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Karaçam K, Erdem RZ. The level of knowledge of medical and dental students regarding prophylaxis for infective endocarditis. J Dent Educ 2024. [PMID: 38634197 DOI: 10.1002/jdd.13553] [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: 12/20/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Infective endocarditis is a rarely seen disease, but has a high mortality rate. Therefore, it is extremely important that the guidelines are followed correctly. The main aim of this study was to evaluate and compare the level of knowledge and attitude of infective endocarditis of fourth- and fifth-year dentistry students in clinical residency and fifth- and sixth-year medical students. METHODS A 42-item questionnaire evaluating the type and dosage of antibiotics administered as infective endocarditis prophylaxis in medical conditions and dentistry procedures was delivered online to the study participants. The data obtained were examined using descriptive statistics and analyzed with the chi-square test. RESULTS The questionnaire was completed by a total of 332 participants. The statistical analyses showed a good level of knowledge in 55% of the dentistry faculty students and in 43.5% of the medical faculty students. CONCLUSIONS When considering that dental and medical faculty students are not expected to receive additional training on antimicrobial management after graduation, the findings of this study have raised significant attitude for the improvement of our education system in this field.
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Affiliation(s)
- Kübra Karaçam
- Department of Periodontology, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Rahime Zeynep Erdem
- Department of Restorative Dentistry, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Diz Dios P, Monteiro L, Pimolbutr K, Gobbo M, France K, Bindakhil M, Holmes H, Sperotto F, Graham L, Turati F, Salvatori A, Hong C, Sollecito TP, Lodi G, Thornhill MH, Lockhart PB, Edefonti V. World Workshop on Oral Medicine VIII: Dentists' compliance with infective endocarditis prophylaxis guidelines for patients with high-risk cardiac conditions: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:757-771. [PMID: 37105883 DOI: 10.1016/j.oooo.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To determine dentists' awareness and/or adherence to antibiotic prophylaxis (AP) guidelines for preventing infective endocarditis (IE) in patients with high-risk heart conditions. STUDY DESIGN A systematic literature review was performed on MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, Proquest, Embase, Dentistry, and Oral Sciences Source databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Nationwide studies based on questionnaires, surveys, and interviews completed by dentists and published since 2007 were included. RESULTS From 2907 articles screened, 28 studies were selected (across 20 countries). The quality of included studies was poor due to a lack of standard evaluation tools, low response rates, and lack of questionnaire validity and/or reliability. Approximately 75% of surveyed dentists reported being knowledgeable about AP guidelines, but only ∼25% complied. Reported compliance with American Heart Association (AHA) guidelines was 4 times higher than with the National Institute for Health and Care Excellence (NICE) recommendations. Some of the highest adherence rates were reported for other national AP guidelines. Significant geographic differences were observed in the estimated adherence to AHA guidelines and the percentage of dentists who reported seeking advice from physicians and/or cardiologists. CONCLUSION Rates of compliance and/or adherence were substantially different from rates of knowledge and/or awareness, including relevant geographic dissimilarities. Compliance/adherence was higher for AHA than NICE.
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Affiliation(s)
- Pedro Diz Dios
- Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), School of Medicine and Dentistry, Santiago de Compostela University, Spain
| | - Luis Monteiro
- University Institute of Health Sciences (CESPU), Portugal
| | | | - Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Treviso, Italy.
