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Ashford JR. Impaired oral health: a required companion of bacterial aspiration pneumonia. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1337920. [PMID: 38894716 PMCID: PMC11183832 DOI: 10.3389/fresc.2024.1337920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.
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Weiss S, Tinsky N, Oren L, Chodick G, Spierer S, Yarom N, Ashkenazi M. Effect of prolonged hospitalization on the maintenance of oral health: A self-report survey. Int J Dent Hyg 2024. [PMID: 38575751 DOI: 10.1111/idh.12804] [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: 07/10/2023] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES This study aims to evaluate the effect of prolonged hospitalization on the maintenance of dental health and to assess the nursing staff's approach to addressing these concerns. METHODS A survey questionnaire explored changes in the routine dental care of patients hospitalized for over a month. The involvement of nursing staff in addressing dental care was also evaluated. RESULTS Fifty adult patients aged 18-89 years (mean age 62.4 ± 20.54 years), 27 (54%) males, completed the survey. During hospitalization (mean 58.59 ± 38.63 days) 26% and 18%, increased consumption of sweets and sugary beverages, between meals, respectively; 26% and 20% of the patients reduced the frequency of tooth brushing in the morning and in the evening, respectively, and 42.2% of them, reduced the quality of their toothbrushing during hospitalization. Nevertheless, 95.9% and 93.9% of them were never instructed during hospitalization to limit their consumption of sweets and sugary beverages and 83.3% and 62.5% of them had never been reminded or offered assistance during hospitalization in performing toothbrushing, respectively. The lower frequency of morning toothbrushing was significantly correlated with a lack of nurses' assistance (p = 0.004). In contrast, 62.6% reported they were reminded every day to shower. Patients in the rehabilitation and geriatrics departments reported a greater need for a brush/toothpaste (p < 0.0001) and assistance in toothbrushing (p < 0.0001). CONCLUSIONS Prolonged hospitalization leads to significant deterioration in inpatients' dental health maintenance. Raising awareness among nurses regarding their inpatient's oral health maintenance is warranted. Providing patients with toothbrushes, toothpaste and educational materials upon hospitalization is recommended.
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Affiliation(s)
| | | | - Liat Oren
- Sheba Medical Center, Tel Hashomer, Israel
| | - Gabi Chodick
- School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Vucelić V, Bratić V, Negovetić Vranić D, Tambić Andrašević A, Degoricija V, Mihaljević Z, Ramić S, Piteša Košutić I, Šimunović L, Špiljak B, Brailo V. Understanding and Practices of Oral Hygiene in the Intensive Care Units: Perspectives of Medical Staff at Two University Hospital Centers. Acta Stomatol Croat 2024; 58:85-93. [PMID: 38562223 PMCID: PMC10981905 DOI: 10.15644/asc58/1/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study assesses the knowledge, practices, and attitudes of medical staff in intensive care units (ICUs) regarding oral hygiene care for critically ill, bedridden patients. Material and methods A cross-sectional study included 65 employees from the Intensive Care Units of the Sestre Milosrdnice Clinical Hospital Centre (CHC SM) and the Clinic for Anesthesiology and Intensive Care at the University Clinical Hospital Centre Zagreb (CHC ZG). A self-administered questionnaire was used to assess knowledge, methods, frequency, and attitudes towards oral care for mechanically ventilated patients. The data were examined through descriptive statistical methods, presented in terms of proportions (percentages). For the purpose of comparing the feedback across the two hospital centers and different educational backgrounds, the Chi-square and Fisher's exact tests were employed. Results Results of a survey of 65 participants (18 from CHC SM and 47 from CHC ZG) revealed a notable disparity in oral hygiene knowledge, with graduate nurses displaying the highest proportion of adequate knowledge (100%) and regular nurses showing the least (30.3%) (p<.001). Although the execution of oral care practices did not vary significantly among the groups, graduate nurses performed oral care more frequently (80% vs. baccalaureate technicians 33.33% and nurses 57.6%, three or more times a day) and demonstrated better proficiency in both mechanical (p=.005) and chemical (p<.001) biofilm management compared to their counterparts. No significant difference was observed in the delivery of oral care to orotracheally intubated patients across different educational levels (p=.127). However, a marked difference was noted in the perception of being adequately trained for such care, with nurses feeling less prepared (12.1%, p<.001). Despite these variances, all respondents recognized the importance of oral hygiene, thus showing a strong dedication to oral health care. Conclusions: This study highlights variability in ICU oral hygiene practices and points to the importance of standardized care protocols and improved training for healthcare staff.
