Mann–Whitney U and Kruskal–Wallis tests were performed to compare the different groups. Spearman's rank correlation coefficient was used to assess the association among knowledge–attitude, knowledge–practice, and attitude–practice. Results: Overall, the mean scores of oral health knowledge, attitude, and self-care practices were found to be 5.27 ± 1.05, 3.89 ± 0.83, and 2.1 ± 0.61, respectively. Male non-Saudi pharmacists working in chain pharmacies, having 11–15 years of experience with a Master's degree qualification showed significantly higher mean knowledge and practices scores as compared to their counterparts. Spearman's correlation tests revealed a significant positive correlation of knowledge–practice (r = 0.262, P < 0.01), whereas knowledge–attitude (r = -0.149, P < 0.05) as well as attitudes–practices (r = -0.196, P < 0.01) were negatively correlated. Conclusion: Pharmacists exhibited an average knowledge, negative attitude, and inadequate self-care practices toward oral health. However, increasing oral health knowledge can have profound improvement in oral self-care practices. PMID:27114953

Oral health care-related beliefs among Finnish geriatric home care nurses.

PubMed

Pihlajamäki, T; Syrjälä, A-M; Laitala, M-L; Pesonen, P; Virtanen, J I

2016-11-01

The aim was to investigate beliefs about oral health care tasks among nursing staff caring for home-dwelling older people using the Nursing Dental Coping Beliefs (nursing DCBS) index. The study population comprised nursing staff working at the homes and sheltered accommodations of older people in Ylivieska, Finland (N = 141). The data were collected using the nursing DCBS index (five-point Likert scale). On average, the nurses held moderate to high Oral health care beliefs, Internal locus of control beliefs and External locus of control beliefs, but low beliefs about Self-efficacy. The nurses with an earlier adjunct education scored lower for Oral health care beliefs on the factor Knowledge about preventing gum diseases (OR = 0.3, 95% CI: 0.1-0.9) than did the others. Regarding beliefs about External locus of control, the age group 31-49 years scored lower on the factor Retaining teeth as one ages (OR = 0.2, 95% CI: 0.1-0.7), but scored higher on the factor How to prevent dental diseases (OR = 5.6, 95% CI: 1.1-29.3) than did younger nurses (≤30 years). The nurses with only a nursing education showed significantly higher mean scores on the Self-efficacy factor Confidence of the need for dental knowledge than did those with an earlier adjunct education (P = 0.034). The nursing staff mostly believed that oral diseases are preventable and teeth can be retained in advanced age, but failed to recognize the value of dental knowledge and had little confidence in their ability to manage oral diseases. Improving the oral health-related knowledge and self-efficacy beliefs of nursing staff will require additional oral health education. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Oral health knowledge, attitude, and self-care practices among pharmacists in Riyadh, Riyadh Province, Saudi Arabia.

PubMed

Baseer, Mohammad Abdual; Mehkari, Mohammed Aleemullah; Al-Marek, Fahad AbdulMohsen Fahad; Bajahzar, Omar Ahmad

2016-01-01

Identifying and addressing gaps in the oral health knowledge, attitude, and practices of pharmacists is important before they can be considered as a member of the oral health promotion team. The aim of this study was to determine the prevailing oral health knowledge, attitude, and self-care practices among a sample of pharmacists from Riyadh, Riyadh Province, Saudi Arabia. A cross-sectional study involving 200 pharmacists working in community- and hospital-based pharmacies was conducted using a structured, self-administered, close-ended questionnaire. The responses were collected and descriptive statistics of the mean scores of knowledge, attitude, and self-care practices were calculated. Mann-Whitney U and Kruskal-Wallis tests were performed to compare the different groups. Spearman's rank correlation coefficient was used to assess the association among knowledge-attitude, knowledge-practice, and attitude-practice. Overall, the mean scores of oral health knowledge, attitude, and self-care practices were found to be 5.27 ± 1.05, 3.89 ± 0.83, and 2.1 ± 0.61, respectively. Male non-Saudi pharmacists working in chain pharmacies, having 11-15 years of experience with a Master's degree qualification showed significantly higher mean knowledge and practices scores as compared to their counterparts. Spearman's correlation tests revealed a significant positive correlation of knowledge-practice (r = 0.262, P < 0.01), whereas knowledge-attitude (r = -0.149, P < 0.05) as well as attitudes-practices (r = -0.196, P < 0.01) were negatively correlated. Pharmacists exhibited an average knowledge, negative attitude, and inadequate self-care practices toward oral health. However, increasing oral health knowledge can have profound improvement in oral self-care practices.

Variability of DKA Management Among Pediatric Emergency Room and Critical Care Providers: A Call for More Evidence-Based and Cost-Effective Care?

PubMed

Clark, Matthew G; Dalabih, Abdallah

2014-09-01

Management protocols have been shown to be effective in the pediatric emergency medicine (PEM) and pediatric critical care (PCC) settings. Treatment protocols define clear goals which are achieved with consistency in implementation. Over the last decade, many new recommendations have been proposed on managing diabetic ketoacidosis (DKA). Although no perfect set of guidelines exist, many institutions are developing DKA treatment protocols. We sought to determine the variability between institutions in implementation of these protocols.

“It was pain. That’s it. It was pain.” Lack of oral health care among otherwise healthy young adults living with HIV in South Africa: A qualitative study

PubMed Central

Orrell, Catherine; Haberer, Jessica E.

2017-01-01

Introduction The purpose of this study is to understand engagement with and availability of dental services among people living with HIV in a low-income community of South Africa. Methods In depth qualitative interviewing was used to collect data, which was analyzed using an inductive content analytical approach. The study was conducted in Gugulethu, a township community located outside of Cape Town, South Africa. Local public sector health services provided free of charge are the main source of primary health and dental care for this population. Participants included South African adults (age 18–35) recently diagnosed with HIV who had a CD4 count >350 cells/mm3. Results Many participants had little to no experience with dental care, did not know which health care providers are appropriate to address oral health concerns, were not aware of available dental services, utilized home remedies to treat oral health problems, harbored many misperceptions of dental care, avoided dental services due to fear, and experienced poverty as a barrier to dental services. Conclusions Our findings suggest that integration of oral healthcare into medical care may increase patient knowledge about oral health and access to care. Leveraging the relatively robust HIV infrastructure to address oral disease may also be an effective approach to reaching these participants and those living in resource poor communities generally. PMID:29272290

Latin-American Special Olympics athletes: evaluation of oral health status, 2010.

PubMed

Hanke-Herrero, Rosana; López Del Valle, Lydia M; Sánchez, Carolina; Waldman, H Barry; Perlman, Steven P

2013-01-01

The purpose of this study was to evaluate the oral health status and dental needs of the athletes with intellectual disabilities from Latin-American and Caribbean countries who were participating in the II Latin-American Special Olympics games held in Puerto Rico, February 2010. There were 930 athletes who participated in the games, of whom 445 received a dental examination, including 367 from Latin-American and 78 from Caribbean countries. Forty-four trained and standardized dental professionals performed dental screenings of athletes with intellectual disabilities, following Special Olympic Special Smiles and CDC protocols. These criteria were used to record untreated caries, missing and filled teeth, and gingival status. Socio-demographics, existence, and severity of pain and oral hygiene habits were assessed by questionnaire. Statistical analysis was performed using EPI-INFO and SPSS Statistical Program to produce descriptive statistics and chi-square test. Untreated dental caries was recorded for more than half of the examined athletes. Missing teeth were noted in more than one-third of the athletes. More than half of the participants had signs of gingival disease and half needed preventive mouth guards. Statistics for each Latin-American country suggests a dissimilar trend of dental decay and treatment needs among nations. While the Special Olympic athletes may not be representative of the entire population of individuals with intellectual disabilities in their specific country, the general consistency of the oral health status of these athletes from the 31 countries supports the certainty of the need for increased dental services for individuals with intellectual disability in the respective countries. ©2013 Special Care Dentistry Association and Wiley Periodicals, Inc.

A pilot study on the feasibility of training nurses to formulate multicomponent oral health interventions in a residential aged care facility.

PubMed

Deutsch, Alan; Siegel, Emma; Cations, Monica; Wright, Clive; Naganathan, Vasi; Brodaty, Henry

2017-12-01

This 10 weeks feasibility study investigated whether residential care nurses with 12 hours advanced oral health training in assessments and saliva testing could formulate, implement and monitor individualised oral care plans of early dementia residents. Four trained lead advocate nurses using SXI-D, OHIP14, oral health assessment tool (OHAT) assessments and a modified saliva test formulated nurse scheduled comprehensive oral care plans (NSCOCPs) by selecting and scheduling preventive products and procedures multiple times throughout the day to alkalise the mouth of 8 residents as an adjunct to assisted brushing and high-fluoride toothpaste. Nurse assessments, saliva tests and care plans were validated against oral health therapist (OHT) findings. Care plan agreement between Nurse and OHT intervention selection and scheduling was high (75%-88%). Untrained nurse compliance was very high, 86%-99% for the 4930 scheduled interventions. Untrained nurses delivered multiple scheduled interventions by following NSCOCPs despite initially not understanding the reason for each of 9 interventions categories. NSCOCPs could track and monitor whether a recommended intervention had been completed by general nursing staff over 3 nursing shifts. The role of nurses may have to be expanded beyond traditional roles to meet the growth and changes in oral health needs in residential facilities. Intensive training of a few lead advocate nurses to assess risk and formulate individualised NSCOCPs provides a method to transfer knowledge to untrained staff and deliver multicomponent preventive interventions soon after entry into residential care where timely visits by dental professionals to examine residents and prescribe preventive interventions are infrequent or unlikely. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial.

PubMed

Li, Ho Kwong; Scarborough, Matthew; Zambellas, Rhea; Cooper, Cushla; Rombach, Ines; Walker, A Sarah; Lipsky, Benjamin A; Briggs, Andrew; Seaton, Andrew; Atkins, Bridget; Woodhouse, Andrew; Berendt, Anthony; Byren, Ivor; Angus, Brian; Pandit, Hemant; Stubbs, David; McNally, Martin; Thwaites, Guy; Bejon, Philip

2015-12-21

Bone and joint infection in adults arises most commonly as a complication of joint replacement surgery, fracture fixation and diabetic foot infection. The associated morbidity can be devastating to patients and costs the National Health Service an estimated £20,000 to £40,000 per patient. Current standard of care in most UK centres includes a prolonged course (4-6 weeks) of intravenous antibiotics supported, if available, by an outpatient parenteral antibiotic therapy service. Intravenous therapy carries with it substantial risks and inconvenience to patients, and the antibiotic-related costs are approximately ten times that of oral therapy. Despite this, there is no evidence to suggest that oral therapy results in inferior outcomes. We hypothesise that, by selecting oral agents with high bioavailability, good tissue penetration and activity against the known or likely pathogens, key outcomes in patients managed primarily with oral therapy are non-inferior to those in patients treated by intravenous therapy. The OVIVA trial is a parallel group, randomised (1:1), un-blinded, non-inferiority trial conducted in thirty hospitals across the UK. Eligible participants are adults (>18 years) with a clinical syndrome consistent with a bone, joint or metalware-associated infection who have received ≤7 days of intravenous antibiotic therapy from the date of definitive surgery (or the start of planned curative therapy in patients treated without surgical intervention). Participants are randomised to receive either oral or intravenous antibiotics, selected by a specialist infection physician, for the first 6 weeks of therapy. The primary outcome measure is definite treatment failure within one year of randomisation, as assessed by a blinded endpoint committee, according to pre-defined microbiological, histological and clinical criteria. Enrolling 1,050 subjects will provide 90 % power to demonstrate non-inferiority, defined as less than 7.5 % absolute increase in treatment failure rate in patients randomised to oral therapy as compared to intravenous therapy (one-sided alpha of 0.05). If our results demonstrate non-inferiority of orally administered antibiotic therapy, this trial is likely to facilitate a dramatically improved patient experience and alleviate a substantial financial burden on healthcare services. ISRCTN91566927 - 14/02/2013.

Treatment needs and impact of oral health screening of athletes with intellectual disability in Belgium.