| | | | | | - Haly Holmes
- Department of Oral Medicine & Periodontology, Faculty of Dentistry University of the Western Cape, South Africa
| | - Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Laurel Graham
- Levy Dental Medicine Library-University of Pennsylvania, USA
| | - Federica Turati
- Branch of Medical Statistics, Biometry, and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | | | - Catherine Hong
- Faculty of Dentistry, National University of Singapore, Singapore
| | | | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche-Università degli Studi di Milano, Italy
| | | | | | - Valeria Edefonti
- Branch of Medical Statistics, Biometry, and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy; Branch of Medical Statistics, Biometry, and Epidemiology "G.A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Doshmangir L, Jabbari H, Arab-Zozani M, Naghavi-Behzad M, Abedi Z, Mostafavi H. Factors affecting hospital services overutilization and reductive strategies in Iran: a qualitative study to explore experts' views. Hosp Pract (1995) 2022; 50:416-424. [PMID: 36222088 DOI: 10.1080/21548331.2022.2134679] [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: 02/24/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to investigate the viewpoints of the main stakeholders of the Iranian healthcare system about the overutilization of hospital services and strategies to eliminate or reduce it in Iran. METHODS This is a qualitative study and thematic data analysis using face-to-face semi-structured interviews and Focus Group Discussions (FGDs). We conducted eight interviewers and two FGDs with hospital stakeholders including faculty members, insurance organizations' authorities, experienced hospital administrative staff, hospital managers, and health-care providers. RESULTS The factors leading to the overutilization of hospital services were categorized into four main themes including site of service, quality, supplier push, and demand pull. Strategies for eliminating or reducing the overutilization of hospital services are also identified based on the influential factors. CONCLUSION Addressing overutilization of hospital services in the health system and adherence to policies for reducing or eliminating overutilization is a way to make preventive strategies to overcome overutilization. Developing a national plan to integrate utilization management into health system programs is a strategy to combat overutilization in various levels of the health system including hospital setting.
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Affiliation(s)
- Leila Doshmangir
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Jabbari
- Department of Community Medicine, School of Medicine, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Zeinab Abedi
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hakimeh Mostafavi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Maeda K, Hirai Y, Nashi M, Yamamoto S, Taniike N, Takenobu T. Clinical features and antimicrobial susceptibility of oral bacteria isolated from the blood cultures of patients with infective endocarditis. J Dent Sci 2022; 17:870-875. [PMID: 35756779 PMCID: PMC9201522 DOI: 10.1016/j.jds.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background/purpose The epidemiology of infective endocarditis (IE) is under constant change due to the aging society and increases in antimicrobial-resistant pathogens. However, IE remains severe. This study aimed to review the current clinical characteristics of IE and the antimicrobial susceptibility of oral bacteria (OB) isolated from blood cultures to implement appropriate antimicrobial prophylaxis. Materials and methods We retrospectively investigated the clinical features of 180 patients with IE in whom OB and pathogens except OB (eOB) were identified as causative microorganisms via blood cultures. The susceptibility of the OB group to eight antibiotics was examined by broth microdilution. Results Among causative microorganisms, the isolation rate of staphylococci was slightly higher than that of OB; however, the difference was not significant (36.7% vs. 33.8%, p = 0.3203). The number of patients with underlying cardiac disease was significantly higher in the OB group than in the eOB group (53.7% vs. 34.1%, p = 0.0113). Only one ampicillin-resistant OB was detected (2.0%). OBs were significantly less susceptible to clarithromycin and azithromycin than to ampicillin (98.0% vs. 66.7% and 98.0% vs. 60.0%, p = 0.0003 and p = 0.0003, respectively). Moreover, OBs were significantly less susceptible to clarithromycin and azithromycin than to clindamycin (66.7% vs. 88.2% and 60.0% vs. 88.2%, p = 0.0301 and p = 0.0217, respectively). Conclusion OBs were susceptible to ampicillin. However, the susceptibility of OBs to clarithromycin and azithromycin was significantly lower than that to ampicillin and clindamycin. These results are important and should help decisions regarding guide antimicrobial prophylaxis.
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Affiliation(s)
- Keigo Maeda
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
- Corresponding author. Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan. Fax: +81 78 302 7537.