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Affiliation(s)
- Vesna Vucelić
- Intensive Care Unit of the University Department of Medicine, Clinical Hospital Centre “Sestre milosrdnice”
| | - Vesna Bratić
- Clinic for Anesthesiology and Intensive Care, University Clinical Hospital Centre Zagreb
| | - Dubravka Negovetić Vranić
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- Clinic for Dentistry, University Clinical Hospital Centre Zagreb
| | - Arjana Tambić Andrašević
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- Department of Clinical Microbiology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia
| | - Vesna Degoricija
- Intensive Care Unit of the University Department of Medicine, Clinical Hospital Centre “Sestre milosrdnice”
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Zlatan Mihaljević
- Department of Clinical Microbiology, Clinical Hospital Centre “Sestre milosrdnice”
| | - Snježana Ramić
- Department of Oncological Pathology and Clinical Cytology “Ljudevit Jurak”, University Department of Pathology, Clinical Hospital Centre “Sestre milosrdnice”
| | - Ivana Piteša Košutić
- Intensive Care Unit of the University Department of Medicine, Clinical Hospital Centre “Sestre milosrdnice”
| | - Luka Šimunović
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Bruno Špiljak
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Vlaho Brailo
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- Clinic for Dentistry, University Clinical Hospital Centre Zagreb
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Mustuloğlu Ş, Özler CÖ, Tekçiçek MU, Arslan SS. Knowledge, attitudes, and behaviors of dysphagia clinicians regarding oral health-An international study. SPECIAL CARE IN DENTISTRY 2024; 44:231-241. [PMID: 37029087 DOI: 10.1111/scd.12861] [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: 11/30/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
AIM The aim of this study was to investigate the knowledge, attitudes, and behaviors of dysphagia clinicians regarding oral health care. METHODOLOGY AND RESULTS An 11-question and 37-statement survey inquiring the clinicians' descriptive information, knowledge, attitudes, and behaviors related to oral health was administered via Google forms. A total of 234 dysphagia clinicians responded on behalf of themselves. The findings showed that 41.5% (n = 97) of the clinicians had a high level of knowledge about oral health. There was a significant relationship between the level of oral health knowledge and the clinicians' oral health education (p < .05). A percentage of 6.4 (n = 15) of the clinicians had a high level of attitude toward oral health. Oral health education status of clinicians and their profession was significantly related to the attitude toward oral health (p < .05). Most of the clinicians (44.0%, n = 103) had low behavior level. The level of behavior was significantly associated with status of receiving oral health education, their professions, duration of experience, and institution (p < .05). CONCLUSIONS The study showed that clinicians exhibit moderate mean knowledge, attitudes, and behaviors scores, and these states are significantly associated with oral health education. This can serve as a stimulus for clinicians caring for dysphagia patients to receive oral health education during their university education.
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Affiliation(s)
- Şeyma Mustuloğlu
- Department of Pediatric Dentistry, Faculty of Dentistry, Mersin University, Mersin, Turkey
| | - Cansu Özsin Özler
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Meryem Uzamış Tekçiçek
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Davies R, Doshi M. Prevention of oral diseases for the older person (Part 1). Br Dent J 2024; 236:35-41. [PMID: 38225311 DOI: 10.1038/s41415-023-6610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.
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Affiliation(s)
| | - Mili Doshi
- Dental and Maxillofacial, Surrey and Sussex Healthcare NHS Trust, Surrey, United Kingdom.
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Pindoria A, Macintyre L, Doshi M. A service evaluation of mouth care referrals for adult inpatients in an acute hospital. Br Dent J 2023:10.1038/s41415-023-6497-y. [PMID: 37978219 DOI: 10.1038/s41415-023-6497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 11/19/2023]
Abstract
Introduction Healthcare professionals working in hospitals often have inadequate training in supporting patients with mouth care, which is one reason oral health deteriorates in hospitalised patients.Aim The aim of this service evaluation is to assess the main reasons healthcare professionals request advice from the mouth care lead nurse and identify common trends.Method Data were collected for patients referred to the mouth care lead between 2020-2022, including age, sex, reason for referral, outcome and whether the patient needed redirecting to a dentist or doctor.Results A total of 204 referrals were analysed and 93% of patients referred were aged over 65 years of age. The most common reason for hospital admission was cancer (14%), followed by falls (9%) and stroke (7%). The most common reasons for mouth care referral were dry mouth (43%), poor oral hygiene (15%) and loose dentures (14%). Overall, 62% patients were deceased within a year of the referral.Conclusion This evaluation shows there is value in having a dedicated mouth care lead nurse who can provide training to staff when required for individual patients. Inpatients tend to be older, often in their last year of life, and there is a need to focus training on dry mouth.
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Affiliation(s)
| | | | - Mili Doshi
- Consultant in Special Care Dentistry, East Surrey Hospital, UK
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Ozaki K, Tohara H, Baba M, Teranaka S, Kawai Y, Komatsumoto S. A Dentist-Led Oral Care System Can Prevent Stroke-Associated Pneumonia: The Effects of Early Intervention by Dental Team. J Multidiscip Healthc 2023; 16:2937-2945. [PMID: 37795380 PMCID: PMC10546933 DOI: 10.2147/jmdh.s415572] [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: 04/21/2023] [Accepted: 08/07/2023] [Indexed: 10/06/2023] Open
Abstract
Background Our facility's dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS's effects on the incidence of stroke-associated pneumonia (SAP). Methods This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression. Results A decrease in SAP rates was observed across the four groups (P<0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49-10.90), hypertension (2.28, 1.39-3.73), cardiac failure (1.72, 1.04-2.85), and diabetes (1.59, 1.11-2.26), 3-digit code on the Japan coma scale (3.57, 2.53-5.05 [reference ≤2-digit code]), age ≥90 years (2.34, 1.15-4.77 [reference 18-59 years]), male (1.86, 1.31-2.67), and the Post-1 (0.49, 0.31-0.76 [reference Pre]), Post-2 (0.38, 0.25-0.61 [reference Pre]), and Post-3 (0.24, 0.15-0.40 [reference Pre]) periods. Conclusion The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.
