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Konadu AB, Iwuozo EU, Sunkwa-Mills G, Ayoola YA, Manu EA, Hewlett SA, Dedey F, Abdulkadir MB, Ogedegbe O. Healthcare professionals' perspectives on oral health care in acute stroke patients: a qualitative study. BDJ Open 2024; 10:52. [PMID: 38898008 PMCID: PMC11187067 DOI: 10.1038/s41405-024-00238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Stroke is a major public health problem, with the disabilities of the patients increasing their risk of poor oral health. Currently, in Ghana and Nigeria, no guideline exists for oral health care in stroke patients, while most of our acute stroke care settings have no documented protocol. AIM This study sought to understand the perspectives of healthcare professionals in Ghana and Nigeria about oral healthcare in acute stroke patients. METHODS A qualitative inductive approach was employed to explore healthcare professionals' perspectives. After obtaining informed consent, in-depth interviews were conducted among doctors, nurses, and physiotherapists using semi-structured question guides. Participants' responses were audiotaped for transcription and analysis. Interviews were conducted until data saturation was reached. Data were analyzed thematically to generate themes and sub-themes using an inductive approach. THE RESULTS Twenty-five (25) health care professionals (HCP) aged 25-60 years with a mean age of 36.2 ± 4.2 years were interviewed. There were 15 (60.0%) males and 10 (40.0%) females. HCP included nurse practitioners 14 (56.0%), medical doctors 7 (28.0%), and physiotherapists 4 (16.0%). The HCP demonstrated adequate knowledge of stroke and considered oral health important for esthetic and clinical reasons. They, however, reported being unable to give it the required attention due to inadequate collaboration between the various professional cadres, insufficient equipment, and a skewed focus on other clinical needs of the acute stroke patients. CONCLUSIONS The findings indicate that HCPs perceived oral health care as very important among patients with acute stroke. However, they reported a lack of collaboration and integration of oral health care in routine stroke care as a major impediment.
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Affiliation(s)
- Akua Boakyewaa Konadu
- Department of Restorative Dentistry, University of Ghana Dental School, Accra, Ghana.
| | - Emmanuel U Iwuozo
- Neurology Unit, Internal Medicine Department, Benue State University Teaching Hospital Makurdi, Makurdi, Benue State, Nigeria
| | - Gifty Sunkwa-Mills
- Municipal Health Directorate, Awutu Senya East Municipal GHS, Awutu Senya East, Ghana
| | - Yekeen A Ayoola
- Department of Medicine, Gombe State University, Gombe, Nigeria
| | - Ewura A Manu
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Sandra A Hewlett
- Department of Restorative Dentistry, University of Ghana Dental School, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Olugbenga Ogedegbe
- Institute of Excellence in Health Equity, NYU Langone, New York, NY, USA
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Poudel P, Paudel G, Acharya R, George A, Borgnakke WS, Rawal LB. Oral health and healthy ageing: a scoping review. BMC Geriatr 2024; 24:33. [PMID: 38191307 PMCID: PMC10773108 DOI: 10.1186/s12877-023-04613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people. METHODS A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework. RESULTS The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride. CONCLUSION There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.
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Affiliation(s)
- Prakash Poudel
- Office of Research and Education, Canberra Health Services, Australian Capital Territory (ACT) Government, Garran, ACT, 2606, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, 2000, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, QLD, Rockhampton, 4702, Australia
| | - Reecha Acharya
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Australia.
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, 2000, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, QLD, Rockhampton, 4702, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, 2751, Australia
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Seedat J. The knowledge-to-action process model for knowledge translation in oral care in South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e9. [PMID: 37526536 PMCID: PMC10397355 DOI: 10.4102/sajcd.v70i1.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/13/2022] [Accepted: 06/12/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Literature supports the mismatch between empirical evidence and service delivery. Given this knowledge gap, it is important that research undertaken has a theoretical foundation, considers the context and stakeholders to confirm its need and that it can be feasibly implemented and sustained. OBJECTIVES The study aimed to facilitate knowledge translation in oral care using the knowledge-to-action (K2A) process model among nurses. METHOD The study was completed in an acute hospital in South Africa. A qualitative design with ethnography incorporating video-recordings and semi-structured interviews were used. A total of 139 nurses were recruited using random purposive sampling and received training on oral care, which was monitored. Inductive thematic analysis was completed. RESULTS The model facilitated information transfer and implementation of oral care by nurses. CONCLUSION With clear directions for use and theoretical underpinning, the K2A model was well-suited to the needs of the study and stakeholders, and the complexity of the context. For challenging contexts such as public healthcare institutions in South Africa, this was ideal and critical to the success of the intervention.Contribution: When nursing managers show interest and recognise nurses for their role in implementation of interventions, the buy-in, support and sustained use of that intervention is enhanced. A model such as the K2A promotes involvement of all stakeholders (e.g. nurses and their managers) in the design and planning for implementation of an intervention, and these are critical for the successful and feasible use of the intervention.