| | - Yuzo Hirai
- Department of Oral and Maxillofacial Surgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Masanori Nashi
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinsuke Yamamoto
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoki Taniike
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshihiko Takenobu
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Lockhart PB, Thornhill MH, Zhao J, Baddour LM, Gilbert GH, McKnight PE, Stephens C, Mougeot JL. Factors that affect dentists’ use of antibiotic prophylaxis. J Am Dent Assoc 2022; 153:552-562. [DOI: 10.1016/j.adaj.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022]
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Al-Mohaissen MA, Al-Mehisen R, Lee T, Al-Madi EM. Managing Cardiac Patients: Dentists' Knowledge, Perceptions, and Practices. Int Dent J 2021; 72:296-307. [PMID: 34256924 PMCID: PMC9275076 DOI: 10.1016/j.identj.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Dental patients may require invasive treatment, and awareness of their medical conditions is essential for optimal care. We assessed the knowledge, perceptions, and attitudes of dentists practicing in Saudi Arabia (SA) and their associations with managing patients with common cardiac conditions. METHODS A national survey of knowledge and attitudes of practicing dentists towards patients with common cardiac conditions was conducted from May 2019 to July 2020 in SA. The survey comprised a newly developed, validated, electronic, self-administered English questionnaire. RESULTS Overall, 282 dentists completed the survey, of whom 45.5% perceived cardiac patients as difficult to manage, while 64.5% stated that they refer these patients to cardiologists before dental intervention. Regarding knowledge about cardiac conditions, 72% achieved an overall knowledge score <55%; however, their infective endocarditis scores were better. Consultants and specialists (P < .001), those with a PhD/board certification (P = .013), dentists with prior education on cardiac patient management (P = .002), and those working with a cardiologist (P = .016) scored higher on knowledge. Conversely, private dentists (P = .003) and those referring patients to cardiologists before treatment (P = .003) scored lower. Dentists' knowledge of cardiovascular diseases in women was low; only those who believed women experience a greater risk of cardiac complications achieved a higher score. Approximately 90.1% wished to receive education regarding cardiac patient management. CONCLUSIONS Knowledge of cardiac patient management was suboptimal in this study. Dentists perceived cardiac patients as difficult to manage, but wished to learn more regarding optimal management. Thus, postgraduate education programmes that promote optimal dental management strategies for cardiac patients are necessary.
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Affiliation(s)
- Maha A Al-Mohaissen
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Rabah Al-Mehisen
- Department of Cardiology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Ebtissam M Al-Madi
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Šutej I, Par M, Lepur D, Peroš K, Pintarić H, Alajbeg I, Vuger L. Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis- National survey study. J Clin Exp Dent 2021; 13:e648-e652. [PMID: 34306527 PMCID: PMC8291157 DOI: 10.4317/jced.58054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background The objective of this study was to assess the attitude, practice, and knowledge of Croatian dentists regarding infective endocarditis (IE) prophylaxis.
Material and Methods A cross-sectional, self-reporting questionnaire survey was conducted with the participation of 348 Croatian dentists. The questionnaire was designed to collect information on participants’ work experience, place of work, their attitudes related to the treatment of IE-risk patients, knowledge and adherence to IE antibiotic prophylaxis guidelines.
Results Knowledge and adherence to the current guidelines decreased with the higher years of experience. Compliance with the current guidelines varied, mostly because of respondents’ insecurity regarding which guidelines to follow. AHA guidelines have been most frequently the first choice (25% participants). Surprisingly, 23% of dentists didn’t follow any of the official guidelines. The majority of participants (68%) have declared a lack of preparedness or willingness to treat the patients at risk of IE. Dentists with specialty or working at university/hospital have shown a higher level of knowledge and preparedness to treat IE-risk patients.
Conclusions The lack of knowledge of guidelines and consequent inconsistencies in IE antibiotic prophylaxis in Croatian dental practice indicates the need for urgent improvement. Key words:Antibiotic prophylaxis, dentistry, infective endocarditis.