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Affiliation(s)
- Kenichiro Ozaki
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Haruka Tohara
- Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Mikoto Baba
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Satoshi Teranaka
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Yosuke Kawai
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Satoru Komatsumoto
- Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Fujita Health University, Toyoake, Aichi, Japan
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Schafthuizen L, Spruit-Bentvelzen L, van Dijk M, van Rosmalen J, Ista E. Implementation of a nursing oral health care protocol in a university teaching hospital: A cluster-randomized stepped-wedge design. Int J Dent Hyg 2023. [PMID: 37722075 DOI: 10.1111/idh.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/24/2023] [Accepted: 07/30/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. METHODS We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0-100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. RESULTS At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. CONCLUSION Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lotte Spruit-Bentvelzen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Croft K, Dallal-York J, Miller S, Anderson A, Donohue C, Jeng E, Plowman EK. Provision of Oral Care in the Cardiothoracic Intensive Care Unit: Survey of Nursing Staff Training, Confidence, Methods, Attitudes, and Perceived Barriers. J Contin Educ Nurs 2023; 54:313-321. [PMID: 37390307 DOI: 10.3928/00220124-20230620-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Poor oral health is associated with adverse outcomes in critical care settings. Although provision of oral care is a fundamental aspect of nursing practice, both formal training and practice among nursing staff remain unclear. METHOD Cardiothoracic intensive care unit nurses were recruited to complete a 16-item survey regarding training, confidence, methods, prioritization, and barriers to provision of oral care. RESULTS A total of 108 nurses participated (70% response rate). Formal training in oral care was reported by 38%, most frequently reported as less than 1 hour (53%) in duration. Of the respondents, 70% reported confidence in providing oral care. Nine methods and 16 products were identified, with variability in the frequency of provision. Prioritization of oral care was rated most frequently as moderate (53%), with 28% reporting barriers. CONCLUSION Despite limited formal training, surveyed nurses reported confidence in providing oral care. Methods, frequency, and prioritization were variable. Both development of formal curricula and evaluation of adherence to standardized protocols for oral care are warranted. [J Contin Educ Nurs. 2023;54(7):313-321.].
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Gardiner W, Brown K, Richardson H, Pretorius N, Heales L. The incidence, characteristics and in-hospital mortality of non-ventilator-associated hospital-acquired pneumonia in regional Queensland: A retrospective descriptive study. Aust J Rural Health 2023; 31:138-143. [PMID: 36106699 DOI: 10.1111/ajr.12923] [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: 11/14/2021] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence, characteristics and in-hospital mortality of non-ventilator-associated hospital-acquired pneumonia (NV-HAP) in a regional (Modified Monash Model 2) Australian hospital. METHODS All cases with NV-HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co-morbidities (measured using the Charlson Comorbidity Index) and in-hospital mortality were extracted. Incidence rate was calculated as a proportion of NV-HAP cases per 1000 bed-days. DESIGN A retrospective study design was used to review all cases of NV-HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM-2). SETTING Rockhampton Hospital, Australia. PARTICIPANTS Patient cases. MAIN OUTCOME MEASURES Incidence rate, Incidence proportion, mortality. RESULTS A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed-days over the study period 2013-2018. Cases with NV-HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in-hospital mortality rate for NV-HAP cases was 18.9%. CONCLUSION This study revealed an overall incidence rate of 0.98 cases per 1000 bed-days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV-HAP at our regional hospital.
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Affiliation(s)
- Wenonah Gardiner
- Department of Speech Pathology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Kassandra Brown
- Department of Speech Pathology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Heather Richardson
- Aged Care, Clinical and Rehabilitation Services, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Nellie Pretorius
- Oral Health Department, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Luke Heales
- School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Cardoso AF, Ribeiro LE, Santos T, Pinto M, Rocha C, Magalhães J, Augusto B, Santos D, Duque FM, Fernandes BL, Sousa RC, Silva R, Ventura F, Fernandes AM, Cardoso D, Rodrigues R. Oral Hygiene in Patients with Stroke: A Best Practice Implementation Project Protocol. NURSING REPORTS 2023; 13:148-156. [PMID: 36810267 PMCID: PMC9944467 DOI: 10.3390/nursrep13010016] [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: 11/28/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Oral hygiene has been shown to reduce adverse events and promote the quality of life of patients with stroke. However, a stroke can result in the impairment of physical, sensory, and cognitive abilities, and comprise self-care. Although nurses recognize its benefits, there are areas for improvement in the implementation of the best evidence-based recommendations. The aim is to promote compliance with the best evidence-based recommendations on oral hygiene in patients with stroke. This project will follow the JBI Evidence Implementation approach. The JBI Practical Application of Clinical Evidence System (JBI PACES) and the Getting Research into Practice (GRiP) audit and feedback tool will be used. The implementation process will be divided into three phases: (i) establishing a project team and undertaking the baseline audit; (ii) providing feedback to the healthcare team, identifying barriers to the implementation of best practices, and co-designing and implementing strategies using GRIP, and (iii) undertaking a follow-up audit to assess the outcomes and plan for sustainability. So, the successful adoption of the best evidence-based recommendations on oral hygiene in patients with stroke will reduce the adverse events related to poor oral care and may improve patients' quality of care. This implementation project has great transferability potential to other contexts.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Correspondence:
| | - Liliana Escada Ribeiro
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Teresa Santos
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Maribel Pinto
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Cláudia Rocha
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Joana Magalhães
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Berta Augusto
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Diana Santos
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Filipa Margarida Duque
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Beatriz Lavos Fernandes
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Hospital de Cascais Dr. José de Almeida, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
| | - Rosário Caixeiro Sousa
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Hospital da Luz, Praceta Robalo Cordeiro, 1, 3020-479 Coimbra, Portugal
| | - Rosa Silva
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Filipa Ventura
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - António Manuel Fernandes
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Rogério Rodrigues
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
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12
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Oral Management by a Full-Time Resident Dentist in the Hospital Ward Reduces the Incidence of Pneumonia in Patients with Acute Stroke. Int J Dent 2022; 2022:6193818. [PMID: 35910086 PMCID: PMC9337935 DOI: 10.1155/2022/6193818] [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: 11/25/2021] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background. A full-time dentist was assigned to a ward at our hospital to improve the quality of oral healthcare for hospitalized patients. A dental care system (DCS) was created to facilitate the collaboration between the full-time dentist and the nursing department. Objective. To investigate the effects of DCS implementation on the incidence of pneumonia in patients with acute stroke. Methods. This retrospective cohort study comprised 945 hospitalized acute stroke patients categorized into three groups: pre-, during-, and post-DCS. The DCS comprised dentist-led lectures and practical sessions, oral assessments, standardized oral care techniques, and information on the procedures for nurse-requested dental intervention. Data were extracted from the Japanese Diagnosis Procedure Combination database and medical records. The attributes of the patients, incidence of pneumonia, and number of patients who requested dental intervention were determined. Results. The odds ratios of pneumonia onset were 3.16 (95% confidence interval [CI], 1.65–6.05;
) in the pre-DCS and 2.80 (95% CI, 1.48–5.31;
) in the during-DCS group compared with the post-DCS group, thereby confirming the effect of DCS on the incidence of pneumonia. The number of dental requests in the post-DCS group was noted to be higher than that in the pre-DCS group (
). Conclusion. Oral management by a full-time dentist was found to be effective in reducing the incidence of pneumonia in patients with acute stroke. To implement the best oral care practices in the hospital wards, the full-time dentist should work as a member of the medical team.