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Affiliation(s)
- Jaishika Seedat
- Department of Speech Pathology and Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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Benli ET, Avci Ş, Öğün MN. Feel it or deal with it: Oral perception and aspiration risk in early stroke. J Oral Rehabil 2023; 50:217-222. [PMID: 36533879 DOI: 10.1111/joor.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/26/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sensation and perception impairments are significant problems faced by individuals with early-stage stroke. Sensory inputs needed in swallowing guide the perceptual process with the involvement of cognitive functions. In the absence of sensory input, bolus perception may be altered, and swallowing safety may be compromised. OBJECTIVES This study aims to evaluate the oral perception of volume change and the aspiration risk of individuals with stroke and determine the relationship between oral perception and aspiration risk. METHODS Total participants were 35. The Gugging Swallowing Screening Test (GUSS) was used to determine individuals' risk of aspiration and divide them into groups 'aspiration risk' and 'non-aspiration risk'. The Oral Perception of Liquid Volume Changes Test (OPLVCT) was used to determine the level of oral perception. RESULTS The groups were statistically similar in terms of age and other descriptives. When the OPLVC test was examined, the scores of the aspiration risk group were significantly lower (p < .001). In addition, a moderate negative correlation was found between aspiration risk and the OPLVC scores (r: -0.502; p < .001). CONCLUSION In this study, a relationship was found between aspiration risk and oral perception. It also revealed that individuals with stroke who are at risk of aspiration have low oral perception abilities. Based on these results, it was concluded that these individuals cannot reliably determine the maximum volume of liquid to be consumed without assistance. We suggest that evaluations and training of oral perception should be added to the rehabilitation of individuals with stroke.
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Affiliation(s)
- Enes Tayyip Benli
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Şebnem Avci
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Muhammed Nur Öğün
- Faculty of Medicine, Department of Neurology, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Oliveira I, Couto G, Santos R, Campolargo A, Lima C, Ferreira P. Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000520505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.
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Kothari SF, Nascimento GG, Jakobsen MB, Nielsen JF, Kothari M. Effectiveness of Standard Oral Care Plan During Hospital Stay in Individuals With Brain Injury. Front Neurol 2021; 12:714167. [PMID: 34975708 PMCID: PMC8714640 DOI: 10.3389/fneur.2021.714167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the effectiveness of an existing standard oral care program (SOCP) and factors associated with it during hospitalization in individuals with acquired brain injury (ABI).Material and Methods: A total of 61 individuals underwent a SOCP for 4 weeks in a longitudinal observational study. Rapidly noticeable changes in oral health were evaluated by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at weeks 1 and 5. Individuals' brushing habits, eating difficulties, and the onset of pneumonia were retrieved from their medical records. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.Results: Dental plaque (P = 0.01) and total BOE score (P < 0.05) decreased over time but not the proportion of dental calculus (P = 0.30), BOP (P = 0.06), and tooth brushing frequency (P = 0.06). Reduction in plaque and BOE over time were negatively associated with higher periodontitis scores at baseline (coef. −6.8; −1.0), respectively, which in turn were associated with an increased proportion of BOP (coef. ≈ 15.0). An increased proportion of calculus was associated with eating difficulties (coef. 2.3) and the onset of pneumonia (coef. 6.2).Conclusions: Nursing care has been fundamental in improving oral health, especially reducing dental plaque and BOE scores. However, our findings indicate a need for improving the existing SOCP through academic-clinical partnerships.Clinical Relevance: Early introduction of oral care program to brain-injured individuals is beneficial in reducing plaque accumulation and improving oral health.
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Affiliation(s)
- Simple F. Kothari
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Gustavo G. Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Mille B. Jakobsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Jørgen F. Nielsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Mohit Kothari
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
- JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
- *Correspondence: Mohit Kothari
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Bangee M, Martinez-Garduno CM, Brady MC, Cadilhac DA, Dale S, Hurley MA, McInnes E, Middleton S, Patel T, Watkins CL, Lightbody E. Oral care practices in stroke: findings from the UK and Australia. BMC Nurs 2021; 20:169. [PMID: 34526030 PMCID: PMC8442320 DOI: 10.1186/s12912-021-00642-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Aims To examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia. Background Poor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries. Design A cross-sectional survey. Methods Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times. Results Completed questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents. Conclusion Unacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00642-y.