PubMed

Fernandez, C; Declerck, D; Dedecker, M; Marks, L

2015-12-30

Special Olympics Special Smiles (SOSS) is an initiative created for oral health data collection and education in oral hygiene for athletes with an intellectual disability. The aims of this study were to evaluate treatment needs of participants of Special Olympics in Belgium 2013 in comparison with those from 2008 and to assess the impact of screening and referral within the SOSS in a group of athletes who participated in two consecutive events, 2012 and 2013. Data were collected following a standardized protocol developed by the U.S. Centres for Disease Control and Prevention, Division of Oral Health. Oral hygiene habits, treatment urgency and reports of oral pain, gingival signs, sealants, untreated caries, missing and filled teeth were recorded. Data analysis of data from 2013 consisted in descriptive statistics followed by the analysis of the data by univariable and multivariable logistic regression. This data was compared with data from 2008 published by Leroy et al., 2012 using Chi square tests. Data from athletes who participated in both Special Olympics events (2012 and 2013) were compared using Exact McNemar's test and Chi-square test for homogeneity of proportions. The level of significance for all tests was set at a p-value < 0.05. A total of 627 athletes with intellectual disability participated to the SOSS program in 2013, while 132 athletes met the inclusion criteria of being a participant at both SO Belgium 2012 and 2013. The prevalence of gingival signs was 44.3 % in 2013, slightly higher than in 2008 (42.4 %). The burden of untreated decay affected 27.1 % of the population showing a net increase in comparison to 2008 (20.9 %). McNemar's test and Chi-square test revealed that there were no statistically significant differences in the proportions of all compared parameters between 2012 and 2013. Special Olympics results from 2013 indicate a considerable unmet treatment need among Belgian Special Olympics Athletes, persistent from 2008 to 2013. Moreover, SO intervention had no impact in the oral health of athletes who participated in 2012 and 2013 events. Continuous efforts for preventive and restorative oral health care are needed for this population.

[An oral function improvement program utilizing health behavior theories ameliorates oral functions and oral hygienic conditions of pre-frail elderly persons].

PubMed

Sakaguchi, Hideo

2014-06-01

Oral function improvement programs utilizing health behavior theories are considered to be effective in preventing the need for long-term social care. In the present study, an oral function improvement program based upon health behavior theories was designed, and its utility was assessed in 102 pre-frail elderly persons (33 males, 69 females, mean age: 76.9 +/- 5.7) considered to be in potential need of long-term social care and attending a long-term care prevention class in Sayama City, Saitama Prefecture, Japan. The degree of improvement in oral functions (7 items) and oral hygienic conditions (3 items) was assessed by comparing oral health before and after participation in the program. The results showed statistically significant improvements in the following oral functions: (1) lip functions (oral diadochokinesis, measured by the regularity of the repetition of the syllable "Pa"), (2) tongue functions, (3) tongue root motor skills (oral diadochokinesis, measured by the regularity of the repetition of the syllables "Ta" and "Ka"), (4) tongue extension/retraction, (5) side-to-side tongue movement functions, (6) cheek motor skills, and (7) repetitive saliva swallowing test (RSST). The following measures of oral hygiene also showed a statistically significant improvement: (1) debris on dentures or teeth, (2) coated tongue, and (3) frequency of oral cleaning. These findings demonstrated that an improvement program informed by health behavior theories is useful in improving oral functions and oral hygiene conditions.

Sage tea-thyme-peppermint hydrosol oral rinse reduces chemotherapy-induced oral mucositis: A randomized controlled pilot study.

PubMed

Mutluay Yayla, Ezgi; Izgu, Nur; Ozdemir, Leyla; Aslan Erdem, Sinem; Kartal, Murat

2016-08-01

This pilot study aimed to investigate the preventive effect of sage tea-thyme-peppermint hydrosol oral rinse used in conjunction with basic oral care on chemotherapy-induced oral mucositis. An open-label randomized controlled study. Two oncology hospitals in Ankara, Turkey. Patients receiving 5-fluorouracil-based chemotherapy regimens were divided into the intervention group (N=30) and control group (N=30). Basic oral care was prescribed to the control group, while the intervention group was prescribed sage tea-thyme-peppermint hydrosol in addition to basic oral care. All patients were called to assess their compliance with the study instructions on day 5 and 14. Oral mucositis was evaluated using an inspection method or by assessing oral cavity photos based on the World Health Organization oral toxicity scale on day 5 and 14. Most of the patients in the intervention group did not develop oral mucositis on day 5. In addition, the incidence of grade 1 oral mucositis was statistically lower in the intervention group (10%) than the control group (53.3%) on day 5. By day 14, the majority of patients in both the groups had grade 0 oral mucositis. Sage tea-thyme-peppermint hydrosol oral rinse has promising results in alleviating oral mucositis. This hydrosol can be recommended for clinical use as it is well tolerated and cost-effective. However, further randomized controlled trials are needed to support the study. Copyright © 2016 Elsevier Ltd. All rights reserved.

How the Maori community sees the dental-care system.

PubMed

Edward, S J

1992-10-01

This report has addressed the question of how the Maori community sees the system of oral health care by indicating the complex factors influencing the Maori community's attitude toward health issues. These factors preclude the Maori community from many of the perceived benefits of the present oral health-care system. There is a need in this current climate of debate over health policies to re-focus on primary prevention policies that will be relevant to the Maori community of today. No one is seen in the Maori community to be articulating concern for oral health issues. The challenge for the Dental Council of New Zealand is how then to create a focus on oral health issues within the Maori community, and to actively promote oral health care and encourage usage of a system that is affordable, available, accessible, and appropriate. Practical and relevant recommendations arising from Rapuora: Health and Maori Women 1984 and the Hui Hauora Mokopuna, 1990(10) should be considered when planning future health-care systems. Health was one of the four key areas highlighted in the Ka Awatea report, and it will be an important feature of the work of the new Ministry of Maori Development. It is timely that the Dental Council of New Zealand and the Ministry of Maori Development should facilitate oral health-care systems for the future in partnership with the Maori community.

[Ingestion of caustic substances: An analysis of the safety and benefit of a less aggressive protocol].

PubMed

Ripoll Trujillo, Noelia; Martínez Sánchez, Lidia; Habimana Jordana, Anna; Trenchs Sainz de La Maza, Victoria; Vila Miravet, Víctor; Luaces Cubells, Carles

2018-04-14

The ingestion of a caustic agent is the most common cause of admission after being in contact with a domestic product. A group of patients could be considered low risk and not require aggressive procedures such a corticosteroid administration and endoscopy, especially in the paediatric population. To evaluate the safety and benefit of a less aggressive protocol for patients defined as low risk. An analytical-observational study conducted on patients who consulted for caustic ingestion between January 2011 and December 2015. Two periods were differentiated according to the current protocol. Period-1: usual protocol (which included admission and parenteral corticosteroid and antibiotic administration) and Period-2: less aggressive protocol for the low risk patients (oral intake test after 6hours and discharged if they remained asymptomatic). Low risk patients were considered as those who met the following criteria: unintentional intake, absence of symptoms and oral lesions. In the rest of the patients the usual protocol was performed. Re-admission with a diagnosis of digestive lesions was considered as a complication. Forty-eight patients were included in period 1, and 35 in period 2. In period 2, thirteen patients met low risk criteria. The adherence to the less aggressive protocol was 100%. None of the low risk patients required admission or endoscopy after discharge. In period 1 the adherence to the usual protocol was 60.4%. Six patients would have benefited from the application of the less aggressive protocol. Adopting a more conservative attitude in low risk patients is safe. These patients benefit from clinical observation, without performing more aggressive measures with their possible iatrogenic adverse effects. Copyright © 2018. Publicado por Elsevier España, S.L.U.

Comparing the World Health Organization-versus China-recommended protocol for first-trimester medical abortion: a retrospective analysis.

PubMed

Ngo, Thoai D; Park, Min Hae; Xiao, Yuanhong

2012-01-01

To compare the effectiveness, in terms of complete abortion, of the World Health Organization (WHO)- and the China-recommended protocol for first-trimester medical abortion. A retrospective analysis of clinical data from women presenting for first trimester medical abortion between January 2009 and August 2010 at reproductive health clinics in Qingdao, Xi'an, Nanjing, Nanning, and Zhengzhou was conducted. One clinic in Qingdao administered the WHO-recommended protocol (200 mg mifepristone orally followed by 0.8 mg misoprostol buccally 36-48 hours later). Four clinics in the other locations provided the China-recommended procedure (Day 1: 50 mg of mifepristone in the morning, 25 mg in the afternoon; Day 2: 50 mg of mifepristone in the morning, 25 mg in the afternoon; Day 3: 0.6 mg oral misoprostol). Data on reproductive and demographic characteristics were extracted from clinic records, and complete termination was determined on day 14 (post-mifepristone administration). A total of 337 women underwent early medical abortion (167 WHO- and 170 China-recommended procedures). Complete abortion was significantly higher among women who had the WHO protocol than those who received the China protocol (91.0% vs 77.7%, respectively; P < 0.001). Women using the China-recommended protocol were three times more likely to require an additional dose of misoprostol than women using the WHO protocol (21.8% vs 7.8%, respectively; P < 0.001), and had significantly more bleeding on the day of misoprostol administration (12.5 mL vs 18.5 mL; P < 0.001). This clinical audit provides preliminary evidence suggesting the WHO-recommended protocol may be more effective than the China-recommended protocol for early medical abortion. A larger scale study is necessary to compare the methods' effectiveness and acceptability.

Comparative Analgesic Efficacy of Pregabalin Administered According to Either a Prevention Protocol or an Intervention Protocol in Rats with Cisplatin-induced Peripheral Neuropathy.

PubMed

Han, F Y; Kuo, A; Nicholson, J R; Corradinni, L; Smith, M T

2018-05-21

Chemotherapy-induced peripheral neuropathy (CIPN) is a type of peripheral neuropathic pain that may be dose-limiting in patients administered potentially curative cancer chemotherapy dosing regimens. In cancer survivors, persistent CIPN adversely affects patient quality of life and so adjuvant drugs (anticonvulsants e.g. pregabalin or antidepressants e.g. amitriptyline) are recommended for the relief of CIPN. However, most studies in rodent models of CIPN involve administration of single bolus doses of adjuvant drugs to assess pain-relieving efficacy. Hence this study was designed to assess the efficacy of pregabalin administered to CIPN-rats according to either a prevention or an intervention protocol. Groups of male Sprague-Dawley rats received four single intraperitoneal bolus doses of cisplatin at 3 mg/kg at once-weekly intervals to induce CIPN. For the prevention protocol, oral pregabalin (or vehicle) was administered to CIPN-rats once-daily for 21 consecutive days from day 0 to day 20 inclusive. For the intervention protocol, oral pregabalin was administered once-daily for 21 consecutive days from day 28 to day 48 inclusive. Mechanical allodynia and mechanical hyperalgesia in the bilateral hindpaws were assessed just prior to each dose of cisplatin and at least once-weekly until study completion (day 27, prevention protocol; or day 48, intervention protocol). Mechanical allodynia and mechanical hyperalgesia were also determined at the time of peak effect at ~2 h post- pregabalin/vehicle administration once-weekly until study completion. For the prevention protocol in CIPN-rats, pregabalin alleviated mechanical hyperalgesia but not mechanical allodynia. For the intervention protocol, pregabalin alleviated both mechanical allodynia and mechanical hyperalgesia in the hindpaws. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[More] evidence to support oral health promotion services targeted to smokers calling tobacco quitlines in the United States.

PubMed

McClure, Jennifer B; Riggs, Karin; St John, Jackie; Catz, Sheryl L

2013-04-11

Prior research demonstrated a need and opportunity to target smokers calling a free, state-funded tobacco quitline to provide behavioral counseling for oral health promotion; however, it is unclear whether these results generalize to tobacco quitline callers of higher socioeconomic status receiving services through commercially-funded quitlines. This knowledge will inform planning for a future public oral health promotion program targeted to tobacco quitline callers. We surveyed smokers (n = 455) who had recently received tobacco quitline services through their medical insurance. Participants were asked about their self-reported oral health indicators, key behavioral risk factors for oral disease, motivation for changing their oral self-care behavior, and interest in future oral health promotion services. Where applicable, results were compared against those from a representative sample of callers to a free, state-funded quitline (n = 816) in the same geographic region. Callers to a commercially-funded quitline had higher socioeconomic status, were more likely to have dental insurance, and reported better overall oral health indicators and routine self-care (oral hygiene, dental visits) than callers to a state-funded quitline. Nevertheless opportunities for oral health promotion were identified. Nearly 80% of commercial quitline callers failed to meet basic daily hygiene recommendations, 32.8% had not visited the dentist in more than a year, and 63.3% reported daily alcohol consumption (which reacts synergistically with tobacco to increase oral cancer risk). Nearly half (44%) were interested in learning how to improve their oral health status and, on average, moderately high levels of motivation for oral health care were reported. Many participants also had dental insurance, eliminating an important barrier to professional dental care. Future public oral health promotion efforts should focus on callers to both free state-supported and commercially-funded tobacco quitlines. While differences exist between these populations, both groups report behavioral risk factors for oral disease which represent important targets for intervention.