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Affiliation(s)
- Ivana Šutej
- Assist. Prof. of Pharmacology, School of Dental Medicine, University in Zagreb, Croatia
| | - Matej Par
- Postdoctoral fellow of Endodontics and Restorative Dentistry, School of Dental Medicine, University in Zagreb, Croatia
| | - Dragan Lepur
- Assoc. Prof. of Infectious Diseases., School of Dental Medicine, University in Zagreb, Croatia
| | - Kristina Peroš
- Assist. Prof. of Pharmacology, School of Dental Medicine, University in Zagreb, Croatia
| | - Hrvoje Pintarić
- Prof. of Internal Medicine, School of Dental Medicine, University in Zagreb, Croatia
| | - Ivan Alajbeg
- Prof. of Oral Medicine. School of Dental Medicine, University in Zagreb, Croatia
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Taradin GG, Ignatenko GA, Rakitskaya IV, Ponomareva EY, Vatutin NT, Bondarenko YD. Practical aspects of infective endocarditis prevention. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The review is devoted to the practical aspects of infective endocarditis (IE) prevention, the issues of which, as before, remain the subject of lengthy discussions. Despite repeatedly updated national and international guidelines on this topic, medical practitioners are not always fully aware of antibiotic prophylaxis of IE. After a brief consideration of the etiological, pathogenetic features and risk factors of the disease, the main provisions of 2015 European Society of Cardiology guidelines on IE prevention, which were approved by the Russian Society of Cardiology, are presented. The categories of patients with the highest risk of IE, procedures associated with an increased risk of IE (dental and other invasive procedures) are described in detail. The main practical approaches to the identification of risk groups and performing invasive procedures that influence the decision to prescribe antibiotic prophylaxis are described. Particular attention is paid to the characteristics of both first-line antibiotic drugs and alternative agents for penicillin allergy or in cases of β-lactamase secreting pathogens.
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Affiliation(s)
- G. G. Taradin
- M. Gorky Donetsk National Medical University; V.K. Gusak Institute of Urgent and Reconstructive Surgery
| | | | | | | | - N. T. Vatutin
- M. Gorky Donetsk National Medical University; V.K. Gusak Institute of Urgent and Reconstructive Surgery
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De Wolf D, Genouw A, Standaert C, Victor A, Vanoverbeke N, De Groote K, Martens L. Endocarditis prophylaxis in daily practice of pediatricians and dentists in Flanders. Eur J Pediatr 2021; 180:397-405. [PMID: 32780192 DOI: 10.1007/s00431-020-03769-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
Endocarditis is a potentially life-threatening disease in children with congenital heart disease (CHD) and correct prophylaxis (EP) is of utmost importance. We conducted two surveys among pediatricians and dentists in Flanders about their knowledge of EP guidelines. The survey was completed by 910 dentists and 100 pediatricians. Sixty-five percent of the dentists did not know any guideline. They relied for information on the internet or the child's physician. 87% identified low risk treatments correctly, but only 64% identified high risk procedures correctly. Eighty-three percent asked for the presence of CHD and allergy to antibiotics. Dentists asked advice of the patient's physician, but 29% would withhold treatments in high-risk patients and 50% did not know the pediatric antibiotic dosages. Forty-seven percent of the pediatricians did not know EP guidelines and they would preferably contact the child's cardiologist. Pediatricians had difficulties with the identification of low-risk procedures and would give unnecessary antibiotics. They identified most CHD at high risk, but scored lower for the identification of lower risk CHD.Conclusion: The knowledge of Flemish dentists and pediatricians of EP guidelines is low. The knowledge about EP guidelines and the communication between dentists and pediatricians should be improved. Patients should be provided with an individual EP card. What is Known: • The knowledge of dentists and cardiologists about EP is not perfect, which has already been described. • There are several guidelines about EP, and they are not identical and sometimes confusing. What is New: • This is the first article combining large scale surveys of the knowledge and application of EP by dentists and pediatricians, allowing us to compare knowledge and gaps of knowledge and use their complementarity in order to offer tailored solutions and use patient education and partnership.