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Affiliation(s)
- Munirah Bangee
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Cintia Mayel Martinez-Garduno
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Dominique A Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, VIC, Melbourne, Australia
| | - Simeon Dale
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Margaret A Hurley
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Elizabeth McInnes
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Sandy Middleton
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Tahera Patel
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Elizabeth Lightbody
- Faculty of Health and Care, University of Central Lancashire, Preston, PR1 2HE, UK.
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Prendergast V, Chapple KM. Evaluation and Acceptance of an Electric Toothbrush Designed for Dependent Patients. Cureus 2021; 13:e15372. [PMID: 34249525 PMCID: PMC8248507 DOI: 10.7759/cureus.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION A key barrier to standardizing evidence-based oral health protocols for highly dependent patients is the lack of validated and accepted oral health products designed specifically for use by caregivers. This study compared preferences by users of a novel electric toothbrush and a manual toothbrush in a health care setting. METHODS We prospectively enrolled health care providers as volunteers. Volunteer brushers completed simulated tooth brushing sessions of mock-intubated and non-intubated volunteer brushees with both toothbrushes. Volunteers rated different domains of toothbrush preference in an anonymous, optional survey. RESULTS A total of 133 health care providers volunteered (123 brushers [providers brushing teeth] and 10 brushees [those having their teeth brushed]). The novel electric toothbrush received significantly higher positive ratings than the standard hospital-issue manual toothbrush in all domains that we surveyed: ease of use, thoroughness, safety, shape and size of the brush head, overall cleanliness, time requirements, and efficiency (p<0.001). Importantly, due to the integrated light and suction of this electric toothbrush, brushers completed more sessions without setting down the toothbrush with the electric toothbrush than with the manual toothbrush (75.4% vs 36.4%; p<0.001). CONCLUSIONS Integrating a lighted electric brush with suction into the caregiver's armamentarium as an evidence-based tool is warranted and should be evaluated in terms of patient outcomes.
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Affiliation(s)
| | - Kristina M Chapple
- Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, USA
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Campbell P, Bain B, Furlanetto DL, Brady MC. Interventions for improving oral health in people after stroke. Cochrane Database Syst Rev 2020; 12:CD003864. [PMID: 33314046 PMCID: PMC8106870 DOI: 10.1002/14651858.cd003864.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND For people with physical, sensory and cognitive limitations due to stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group. OBJECTIVES To compare the effectiveness of OHC interventions with usual care or other treatment options for ensuring oral health in people after a stroke. SEARCH METHODS We searched the Cochrane Stroke Group and Cochrane Oral Health Group trials registers, CENTRAL, MEDLINE, Embase, and six other databases in February 2019. We scanned reference lists from relevant papers and contacted authors and researchers in the field. We handsearched the reference lists of relevant articles and contacted other researchers. There were no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated one or more interventions designed to improve the cleanliness and health of the mouth, tongue and teeth in people with a stroke who received assisted OHC led by healthcare staff. We included trials with a mixed population provided we could extract the stroke-specific data. The primary outcomes were dental plaque or denture plaque. Secondary outcomes included presence of oral disease, presence of related infection and oral opportunistic pathogens related to OHC and pneumonia, stroke survivor and providers' knowledge and attitudes to OHC, and patient satisfaction and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text articles according to prespecified selection criteria, extracted data and assessed the methodological quality using the Cochrane 'Risk of bias' tool. We sought clarification from investigators when required. Where suitable statistical data were available, we combined the selected outcome data in pooled meta-analyses. We used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS Fifteen RCTs (22 randomised comparisons) involving 3631 participants with data for 1546 people with stroke met the selection criteria. OHC interventions compared with usual care Seven trials (2865 participants, with data for 903 participants with stroke, 1028 healthcare providers, 94 informal carers) investigated OHC interventions compared with usual care. Multi-component OHC interventions showed no evidence of a difference in the mean score (DMS) of dental plaque one month after the intervention was delivered (DMS -0.66, 95% CI -1.40 to 0.09; 2 trials, 83 participants; I2 = 83%; P = 0.08; very low-quality evidence). Stroke survivors had less plaque on their dentures when staff had access to the multi-component OHC intervention (DMS -1.31, 95% CI -1.96 to -0.66; 1 trial, 38 participants; P < 0.0001; low-quality evidence). There was no evidence of a difference in gingivitis (DMS -0.60, 95% CI -1.66 to 0.45; 2 trials, 83 participants; I2 = 93%; P = 0.26: very low-quality evidence) or