Objectives
Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very ...important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP.
Materials and methods
In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital’s point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…).
Results
A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%,
p
= 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program.
Conclusion and clinical relevance
Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable.
Trial registration
NCT02400294
The Alpha Omega-Henry Schein Cares Holocaust Survivors Oral Care Project is an international collaboration to treat low-income, high-need Holocaust survivors in nine U.S. and two Canadian cities. The ...project partners are Alpha Omega, the oldest international dental organization
and oldest international Jewish medical organization, and Henry Schein, Inc., the world's largest provider of healthcare products and services to office-based dental, animal health, and medical practitioners (The Partnership for Quality Medical Donations, 2014). The project was spurred by
a 2013 Health and Human Services initiative to treat Holocaust survivors living in poverty who were due services, but not receiving them.
Background
A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health ...inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness.
Methods
Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross‐referencing was performed using a standardised searching algorithm. Randomised and non‐randomised controlled trials, controlled before‐and‐after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265).
Results
Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal‐coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance.
Conclusions
The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.
Purpose:
Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The ...purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care.
Methods:
The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed.
Results:
There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group (p < 0.001). 2) Severe cases of dry mouth (Grade-2&3) were noted in 20.0% and 64.8% in good and poor oral intake groups, respectively (p < 0.0001). Candidiasis complication rate was significantly higher in poor oral intake group (p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3.
Conclusion:
Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.
Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs). ...Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages). A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3%) working 12-h shifts in the ICU (70.4%); about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05). Most reported using spatulas, gauze, and toothbrushes (49.3%) or only toothbrushes (28.2%) with 0.12% chlorhexidine (49.3%) to sanitize the oral cavity of ICU patients (P < 0.01). Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05). However, most professionals (56.4%) reported feeling that the oral cavity was difficult to clean (P < 0.05). Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.
Chinese dentists are obliged to provide reliable guidance to patients about tooth brushing. However, attitudes and behaviours of Chinese dental students regarding oral health have been insufficient. ...Traditionally, dental students were taught how to brush, but not how to evaluate tooth brushing. Here, we applied a three-session-procedure (TSP) based on experiential learning (EL) in a tooth brushing course for Chinese dental students. The aim was to improve dental students' knowledge, practice of tooth brushing and self-evaluation, which may help cultivate their ability to conduct evaluation for friends, relatives and future patients.
A quasi-experimental study design with a pre-test and post-test group was applied. A total of 176 students were enrolled in the TSP, which included a 1.5-h lecture course, a 3-h practice course for evaluation and comparison of manual and electric tooth brushing, and an after-class experience report. A survey including a knowledge test and a questionnaire on tooth brushing habits and opinions about the TSP was conducted 2 weeks later. The data about tooth brushing and the survey were collected and analysed.
Manual and electric tooth brush demonstrated almost equal overall efficiency in reducing plaque. However, for some students, either manual or electric tooth brushing was more suitable. Thus, it is advisable to estimate the exact differences in the efficiency of tooth brushing methods for each individual. The survey showed that tooth brushing by dental students significantly improved after TSP. The students could make self-evaluation and proper recommendations to family members and friends. The TSP was helpful in interpreting and evaluating manual and electric tooth brushing methods.
A TSP course improved dental students' knowledge, practice of tooth brushing and self-evaluation. In conclusion, a TSP based on EL is an effective and well-organized method of education on tooth brushing for Chinese dental students.
At present, diseases of mucous membrane of the oral cavity (MMOC), periodontal disease remain an unresolved problem of dentistry, due to the multifactorial nature of their occurrence. The aim of the ...work is to increase the effectiveness of treatment of periodontal diseases, the mucous membrane of the oral cavity against a background of gastritis with an increased acid-forming function by applying pathogenetically grounded local therapy. Local application of a new apigel based on propolis and biologically active substances in the complex treatment of patients with chronic generalized periodontitis of the first degree against a background of hyperacid gastritis has a beneficial effect on the clinical symptoms of inflammation of the oral mucosa and periodontium. In comparison with patients in whom anti-inflammatory local therapy was performed using the traditional method with local use of dental gel based on chamomile flowers, patients whose treatment regimen included local apigel use noted improvement in oral dental status 5-7 days faster. The proposed method quickly removed inflammation, bleeding gums that correlated with the improvement of the hygienic state of the oral cavity. The results of the clinical and laboratory evaluation of the effectiveness of the use of the newly developed anti-inflammatory hygienic remedy for the treatment of periodontal disease in the context of heli bacterium in patients with hyperacid gastritis revealed a rapid normalization of indices of nonspecific and specific protection in the oral liquid than with conventional therapy. Under the influence of the developed local method of treatment for inflammatory diseases of MMOC and periodontal disease in patients with hyperacid gastritis, in particular, in tobacco-producing, optimal conditions are created for the elimination of violations of the immunological status of the oral cavity and the restoration of the structural and functional state of the periodontal and mucous membranes. The authors came to the conclusion that the local application of the proposed treatment method reduces the period of restoration of the structural and functional integrity of MMOC, improves the hygienic state of the cavity, promotes the rapid normalization of indices of nonspecific and specific protection in the oral fluid, preventing the development of inflammatory complications in tobacco-dependent, which increases the effectiveness of treatment and quality. the life of patients with conjunctival diseases of the digestive canal with an increased acid-forming function.