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Remijn L, Sanchez F, Heijnen BJ, Windsor C, Speyer R. Effects of Oral Health Interventions in People with Oropharyngeal Dysphagia: A Systematic Review. J Clin Med 2022; 11:jcm11123521. [PMID: 35743591 PMCID: PMC9225542 DOI: 10.3390/jcm11123521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
People with oropharyngeal dysphagia (OD) are at risk of developing aspiration pneumonia. However, there is no “best practice” for oral health interventions to improve swallowing-related outcomes, the incidence of aspiration pneumonia, and oral health in people with OD. Systematic literature searches were conducted for oral health interventions in OD in PubMed, Embase, CINAHL, and PsycINFO until July 2021. Original articles published in English and reporting pre- and post-intervention measurements were included. The methodology and reporting were guided by the PRISMA checklist. The methodological quality of the eight included studies was rated using the QualSyst critical appraisal tool. The oral health interventions in people with OD were diverse. This study shows little evidence that regular oral care and the free water protocol or oral disinfection reduced the incidence of aspiration pneumonia in people with OD. Oral cleaning, twice a day with an antibacterial toothpaste in combination with intraoral cleaning or the free water protocol, proved to be the most promising intervention to improve oral health. The effect of improved oral health status on swallowing-related outcomes could not be established. Increasing awareness of the importance of oral health and implementing practical oral care guidelines for people involved in the daily care of people with OD are recommended.
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Affiliation(s)
- Lianne Remijn
- Academy of Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-353-1500
| | - Fabiola Sanchez
- Pedagogical Professional Team District Frogner, 0201 Oslo, Norway;
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway; (C.W.); (R.S.)
| | - Bas J. Heijnen
- Department Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Catriona Windsor
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway; (C.W.); (R.S.)
| | - Renée Speyer
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway; (C.W.); (R.S.)
- Department Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
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14
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Doshi M, Mann J, Quentin L, Morton-Holtham L, Eaton KA. Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England. J Res Nurs 2022; 26:574-590. [PMID: 35265164 DOI: 10.1177/17449871211016524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background This study investigated the training and mouth care practice of nursing staff in hospital Trusts across England. Oral health has been found to deteriorate during hospital admission, mouth care standards have been found to be poor. Aims The objectives of the study were to assess if and what the barriers are to supporting inpatients' mouth care, and to assess how confident nursing staff are in carrying out mouth care assessments and mouth care and see if this is related to previous training. Methods A cross-sectional descriptive survey was conducted in 33 Trusts in England with 1576 members of the nursing team including nurses and nursing assistants. Nursing staff were asked to complete a questionnaire on previous oral health training and their current practice. Results Nursing staff reported that they had limited training in mouth care. The main barriers to mouth care were time and patient compliance. Confidence in recognising oral cancer was low. Conclusions Nursing staff would benefit from mouth care training targeted at assessing the mouth and providing mouth care for all inpatients.
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Affiliation(s)
- Mili Doshi
- Consultant in Special Care Dentistry, Surrey and Sussex Healthcare Trust, UK
| | - Jessica Mann
- Specialty Registrar in Special Care Dentistry, Bristol Dental Hospital, UK
| | - Léa Quentin
- Kent Surrey Sussex Academic Health Science Network Hospital, UK
| | - Luke Morton-Holtham
- Senior Analyst, Kent Surrey Sussex Academic Health Science Network Hospital, UK
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15
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Nardi GM, Grassi R, Grassi FR, Di Giorgio R, Guerra F, Ottolenghi L, Acito G, Basari N, Bisegna S, Chiavistelli L, Cimarossa R, Colavito A, Figlia L, Gabrielli C, Sabatini S, Jedliński M, Mazur M. How Did the COVID-19 Pandemic Effect Dental Patients? An Italian Observational Survey Study. Healthcare (Basel) 2021; 9:healthcare9121748. [PMID: 34946472 PMCID: PMC8701184 DOI: 10.3390/healthcare9121748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
The primary aim of this observational survey study was to assess patients' attitudes toward clinical dental practice during the COVID-19 pandemic; the secondary aim was to evaluate patients' attitudes towards oral health by maintaining an appropriate lifestyle and oral hygiene at home. The questionnaire was developed using Google Forms. The questionnaire consisted of three parts: Part A-geographic, demographic, and personal data; Part B-patients' attitude toward oral health selfcare and lifestyle; Part C-patients' attitude toward dental practice. This survey, conducted during the months of November and December 2020, enrolled 1135 subjects throughout Italy. All data were statistically analyzed. COVID-19 has changed patients' approach to dental procedures. Most of the people interviewed lived in families, and their greatest fear was infecting a family member. Restrictive measures forced people to stay at home, which led to an increased consumption of various types of food, including cariogenic foods. People said they felt safe when they went to the dentist, but they also paid special attention to measures to prevent contagion. Among the measures that should be introduced in similar situations in the future, people wanted telemedicine, a phone recall, and the possible use of video clips for home oral care instructions.