denture-induced stomatitis (DMS -0.33, 95% CI -0.92 to 0.26; 1 trial, 38 participants; P = 0.69; low-quality evidence) among participants receiving the multi-component OHC protocol compared with usual care one month after the intervention. There was no difference in the incidence of pneumonia in participants receiving a multi-component OHC intervention (99 participants; 5 incidents of pneumonia) compared with those receiving usual care (105 participants; 1 incident of pneumonia) (OR 4.17, CI 95% 0.82 to 21.11; 1 trial, 204 participants; P = 0.08; low-quality evidence). OHC training for stroke survivors and healthcare providers significantly improved their OHC knowledge at one month after training (SMD 0.70, 95% CI 0.06 to 1.35; 3 trials, 728 participants; I2 = 94%; P = 0.03; very low-quality evidence). Pooled data one month after training also showed evidence of a difference between stroke survivor and providers' oral health attitudes (SMD 0.28, 95% CI 0.01 to 0.54; 3 trials, 728 participants; I2 = 65%; P = 0.06; very low-quality evidence). OHC interventions compared with placebo Three trials (394 participants, with data for 271 participants with stroke) compared an OHC intervention with placebo. There were no data for primary outcomes. There was no evidence of a difference in the incidence of pneumonia in participants receiving an OHC intervention compared with placebo (OR 0.39, CI 95% 0.14 to 1.09; 2 trials, 242 participants; I2 = 42%; P = 0.07; low-quality evidence). However, decontamination gel reduced the incidence of pneumonia among the intervention group compared with placebo gel group (OR 0.20, 95% CI 0.05 to 0.84; 1 trial, 203 participants; P = 0.028). There was no difference in the incidence of pneumonia in participants treated with povidone-iodine compared with a placebo (OR 0.81, 95% CI 0.18 to 3.51; 1 trial, 39 participants; P = 0.77). One OHC intervention compared with another OHC intervention Twelve trials (372 participants with stroke) compared one OHC intervention with another OHC intervention. There was no difference in dental plaque scores between those participants that received an enhanced multi-component OHC intervention compared with conventional OHC interventions at three months (MD -0.04, 95% CI -0.33 to 0.25; 1 trial, 61 participants; P = 0.78; low-quality evidence). There were no data for denture plaque. AUTHORS' CONCLUSIONS We found low- to very low-quality evidence suggesting that OHC interventions can improve the cleanliness of patient's dentures and stroke survivor and providers' knowledge and attitudes. There is limited low-quality evidence that selective decontamination gel may be more beneficial than placebo at reducing the incidence of pneumonia. Improvements in the cleanliness of a patient's own teeth was limited. We judged the quality of the evidence included within meta-analyses to be low or very low quality, and this limits our confidence in the results. We still lack high-quality evidence of the optimal approach to providing OHC to people after stroke.
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Affiliation(s)
- Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Bain
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Denise Lc Furlanetto
- Public Health Department, Health Sciences Faculty, University of Brasilia, Brasilia, Brazil
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Gurgel-Juarez N, Perrier MF, Hoffmann T, Lannin N, Jolliffe L, Lee R, Brosseau L, Flowers H. Guideline Recommendations for Oral Care After Acquired Brain Injury: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e17249. [PMID: 32609090 PMCID: PMC7367530 DOI: 10.2196/17249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/18/2020] [Accepted: 04/07/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Oral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. OBJECTIVE This systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. METHODS A search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. RESULTS This project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. CONCLUSIONS Nursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/17249.
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Affiliation(s)
- Nalia Gurgel-Juarez
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Marie-France Perrier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Natasha Lannin
- Occupational Therapy Department, Alfred Health Hospital, Melbourne, Australia.,School of Allied Health, Faculty of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Laura Jolliffe
- Occupational Therapy Department, Alfred Health Hospital, Melbourne, Australia.,School of Allied Health, Faculty of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Rachel Lee
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Heather Flowers
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,Toronto General Hospital, University Health Network, Toronto, ON, Canada
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11
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Brady MC, Stott DJ, Weir CJ, Chalmers C, Sweeney P, Barr J, Pollock A, Bowers N, Gray H, Bain BJ, Collins M, Keerie C, Langhorne P. A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards. Int J Stroke 2020; 15:318-323. [PMID: 31564241 PMCID: PMC7153219 DOI: 10.1177/1747493019871824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life. AIMS We piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings. METHODS Scottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque. RESULTS We screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare (P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42). CONCLUSIONS Our stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect. TRIAL REGISTRATION NCT01954212.