Knowledge and Oral Health Attitudes among Parents of Children with Congenital Heart Disease.

PubMed

Suvarna, Reshma; Rai, Kavita; Hegde, Amitha M

2011-01-01

Congenital heart disease (CHD) is a devastating complex of diseases resulting from defects of development. It affects more than 1 of every 100 live births. Early preventive dental care should be adjusted to the special needs of these children in their first years of life. Knowledge of parental attitudes and experiences of dental care are therefore important. Aim : This study was done to assess the knowledge and attitudes among parents of children with congenital heart disease towards oral health and dental care. Materials and methods : Parents (n = 105) of children with congenital heart disease of an age ranging from 0 to 16 years were included in the study. A questionnaire was used to assess the knowledge and oral health attitudes. Results : The parents' knowledge was fair but the oral health attitudes were not very satisfactory. The parents in this study also recognized the importance of oral health for the well-being of rest of the body. Conclusion : The results of this study indicate that parents' and children's attitudes toward oral health and dental care need to be improved.

Pediatric caries worldwide: implications for oral hygiene products.

PubMed

Edelstein, Burton L

2005-05-01

International data on pediatric caries epidemiology confirms that tooth decay remains a significant and consequential disease of childhood that is increasingly localized in a subset of at-risk children in both developing and developed countries. A conceptual schema is presented to characterize the occurrence of caries in child populations, and observations are made regarding the countervailing impact of simple sugars and fluoride in these populations. Temporal changes in caries distribution suggest that targeted dental caries management protocols are increasingly indicated to more effectively manage the particular risk and caries activity of individual children. Criteria for successful protocols are discussed in light of both caries pathogenesis and international recommendations to improve children's oral health.

Reasons for attending dental-care services in Ouagadougou, Burkina Faso.

PubMed Central

Varenne, Benoît; Msellati, Philippe; Zoungrana, Célestin; Fournet, Florence; Salem, Gérard

2005-01-01

OBJECTIVE: To determine why patients attend dental-care facilities in Ouagadougou, Burkina Faso and to improve understanding of the capacity of oral health-care services in urban west Africa. METHODS: We studied a randomly selected sample of patients attending 15 dental-care facilities in Ouagadougou over a 1-year period in 2004. Data were collected using a simple daily record form. FINDINGS: From a total of 44,975 patients, the final sample was established at 14,591 patients, of whom 55.4% were new patients and 44.6% were "booking patients". Most patients seeking care (71.9%) were aged 15-44 years. Nongovernmental not-for-profit dental services were used by 41.5% of all patients, 36% attended private dental-care services, and 22.5% of patients visited public services. The most common complaint causing the patient to seek dental-care services was caries with pulpal involvement (52.4%), and 60% of all complaints were associated with pain. The patients' dental-care requirements were found to differ significantly according to sex, health insurance coverage and occupation. CONCLUSION: Urban district health authorities should ensure provision of primary health-care services, at the patients' first point of contact, which are directed towards the relief of pain. In addition to the strengthening of outreach emergency care, health centres should also contribute to the implementation of community-based programmes for the prevention of oral disease and the promotion of oral health. Exchange of experiences from alternative oral health-care systems relevant to developing countries is urgently needed for tackling the growing burden of oral disease. PMID:16211155

Risk factors for dental problems: Recommendations for oral health in infancy.

PubMed

Wagner, Yvonne; Heinrich-Weltzien, Roswitha

2017-11-01

Primary care providers, gynaecologists and paediatricians have to be aware of the importance of oral health in infancy and possible consequences for child's development, growth, health and quality of life. Oral diseases, particularly dental caries, developmental defects of the dental tissues and periodontal or orthodontic issues have a complex and interrelated aetiology with common, primarily behavioral based risk factors. A sugar-rich diet is the key risk factor with detrimental consequences for general and oral health, particularly in combination with an insufficient oral hygiene. Therefore, daily tooth brushing with fluoride toothpaste and reducing of sugar intake are the key pillars to prevent oral diseases, including a positive effect on numerous chronic diseases. Future preventive approaches should focus on pregnant women and mothers of infants with a common vision of health and a shared responsibility for children's oral health care to promote healthy lifestyles and self-care practices in families. Copyright © 2017 Elsevier B.V. All rights reserved.

Advocacy for the Provision of Dental Hygiene Services Within the Hospital Setting: Development of a Dental Hygiene Student Rotation.

PubMed

Juhl, Jacqueline A; Stedman, Lynn

2016-06-01

Educational preparation of dental hygiene students for hospital-based practice, and advocacy efforts promote inclusion of dental hygienists within hospital-based interdisciplinary health care teams. Although the value of attending to the oral care needs of patients in critical care units has been recognized, the potential impact of optimal oral health care for the general hospital population is now gaining attention. This article describes a hospital-based educational experience for dental hygiene students and provides advocacy strategies for inclusion of dental hygienists within the hospital interdisciplinary team. The dental hygienist authors, both educators committed to evidence-based oral health care and the profession of dental hygiene, studied hospital health care and recognized a critical void in oral health care provision within that setting. They collaboratively developed and implemented a hospital-based rotation within the curriculum of a dental hygiene educational program and used advocacy skills to encourage hospital administrators to include a dental hygiene presence within hospital-based care teams. Hospital-based dental hygiene practice, as part of interprofessional health care delivery, has the potential to improve patient well-being, shorten hospital stays, and provide fiscal savings for patients, institutions, and third party payers. Advocacy efforts can promote dental hygienists as members of hospital-based health care teams. Further research is needed to document: (1) patient outcomes resulting from optimal oral care provision in hospitals; (2) best ways to prepare dental hygienists for career opportunities within hospitals and other similar health care settings; and (3) most effective advocacy strategies to promote inclusion of dental hygienists within care teams. Copyright © 2016 Elsevier Inc. All rights reserved.

Disease Management of Early Childhood Caries: ECC Collaborative Project

PubMed Central

Lee, Jessica Y.

2014-01-01

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice. PMID:24723953

Disease Management of Early Childhood Caries: ECC Collaborative Project.

PubMed

Ng, Man Wai; Ramos-Gomez, Francisco; Lieberman, Martin; Lee, Jessica Y; Scoville, Richard; Hannon, Cindy; Maramaldi, Peter

2014-01-01

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.

CareTrack Kids—part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review

PubMed Central

Hibbert, Peter D; Hallahan, Andrew R; Muething, Stephen E; Lachman, Peter; Hooper, Tamara D; Wiles, Louise K; Jaffe, Adam; White, Les; Wheaton, Gavin R; Runciman, William B; Dalton, Sarah; Williams, Helena M; Braithwaite, Jeffrey

2015-01-01

Introduction A high-quality health system should deliver care that is free from harm. Few large-scale studies of adverse events have been undertaken in children's healthcare internationally, and none in Australia. The aim of this study is to measure the frequency and types of adverse events encountered in Australian paediatric care in a range of healthcare settings. Methods and analysis A form of retrospective medical record review, the Institute of Healthcare Improvement's Global Trigger Tool, will be modified to collect data. Records of children aged <16 years managed during 2012 and 2013 will be reviewed. We aim to review 6000–8000 records from a sample of healthcare practices (hospitals, general practices and specialists). Ethics and dissemination Human Research Ethics Committee approvals have been received from the Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Hospital Network in South Australia. An application is under review with the Royal Australian College of General Practitioners. The authors will submit the results of the study to relevant journals and undertake national and international oral presentations to researchers, clinicians and policymakers. PMID:25854978

Performance of Stochastic Targeted Blood Glucose Control Protocol by virtual trials in the Malaysian intensive care unit.

PubMed

Jamaludin, Ummu K; M Suhaimi, Fatanah; Abdul Razak, Normy Norfiza; Md Ralib, Azrina; Mat Nor, Mohd Basri; Pretty, Christopher G; Humaidi, Luqman

2018-08-01

Blood glucose variability is common in healthcare and it is not related or influenced by diabetes mellitus. To minimise the risk of high blood glucose in critically ill patients, Stochastic Targeted Blood Glucose Control Protocol is used in intensive care unit at hospitals worldwide. Thus, this study focuses on the performance of stochastic modelling protocol in comparison to the current blood glucose management protocols in the Malaysian intensive care unit. Also, this study is to assess the effectiveness of Stochastic Targeted Blood Glucose Control Protocol when it is applied to a cohort of diabetic patients. Retrospective data from 210 patients were obtained from a general hospital in Malaysia from May 2014 until June 2015, where 123 patients were having comorbid diabetes mellitus. The comparison of blood glucose control protocol performance between both protocol simulations was conducted through blood glucose fitted with physiological modelling on top of virtual trial simulations, mean calculation of simulation error and several graphical comparisons using stochastic modelling. Stochastic Targeted Blood Glucose Control Protocol reduces hyperglycaemia by 16% in diabetic and 9% in nondiabetic cohorts. The protocol helps to control blood glucose level in the targeted range of 4.0-10.0 mmol/L for 71.8% in diabetic and 82.7% in nondiabetic cohorts, besides minimising the treatment hour up to 71 h for 123 diabetic patients and 39 h for 87 nondiabetic patients. It is concluded that Stochastic Targeted Blood Glucose Control Protocol is good in reducing hyperglycaemia as compared to the current blood glucose management protocol in the Malaysian intensive care unit. Hence, the current Malaysian intensive care unit protocols need to be modified to enhance their performance, especially in the integration of insulin and nutrition intervention in decreasing the hyperglycaemia incidences. Improvement in Stochastic Targeted Blood Glucose Control Protocol in terms of u en model is also a must to adapt with the diabetic cohort. Copyright © 2018 Elsevier B.V. All rights reserved.

Oral healthcare of preschool children in Trinidad: a qualitative study of parents and caregivers.

PubMed

Naidu, Rahul; Nunn, June; Forde, Maarit

2012-08-03

Little is known about oral health in early childhood in the West Indies or the views and experiences of caregivers about preventive oral care and dental attendance The aims of this study were to explore and understand parents and caregivers' experience of oral healthcare for their preschool aged children and how, within their own social context, this may have shaped their oral health attitudes and behaviours. These data can be used to inform oral health promotion strategies for this age group. After ethical approval, a qualitative study was undertaken using a focus group approach with a purposive sample of parents and caregivers of preschool children in central Trinidad.Group discussions were initiated by use of a topic guide. Audio recording and field notes from the three focus groups, with a total of 18 participants, were transcribed and analysed using a thematic approach. Despite some ambivalence toward the importance of the primary teeth, the role of fluoride and confusion about when to take a child for their first dental visit, most participants understood the need to ensure good oral hygiene and dietary habits for their child. Problems expressed included, overcoming their own negative experiences of dentistry, which along with finding affordable and suitable dental clinics, affected their attitude to taking their child for a dental visit. There was difficulty in establishing good brushing routines and controlling sweet snacking in the face of many other responsibilities at home. Lack of availability of paediatric dental services locally and information on oral health care were also highlighted. Many expressed a need for more contact with dental professionals in non-clinic settings, for oral health care advice and guidance. Parents and caregivers in this qualitative study showed generally positive attitudes towards oral health but appear to have encountered several barriers and challenges to achieving ideal preventive care for their child, with respect to healthy diet, good oral hygiene and dental attendance. Oral health promotion should include effective dissemination of oral health information, more practical health advice and greater access to dental care for families with preschool children.