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Affiliation(s)
- Gianna Maria Nardi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.M.N.); (R.D.G.); (F.G.); (L.O.); (M.M.)
| | - Roberta Grassi
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Felice Roberto Grassi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, 70122 Bari, Italy;
| | - Roberto Di Giorgio
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.M.N.); (R.D.G.); (F.G.); (L.O.); (M.M.)
| | - Fabrizio Guerra
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.M.N.); (R.D.G.); (F.G.); (L.O.); (M.M.)
| | - Livia Ottolenghi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.M.N.); (R.D.G.); (F.G.); (L.O.); (M.M.)
| | - Giovanna Acito
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Nasrin Basari
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Simone Bisegna
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Lorella Chiavistelli
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Roberta Cimarossa
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Arcangela Colavito
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Luigina Figlia
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Claudio Gabrielli
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Silvia Sabatini
- ATASIO: Accademia delle Tecnologie Avanzate nelle Scienze di Igiene Orale-Academy of Advanced Technologies in Oral Hygiene Sciences, 70126 Bari, Italy; (G.A.); (N.B.); (S.B.); (L.C.); (R.C.); (A.C.); (L.F.); (C.G.); (S.S.)
| | - Maciej Jedliński
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.M.N.); (R.D.G.); (F.G.); (L.O.); (M.M.)
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-466-1690
| | - Marta Mazur
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (G.M.N.); (R.D.G.); (F.G.); (L.O.); (M.M.)
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16
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Andersson M, Persenius M. Good in Providing Oral Care, but we Could be Better-Nursing Staff Identification of Improvement Areas in Oral Care. SAGE Open Nurs 2021; 7:23779608211045258. [PMID: 34632061 PMCID: PMC8495511 DOI: 10.1177/23779608211045258] [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: 06/27/2019] [Accepted: 12/23/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Oral care to older people in short-term care units is a complex and challenging everyday practice for nursing staff. Oral care research and knowledge about prerequisites and obstacles is extensive. However, there is a lack of knowledge about how nursing staff in short-term care units describe their satisfaction about provided oral care in order to maintain older people's oral health. Objective The purpose of this study was to describe how nursing staff perceive their satisfaction of oral care provided for older people in short-term care units and to identify oral care improvements. Methods This study reports on the results of two open-ended questions that were part of a larger study. Informants (n = 54) were nursing staff working in the involved short-term care units in municipalities from both densely and sparsely populated regions in central and northern Sweden. The answers to the open-ended questions were analyzed using content analysis. Results The analysis yielded one main category; “Working together to improve satisfaction with older people's oral care” and four subcategories: “Older people's oral health,” “Consideration and respect for the older person's autonomy,” “Having access to adequate products,” and “Working together in the same direction.” Conclusion Identification of older people's oral health problems together with adequate nursing intervention will increase older people's health outcomes and quality of life. However, regardless of work role, the nursing staff might have difficulty changing their behavior or transforming intentions into actions. Oral care is a complicated and proactive practice that requires nursing staff's attention as well as both educational and organizational initiatives. Working in a supportive and collaborative relationship provides prerequisites for optimal oral care in short-term care units.
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Affiliation(s)
- Maria Andersson
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Mona Persenius
- Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Luong HM, Nguyen TT, Tran HT, Tran PT, Nguyen PN, Nguyen HT, Nguyen DM, Duc HTT, Tong SM. Oro-Dental Health and Primary Nephrotic Syndrome among Vietnamese Children. CHILDREN-BASEL 2021; 8:children8060494. [PMID: 34200617 PMCID: PMC8229337 DOI: 10.3390/children8060494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
Primary nephrotic syndrome (PNS) is common in children, affecting the soft and hard tissues of the oral cavity. This study aimed to investigate the percentage of dental caries, gingivitis, hypertrophic gingivitis, and developmental defects of enamel (DDE) in children with PNS. The association of PNS with these diseases and oral care behavior was also assessed. A total of 407 children with PNS and 407 age- and gender-matched controls were recruited. PNS was diagnosed based on blood and urinary tests. The Simplified Oral Hygiene Index (OHI-S), the Gingival Index (GI), the Gingival Overgrowth Index (GOI), the Decayed, Missing, and Filled Teeth Index (dmft/DMFT), and DDE were collected. The PNS patients showed significantly higher scores of OHI-S, GI, and dmft, and higher proportions of dental caries and DDE than those of the controls (p < 0.001). It is necessary to establish a periodic dental protocol for PNS patients to improve their oral health status.