At present, diseases of mucous membrane of the oral cavity (MMOC), periodontal disease remain an unresolved problem of dentistry, due to the multifactorial nature of their occurrence. The aim of the ...work is to increase the effectiveness of treatment of periodontal diseases, the mucous membrane of the oral cavity against a background of gastritis with an increased acid-forming function by applying pathogenetically grounded local therapy. Local application of a new apigel based on propolis and biologically active substances in the complex treatment of patients with chronic generalized periodontitis of the first degree against a background of hyperacid gastritis has a beneficial effect on the clinical symptoms of inflammation of the oral mucosa and periodontium. In comparison with patients in whom anti-inflammatory local therapy was performed using the traditional method with local use of dental gel based on chamomile flowers, patients whose treatment regimen included local apigel use noted improvement in oral dental status 5-7 days faster. The proposed method quickly removed inflammation, bleeding gums that correlated with the improvement of the hygienic state of the oral cavity. The results of the clinical and laboratory evaluation of the effectiveness of the use of the newly developed anti-inflammatory hygienic remedy for the treatment of periodontal disease in the context of heli bacterium in patients with hyperacid gastritis revealed a rapid normalization of indices of nonspecific and specific protection in the oral liquid than with conventional therapy. Under the influence of the developed local method of treatment for inflammatory diseases of MMOC and periodontal disease in patients with hyperacid gastritis, in particular, in tobacco-producing, optimal conditions are created for the elimination of violations of the immunological status of the oral cavity and the restoration of the structural and functional state of the periodontal and mucous membranes. The authors came to the conclusion that the local application of the proposed treatment method reduces the period of restoration of the structural and functional integrity of MMOC, improves the hygienic state of the cavity, promotes the rapid normalization of indices of nonspecific and specific protection in the oral fluid, preventing the development of inflammatory complications in tobacco-dependent, which increases the effectiveness of treatment and quality. the life of patients with conjunctival diseases of the digestive canal with an increased acid-forming function.
Dental anxiety is a barrier to dental care utilization and is associated with poor oral health outcomes. The aim of the study was to assess the relationship between dental anxiety of mothers and ...dental caries of their children in the Eastern Province, Saudi Arabia.
A cross-sectional study was conducted on a sample of mother-child pairs (N= 199) in Dammam, AlKhobar, and Dhahran, Saudi Arabia. Dental caries experience among children was determined using dmft/DMFT indexes following the World Health Organization's guidelines. Maternal dental anxiety was assessed by using the Modified Dental Anxiety Scale (MDAS).
The mean ages of mothers and children were 33.98 ± 5.41 and 6.74 ± 2.29 years, respectively. The mean dmft score was 4.3 ± 3.99 in primary dentition and the mean maternal dental anxiety score was 13.89 ± 5.33. Ninety-two percent of mothers had low to extreme dental anxiety and only 8% reported no dental anxiety. Dental caries experience in primary teeth was higher in children of dentally anxious mothers (mean dmft 4.45 ± 3.92) than the children of mothers who were non-anxious (mean dmft 2.56 ± 4.59) (P=0.07). The mean maternal anxiety score was significantly higher in children with untreated decay in primary dentition (14.49 ± 5.08) than those with sound primary dentition (12.24 ± 5.67) (P = 0.008). The study also found a statistically significant correlation between maternal dental anxiety and untreated decay in the primary dentition (Pearson's r =0.171, P = 0.015).
Dental anxiety was highly prevalent among mothers in the present study. There was a significant relationship between maternal dental anxiety and untreated decay in the primary dentition. Awareness should be raised among dentally anxious mothers to reduce the burden of dental caries in their children.
Mucositis is a common and devastating side effect of chemotherapeutic agents in children undergoing chemotherapy. The prevention and management of mucositis are necessary to improve these children's ...quality of life. Oral care is a recommended strategy for preventing and managing oral mucositis. Thus, the objective of this study was to identify the relationship between oral care practice and mucositis incidence. A cross-sectional analytical design was used in this study. A total of 34 children from 3 to 12 years of age with acute lymphoblastic leukemia who were in the last cycle of chemotherapy were recruited through a snowball sampling method. The Oral Assessment Guide (OAG) was administered to assess the severity of mucositis. A majority of the participants (51.5%) had mucositis after completing the last cycle of chemotherapy. Furthermore, there was a statistically significant relationship between their oral care practice at home and mucositis incidence. These results show that oral care at home is linked with the incidence and severity of mucositis. Nurses should educate children with leukemia and their parents regarding good oral hygiene practice.
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