Oral healthcare of preschool children in Trinidad: a qualitative study of parents and caregivers

PubMed Central

2012-01-01

Background Little is known about oral health in early childhood in the West Indies or the views and experiences of caregivers about preventive oral care and dental attendance The aims of this study were to explore and understand parents and caregivers’ experience of oral healthcare for their preschool aged children and how, within their own social context, this may have shaped their oral health attitudes and behaviours. These data can be used to inform oral health promotion strategies for this age group. Method After ethical approval, a qualitative study was undertaken using a focus group approach with a purposive sample of parents and caregivers of preschool children in central Trinidad. Group discussions were initiated by use of a topic guide. Audio recording and field notes from the three focus groups, with a total of 18 participants, were transcribed and analysed using a thematic approach. Results Despite some ambivalence toward the importance of the primary teeth, the role of fluoride and confusion about when to take a child for their first dental visit, most participants understood the need to ensure good oral hygiene and dietary habits for their child. Problems expressed included, overcoming their own negative experiences of dentistry, which along with finding affordable and suitable dental clinics, affected their attitude to taking their child for a dental visit. There was difficulty in establishing good brushing routines and controlling sweet snacking in the face of many other responsibilities at home. Lack of availability of paediatric dental services locally and information on oral health care were also highlighted. Many expressed a need for more contact with dental professionals in non-clinic settings, for oral health care advice and guidance. Conclusion Parents and caregivers in this qualitative study showed generally positive attitudes towards oral health but appear to have encountered several barriers and challenges to achieving ideal preventive care for their child, with respect to healthy diet, good oral hygiene and dental attendance. Oral health promotion should include effective dissemination of oral health information, more practical health advice and greater access to dental care for families with preschool children. PMID:22862892

Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

PubMed

Goicolea, Isabel; Carson, Dean; San Sebastian, Miguel; Christianson, Monica; Wiklund, Maria; Hurtig, Anna-Karin

2018-01-11

The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.

Dental Care Every Day: A Caregiver's Guide

MedlinePlus

... oral health professionals and caregivers who contributed their time and expertise to reviewing and pretesting the Practical Oral Care series. Expert Review Panel • Mae Chin, RDH, MEd, University ...

Prevalence and Determinants of Oral Human Papillomavirus Infection in 500 Young Adults from Italy

PubMed Central

Höfler, Daniela; Menegaldo, Anna; Giorgi Rossi, Paolo; Del Mistro, Annarosa; Da Mosto, Maria Cristina; Pawlita, Michael

2017-01-01

Although the prevalence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is increasing in developed countries and becoming a relevant health issue, the natural history of oral HPV infection is still unclear. Estimating the infection’s prevalence in specific populations and identifying risk factors can widen our understanding of its natural history and help to delineate appropriate prevention strategies. This study sought to (i) determine oral HPV prevalence and genotype distribution in a large series of young Italian adults, (ii) validate an oral rinse sampling/storage protocol, and (iii) pinpoint factors associated with oral HPV infection. Five hundred students, nurses, and technicians (19–35 years-old) studying and working at/for the University of Padua were recruited. Each participant was provided with an oral rinse sampling kit and instructions for use. They were also asked to complete an anonymous questionnaire concerning their demographic characteristics and behaviors. The questionnaires and oral rinse containers were labeled with the same identification code number. The oral rinse samples were tested using a bead-based multiplex BSGP5+/6+-MPG genotyping assay which amplifies the L1 region of 51 mucosal HPV types. The prevalence of oral HPV infection was 4.0% (95% confidence interval (CI), 2.5%-6.1%); those of 14 high-risk HPV types and of HPV-type 16 (HPV16) infection were 2.2% (95% CI, 1.1%-3.9%) and 1.6% (95% CI, 0.6%-3.1%), respectively. HPV16 was the most frequent genotype (40.0% of oral HPV infections). No association was found between oral infection and the co-variables studied (gender, tobacco, alcohol and illegal drug use, number of sex and oral sex partners, HPV vaccination status, history of HPV and sexually transmitted infections, abnormal pap smears, recurrent tonsillitis and tonsillectomy). The oral rinse sampling protocol outlined here proved to be simple, efficient and well tolerated, and the prevalence rate can be considered reliable and thus useful to guide future research. Determinants of oral HPV infection are still unclear and further studies are certainly warranted. PMID:28103272

[Modern concepts of trauma care and multiple trauma management in oral and maxillofacial region].

PubMed

Tan, Yinghui

2015-06-01

Multiple trauma management requires the application of modem trauma care theories. Optimal treatment results can be achieved by reinforcing cooperation and stipulating a treatment plan together with other disciplines. Based on modem theories in trauma care and our understanding of the theoretical points, this paper analyzes the injury assessment strategies and methods in oral and maxillofacial multiple trauma management. Moreover, this paper discusses operating time and other influencing factors as well as proposed definitive surgical timing and indications in comprehensive management of oral and maxillofacial multiple trauma patients associated with injuries in other body parts. We hope that this paper can help stomatological physicians deepen their understanding of modem trauma care theories and improve their capacity and results in the treatment of oral and maxillofacial multiple trauma.

Knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city.

PubMed

Priya, Shanmuga; Madan Kumar, P D; Ramachandran, S

2008-01-01

This study was done to find out the knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city. A cross-sectional survey among a sample of the pharmacists in Chennai city was done and data regarding their knowledge and attitudes towards oral health care and oral hygiene products were obtained using a closed-ended questionnaire. Among the 60 pharmacies approached, 50 pharmacists participated in the study and completed the questionnaire. Though 48% of the participants gave a positive answer when asked whether they had met the dentist practicing close to their pharmacies, the frequency with which they met the dentist ranged from once a week (24%) to once a month (28%). Most of the pharmacists stocked oral health-related products, which comprised 15-25% of their total stock. Of these products toothpaste was the most common (62%), followed by mouth rinses (12%). Toothache or painful teeth was the most common dental problem (78%) for which patients approached the pharmacists for advice. With regard to the advice given, 38.5% of the pharmacists asked the patient to consult a nearby dentist after dispensing medications, while 22.4% of the pharmacists dispensed antibiotics and painkillers without any referral. Seventy percent of the pharmacists expressed interest in giving oral health care advice to patients. However, many of them (38%) felt that lack of proper knowledge is a barrier to providing oral health care advice. It is clear from the present study that pharmacists are presently an underutilized resource, and there is a definitive need to improve their training and access to information on available dental services.

Dental care in children with developmental disabilities: attention deficit disorder, intellectual disabilities, and autism.

PubMed

Charles, Jane M

2010-01-01

The Federal government reports that 13% of Americans between birth and 18 years of old meet the definition of a child with special health care needs. These children and young adults present unique challenges for both pediatric and general dentists to provide access to the oral health care system--establishing a treatment plan for those with unique medical, behavioral and dental needs and maintaining oral health over the lifetime. The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.

Randomised trial of neonatal hypoglycaemia prevention with oral dextrose gel (hPOD): study protocol.

PubMed

Harding, Jane E; Hegarty, Joanne E; Crowther, Caroline A; Edlin, Richard; Gamble, Greg; Alsweiler, Jane M

2015-09-16

Neonatal hypoglycaemia is common, affecting up to 15% of newborn babies and 50% of those with risk factors (preterm, infant of a diabetic, high or low birthweight). Hypoglycaemia can cause brain damage and death, and babies born at risk have an increased risk of developmental delay in later life. Treatment of hypoglycaemia usually involves additional feeding, often with infant formula, and admission to Neonatal Intensive Care for intravenous dextrose. This can be costly and inhibit the establishment of breast feeding. Prevention of neonatal hypoglycaemia would be desirable, but there are currently no strategies, beyond early feeding, for prevention of neonatal hypoglycaemia. Buccal dextrose gel is safe and effective in treatment of hypoglycaemia. The aim of this trial is to determine whether 40% dextrose gel given to babies at risk prevents neonatal hypoglycaemia and hence reduces admission to Neonatal Intensive Care. Randomised, multicentre, placebo controlled trial. Babies at risk of hypoglycaemia (preterm, infant of a diabetic, small or large), less than 1 h old, with no apparent indication for Neonatal Intensive Care Unit admission and mother intends to breastfeed. Trial entry & randomisation: Eligible babies of consenting parents will be allocated by online randomisation to the dextrose gel group or placebo group, using a study number and corresponding trial intervention pack. Babies will receive a single dose of 0.5 ml/kg study gel at 1 h after birth; either 40% dextrose gel (200 mg/kg) or 2% hydroxymethylcellulose placebo. Gel will be massaged into the buccal mucosal and followed by a breast feed. Primary study outcome: Admission to Neonatal Intensive Care. 2,129 babies are required to detect a decrease in admission to Neonatal Intensive Care from 10-6% (two-sided alpha 0.05, 90% power, 5% drop-out rate). This study will investigate whether admission to Neonatal Intensive Care can be prevented by prophylactic oral dextrose gel; a simple, cheap and painless intervention that requires no special expertise or equipment and hence is applicable in almost any birth setting. Australian New Zealand Clinical Trials Registry--ACTRN 12614001263684.

Combined electrical stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial.

PubMed

Sproson, Lise; Pownall, Sue; Enderby, Pam; Freeman, Jenny

2018-03-01

Dysphagia is common after stroke, affecting up to 50% of patients initially. It can lead to post-stroke pneumonia, which causes 30% of stroke-related deaths, a longer hospital stay and poorer health outcomes. Dysphagia care post-stroke generally focuses on the management of symptoms, via modified oral intake textures and adapted posture, rather than direct physical rehabilitation of the swallowing function. Transcutaneous neuromuscular electrical stimulation (NMES) is a promising rehabilitation technology that can be used to stimulate swallowing; however, findings regarding efficacy have been conflicting. This pilot randomized controlled study involving three UK sites compared the efficacy of the Ampcare Effective Swallowing Protocol (ESP), combining NMES with swallow-strengthening exercises, with usual care in order to clarify evidence on NMES in the treatment of dysphagia post-stroke. A further objective was to pilot recruitment procedures and outcome measures in order to inform the design of a full-scale trial. Thirty patients were recruited and randomized into either (1) usual speech and language therapy dysphagia care; or (2) Ampcare ESP, receiving treatment 5 days/week for 4 weeks. Outcome measures included: the Functional Oral Intake Scale (FOIS), the Rosenbek Penetration-Aspiration Scale (PAS) and patient-reported outcomes (Swallow Related Quality of Life-SWAL-QOL). Thirty patients were recruited; 15 were randomized to the Ampcare ESP intervention arm and 15 to usual care. A greater proportion (75%, or 9/12) of patients receiving Ampcare ESP improved compared with 57% (or 8/14) of the usual-care group. Patients receiving Ampcare ESP also made clinically meaningful change (a comparative benefit of 1.5 on the FOIS, and on the PAS: 1.35 for diet and 0.3 for fluids) compared with usual care. The intervention group also reported much better outcome satisfaction. The pilot demonstrated successful recruitment, treatment safety and tolerability and clinically meaningful outcome improvements, justifying progression to a fully powered study. It also showed clinically meaningful treatment trends for the Ampcare ESP intervention. © 2017 Royal College of Speech and Language Therapists.

Boron neutron capture therapy for oral precancer: proof of principle in an experimental animal model

DOE Office of Scientific and Technical Information (OSTI.GOV)

A. Monti Hughes; ECC Pozzi; S. Thorp

Field-cancerized tissue can give rise to second primary tumours, causing therapeutic failure. Boron neutron capture therapy (BNCT) is based on biological targeting and would serve to treat undetectable foci of malignant transformation. The aim of this study was to optimize BNCT for the integral treatment for oral cancer, with particular emphasis on the inhibitory effect on tumour development originating in precancerous conditions, and radiotoxicity of different BNCT protocols in a hamster cheek pouch oral precancer model.

Filling in the Gaps: An Explicit Protocol for Scaffolding Inquiry Lessons

ERIC Educational Resources Information Center

Hitt, Austin M.; Smith, Douglas

2017-01-01

The goal of this paper is to introduce an explicit protocol that preservice science teachers can use to improve the quality of the scaffolding (written and oral prompts) of their inquiry lessons. Scaffolding is an essential component of effective inquiry lessons because it keeps students focused on the target science content and divides the…

Teaching and Learning Foreign Languages via System of "Voice over Internet Protocol" and Language Interactions Case Study: Skype

ERIC Educational Resources Information Center

Wahid, Wazira Ali Abdul; Ahmed, Eqbal Sulaiman; Wahid, Muntaha Ali Abdul

2015-01-01

This issue expresses a research study based on the online interactions of English teaching specially conversation through utilizing VOIP (Voice over Internet Protocol) and cosmopolitan online theme. Data has been achieved by interviews. Simplifiers indicate how oral tasks require to be planned upon to facilitate engagement models propitious to…

Testing the Validity of a Protocol to Screen for Spiritual Struggle among Parents of Children with Cystic Fibrosis

PubMed Central

Grossoehme, Daniel H.; Fitchett, George

2015-01-01

Spirituality is important to many Americans and is used to cope with adverse events. Some forms of spiritual coping are maladaptive or troubling, and are known as negative spiritual coping or spiritual struggle. These forms of spirituality are often associated with poorer physical and mental health outcomes. Thus, in clinical contexts there is a need to identify persons who may be experiencing spiritual struggle and, if indicated, offer spiritual care that may address that struggle. Twenty-two parents of children with cystic fibrosis (CF) completed semi-structured interviews and questionnaires exploring spirituality’s role in their child’s illness. Interviews included oral administration of a protocol to screen for spiritual struggle. The parents also completed the negative religious coping subscale of the Brief RCOPE, a commonly used measure of spiritual struggle. Descriptive statistics were obtained. The screening protocol identified 18% of the parents as potentially having spiritual struggle. Thirty-two percent had negative religious coping scores suggestive of spiritual struggle. Comparison of results with both measures found the screening protocol had good specificity (87%) but relatively low sensitivity (29%). Using either measure, indications of spiritual struggle were associated with higher levels of depressive symptoms. The screener’s administration was acceptable and feasible. The low sensitivity may be due in part to differences between the focus of the screener and that of the negative religious coping subscale, which focuses on struggle with the Divine. Further work is needed to establish the best approach to screening for spiritual struggle. PMID:26966344

Envisioning an oral healthcare workforce for the future.