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Affiliation(s)
- Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Luc Martens
- Department of Oral Health Sciences, Ghent University, Ghent, Belgium
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Taradin GG, Vatutin NT, Ignatenko GA, Ponomareva EJ, Prendergast BD. [Antibiotic prophylaxis for infective endocarditis: current approaches]. KARDIOLOGIIA 2021; 60:117-124. [PMID: 33522476 DOI: 10.18087/cardio.2020.12.n886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 06/12/2023]
Abstract
This review addresses current views on prevention of infectious endocarditis (IE). History of establishing the concept of antibacterial prophylaxis (ABP), major approaches, and substantiation of changes in ABP in recent years are described. Recent international and national guidelines are highlighted, specifically, guidelines of the European Society of Cardiologists, American Heart Association/American College of Cardiology, and the Japanese Circulation Society. The review presents critical evaluation of previously approved international guidelines, including analysis of the effect of partial or complete ABP restriction on IE morbidity and incidence of complications. Special attention is paid to awareness of practitioners, particularly dentists, about ABP issues in their practice. Aspects of validity and key features of preventive approaches in implanting cardiac electronic devices and transcatheter aortic valve implantation are discussed.
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Affiliation(s)
- G G Taradin
- State Educational Organization of Higher Professional Education "M. Gorky Donetsk National Medical University", Donetsk, Ukraine
| | - N T Vatutin
- State Educational Organization of Higher Professional Education "M. Gorky Donetsk National Medical University", Donetsk, Ukraine
| | - G A Ignatenko
- State Educational Organization of Higher Professional Education "M. Gorky Donetsk National Medical University", Donetsk, Ukraine
| | - E Ju Ponomareva
- Federal State Budgetary Educational Institution of Higher Education "Saratov State Medical University named after V.I. Razumovsky", Saratov, Russia
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Aragoneses JM, Aragoneses J, Brugal VA, Algar J, Suarez A. Evaluation of the Current Knowledge About Bacterial Endocarditis Prevention Among General Dentists in the City of Santo Domingo, Dominican Republic. Front Public Health 2020; 8:585332. [PMID: 33330328 PMCID: PMC7732663 DOI: 10.3389/fpubh.2020.585332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease caused by bacterial adherence to the lining of the heart and heart valve, and it can be caused by bacterial contamination of the bloodstream during invasive dental procedures. The American Heart Association (AHA) recommended guidelines for antibiotic prophylaxis in 2008 before invasive dental procedures; however, in the Dominican Republic, no official guidelines or regulations on this topic have been yet established. This study aimed to evaluate the current knowledge about bacterial endocarditis prevention among dentists in Santo Domingo. The study participants were dentists who attended a conference organized by Universidad Federico Henríquez y Carvajal (n = 95), of which 74 responded to the questionnaire survey. Seventy-eight percentage of the participants responded that an indication of antibiotics is recommended in cases of prophylaxis for IE. The prescription of antibiotics was applied to patients with prosthetic valves (78.4%), presented a history of previous IE (77%) among others. Among all the interventions in which the respondents would prescribe antibiotics, tooth extraction (70.7%) was the most frequent. Amoxicillin was the preferred drug choice (63.5%) and clindamycin was the antibiotic of choice in allergic patients (55.4%). Even though the choice of antibiotics were according to AHA guidelines (2008), majority of the dentists (58.82 and 55.4%) were not aware of the correct dosage and timing of administration of azithromycin and clindamycin in drugs in patients allergic to penicillin.
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Affiliation(s)
- Juan Manuel Aragoneses
- Department of Dental Research, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Javier Aragoneses
- Department of Dentistry, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Vanessa Arlette Brugal
- Department of Pediatric Dentistry and Orthopedics, School of Dentistry, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Suarez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
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12
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Prophylactic antibiotic prescribing in dental practice: Findings from a National Dental Practice-Based Research Network questionnaire. J Am Dent Assoc 2020; 151:770-781.e6. [PMID: 32979956 DOI: 10.1016/j.adaj.2020.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about antibiotic prescribing practices of dentists. The objective of this study was to gain a better understanding of dentists' beliefs and behaviors regarding the use of antibiotic prophylaxis (AP) before invasive dental procedures. METHODS A multidisciplinary team developed and disseminated a questionnaire to 3,584 dentist members of the National Dental Practice-Based Research Network. RESULTS Overall, 2,169 network dentists (61%) responded. Respondents saw patients at risk of developing infective endocarditis (IE) and prosthetic joint infection (PJI) at least once per week (35% and 65%, respectively). Although 78% of dentists agreed that the 2007 American Heart Association guidelines for the prevention of IE are well-defined and clear, only 49% agreed concerning PJI guidelines. Differences for the IE and PJI patient populations also existed for questions regarding dentists' understanding of the specific patient groups at risk, the recommended antibiotic regimens, and the need to consult with a patient's cardiologist or orthopedic surgeon. CONCLUSIONS The survey results indicate that decision making regarding the use of AP occurs frequently among dentists. Moreover, dentists reported uncertainty about the appropriate use of AP as defined by both IE and PJI guidelines, which may have resulted in a lack of concordance between dentists' beliefs and their practice behaviors. PRACTICAL IMPLICATIONS The results reported by the authors highlight the need to develop better educational programs that address antimicrobial stewardship in AP for patients at risk of developing IE and PJI and target the dental profession.