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Affiliation(s)
- Hang Minh Luong
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
| | - Tra Thu Nguyen
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
- Graduate School of Medicine, Nagoya University, Aichi 466-8560, Japan
- Correspondence: (T.T.N.); (S.M.T.)
| | - Huy-Thinh Tran
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
| | - Phung Thi Tran
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
- Health Economics, Hanoi University of Public Health, Hanoi 100000, Vietnam
| | - Phuong-Nga Nguyen
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
| | - Huong Thu Nguyen
- Nephrology and Dialysis Department, National Children’s Hospital, Hanoi 100000, Vietnam;
| | - Duc Minh Nguyen
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
- Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Aichi 464-8651, Japan
| | - Hanh Tran Thi Duc
- Department of Epidemiology, Hanoi University of Public Health, Hanoi 100000, Vietnam;
| | - Son Minh Tong
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam; (H.M.L.); (H.-T.T.); (P.T.T.); (P.-N.N.); (D.M.N.)
- Correspondence: (T.T.N.); (S.M.T.)
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18
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Thapa R, Chimoriya R, Arora A. The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review. BMC Geriatr 2021; 21:35. [PMID: 33422009 PMCID: PMC7797120 DOI: 10.1186/s12877-020-01989-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/25/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties. METHODS This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines. RESULTS Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria. CONCLUSIONS None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.
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Affiliation(s)
- Rojina Thapa
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
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Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge. Am J Med 2020; 133:1406-1410. [PMID: 32619432 PMCID: PMC7324918 DOI: 10.1016/j.amjmed.2020.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 02/04/2023]
Abstract
Many physicians care for patients who remain in the hospital for prolonged periods despite being "medically ready" or stable for discharge. However, this phenomenon is not well-defined, and optimal strategies to address the problem are not known. A prolonged hospitalization past the point of medical necessity can harm patients, frustrate care teams, and is costly for the health care system. In this perspective, we describe opportunities to improve value of care for these patients through the lens of the Quadruple Aim, a common framework used to guide health care transformation efforts. We then offer recommendations, including some employed by our hospitals, for clinicians, researchers, and health care systems to improve the care for patients who are "stuck" in the hospital.
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20
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Chen X, D'Souza V, Comnick CL, Xie X. How accurate is the assessment of certified nursing assistants on resident's oral self-care function in three North Carolina assisted-living facilities? SPECIAL CARE IN DENTISTRY 2020; 40:580-588. [PMID: 32991747 DOI: 10.1111/scd.12521] [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: 04/13/2020] [Revised: 07/25/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
AIMS To examine the association between the assessments of certified nursing assistants (CNAs) on resident's oral self-care function and resident's oral hygiene outcomes in three North Carolina assisted-living (AL) facilities. METHODS AND RESULTS Sixty-five dentate AL residents were included in this secondary analysis. CNAs were asked to rate the AL residents' overall oral self-care function using a 6-point Likert scale. Their assessments were then compared with the objective, performance-based Dental Activities Test and the oral hygiene and gingival health measures. The analysis showed that nearly 90% of the participants presented with at least one untreated decayed or broken tooth. On average, nearly two-thirds of the surfaces were covered by soft deposits (Debris Index = 1.83, SD = 0.60). Generalized mild to moderate inflammation (Gingival Index = 1.51, SD = 0.53) commonly presented on residents' gingiva. CNAs were able to accurately identify the residents with substantial impairment in oral self-care function, yet they tended to overestimate the oral self-care function of residents with mild to moderate impairment. CNAs assessments were also not significantly correlated with residents' oral hygiene measures. CONCLUSION CNAs failed to identify and provide assistance to AL residents with impaired oral self-care function, contributing to poor oral oral hygiene in these vulnerable individuals.
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Affiliation(s)
- Xi Chen
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa, Iowa City
| | - Violet D'Souza
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Carissa L Comnick
- Department of Biostatistics, School of Public Health, University of Iowa, Iowa, Iowa City
| | - Xianjin Xie
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa, Iowa City
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Venkatasalu MR, Murang ZR, Husaini HABH, Idris DR, Dhaliwal JS. Why oral palliative care takes a backseat? A national focus group study on experiences of palliative doctors, nurses and dentists. Nurs Open 2020; 7:1330-1337. [PMID: 32802353 PMCID: PMC7424450 DOI: 10.1002/nop2.480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/21/2020] [Accepted: 03/02/2020] [Indexed: 12/03/2022] Open
Abstract
Aim Poor oral care among frail older people at the end of life endangers quality of life. However, only few dying people have access to oral palliative care services. Therefore, this study aimed to investigate oral palliative care practices and referral patterns for palliative patients in the Brunei healthcare settings. Design An exploratory qualitative study. Methods Five focus groups were conducted among palliative care nurses (N = 7), palliative medicine doctors (N = 4), dentists (N = 6), oncologists (N = 4) and oncology nurses (N = 4). Verbatim was analysed using qualitative thematic analysis. Results Analyses revealed four distinct themes emerging as current oral palliative care assessment and referral practice in the Brunei healthcare settings: "taking a back seat," "opportunistic oral care," "they refused and refused" and "challenging healthcare resources and oral palliative care."