PubMed

Nash, David A

2012-10-01

Health is critical to human well-being. Oral health is an integral component of health. One is not healthy without oral health. As health is essential to human flourishing, it is important that an oral healthcare delivery system and workforce be developed and deployed which can help ensure all citizens have the potential to access oral health care. As such access does not generally exist today, it is imperative to advance the realization of this goal and to develop a vision of an oral healthcare workforce to functionally support access. Public funding of basic oral health care is an important element to improving access. However, funding is only economically feasible if a workforce exists that is structured in a manner such that duties are assigned to individuals who have been uniquely trained to fulfill specific clinical responsibilities. An essential element of any cost-effective organizational system must be the shared responsibility of duties. Delegation must occur in the oral health workforce if competent, cost-effective care is to be provided. Desirable members of the oral health team in an efficient and effective system are as follows: generalist dentists who are educated as physicians of the stomatognathic system (oral physicians), specialist dentists, dental therapists, dental hygienists, dually trained hygienists/therapists (oral health therapists), oral prosthetists (denturists), and expanded function dental assistants (dental nurses). © 2012 John Wiley & Sons A/S.

Oral complaints and dental care of haematopoietic stem cell transplant patients: a qualitative survey of patients and their dentists.

PubMed

Bos-den Braber, Jacolien; Potting, Carin M J; Bronkhorst, Ewald M; Huysmans, Marie-Charlotte D N J M; Blijlevens, Nicole M A

2015-01-01

Little is known about the understanding of the oral and dental needs of haematopoietic stem cell transplant (HSCT) patients or about dentists' views and experiences regarding this patient group. This information is essential if we want to improve the standard of peri-HSCT dental care. The primary objective of this qualitative survey was to explore the following: (1) The understanding of dental care pre- and post-HSCT (2) The subjective oral complaints of HSCT patients both short- and long-term (3) The relationship of these oral complaints to the severity of oral mucositis during hospitalization The secondary objective was to explore the opinions of dentists regarding dental care before and after HSCT. All adult patients who survived HSCT at the Radboud University Medical Centre between 2010 and 2011 (n = 101) received a questionnaire. During hospitalization, mucositis scores were recorded daily in the patient's chart. The patients' dentist (n = 88) was also sent a questionnaire after permission of the patient. Ninety-six out of 101 patients (95%) responded. The average period since HSCT was 19 months (range 8-31 months). The overall mean maximum mucositis score was 6.6 (sd = 3.3). Only eight patients reported not having visited a dentist pre-HSCT. The majority of the patients (59%) reported short-term oral complaints, and 28% reported long-term oral complaints. Fifty-two dentists responded (59%). Nine had not performed pre-HSCT screening and eight dentists reported screening their patients but could not complete the necessary treatments. Only 44 dentists succeeded in completing the required treatments. The most important advice of the dentist was to reinforce the importance of regular dental care. Most patients report short-term and/or long-term oral complaints after HSCT. Most dentists stress the importance of regular dental care before and after HSCT but report not being familiar with the particular dental care needs of this patient group. The high response rate and the high rate of HSCT-related oral complaints emphasize the need of further research in this area.

Utilization of oral health care services among adults attending community outreach programs.

PubMed

Kadaluru, Umashankar Gangadhariah; Kempraj, Vanishree Mysore; Muddaiah, Pramila

2012-01-01

Good oral health is a mirror of overall health and well-being. Oral health is determined by diet, oral hygiene practices, and the pattern of dental visits. Poor oral health has significant social and economic consequences. Outreach programs conducted by dental schools offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures. To assess the utilization of oral healthcare services among adults attending outreach programs. This study included 246 adults aged 18-55 years attending community outreach programs in and around Bangalore. Using a questionnaire we collected data on dental visits, perceived oral health status, reasons for seeking care, and barriers in seeking care. Statistical significance was assessed using the Chi-square test. In this sample, 28% had visited the dentist in the last 12 months. Males visited dentist more frequently than females. The main reason for a dental visit was for tooth extraction (11%), followed by restorative and endodontic treatment 6%. The main barriers to utilization of dental services were high cost (22%), inability to take time off from child care duties (19.5%), and fear of the dentist or dental tools (8.5%). The utilization of dental services in this population was poor. The majority of the dental visits were for treatment of acute symptoms rather than for preventive care. High cost was the main barrier to the utilization of dental services. Policies and programs should focus on these factors to decrease the burden of oral diseases and to improve quality of life among the socioeconomically disadvantaged.

Promoting Oral Health and Quality of Life of Older People - The Need for Public Health Action.

PubMed

Petersen, Poul Erik; Ogawa, Hiroshi

2018-01-01

This report intends to review the global burden of oral disease among older people and to examine their oral health needs. The evidence on the inter-relationships between poor oral health conditions of older people, general health and quality of life is highlighted. Finally, WHO strategies to improve oral health of older people are reviewed. The information relevant to this review was extracted from the WHO Global Oral Health Data Bank, the PubMed database, and the Cochrane Library. Surveys were carried out according to the criteria recommended by the WHO epidemiological manual Oral Health Surveys - Basic Methods. In addition, global data were sought on coverage of oral health care among older people. Finally, WHO policy documents on health care for aged people were gathered through the WHO website. Across the globe, many older people suffer from oral pain or discomfort. Poor oral health during old age is mostly manifest in high caries experience, high prevalence rates of advanced periodontal disease, severe tooth loss, dry mouth, and oral pre-cancer/cancer. In both developing and developed countries, the burden of disease is particularly high among underprivileged and disadvantaged older people. In numerous countries, high proportions of the aged population are not covered by primary oral health care; this is mainly the case in low and middle income countries due to a critical shortage of dentists. In 2015, the WHO published the World Report on Ageing and Health, which outlines a framework for action to foster healthy ageing. The policies are highly relevant to the improvement of oral health. Transformation of oral health systems away from a disease-based curative model and towards disease prevention, as well as the provision of older-person-centred integrated care are required. Moreover, wide-ranging public health action on ageing is urgently needed.

Influence of real-world characteristics on outcomes for patients with methicillin-resistant Staphylococcal skin and soft tissue infections: a multi-country medical chart review in Europe.

PubMed

Nathwani, Dilip; Eckmann, Christian; Lawson, Wendy; Solem, Caitlyn T; Corman, Shelby; Stephens, Jennifer M; Macahilig, Cynthia; Simoneau, Damien; Chambers, Richard; Li, Jim Z; Haider, Seema

2014-09-02

Patient-related (demographic/disease) and treatment-related (drug/clinician/hospital) characteristics were evaluated as potential predictors of healthcare resource use and opportunities for early switch (ES) from intravenous (IV)-to-oral methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotic therapy and early hospital discharge (ED). This retrospective observational medical chart study analyzed patients (across 12 European countries) with microbiologically confirmed MRSA complicated skin and soft tissue infections (cSSTI), ≥3 days of IV anti-MRSA antibiotics during hospitalization (July 1, 2010-June 30, 2011), and discharged alive by July 31, 2011. Logistic/linear regression models evaluated characteristics potentially associated with actual resource use (length of IV therapy, length of hospital stay [LOS], IV-to-oral antibiotic switch), and ES and ED (using literature-based and expert-verified criteria) outcomes. 1542 patients (mean ± SD age 60.8 ± 16.5 years; 61.5% males) were assessed with 81.0% hospitalized for MRSA cSSTI as the primary reason. Several patient demographic, infection, complication, treatment, and hospital characteristics were predictive of length of IV therapy, LOS, IV-to-oral antibiotic switch, or ES and ED opportunities. Outcomes and ES and ED opportunities varied across countries. Length of IV therapy and LOS (r = 0.66, p < 0.0001) and eligibilities for ES and ED (r = 0.44, p < 0.0001) showed relatively strong correlations. IV-to-oral antibiotic switch patients had significantly shorter length of IV therapy (-5.19 days, p < 0.001) and non-significantly shorter LOS (-1.86 days, p > 0.05). Certain patient and treatment characteristics were associated with increased odds of ES (healthcare-associated/ hospital-acquired infection) and ED (patient living arrangements, healthcare-associated/ hospital-acquired infection, initiating MRSA-active treatment 1-2 days post cSSTI index date, existing ED protocol), while other factors decreased the odds of ES (no documented MRSA culture, ≥4 days from admission to cSSTI index date, IV-to-oral switch, IV line infection) and ED (dementia, no documented MRSA culture, initiating MRSA-active treatment ≥3 days post cSSTI index date, existing ES protocol). Practice patterns and opportunity for further ES and ED were affected by several infection, treatment, hospital, and geographical characteristics, which should be considered in identifying ES and ED opportunities and designing interventions for MRSA cSSTI to reduce IV days and LOS while maintaining the quality of care.

Child oral health concerns amongst parents and primary care givers in a Sure Start local programme.

PubMed

Daly, B; Clarke, W; McEvoy, W; Periam, K; Zoitopoulos, L

2010-09-01

To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP). To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP. A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method. The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours. SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

Oral health content of early education and child care regulations and standards.

PubMed

Kranz, Ashley M; Rozier, R Gary

2011-01-01

Almost two out of every three US children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers. State licensing regulations were obtained from the National Resource Center for Health and Safety in Child Care's online database. Professional standards were identified through a search of PubMed, early childhood organizations' websites, and early childhood literature. All EECC guidelines were reviewed for key terms related to oral health promotion in children and summarized by domains. Thirty-six states include oral health in their licensing regulations, but recommendations are limited and most often address the storage of toothbrushes. Eleven sets of standards were identified, four of which make recommendations about oral health. Standards from the American Academy of Pediatrics/American Public Health Association (AAP/APHA) and the Office of Head Start (OHS) provide the most comprehensive oral health recommendations regarding screening and referral, classroom activities, and education. Detailed guidelines for oral health practices exist but they exhibit large variation in number and content. States can use the comprehensive standards from the AAP/APHA and OHS to inform and strengthen the oral health content of their licensing regulations. Research is needed to determine compliance with regulations and standards, and their effect on oral health.

'We are all scared for the baby': promoting access to dental services for refugee background women during pregnancy.

PubMed

Riggs, Elisha; Yelland, Jane; Shankumar, Ramini; Kilpatrick, Nicky

2016-01-21

Vulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for 'priority' care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women's knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women. One agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data. Four community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men's perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the 'priority of access' policy that entitles pregnant women to receive dental care cost-free. This study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care.

An Examination of Racial/Ethnic Disparities in Children’s Oral Health in the United States

PubMed Central

Fisher-Owens, Susan A.; Isong, Inyang A.; Soobader, Mah-J; Gansky, Stuart A.; Weintraub, Jane A.; Platt, Larry J.; Newacheck, Paul W.