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Benslama L. Infective Endocarditis: The imbroglio. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:199-200. [PMID: 32171968 DOI: 10.1016/j.jormas.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 06/10/2023]
Affiliation(s)
- L Benslama
- Service de Stomatologie et Chirurgie Maxillo-Faciale, Hopital Pitie Salpetriere, France.
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Baudet A, Kichenbrand C, Pulcini C, Descroix V, Lesclous P, Thilly N, Clément C, Guillet J. Antibiotic use and resistance: a nationwide questionnaire survey among French dentists. Eur J Clin Microbiol Infect Dis 2020; 39:1295-1303. [PMID: 32062724 DOI: 10.1007/s10096-020-03849-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022]
Abstract
The aim of this survey was to describe the attitudes and self-reported practices of French dentists towards antibiotic use and resistance and to compare practices with national guidelines. A nationwide cross-sectional internet-based survey was conducted among the 41,800 French dentists. The online questionnaire was distributed through professional networks from April 2017 to April 2018. Seven-hundred seventy-five dentists participated but only 455 questionnaires were complete enough to be included in the analyses. Amoxicillin was the most frequently prescribed antibiotic (65.8%, 1783/2711), followed by spiramycin + metronidazole fixed-dose combination (11.6%, 312/2711) and amoxicillin-clavulanic acid (10.3%, 279/2711). The main indications for use were abscess (349/423, 82.5%), cervicofacial cellulitis (74.2%, 314/423), and pericoronitis (58.6%, 239/408). Most dentists (90.5%, 381/421) considered that antibiotic resistance is of concern but only half of them (56.3%, 238/423) felt adequately informed about antibiotic use. Many dentists did not comply with the national guidelines: the majority of them declared inappropriate antibiotic prescriptions for 11/17 clinical situations. They did not prescribe antibiotics for 5/6 clinical situations requiring prophylaxis. They reported that the publication of clinical guidelines is the main factor influencing their prescriptions (71.0%, 299/421). They wished to receive regular updates of national guidelines in the form of practical sheets (93.0%, 172/185). French dentists should urgently be targeted by antibiotic stewardship initiatives.
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Affiliation(s)
- A Baudet
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - C Kichenbrand
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - C Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- CHRU-Nancy, Infectious Diseases Department, F-54000, Nancy, France
| | - V Descroix
- Hôpital Pitié-Salpêtrière, Service d'Odontologie, F-75013, Paris, France
| | - P Lesclous
- CHU Nantes, Service d'Odontologie, F-44000, Nantes, France
| | - N Thilly
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- CHRU-Nancy, Département Méthodologie Promotion Investigation, F-54000, Nancy, France
| | - C Clément
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France
| | - J Guillet
- Faculté d'Odontologie de Lorraine, Université de Lorraine, F-54000, Nancy, France.
- CHRU-Nancy, Service d'Odontologie, F-54000, Nancy, France.