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Affiliation(s)
| | - Zaidah Rizidah Murang
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
| | - Hajah Asmah binti Haji Husaini
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
| | - Deeni Rudita Idris
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
| | - Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health SciencesUniversiti Brunei DarussalamBruneiBrunei Darussalam
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22
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Dagnew ZA, Abraham IA, Beraki GG, Tesfamariam EH, Mittler S, Tesfamichael YZ. Nurses' attitude towards oral care and their practicing level for hospitalized patients in Orotta National Referral Hospital, Asmara-Eritrea: a cross-sectional study. BMC Nurs 2020; 19:63. [PMID: 32665767 PMCID: PMC7348104 DOI: 10.1186/s12912-020-00457-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Effective and routine mouth care is necessary for hospitalized patients as it helps to maintain the health of oral cavity and overall health. However, oral care is often overlooked and not prioritized in daily activity plan of nurses even when oral problems are apparent. Therefore, the aim of this study was to assess nurses' attitude towards oral care and their practicing level for hospitalized patients. METHODS A cross-sectional study design was conducted in adult medical-surgical department of Orotta hospital from December 2017 to January 2018. Data was collected from all (N = 73) diploma and associate nurses through face to face interview using a pretested and structured questionnaire. Kruskal-Wallis, Mann-Whitney U tests and spearman rank correlation coefficient tools were performed to analyze the data using SPSS (Version 22). RESULTS Out of the 79 participants, 73 completed the interview successfully with a response rate of 92.4%. Of the total, 56.2% were diploma nurses and 43.9% were associate nurses. The median attitude score was 68.89/100 (IQR = 48.89). The majority (94.5%) of the nurses agreed that oral cavity assessment is nurse's responsibility and 94.5% reported adequate training is needed to provide quality oral care. On the other hand, the median practice score was 50.00/100 (IQR = 17.86). Majority of the participants (76.7%) did not perform routine oral health assessment. Almost all (98.4%) used gauze and normal saline for oral care. Practice score was significantly different across the various wards (p < 0.001), however, it was not significantly correlated with attitude (p = 0.646). CONCLUSIONS The participants had poor level of oral care practice to hospitalized patients, nevertheless, they had favourable attitude. Therefore, Orotta National Referral Hospital needs to give further effort to train the nursing staff, ensure the availability of adequate oral care equipment and provide clear guidelines regarding oral care of hospitalized patients.
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Affiliation(s)
- Zewdi Amanuel Dagnew
- Emergency and Critical Care Unit, Department of Nursing, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | - Isayas Afewerki Abraham
- Emergency and Critical Care Unit, Department of Nursing, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | | | - Eyasu Habte Tesfamariam
- Epidemiology and Biostatistics Unit, Department of Statistics, College of Sciences, Eritrean Institute of Technology, MaiNefhi, Eritrea
| | - Sibyl Mittler
- Anesthesia Unit, Department of Nursing, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
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23
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Bains VK, Bains R. Is oral hygiene as important as hand hygiene during COVID-19 pandemic? ACTA ACUST UNITED AC 2020. [DOI: 10.25259/ajohas_8_2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Oral hygiene is an integral part of personal hygiene practices and should not be neglected. Similar to hand hygiene, oral hygiene is essential in reducing infection from the oral cavity, and thus, its transfer to the upper and lower respiratory tract. Although there is no randomized clinical trial, oral hygiene may imply to reduce the morbidity and mortality related to coronavirus disease pandemic potentially. At present, standard oral hygiene measures consist of thorough cleaning of all surfaces of teeth, interdental areas, and tongue daily. Oral health-care providers should emphasize its importance. Thorough toothbrushing for “Two Times For Two Minutes” in a day is an easy key to remember.
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Affiliation(s)
- Vivek Kumar Bains
- Department of Periodontology, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India,
| | - Rhythm Bains
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India,
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24
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Oral health status as predictor of 1-year mortality after discharge from an acute geriatric unit. Eur Geriatr Med 2019; 10:889-897. [DOI: 10.1007/s41999-019-00248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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25
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Nagarakanti S, Avuluri J, Chava VK. Evaluation of Nurses' Attitude toward the Provision of Oral Hygiene Care to Hospitalized Patients at Two Private Hospitals in South India. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:472-474. [PMID: 31772924 PMCID: PMC6875888 DOI: 10.4103/ijnmr.ijnmr_39_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/31/2019] [Accepted: 08/26/2019] [Indexed: 11/22/2022]
Abstract
Background: Several hospitalized patients with complex medical issues depend on nursing staff for their daily health care due to several functional limitations. This study investigates the Oral Hygiene Care (OHC) activities and attitudes of nurses toward hospitalized patients. Materials and Methods: A cross-sectional survey was conducted at two private hospitals using a self-administered, structured questionnaire distributed to 585 nursing staff. Data were analyzed through percentages. Results: About 85.70% of the nurses ranked OHC as important; among them, 74.00% ranked as important to extremely important. Very few (2.40%) rated providing OHC to be an unpleasant task and the majority (41.80%) felt lack or proper training is one of the reasons for providing OHC satisfactorily. Conclusions: Nurses experienced significant behavioral and physical difficulties while providing OHC, but still found it important. Therefore, training programs are needed for nurses to improve OHC to hospitalized patients.
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Affiliation(s)
- Sreenivas Nagarakanti
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Joshna Avuluri
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Vijay K Chava
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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26
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Infrequent Denture Cleaning Increased the Risk of Pneumonia among Community-dwelling Older Adults: A Population-based Cross-sectional Study. Sci Rep 2019; 9:13734. [PMID: 31551442 PMCID: PMC6760190 DOI: 10.1038/s41598-019-50129-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/06/2019] [Indexed: 01/29/2023] Open
Abstract
Pneumonia is a leading cause of death among older adults. The effectiveness of oral care in preventing pneumonia in nursing homes and hospitals has been reported. However, in community-dwelling older adults, the role of denture cleaning in preventing pneumonia remains unknown. We aimed to investigate the association between infrequent denture cleaning and the risk of pneumonia in community-dwelling older adults. This cross-sectional study was based on the self-reported questionnaire targeting towards community-dwelling older adults aged ≥65 years. Responses of 71,227 removable full/partial denture users were included. The incidence of pneumonia within the last one-year and the frequency of denture cleaning (daily/non-daily) were treated as dependent and independent variables, respectively. The odds ratio (OR) and 95% confidence interval (CI) were calculated by the inverse probability weighting (IPW) method based on the logistic regression model. The mean age of the participants was 75.2 ± 6.5 years; 48.3% were male. Overall, 4.6% of the participants did not clean their dentures daily; 2.3% and 3.0% who did and did not clean their dentures daily, respectively, experienced pneumonia. After IPW, infrequent denture cleaning was significantly associated with pneumonia incidence (OR = 1.30, 95% CI = 1.01–1.68)). This study suggests that denture cleaning could prevent pneumonia among community-dwelling older adults.