2012-01-01

Objective Assess the extent apparent racial/ethnic disparities in children’s oral health and oral health care are explained by factors other than race/ethnicity. Data Source 2007 National Survey of Children’s Health, for children 2–17 years (N=82,020). Outcomes included parental reports of child’s oral health status, receipt of preventive dental care, and delayed dental care/unmet need. Model-based survey data analysis examined racial/ethnic disparities, controlling for other child, family, and community/state (contextual) factors. Results Unadjusted results show large oral health disparities by race/ethnicity. Compared to non-Hispanic Whites, Hispanics and non-Hispanic Blacks were markedly more likely to be reported in only fair/poor oral health (odds ratios (ORs) [95% confidence intervals] 4.3 [4.0–4.6], 2.2 [2.0–2.4], respectively), lack preventive care (ORs 1.9 [1.8–2.0], 1.4 [1.3–1.5]), and experience delayed care/unmet need (ORs 1.5 [1.3–1.7], 1.4 [1.3–1.5]). Adjusting for child, family, and community/state factors reduced or eliminated racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non-Hispanic Blacks attenuated for fair/poor oral health, to 1.6 [1.5–1.8] and 1.2 [1.1–1.4], respectively. Adjustment eliminated disparities in each group for lacking preventive care (AORs 1.0 [0.9–1.1], 1.1 [1.1–1.2]), and in Hispanics for delayed care/unmet need (AOR 1.0). Among non-Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need (AOR 0.6 [0.6–0.7]). Conclusions Racial/ethnic disparities in children’s oral health status and access were found to be attributable largely to determinants such as socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at the social, economic, and other factors associated with minority racial/ethnic status, and may also have collateral positive effects on sectors of the majority population who share similar social, economic and cultural characteristics. PMID:22970900

Inter-Professional Working and Learning: Instructional Actions and Boundary Crossing or Boundary Making in Oral Healthcare

ERIC Educational Resources Information Center

Teräs, Marianne

2016-01-01

Inter-professional teams are typical in health care, and inter-professional education has thus become more common. This empirical study explores the instruction-related challenges when students of dentistry and oral hygiene collaborate during their internship in caring for the oral health of patients. The conceptual framework of the study stems…

World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation.

PubMed

Brailo, Vlaho; Firriolo, Francis John; Tanaka, Takako Imai; Varoni, Elena; Sykes, Rosemary; McCullough, Michael; Hua, Hong; Sklavounou, Alexandra; Jensen, Siri Beier; Lockhart, Peter B; Mattsson, Ulf; Jontell, Mats

2015-08-01

To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed. Copyright © 2015 Elsevier Inc. All rights reserved.

The oral health of seniors in Brazil: addressing the consequences of a historic lack of public health dentistry in an unequal society.

PubMed

Fonesca, Flamorion A; Jones, Kimberly M; Mendes, Danilo C; dos Santos Neto, Pedro E; Ferreira, Raquel C; Pordeus, Isabela A; Martins, Andréa M E de Barros Lima

2015-03-01

National epidemiological data on the oral health of elders was analysed to examine relationships between the need for oral treatment and external environment, the dental care delivery system, personal characteristics and subjective conditions of oral health. Brazil's universal public healthcare system is theoretically responsible to provide dental care to Brazilians of all ages. However, as dentists were integrated into public primary care facilities only in 2000, Brazilian seniors have accumulated needs. Seniors (65-74 years old) were examined and interviewed by calibrated professionals. The association of overall need for oral treatment and component factors were analysed. Associations with socio-demographic factors and self-reported attitudes and behaviours were also calculated. A total of 85.9% of Brazilian seniors demonstrated a need for some oral treatment, 83.8% of the dentate needed periodontal treatment and 57.3% of all seniors needed full or partial prostheses. Social inequalities were also evident as Brazilians using free oral care services demonstrated a higher degree of need, as did elders who had not previously accessed dental services, nonwhites and males. Our findings demonstrate that the elderly population in Brazil has a very high degree of need in general and that certain subgroups have been especially vulnerable to oral disease. © 2013 The Gerodontology Society and John Wiley & Sons A/S.

Oral health care knowledge and practices of a group of deaf adolescents in Lagos, Nigeria.

PubMed

Oredugba, Folakemi A

2004-01-01

This study sought to determine the oral health care knowledge and practices of a group of deaf adolescents in Lagos. The study involved 50 students of Wesley School 1 for the Deaf, Lagos (26 males and 24 females, aged 10-19 years, mean 13.3 +/- 2.8). Information about previous dental care, oral hygiene, and snacking habits were obtained through a questionnaire and sign language by the teachers. Only 12 percent of pupils had received dental care. Eight percent and 72 percent, respectively, gave correct answers to causes of tooth decay and bleeding gums. Ninety-four percent brushed their teeth once daily, with no significant sex difference (P > .05). Reported dental problems include bleeding gums (36%), tooth discoloration, and tooth decay. The majority of pupils (60%) preferred biscuits and soft drinks as snacks. More than 90 percent were willing to have a dental check-up. The oral health knowledge and practices of this group of children will improve through a controlled school-based oral health education program.

Collaboration Between Medical Providers and Dental Hygienists in Pediatric Health Care.

PubMed

Braun, Patricia A; Cusick, Allison

2016-06-01

Basic preventive oral services for children can be provided within the medical home through the collaborative care of medical providers and dental hygienists to expand access for vulnerable populations. Because dental caries is a largely preventable disease, it is untenable that it remains the most common chronic disease of childhood. Leveraging the multiple visits children have with medical providers has potential to expand access to early preventive oral services. Developing interprofessional relationships between dental providers, including dental hygienists, and medical providers is a strategic approach to symbiotically expand access to dental care. Alternative care delivery models that provide dental services in the medical home expand access to these services for vulnerable populations. The purpose of this article is to explore 4 innovative care models aimed to expand access to dental care. Current activities in Colorado and around the nation are described regarding the provision of basic preventive oral health services (eg, fluoride varnish) by medical providers with referral to a dentist (expanded coordinated care), the colocation of dental hygiene services into the medical home (colocated care), the integration of a dental hygienist into the medical care team (integrated care), and the expansion of the dental home into the community setting through telehealth-enabled teams (virtual dental home). Gaps in evidence regarding the impacts of these models are elucidated. Bringing preventive and restorative dental services to the patient both in the medical home and in the community has potential to reduce long-standing barriers to receive these services, improve oral health outcomes of vulnerable patients, and decrease oral health disparities. Copyright © 2016 Elsevier Inc. All rights reserved.

Protocolized fluid therapy in brain-dead donors: the multicenter randomized MOnIToR trial.

PubMed

Al-Khafaji, Ali; Elder, Michele; Lebovitz, Daniel J; Murugan, Raghavan; Souter, Michael; Stuart, Susan; Wahed, Abdus S; Keebler, Ben; Dils, Dorrie; Mitchell, Stephanie; Shutterly, Kurt; Wilkerson, Dawn; Pearse, Rupert; Kellum, John A

2015-03-01

Critical shortages of organs for transplantation jeopardize many lives. Observational data suggest that better fluid management for deceased organ donors could increase organ recovery. We conducted the first large multicenter randomized trial in brain-dead donors to determine whether protocolized fluid therapy increases the number of organs transplanted. We randomly assigned donors to either protocolized or usual care in eight organ procurement organizations. A "protocol-guided fluid therapy" algorithm targeting the cardiac index, mean arterial pressure and pulse pressure variation was used. Our primary outcome was the number of organs transplanted per donor, and our primary analysis was intention to treat. Secondary analyses included: (1) modified intention to treat where only subjects able to receive the intervention were included and (2) 12-month survival in transplant recipients. The study was stopped early. We enrolled 556 donors: 279 protocolized care and 277 usual care. Groups had similar characteristics at baseline. The study protocol could be implemented in 76 % of subjects randomized to the intervention. There was no significant difference in mean number of organs transplanted per donor: 3.39 organs per donor (95 % CI 3.14-3.63) with protocolized care compared to 3.29 usual care (95 % CI 3.04-3.54; mean difference, 0.1, 95 % CI -0.25 to 0.45; p = 0.56). In modified intention-to-treat analysis the mean number of organs increased (3.52 organs per donor, 95 % CI 3.23-3.8), but not statistically significantly (mean difference, 0.23, 95 % CI -0.15 to 0.61; p = 0.23). Among the 1,430 recipients of organs from study subjects with data available, 56 deaths (7.8 %) occurred in the protocolized care arm and 56 (7.9 %) in the usual care arm in the first year (hazard ratio: 0.97, p = 0.86). In brain-dead organ donors, protocol-guided fluid therapy compared to usual care may not increase the number of organs transplanted per donor.

Diagnostic protocol for gestational diabetes mellitus (GDM) (IADPSG/ADA, 2011): influence on the occurrence of GDM and mild gestational hyperglycemia (MGH) and on the perinatal outcomes.

PubMed

Sirimarco, Mariana Pinto; Guerra, Helena Maciel; Lisboa, Eduardo Guimarães; Vernini, Joice Monalisa; Cassetari, Bianca Nicolosi; de Araujo Costa, Roberto Antonio; Rudge, Marilza Vieira Cunha; de Mattos Paranhos Calderon, Iracema

2017-01-01

In August 2011, the Specialized Center for Diabetes and Pregnancy of the Botucatu Medical School/Unesp adopted a new diagnostic protocol for gestational diabetes mellitus, recommended by the American Diabetes Association and the International Association of the Diabetes and Pregnancy Study Group. The glycemic profile was evaluated using the 75-g oral glucose tolerance test (OGTT) used to diagnose mild gestational hyperglycemia, recognized and treated in our department as gestational diabetes mellitus. The cost-effectiveness of the new guidelines and the continued need for the evaluation of the glycemic profile, as part of our Service protocol, are controversial and require further investigation. We aimed to assess the impact of the new guidelines on the evaluation of mild gestational hyperglycemia and gestational diabetes mellitus, the incidence of adverse perinatal outcomes, and the association between the 75-g OGTT and the glycemic profile for the diagnosis of mild gestational hyperglycemia. This cross-sectional study was performed identifying a convenience sample of pregnant women and their newborns. The women used our Service for diagnostic procedures, prenatal care and delivery, both before (January 2008 to August 14, 2011) and after (August 15, 2011 to December 2014) the protocol modification. The following variables were compared, following stratification according to diagnostic protocol: prevalence of gestational diabetes mellitus and mild gestational hyperglycemia, newborns large for gestational age, macrosomia, first cesarean delivery, and newborn hospital stay. Statistical analysis was performed using Poisson regression, the Student's t test, the Chi square or Fisher's exact test and risk estimate. The statistical significance threshold was set at 95% (p < 0.05). The new protocol resulted in an 85% increase in the number of women with GDM, but failed to identify 17.3% of pregnant women classified as having mild gestational hyperglycemia, despite a normal 75-g OGTT. The new guidelines did not affect perinatal outcome. These results support the validity of maintaining the glycemic profile as part of the diagnostic protocol at our hospital. Large multicenter studies with an adequate sample size are required for conclusive evidence on the cost-effectiveness of the new protocol.

Medical Providers' Oral Health Knowledgeability, Attitudes, and Practice Behaviors: An Opportunity for Interprofessional Collaboration.

PubMed

Shimpi, Neel; Schroeder, Dixie; Kilsdonk, Joseph; Chyou, Po-Huang; Glurich, Ingrid; Penniman, Eric; Acharya, Amit

2016-03-01

Evaluation of current knowledgeability, attitudes, and practice behaviors of medical providers from a large health care system toward oral health was undertaken as a pilot effort to better understand and integrate oral health into the overall health care delivery. Invitations to complete a 28-question survey, designed in a web-based platform (SurveyMonkey(®)), were emailed to 1407 medical multispecialty physicians, residents, and nurses within the health system. The questionnaire included sections on provider demographics, oral health knowledgeability and attitudes, and current practice conducting oral health screenings. A 14% (n = 199/1407) response rate was achieved for survey completion. There were 16% who reported good coverage of oral/dental health topics in their medical training curriculum. Competency level was <30% for identifying tooth decay and oral pathology. There were 95% who reported never applying fluoride varnish in their practice, while >80% answered knowledge-based questions correctly. Frequency rates for dental referral by the medical providers were 32% 'frequently' and 68% 'infrequently.' Perceptions of optimal frequency for conducting oral health assessment in their professional practices ranged from 69% indicating 'frequently' to 25% indicating 'infrequently.' Overall, positive attitudes were observed toward incorporation of oral health examination into medical practice. The study identified lack of oral health treatment and infrequent referral by medical providers to dental providers. Results support likelihood for acceptance of care models that incorporate a medical/dental team-based approach complemented by oral health training for medical providers to enhance holistic health care delivery. Limitations of this pilot study include potential selection bias and lack of generalizability beyond our institution; further studies are planned in additional settings statewide to validate findings. Copyright © 2016 Elsevier Inc. All rights reserved.