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Pisarnturakit PP, Sooampon S, Sooampon S. Managing knowledge for health care quality: An investigation of rational antibiotic use among Thai dentists. Int J Health Plann Manage 2019; 35:606-613. [PMID: 31755146 DOI: 10.1002/hpm.2971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/03/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Because of the irrational use of antibiotics, antimicrobial resistance is now a global concern that requires developing effective strategies against. The aim of this study was to assess the knowledge gap that causes the irrational use of antibiotics among Thai dentists. METHODS Thai dentists were asked to complete an online questionnaire regarding their knowledge, perception, and attitude towards rationale antibiotic use. The survey was conducted during November to December 2018. RESULTS Online questionnaires were completed by 588 dentists. Most respondents had a positive perception and were aware of the rational use of antibiotics. However, the use of antibiotics without proper indication and the lack of pharmacological knowledge were found. A mobile application was considered the most preferable approach to manage knowledge for rational drug use. CONCLUSION Irrational drug use among Thai dentists can be caused by lack of knowledge, attitude, and the perception of each dentist. Policy makers should promote self-learning through knowledge management strategies that can complement the pharmacology courses taught in dental school.
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Affiliation(s)
| | - Sireerat Sooampon
- Department of Pharmacology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sutti Sooampon
- Department of International Business Administration, Faculty of Administration and Management, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
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16
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Cronin F, Clarke N, Hendrick L, Conroy R, Brugha R. The impacts of training pathways and experiences during intern year on doctor emigration from Ireland. HUMAN RESOURCES FOR HEALTH 2019; 17:74. [PMID: 31690317 PMCID: PMC6833241 DOI: 10.1186/s12960-019-0407-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/05/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Emigration of domestically-trained health professionals is widespread, including in Ireland which has the highest rate of medical graduates in the OECD. Ireland's failure to retain graduates necessitates high levels of international recruitment. This study aimed to identify factors associated with recently graduated doctors' intention to migrate, focusing on their work experiences during the mandatory post-graduation year, their wellbeing, and their perceptions of postgraduate training in Ireland. METHODS A baseline survey was administered online to all final year students in Ireland's six medical schools. A subsequent sweep surveyed those who consented to follow-up (n = 483) during the final month of first year of practice. RESULTS Of the 232 respondents (48% response rate), 210 (94%) were Irish passport holders. Of these, only 36% intended to remain in Ireland after their internship, 57% intended to leave but return later, and 7% intended to leave permanently. A strong predictor of intention was study pathway: 60% of Graduate Entry Medicine (GEM) graduates and 25% of Direct Entry Medicine (DEM) graduates intended to remain in Ireland. Equal proportions intended to leave permanently (8% DEM, 6% GEM). Being a GEM graduate significantly reduced the likelihood of leaving to return (relative risk ratio (RRR) 0.20, 95% confidence interval (CI) (0.11-0.39), p < 0.001). When adjusted for study pathway, a negative experience as an intern increased the likelihood of leaving to return (RRR 1.16 CI (1.00-1.34), p = 0.043) and leaving permanently (1.54 (1.15-2.04), p = 0.003). Similarly, experience of callousness was associated with leaving to return (1.23 (1.03-1.46), p = 0.023) and leaving permanently (1.77 (1.24-2.53), p = 0.002), as was burnout with leaving permanently (1.57 (1.08-2.27), p = 0.017). Those planning to specialise in Medicine versus General Practice were more likely to leave and return (3.01 (1.09-8.34), p = 0.034). Those with negative perceptions of training in Ireland were more likely to leave and return (1.16 (1.01-1.34), p = 0.037); a positive perception reduced the likelihood of leaving permanently (0.50 (0.26-0.94), p = 0.032). CONCLUSIONS Increasing GEM training places might improve Ireland's retention of domestically-trained doctors, reducing reliance on non-EU-trained doctors. However, improvements in the working experiences, perceptions of training, and protection of wellbeing are essential for retaining this highly sought-after and geographically mobile cohort.
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Affiliation(s)
- Frances Cronin
- RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland.
| | - Nicholas Clarke
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Louise Hendrick
- National Doctors Training and Planning, Health Service Executive, Sancton Wood Building, Heuston South Quarter, St John's Road West, Dublin 8, Ireland
| | - Ronan Conroy
- RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
| | - Ruairi Brugha
- RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland
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