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27
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A survey of the knowledge of junior doctors in managing oral conditions in adult inpatients. Br Dent J 2019; 227:393-398. [DOI: 10.1038/s41415-019-0666-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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28
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Chen HJ, Chen JL, Chen CY, Lee M, Chang WH, Huang TT. Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122228. [PMID: 31238591 PMCID: PMC6617028 DOI: 10.3390/ijerph16122228] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group (n = 33) and a control group (n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI =−2.69 to −1.25, Wald χ2 = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = −0.16 to 0.89, Wald χ2 = 1.86, p > 0.05), MNA-SF (95% CI =−0.35 to 0.53, Wald χ2 =−0.17, p > 0.05), and nasogastric tube removal (p > 0.05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake.
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Affiliation(s)
- Hsiao-Jung Chen
- Graduate Institute of Clinical Medical Sciences, Nursing, Chang Gung University, Taoyuan City 33378, Taiwan.
| | - Jean-Lon Chen
- Department of Physical Medicine & Rehabilitation, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33378, Taiwan.
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33378, Taiwan.
| | - Chung-Yao Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33378, Taiwan.
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Keelung, Keelung City 20401, Taiwan.
| | - Megan Lee
- Department of Biochemistry, University of Washington, Seattle, WA 98134, USA.
| | - Wei-Han Chang
- Department of Physical Medicine & Rehabilitation, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33378, Taiwan.
| | - Tzu-Ting Huang
- School of Nursing, Healthy Aging Research Center School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 33378, Taiwan.
- Department of Dementia Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City 33378, Taiwan.
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29
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Koistinen S, Olai L, Ståhlnacke K, Fält A, Ehrenberg A. Oral health and oral care in short-term care: prevalence, related factors and coherence between older peoples' and professionals' assessments. Scand J Caring Sci 2019; 33:712-722. [PMID: 30859599 PMCID: PMC7328680 DOI: 10.1111/scs.12667] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
Background Oral health is important for well‐being and overall health. Older peoples′ oral health is well described in the residential care context, but remains understudied in short‐term care. Objective The aim of this study was to describe oral health, daily oral care and related factors among older people in short‐term care and to compare self‐perceived oral health with professional assessment. Materials and methods This cross‐sectional study included 391 older people in 36 short‐term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self‐perceived oral health. Self‐care ability was assessed with Katz Index of Activities of Daily Living (Katz‐ADL). Results Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self‐care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self‐perceived oral health. Conclusion Professionals’ assessments of oral health differed considerably from the older peoples′ own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self‐care (ADL). This study indicates that in order to improve older peoples′ oral health and oral care we need to provide person‐centred oral care and to develop a close collaboration between nursing and dental staff.
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Affiliation(s)
- Susanne Koistinen
- School of Education, Health and Social Studies, Dalarna University, Dalarna, Sweden.,School of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Lena Olai
- School of Education, Health and Social Studies, Dalarna University, Dalarna, Sweden.,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Katri Ståhlnacke
- School of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,Dental Research Department, Postgraduate Dental Education Center, Örebro, Sweden
| | - Anna Fält
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Dalarna, Sweden
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30
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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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31
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Wonder AH, Martin EK, Jackson K. Supporting and Empowering Direct-Care Nurses to Promote EBP: An Example of Evidence-Based Policy Development, Education, and Practice Change. Worldviews Evid Based Nurs 2017; 14:336-338. [PMID: 28742288 DOI: 10.1111/wvn.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.
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Affiliation(s)
- Amy Hagedorn Wonder
- Assistant Professor, Indiana University School of Nursing, Bloomington, IN, USA
| | - Emily K Martin
- Direct Care Nurse, Columbus Regional Health, Columbus, IN, USA
| | - Kathryn Jackson
- Clinical Nurse Specialist, Columbus Regional Health, Columbus, IN, USA
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32
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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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33
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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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34
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Hilton S, Sheppard JJ, Hemsley B. Feasibility of implementing oral health guidelines in residential care settings: views of nursing staff and residential care workers. Appl Nurs Res 2015; 30:194-203. [PMID: 27091278 DOI: 10.1016/j.apnr.2015.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/29/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the views of nurses and on the feasibility of implementing current evidence-based guidelines for oral care, examining barriers and facilitators to implementation. RESULTS This mixed-methods study involved an online survey of 35 nurses and residential care workers, verified and expanded upon by one focus group of six residential care workers. Results reflected that nurses and residential care workers (a) have little or no training in recommended oral care techniques, and (b) lack access to the equipment and professional supports needed to provide adequate oral care. Basic oral care might be performed less than once per day in some settings and patients with problematic behaviours, dysphagia, or sensitivities associated with poor oral health might be less likely to receive oral care. While lack of time was highlighted as a barrier in the survey findings, focus group members considered that time should not be a barrier to prioritising oral care practices on a daily basis in residential care settings. CONCLUSION There are several important discrepancies between the recommendations made in evidence-based guidelines for oral care and the implementation of such practices in residential care settings. Nursing and residential care staff considered adequate oral care to be feasible if access, funding and training barriers are removed and facilitators enhanced.
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