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Affiliation(s)
- Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - David J Stott
- Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK
| | - Christopher J Weir
- Centre for Population Health Sciences,
The University of Edinburgh, Edinburgh, UK
| | | | - Petrina Sweeney
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - John Barr
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - Alex Pollock
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - Naomi Bowers
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | - Heather Gray
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | | | - Marissa Collins
- NMAHP Research Unit, Glasgow Caledonian
University, Glasgow, UK
| | | | - Peter Langhorne
- Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK
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12
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Jablonski RA, Winstead V, Azuero A, Ptacek T, Jones-Townsend C, Byrd E, Geisinger ML, Morrow C. Feasibility of Providing Safe Mouth Care and Collecting Oral and Fecal Microbiome Samples from Nursing Home Residents with Dysphagia: Proof of Concept Study. J Gerontol Nurs 2018; 43:9-15. [PMID: 28841221 DOI: 10.3928/00989134-20170811-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with dysphagia who reside in nursing homes often receive inadequate mouth care and experience poor oral health. From a policy perspective, the combination of absent evidence-based mouth care protocols coupled with insufficient dental coverage create a pool of individuals at great risk for preventable infectious illnesses that contribute to high health care costs. The purpose of the current study was to determine (a) the safety of a mouth care protocol tailored for individuals with dysphagia residing in nursing homes without access to suction equipment, and (b) the feasibility of collecting oral and fecal samples for microbiota analyses. The mouth care protocol resulted in improved oral hygiene without aspiration, and oral and fecal samples were safely collected from participants. Policies supporting ongoing testing of evidence-based mouth care protocols for individuals with dysphagia are important to improve quality, demonstrate efficacy, and save health care costs. [Journal of Gerontological Nursing, 43(9), 9-15.].
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13
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Lyons M, Smith C, Boaden E, Brady MC, Brocklehurst P, Dickinson H, Hamdy S, Higham S, Langhorne P, Lightbody C, McCracken G, Medina-Lara A, Sproson L, Walls A, Watkins DC. Oral care after stroke: Where are we now? Eur Stroke J 2018; 3:347-354. [PMID: 31236482 DOI: 10.1177/2396987318775206] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/12/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.
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Affiliation(s)
- Mary Lyons
- Faculty of Health and Wellbeing, University of Central Lancashire, UK.,Department of International Public Health, Liverpool School of Tropical Medicine, UK
| | - Craig Smith
- Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Department of Neurosciences, Salford Royal NHS Foundation Trust, UK
| | - Elizabeth Boaden
- Faculty of Health and Wellbeing, University of Central Lancashire, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor Institute of Health and Medical Research and Salford Royal NHS Foundation Trust, UK
| | - Hazel Dickinson
- Faculty of Health and Wellbeing, University of Central Lancashire, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Susan Higham
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | | | - Giles McCracken
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | | | - Lise Sproson
- National Institute for Health Research Devices for Dignity Healthcare Technology Cooperative, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Angus Walls
- Edinburgh Dental Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Dame Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, UK.,Faculty of Health Sciences, Australian Catholic University, Australia
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14
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Ab Malik N, Mohamad Yatim S, Hussein N, Mohamad H, McGrath C. Oral hygiene practices and knowledge among stroke-care nurses: A multicentre cross-sectional study. J Clin Nurs 2018; 27:1913-1919. [PMID: 29266493 DOI: 10.1111/jocn.14241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia. BACKGROUND Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia. DESIGN A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided. METHODS All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined. RESULTS Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p < .001). CONCLUSIONS The clinical practice of providing oral hygiene care is less than ideal, and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.
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Affiliation(s)
- Normaliza Ab Malik
- Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia.,Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | | | - Norhayati Hussein
- Department of Rehabilitation Medicine (Neurological), Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia
| | - Hanita Mohamad
- Department of Rehabilitation Medicine, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia
| | - Colman McGrath
- Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
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15
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Pillai RS, Iyer K, Spin-Neto R, Kothari SF, Nielsen JF, Kothari M. Oral Health and Brain Injury: Causal or Casual Relation? Cerebrovasc Dis Extra 2018; 8:1-15. [PMID: 29402871 PMCID: PMC5836263 DOI: 10.1159/000484989] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background To systematically review the current literature investigating the association between oral health and acquired brain injury. Methods A structured search strategy was applied to PubMed, Embase, Web of Science, and CENTRAL electronic databases until March 2017 by 2 independent reviewers. The preferred reporting items for systematic review and meta-analysis guidelines were used for systematic review. Results Even though the objective was to assess the association between oral health and acquired brain injury, eligible studies focused solely on different forms of stroke and stroke subtypes. Stroke prediction was associated with various factors such as number of teeth, periodontal conditions (even after controlling for confounding factors), clinical attachment loss, antibody levels to Aggregatibacter actinomycetemcomitans and Prevotella intermedia. The literature showed no consensus on the possible association between gingivitis and stroke. Patients with stroke generally had poorer oral hygiene practices and oral health. Dental prophylaxis and professional intervention reduced the incidence of stroke. Conclusions Overall, oral health and stroke were related. Periodontitis and tooth loss were independently associated with stroke. However, prevention and timely intervention may reduce the risk of stroke. Stroke was the main cerebral lesion studied in the literature, with almost no publications on other brain lesions.