A school-based oral health educational program: the experience of Maringa- PR, Brazil.

PubMed

Conrado, Carlos Alberto; Maciel, Sandra Mara; Oliveira, Márcia Regina

2004-03-01

The main purpose of this study was to evaluate the preliminary results of a school-based oral health educational strategy adopted in public primary schools from the city of Maringa, State of Parana, Brazil. The study sample was composed by 556 children and adolescents aged 6 to 17 years old, 124 schoolteachers and a group of 55 mothers. The educational approach was implemented for 18 months and consisted of reinforcements of interventions addressed to students and schoolteachers at school level and few activities targeted at the mothers, performed by means of home visits. Baseline and follow-up interviews focused on oral health care were undertaken for the entire study population. As a stimulus for the students to achieve proper oral hygiene habits, the simplified oral hygiene index was assessed at three different moments. A statistically significant improvement in their oral hygiene index (p<0.001) was recorded. The results achieved suggest an encouraging tendency towards the improvement in the levels of oral health care among the school-age youths studied. They also point out the need of intensifying the preparation of schoolteachers in oral health topics, as well the instructions to the mothers for their oral health care. Moreover, they highlight the importance of the continuous implementation of school-based programs to promote the oral health.

Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

PubMed

Dyson, Kate; Kruger, Estie; Tennant, Marc

2012-12-01

This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

STIGMA AROUND HIV IN DENTAL CARE: PATIENTS' EXPERIENCES.

PubMed

Brondani, Mario A; Phillips, J Craig; Kerston, R Paul; Moniri, Nardin R

2016-02-01

Tooth decay and other oral diseases can be highly prevalent among people living with HIV/AIDS (PLWHA). Even though dental professionals are trained to provide equal and non-judgemental services to all, intentional or unintentional biases may exist with regard to PLWHA. We conducted qualitative descriptive research using individual interviews to explore the experiences of PLWHA accessing dental care services in Vancouver, Canada. We interviewed 25 PLWHA, aged 23-67 years; 21 were men and 60% reported fair or poor oral health. Thematic analysis showed evidence of both self-stigma and public stigma with the following themes: fear, self-stigma and dental care; overcoming past offences during encounters with dental care professionals; resilience and reconciliation to achieve quality care for all; and current encounters with dental care providers. Stigma attached to PLWHA is detrimental to oral care. The social awareness of dental professionals must be enhanced, so that they can provide the highest quality care to this vulnerable population.

Three- to 21-year-old patients with autism spectrum disorders: parents' perceptions of severity of symptoms, oral health, and oral health-related behavior.

PubMed

Weil, Taryn N; Inglehart, Marita Rohr

2012-01-01

The purpose was to explore the relationship between the level of functioning (listening/talking/reading/daily self-care/care at home/social skills) of three to 21-year-old patients with autism spectrum disorders (ASDs) and their oral health and oral health-related behavior (brushing, flossing, dental visits). Survey data were collected from 85 parents of ASD patients. Patients' level of functioning was determined with a short version of the Survey Interview Form of the Vineland Adaptive Behavior Scales (2nd edition). The patients ranged from very low to high levels of functioning. Oral health correlated with the ability to: listen (r=.53; P<.001); talk (r=.40; P<.001); read (r=.30; P<.01); engage in daily self-care (r=.36; P<.001); engage in care at home (r=.44; P<.001); and demonstrate social skills (r=.36; P<.001). The parents' comfort levels concerning brushing and flossing their children's teeth and taking their children to the dentist varied considerably and correlated with children's level of functioning. Frequency of tooth-brushing correlated with listening skills (r=31; P<.01); the frequency of flossing correlated with the ability to talk (r=.31; P<.01). Understanding the relationships between level of functioning of children with ASDs and their oral health and oral health-related behavior could increase dentists' ability to provide the best possible care for these patients.

The history and global market of oral home-care products.

PubMed

Jardim, Juliana Jobim; Alves, Luana Severo; Maltz, Marisa

2009-01-01

This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12% increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2%. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.

Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda.

PubMed

Awor, Phyllis; Wamani, Henry; Tylleskar, Thorkild; Peterson, Stefan

2015-07-16

Drug shops are usually the first source of care for febrile children in Uganda although the quality of care they provide is known to be poor. Within a larger quasi-experimental study introducing the WHO/UNICEF recommended integrated community case management (iCCM) of malaria, pneumonia and diarrhoea intervention for community health workers in registered drug shops, the level of adherence to clinical protocols by drug sellers was determined. All drug shops (N = 44) in the intervention area were included and all child visits (N = 7,667) from October 2011-June 2012 to the participating drug shops were analysed. Drug shops maintained a standard iCCM register where they recorded the children seen, their symptoms, diagnostic test performed, treatments given and actions taken. The proportion of children correctly assessed and treated was determined from the registers. Malaria management: 6,140 of 7,667 (80.1%) total visits to drug shops were of children with fever. 5986 (97.5%) children with fever received a malaria rapid diagnostic test (RDT) and the RDT positivity rate was 78% (95% CI 77-79). 4,961/5,307 (93.4%) children with a positive RDT received artemisinin combination therapy. Pneumonia management: after respiratory rate assessment of children with cough and fast/difficult breathing, 3,437 (44.8%) were categorized as "pneumonia", 3,126 (91.0%) of whom received the recommended drug-amoxicillin. Diarrhoea management: 2,335 (30.5%) child visits were for diarrhoea with 2,068 (88.6%) correctly treated with oral rehydration salts and zinc sulphate. Dual/Triple classification: 2,387 (31.1%) children had both malaria and pneumonia and 664 (8.7%) were classified as having three illnesses. Over 90% of the children with dual or triple classification were treated appropriately. Meanwhile, 381 children were categorized as severely sick (with a danger sign) with 309 (81.1%) of them referred for appropriate management. With the introduction of the iCCM intervention at drug shops in Eastern Uganda, it was possible to achieve high adherence to the treatment protocols, which is likely compatible with increased quality of care.

Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings.

PubMed

Ostroff, Jamie S; Li, Yuelin; Shelley, Donna R

2014-02-21

Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. NCT01615237.

Pioneering and Interprofessional Pediatric Dentistry Programs Aimed at Reducing Oral Health Disparities.

PubMed

Ramos-Gomez, Francisco; Askaryar, Hamida; Garell, Cambria; Ogren, Jennifer

2017-01-01

Early Childhood Caries (ECC) is the most chronic childhood disease and more predominant in low-income and underserved children. Although easily transmitted, ECC is entirely preventable. Dr. Ramos-Gomez and his team at the University of California, Los Angeles put together an interprofessional curriculum where both medical and dental knowledge and practice is integrated to prepare dentists and primary care providers to more cost effectively address ECC and thereby reduce disparities in oral health. The curriculum, known as the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD), consists of nine evidence-based training modules: applied statistics and research, community partners, interprofessional education/training, quality improvement, policy and advocacy, disease management/risk assessment, ethics/professionalism, cultural competency and children with special heath-care needs. SPICE aims to prepare pediatric dental residents and primary care providers to provide preventive, culturally competent, and minimally invasive oral care for underserved, low income, and special needs children. Additionally, the Infant Oral Care Program (IOCP), located at a local community health clinic, provides culturally sensitive preventive oral health care for children aged 0-5 years. The medical-dental integration model utilized at IOCP helps reduce oral health disparities by providing a systems-based and cost-effective approach to combat the burden of ECC. To track the progress of SPICE, a comprehensive evaluation framework has been designed, which aligns goals and objectives with program activities, desired outcomes, and measured indicators.

Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

PubMed

Brickle, Colleen M; Self, Karl D

2017-09-01

The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Low-dose oral microemulsion ciclosporin for severe, refractory ulcerative colitis.

PubMed

de Saussure, P; Soravia, C; Morel, P; Hadengue, A

2005-08-01

The optimal modalities of treatment with oral microemulsion ciclosporin in patients with severe, steroid-refractory ulcerative colitis are uncertain. To assess the applicability, in terms of efficacy and tolerability, of a standard oral microemulsion ciclosporin treatment protocol targeting relatively low blood ciclosporin concentrations, in patients with severe, steroid-resistant ulcerative colitis. Patients with a severe attack of ulcerative colitis and no satisfactory response to intravenous corticosteroids were started on oral microemulsion ciclosporin. Dosages were adapted according to a standard protocol, targeting a blood predose ciclosporin concentration (C0) of 100-200 ng/mL. Patients without a clinical response on day 8 were scheduled for colectomy. Sixteen patients were enrolled. A clinical response was observed in 14/16 (88%). The mean clinical activity index scores and concentrations of C-reactive protein on days 0, 4 and 8 were 11.8, 6.7 and 4.1, and 50.3, 19.3 and 9.7 mg/L respectively. The mean C0 (days 0-8) was 149 pg/mL. The mean creatinine clearance rates on days 0 and 8 were 88 and 96 mL/min. One patient had an acute elevation of transaminases that resulted in discontinuing ciclosporin. Even when dosed for a target C0 of 100-200 ng/mL, oral microemulsion ciclosporin for severe, steroid-refractory ulcerative colitis achieves an efficacy similar to that attained with higher, potentially more toxic levels. The oral route should replace intravenous treatment in this clinical setting.

Dual specific oral tolerance induction using interferon gamma for IgE-mediated anaphylactic food allergy and the dissociation of local skin allergy and systemic oral allergy: tolerance or desensitization?

PubMed

Noh, G; Jang, E H

2014-01-01

Specific oral tolerance induction (SOTI) for IgE-mediated food allergy (IFA) can be successfully achieved using interfero gamma (classic SOTI). In this study, a tolerable dose was introduced during tolerance induction with interferon gamma (dual SOTI), and its effectiveness was evaluated. The study population comprised 25 IFA patients. Blood samples were taken for analysis, including complete blood count with differential counts of eosinophils, serum total IgE levels, and specific IgE for allergenic foods. Skin prick tests were conducted with the allergens. Oral food challenges were performed to diagnose IFA. Ten patients received dual SOTI, 5 received classic SOTI, 5 received SOTI without interferon gamma (original SOTI), and 5 were not treated (controls). Patients treated with dual SOTI and classic SOTI using interferon gamma became tolerant to the allergenic food. The tolerable dose was introduced successfully in dual SOTI. It was difficult to proceed with the same dosing protocol used for classic SOTI in cases treated with original SOTI. Following dual SOTI, the systemic reaction to oral intake subsided, but the local skin reaction to contact with the allergenic food persisted. Dual SOTI is an improved protocol for SOTI using interferon gamma for IFA.The local skin reaction and systemic reaction to oral intake were dissociated following dual SOTI. In cases of food allergy, tolerance appears to result from desensitization to allergens.

Oral lesions in infection with human immunodeficiency virus.

PubMed Central

Coogan, Maeve M.; Greenspan, John; Challacombe, Stephen J.

2005-01-01

This paper discusses the importance of oral lesions as indicators of infection with human immunodeficiency virus (HIV) and as predictors of progression of HIV disease to acquired immunodeficiency syndrome (AIDS). Oral manifestations are among the earliest and most important indicators of infection with HIV. Seven cardinal lesions, oral candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and non-Hodgkin lymphoma, which are strongly associated with HIV infection, have been identified and internationally calibrated, and are seen in both developed and developing countries. They may provide a strong indication of HIV infection and be present in the majority of HIV-infected people. Antiretroviral therapy may affect the prevalence of HIV-related lesions. The presence of oral lesions can have a significant impact on health-related quality of life. Oral health is strongly associated with physical and mental health and there are significant increases in oral health needs in people with HIV infection, especially in children, and in adults particularly in relation to periodontal diseases. International collaboration is needed to ensure that oral aspects of HIV disease are taken into account in medical programmes and to integrate oral health care with the general care of the patient. It is important that all health care workers receive education and training on the relevance of oral health needs and the use of oral lesions as surrogate markers in HIV infection. PMID:16211162

Innovative Models of Dental Care Delivery and Coverage: Patient-Centric Dental Benefits Based on Digital Oral Health Risk Assessment.

PubMed

Martin, John; Mills, Shannon; Foley, Mary E

2018-04-01

Innovative models of dental care delivery and coverage are emerging across oral health care systems causing changes to treatment and benefit plans. A novel addition to these models is digital risk assessment, which offers a promising new approach that incorporates the use of a cloud-based technology platform to assess an individual patient's risk for oral disease. Risk assessment changes treatment by including risk as a modifier of treatment and as a determinant of preventive services. Benefit plans are being developed to use risk assessment to predetermine preventive benefits for patients identified at elevated risk for oral disease. Copyright © 2017 Elsevier Inc. All rights reserved.

Influence of host related factors on the antibody response to trivalent oral polio vaccine in Tunisian infants.

PubMed

Triki, H; Abdallah, M V; Ben Aissa, R; Bouratbine, A; Ben Ali Kacem, M; Bouraoui, S; Koubaa, C; Zouari, S; Mohsni, E; Crainic, R; Dellagi, K

1997-07-01

The low efficiency of trivalent oral polio vaccine (TOPV) in inducing protective antibody titres to polio3 is a problem of great importance in many regions of the world. A prospective study was conducted in 121 Tunisian infants aged 3 months during routine immunization with TOPV under carefully controlled conditions. Seroconversion rates to polio1, polio2 and polio3, one month after the third dose, were 94.7, 100 and 89.5%, respectively. The kinetics of the antibody response showed delayed and more difficult responses to polio3 compared to polio2 and polio1. The following host related factors, previously suggested to interfere with the immune response, were assessed: maternal antibodies; breast-feeding; concurrent enteric infections; and other illnesses. The main factor associated with the lack of seroconversion was concurrent infection with non-polio enteroviruses (NPE) which was found in 50% of non-responders to polio1 and/or to polio3 during the vaccination protocol whereas no NPE was isolated in vaccine responders. The other studied factors seemed not to interfere in the infants according to the locally adopted vaccination schedule and to the specific socio-economic conditions.

Dental Anxiety and the Use of Oral Health Services Among People Attending Two HIV Primary Care Clinics in Miami

PubMed Central

Singer, Richard; Cardenas, Gabriel; Xavier, Jessica; Jeanty, Yves; Pereyra, Margaret; Rodriguez, Allan; Metsch, Lisa R.

2012-01-01

Objectives We examined factors associated with dental anxiety among a sample of HIV primary care patients and investigated the independent association of dental anxiety with oral health care. Methods Cross-sectional data were collected in 2010 from 444 patients attending two HIV primary care clinics in Miami-Dade County, Florida. Corah Dental Anxiety Scores and use of oral health-care services were obtained from all HIV-positive patients in the survey. Results The prevalence of moderate to severe dental anxiety in this sample was 37.8%, while 7.9% of the sample was characterized with severe dental anxiety. The adjusted odds of having severe dental anxiety were 3.962 times greater for females than for males (95% confidence interval [CI] 1.688, 9.130). After controlling for age, ethnicity, gender, education, access to dental care, and HIV primary clinic experience, participants with severe dental anxiety had 69.3% lower adjusted odds of using oral health-care services within the past 12 months (vs. longer than 12 months ago) compared with participants with less-than-severe dental anxiety (adjusted odds ratio = 0.307, 95% CI 0.127, 0.742). Conclusion A sizable number of patients living with HIV have anxiety associated with obtaining needed dental care. Routine screening for dental anxiety and counseling to reduce dental anxiety are supported by this study as a means of addressing the impact of dental anxiety on the use of oral health services among HIV-positive individuals. PMID:22547875

Outlining a preventive oral health care system for China.

PubMed

Saekel, Rüdiger

2015-01-01

The most recent Chinese health care reform, scheduled to run until 2020, has been underway for a number of years. Oral health care has not been explicitly mentioned in the context of this reform. However, oral health is an integral part of general health and the under-servicing of the Chinese population in the area of dental care is particularly high. The article describes how this problem could be addressed. Based on present scientific knowledge,specifically on evidence-based strategies and long-term empirical experience from Western industrialised countries, as well as findings from Chinese pilot studies, the author outlines a preventive oral health care system tailored specifically to the conditions prevailing in China. He describes the background and rationale for a clearly structured, preventive system and summarises the scientific cornerstones on which this concept is founded. The single steps of this model, that are adapted specifically to China, are presented so as to facilitate a critical discussion on the pros and cons of the approach. The author concludes that, by implementing preventive oral care, China could gradually reduce the under-servicing of great parts of the population with dental care that largely avoids dental disease and preserves teeth at a price that is affordable to both public health and patients. This approach would minimise the danger of starting a cycle of re-restorations, owing to outdated treatment methods. The proposal would both fit in well with and add to the current blueprint for Chinese health care reform.

Interdisciplinary development and implementation of communication checklist for postoperative management of pediatric airway patients.

PubMed

Kim, Sang W; Maturo, Stephen; Dwyer, Danielle; Monash, Bradley; Yager, Phoebe H; Zanger, Kerstin; Hartnick, Christopher J

2012-01-01

The authors describe their multidisciplinary experience in applying the Institute of Health Improvement methodology to develop a protocol and checklist to reduce communication error during transfer of care for postoperative pediatric surgical airway patients. Preliminary outcome data following implementation of the protocol and checklist are also presented. Prospective study from July 1, 2009, to February 1, 2011. Tertiary care center. Subjects. One hundred twenty-six pediatric airway patients who required coordinated care between Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. Two sentinel events involving airway emergencies demonstrated a critical need for a standardized, comprehensive instrument that would ensure safe transfer of care. After development and implementation of the protocol and checklist, an initial pilot period on the first set of 9 pediatric airway patients was reassessed. Subsequent prospective 11-month follow-up data of 93 pediatric airway patients were collected and analyzed. A multidisciplinary pediatric team developed and implemented a formalized, postoperative checklist and transfer protocol. After implementation of the checklist and transfer protocol, prospective analysis showed no adverse events from miscommunication during transfer of care over the subsequent 11-month period involving 93 pediatric airway patients. There has been very little written in the quality and safety patient literature about coordinating effective transfer of care between the pediatric surgical and medical subspecialty realms. After design and implementation of a simple, electronically based transfer-of-care checklist and protocol, the number of postsurgical pediatric airway information transfer and communication errors decreased significantly.

Academic-practice partnerships to promote evidence-based practice in long-term care: oral hygiene care practices as an exemplar.

PubMed

McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa

2007-01-01

Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in long-term care settings. Our experience demonstrates that translation of research on oral care practices into LTC practice through academic-practice partnerships is feasible, is associated with positive resident outcomes, and illustrates a process that has broader applicability to other common problems in LTC, where incomplete implementation of an extant research base for practice may inhibit student learning.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

PubMed

Martins, Renata Castro; Reis, Clarice Magalhães Rodrigues Dos; Matta Machado, Antonio Thomaz Gonzaga da; Amaral, João Henrique Lara do; Werneck, Marcos Azeredo Furquim; Abreu, Mauro Henrique Nogueira Guimarães de

2016-01-01

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Dental implant status of patients receiving long-term nursing care in Japan.

PubMed

Kimura, Toru; Wada, Masahiro; Suganami, Toru; Miwa, Shunta; Hagiwara, Yoshiyuki; Maeda, Yoshiobu

2015-01-01

The increase in implant patients is expected to give rise to a new problem: the changing general health status of those who have had implants placed. The aim of this present study was to find out the needs of and proper measures for elderly implant patients in long-term care facilities. A questionnaire was sent by mail to 1,591 long-term care health facilities, daycare services for people with dementia, and private nursing homes for the elderly in the Osaka area, which is in the middle area of Japan, in order to extract patients with cerebrovascular disease or dementia who were possibly at risk of inadequate oral self-care, as well as patients with implants. Approximately half of all facilities responded that they cannot recognize implants, and many facilities did not know anything about oral care for implant patients. Residents with implants were reported at 19% of all facilities. Also, the facilities pointed out problems with implants relating to the difference in oral care between implants and natural teeth. There are people with implants in some 20% of caregiving facilities, and there is a low level of understanding regarding implants and their care among nurses and care providers who are providing daily oral care. © 2013 Wiley Periodicals, Inc.

The community care model of the Intercountry Centre for Oral Health at Chiangmai, Thailand.

PubMed

Anumanrajadhon, T; Rajchagool, S; Nitisiri, P; Phantumvanit, P; Songpaisan, Y; Barmes, D E; Sardo-Infirri, J; Davies, G N; Møller, I J; Pilot, T

1996-08-01

The Intercountry Centre for Oral Health opened in Chiangmai, Thailand, in November, 1981. In 1984, as part of its mandate to promote new approaches to the delivery of oral health care, it initiated a demonstration project known as the Community Care Model for Oral Health. Logistic, financial and organisational difficulties prevented the full implementation of the original plan. Nevertheless, consideration of the strengths and weaknesses of the Model has provided valuable suggestions for adoption by national and international health agencies interested in adopting a primary health care approach to the delivery of oral health services. Important features which could be appropriate for disadvantaged communities include: integration into the existing health service infrastructure; emphasis on health promotion and prevention; minimal clinical interventions; an in-built monitoring and evaluation system based on epidemiological principles, full community participation in planning and implementation; the establishment of specific targets and goals; the instruction of all health personnel, teachers and senior students in the basic principles of the recognition, prevention and control of oral diseases and conditions; the application of relevant principles of Performance Logic to training; and the provision of a clear career path for all health personnel.

Independent older adults perspectives on oral health.

PubMed

Khabra, K K; Compton, S M; Keenan, L P

2017-11-01

The purpose of this study was to explore oral health experiences from the perspective of older adults' living in community dwellings. The two objectives of this study were to identify facilitators and barriers to oral health care, and to determine how utilization of oral health services compares to utilization of other healthcare services. An interpretive descriptive methodology was employed with a purposive sample of 12 adults, aged 70 years or older. The inclusion criterion was English-speaking seniors residing in community dwellings. Community dwellings were defined as any housing outside of long-term care or other supportive living facilities. Semi-structured interviews were 30-80 min, audio-recorded and transcribed verbatim. Three researchers participated in the comparative analysis process to develop codes, generate categories, interpret patterns and construct themes. Three central themes surfacing from the data were as follows: life course influences on oral health, transparency in delivery of oral health services and interrelationships between oral health and overall health. Older adults in this study emphasized the value of establishing collaborative and trusting relationships between oral health practitioners and older adults. Oral health practitioners should be clear and transparent when communicating information about oral health costs and be cognizant of different circumstances from childhood to older adulthood that inhibit or promote routine utilization of oral health services. Including oral health services as part of interdisciplinary care teams could help promote understandings of the reciprocal relationship between oral health and general health and improve oral health status for older adults. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of a low dose combined oral contraceptive pill on the hormonal profile and cycle outcome following COS with a GnRH antagonist protocol in women over 35 years old.

PubMed

Bakas, Panagiotis; Hassiakos, Dimitrios; Grigoriadis, Charalampos; Vlahos, Nikolaos F; Liapis, Angelos; Creatsas, George

2014-11-01

This prospective study examines if pre-treatment with two different doses of an oral contraceptive pill (OCP) modifies significantly the hormonal profile and/or the IVF/ICSI outcome following COS with a GnRH antagonist protocol. Infertile patients were allocated to receive either OCP containing 0.03 mg of ethinylestradiol and 3 mg of drospirenone, or OCP containing 0.02 mg of ethinylestradiol and 3 mg of drospirenone prior to initiation of controlled ovarian stimulation (COS) with recombinant gonadotropins on a variable multi-dose antagonist protocol (Ganirelix), while the control group underwent COS without OCP pretreatment. Lower dose OCP was associated with recovery of FSH on day 3 instead of day 5, but the synchronization of the follicular cohort, the number of retrieved oocytes and the clinical pregnancy rate were similar to higher dose OCP.

Lead optimization in the nondrug-like space.

PubMed

Zhao, Hongyu

2011-02-01

Drug-like space might be more densely populated with orally available compounds than the remaining chemical space, but lead optimization can still occur outside this space. Oral drug space is more dynamic than the relatively static drug-like space. As new targets emerge and optimization tools advance the oral drug space might expand. Lead optimization protocols are becoming more complex with greater optimization needs to be satisfied, which consequently could change the role of drug-likeness in the process. Whereas drug-like space should usually be explored preferentially, it can be easier to find oral drugs for certain targets in the nondrug-like space. Copyright © 2010 Elsevier Ltd. All rights reserved.

A Video Recording and Viewing Protocol for Student Group Presentations: Assisting Self-Assessment through a Wiki Environment

ERIC Educational Resources Information Center

Barry, Shane

2012-01-01

The purpose of this research was to firstly develop a protocol for video recording student group oral presentations, for later viewing and self-assessment by student group members. Secondly, evaluations of students' experiences of this process were undertaken to determine if this self-assessment method was a positive experience for them in gaining…