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Affiliation(s)
- Rajath Sasidharan Pillai
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Kiran Iyer
- Department of Public Health Dentistry, Oxford Dental College and Hospital, Bengaluru, India
| | - Rubens Spin-Neto
- Section of Oral Radiology, Institute of Odontology and Oral Health, Aarhus University, Aarhus, Denmark
| | - Simple Futarmal Kothari
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Mohit Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
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16
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Ab Malik N, Mohamad Yatim S, Lam OLT, Jin L, McGrath CPJ. Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial. J Med Internet Res 2017; 19:e87. [PMID: 28363880 PMCID: PMC5392212 DOI: 10.2196/jmir.7024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/23/2017] [Accepted: 02/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia. Objective The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on “general intention” of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB). Methods A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: “attitude,” “subjective norm” (SN), “perceived behavior control” (PBC), “general intention” (GI), and “knowledge” related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention. Results The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (P<.001) and knowledge (P=.001) between the test and control groups. Regression analyses identified that the key factors associated with a change in GI at 6 months were changes in SN (beta=.36, P<.001) and changes in PBC (beta=.23, P<.001). Conclusions The Web-based CPD program based on TPB increased general intention, attitudes, subjective norms, and knowledge to provide oral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care. Trial Registration National Medical Research Register, Malaysia NMRR-13-1540-18833 (IIR); https://www.nmrr.gov.my/ fwbLoginPage.jsp
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Affiliation(s)
- Normaliza Ab Malik
- Periodontology and Dental Public Health, The University of Hong Kong, Hong Kong SAR, China.,Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia
| | | | - Otto Lok Tao Lam
- Department of Oral Rehabilitation, The University of Hong Kong, Hong Kong SAR, China
| | - Lijian Jin
- Periodontology and Dental Public Health, The University of Hong Kong, Hong Kong SAR, China
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17
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Ajwani S, Jayanti S, Burkolter N, Anderson C, Bhole S, Itaoui R, George A. Integrated oral health care for stroke patients - a scoping review. J Clin Nurs 2016; 26:891-901. [DOI: 10.1111/jocn.13520] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Shilpi Ajwani
- Sydney Local Health District Oral Health Services and Sydney Dental Hospital; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | | | | | - Craig Anderson
- The George Institute for Global Health; Sydney NSW Australia
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services and Sydney Dental Hospital; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - Rhonda Itaoui
- CoHORTE Research Group; Western Sydney University; Sydney NSW Australia
- South Western Sydney Local Health District; Sydney NSW Australia
- Ingham Institute Applied Medical Research; Sydney NSW Australia
| | - Ajesh George
- University of Sydney; Sydney NSW Australia
- CoHORTE Research Group; Western Sydney University; Sydney NSW Australia
- South Western Sydney Local Health District; Sydney NSW Australia
- Ingham Institute Applied Medical Research; Sydney NSW Australia
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18
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Mehl AE, Ellingsen ØG, Kjeksrud J, Willumsen T. Oral healthcare education of future nursing personnel and auxiliary nurses. Gerodontology 2014; 33:233-9. [PMID: 25209113 DOI: 10.1111/ger.12147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the oral healthcare training in the education of auxiliary nurses in Norway. BACKGROUND Many elderly residents need assistance in every aspect of daily living, including help with oral care. Auxiliary nurses are the professional group who most often provide this help. MATERIALS AND METHODS An e-mail administered questionnaire was sent to all 164 high schools in Norway offering basic education for auxiliary nurse. RESULTS Of the 114 high schools responding to the survey (69.5% response rate), 83.3% reported mandatory courses, 49.1% offered three or more hours of teaching in oral health care. 89.5% offered both lectures and practical training, 93.9% had training in tooth cleaning, 37.7% lectured about different dental restorations, 50% lectured on ergonomic working positions, 12.3% on the working lights, 16.7% on inspection techniques, 25.4% on interdental brushes and 6.1% on electrical powered toothbrushes. Additionally, 45.6% assessed that their students are prepared for later work with oral health care. More lessons led to better quality of education. CONCLUSION Almost all of the high schools had mandatory education in oral care in the auxiliary nurse programme. Increasing the number of lessons may improve the quality of knowledge, but the teaching programmes for a number of topics seem insufficient. There is a need to strengthen the position of oral health in the education of auxiliary nurses. To meet the future challenges in oral health, international or national expert-developed guidelines for oral care training programmes would be useful for the education of auxiliary nurses.
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Affiliation(s)
- Astrid E Mehl
- Dental Faculty, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Øivind G Ellingsen
- Dental Faculty, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Joakim Kjeksrud
- Dental Faculty, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Tiril Willumsen
- Dental Faculty, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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19
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Niesten D, van Mourik K, van der Sanden W. The impact of frailty on oral care behavior of older people: a qualitative study. BMC Oral Health 2013; 13:61. [PMID: 24175989 PMCID: PMC3819177 DOI: 10.1186/1472-6831-13-61] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people. METHODS We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers. RESULTS Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports. CONCLUSION The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.
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Affiliation(s)
- Dominique Niesten
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, PO Box 9101HB, Nijmegen, The Netherlands.
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20
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Edward KL, Salamone K, Mahoney AM, Mills C, Mann R, Arunasalam K, McLean A, Yacoub E, Lorman S, Aspiridis K, McGillion T. Oral care for in-patients: current practice—future directions. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/denn.2013.9.5.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen-leigh Edward
- StVPH (Melbourne)/St Vincent's Private Hospital (Melbourne) Nursing Research Unit, Faculty of Health Sciences, Australian Catholic University
| | | | | | - Cally Mills
- St Vincent's Private Hospital (Melbourne) Nursing Research Unit, Faculty of Health Sciences, Australian Catholic University
| | - Rod Mann
- Mental Health Clinical Services Unit, Austin Health
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21
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Systematic reviews identify important methodological flaws in stroke rehabilitation therapy primary studies: review of reviews. J Clin Epidemiol 2012; 65:358-67. [PMID: 22360987 DOI: 10.1016/j.jclinepi.2011.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 10/17/2011] [Accepted: 10/30/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A "review of reviews" was undertaken to assess methodological issues in studies evaluating nondrug rehabilitation interventions in stroke patients. STUDY DESIGN AND SETTING MEDLINE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews were searched from January 2000 to January 2008 within the stroke rehabilitation setting. Electronic searches were supplemented by reviews of reference lists and citations identified by experts. Eligible studies were systematic reviews; excluded citations were narrative reviews or reviews of reviews. Review characteristics and criteria for assessing methodological quality of primary studies within them were extracted. RESULTS The search yielded 949 English-language citations. We included a final set of 38 systematic reviews. Cochrane reviews, which have a standardized methodology, were generally of higher methodological quality than non-Cochrane reviews. Most systematic reviews used standardized quality assessment criteria for primary studies, but not all were comprehensive. Reviews showed that primary studies had problems with randomization, allocation concealment, and blinding. Baseline comparability, adverse events, and co-intervention or contamination were not consistently assessed. Blinding of patients and providers was often not feasible and was not evaluated as a source of bias. CONCLUSIONS The eligible systematic reviews identified important methodological flaws in the evaluated primary studies, suggesting the need for improvement of research methods and reporting.
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Prasad K, Kaul S, Padma MV, Gorthi SP, Khurana D, Bakshi A. Stroke management. Ann Indian Acad Neurol 2011; 14:S82-96. [PMID: 21847335 PMCID: PMC3152174 DOI: 10.4103/0972-2327.83084] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Indexed: 01/13/2023] Open
Affiliation(s)
- Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Brady MC, Stott DJ, Norrie J, Chalmers C, St George B, Sweeney PM, Langhorne P. Developing and evaluating the implementation of a complex intervention: using mixed methods to inform the design of a randomised controlled trial of an oral healthcare intervention after stroke. Trials 2011; 12:168. [PMID: 21729277 PMCID: PMC3155479 DOI: 10.1186/1745-6215-12-168] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 07/05/2011] [Indexed: 11/26/2022] Open
Abstract
Background Many interventions delivered within the stroke rehabilitation setting could be considered complex, though some are more complex than others. The degree of complexity might be based on the number of and interactions between levels, components and actions targeted within the intervention. The number of (and variation within) participant groups and the contexts in which it is delivered might also reflect the extent of complexity. Similarly, designing the evaluation of a complex intervention can be challenging. Considerations include the necessity for intervention standardisation, the multiplicity of outcome measures employed to capture the impact of a multifaceted intervention and the delivery of the intervention across different clinical settings operating within varying healthcare contexts. Our aim was to develop and evaluate the implementation of a complex, multidimensional oral health care (OHC) intervention for people in stroke rehabilitation settings which would inform the development of a randomised controlled trial. Methods After reviewing the evidence for the provision of OHC following stroke, multi-disciplinary experts informed the development of our intervention. Using both quantitative and qualitative methods we evaluated the implementation of the complex OHC intervention across patients, staff and service levels of care. We also adopted a pragmatic approach to patient recruitment, the completion of assessment tools and delivery of OHC, alongside an attention to the context in which it was delivered. Results We demonstrated the feasibility of implementing a complex OHC intervention across three levels of care. The complementary nature of the mixed methods approach to data gathering provided a complete picture of the implementation of the intervention and a detailed understanding of the variations within and interactions between the components of the intervention. Information on the feasibility of the outcome measures used to capture impact across a range of components was also collected, though some process orientated uncertainties including eligibility and recruitment rates remain to be further explored within a Phase II exploratory trial. Conclusions Complex interventions can be captured and described in a manner which facilitates evaluation in the form of exploratory and subsequently definitive clinical trials. If effective, the evidence captured relating to the intervention context will facilitate translation into clinical practice.
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Affiliation(s)
- Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
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24
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An evidence-based oral hygiene education program for nursing staff. Nurse Educ Pract 2011; 11:256-9. [DOI: 10.1016/j.nepr.2010.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 08/03/2010] [Accepted: 11/20/2010] [Indexed: 11/17/2022]
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Abstract
Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice.
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Affiliation(s)
- Peter Langhorne
- Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Royal Infirmary, Glasgow, UK.
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Kullberg E, Forsell M, Wedel P, Sjögren P, Johansson O, Herbst B, Hoogstraate J. Dental Hygiene Education for Nursing Staff. Geriatr Nurs 2009; 30:329-33. [DOI: 10.1016/j.gerinurse.2009.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 06/10/2009] [Accepted: 06/16/2009] [Indexed: 11/26/2022]
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Miegel K, Wachtel T. Improving the oral health of older people in long-term residential care: a review of the literature. Int J Older People Nurs 2009; 4:97-113. [PMID: 20925809 DOI: 10.1111/j.1748-3743.2008.00150.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background. Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care. Aims and objectives. The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents. Conclusions. Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools. Relevance to clinical practice. The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.
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Affiliation(s)
- Karen Miegel
- Graduate Registered Nurse, Riverland Regional Health Services, Berri, SA, AustraliaLecturer in Nursing, School of Nursing and Midwifery, Flinders University Renmark Campus, Renmark, SA, Australia
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Brady M, Furlanetto D, Hunter RV, Lewis S, Milne V. Staff-led interventions for improving oral hygiene in patients following stroke. Cochrane Database Syst Rev 2006:CD003864. [PMID: 17054189 DOI: 10.1002/14651858.cd003864.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND For people with limitations due to neurological conditions such as stroke, the routine practice of oral care may become a challenge. Evidence-based supported oral care intervention is essential for this patient group. OBJECTIVES To compare the effectiveness of staff-led oral care interventions with standard care for ensuring oral hygiene for individuals after a stroke. SEARCH STRATEGY We searched the trials registers of the Cochrane Stroke Group and Oral Health Group (August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to February 2006), CINAHL (1982 to February 2006), Research Findings Electronic Register (February 2006), National Research Register (Issue 1, 2006), ISI Science and Technology Proceedings (August 2005), Dissertation Abstracts and Conference Papers Index (August 2005). We scanned reference lists from relevant papers and contacted authors and researchers in the field. SELECTION CRITERIA We identified randomised controlled trials that evaluated one or more interventions designed to improve oral hygiene. Trials based on a mixed population were included, provided it was possible to extract the data specific to the individuals post stroke. DATA COLLECTION AND ANALYSIS Two review authors independently classified identified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. Clarification was sought from study authors when required. MAIN RESULTS Eight eligible randomised controlled trials were identified but only one provided stroke-specific information. It compared an oral health care education training programme (OHCE) delivered to nursing home care assistants to delayed training intervention in the control group. Comparisons were made at one and six months after the intervention, using the primary outcome measures dental plaque and denture plaque, and three secondary outcomes. The data available for the 67 individuals with a stroke (obtained from the larger cluster randomised controlled trial) showed that denture plaque scores were significantly reduced up to six months (p < 0.00001) after the intervention. Staff knowledge (P = 0.0008) and attitudes (P = 0.0001) towards oral care also improved significantly. AUTHORS' CONCLUSIONS Based on one study with a small number of stroke survivors, providing oral care training for carers in a nursing home setting improves their knowledge of and attitudes towards the provision of oral care. In turn, residents' dentures were cleaner, though other oral hygiene measures did not change. Further evidence relating to oral care interventions is severely lacking, in particular with reference to care in hospital for those following stroke.
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Affiliation(s)
- M Brady
- Glasgow Caledonian University, Nursing, Midwifery and Allied Health Professions Research Unit, Cowcaddens Road, Glasgow, UK.
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