Preventive dentistry. I. Dental caries

Primary care physicians and nurses have numerous opportunities to assist in the prevention of dental caries, periodontal diseases, malocclusion, trauma to the mouth and teeth, and oral cancer. This is the first of two articles that provide background for the US Preventive Services Task Force recommendations for interventions by physicians, nurses, and other clinicians to prevent these oral diseases and conditions. Physicians and other health professionals are urged to be aware of these opportunities and to take appropriate action in collaboration with the patient's dentist.     

老年病房不同职称护士对预防肺部感染知识掌握情况调查

目的了解老年病区不同职称护理人员对预防肺部感染相关知识掌握情况,有针对性的加强薄弱环节,提高护理质量。方法采用自行设计的问卷调查表,对本院老年病房90名护理人员进行调查。结果主管护师在翻身、叩背、吸痰的基础知识及操作技能方面得分均大于雾化吸入有振动排痰仪得分。主管护师组得分显著高于护师组、护士组。结论需要加强雾化吸入、振动排痰仪相关知识的宣教及继续教育。     

Improving person-centered advance care planning conversation with older people: a qualitative study of core components perceived by healthcare professionals

Objective: The non-medical needs of patients, such as values and personal preferences, are likely to be omitted from advance care planning (ACP) discussions because of a lack of readiness and awareness on the part of healthcare professionals. The aim of the present study was to identify core components perceived by multidisciplinary healthcare professionals to improve person-centered ACP conversations with older people.Methods: The study participants were healthcare professionals (physicians, nurses, and care managers) working in different cities. This qualitative study was performed online using eight individual in-depth interviews and one subsequent focus group composed of eight healthcare professionals. The interviews and focus group discussion were audio-recorded online and transcribed verbatim. The aim of the analysis of the individual in-depth interviews was to summarize the transcribed results, create a conceptual framework for person-centered ACP conversation, and provide meaningful interpretations of the focus group participant discourse. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach.Results: Five themes capturing the core components for successful person-centered ACP were extracted from the ideas voiced by participants: Placing highest value on patient autonomy and human life; uncovering patient’s true feelings and desires; sharing collected information on patients’ end-of-life wishes with other team members; relaying patients’ wishes to the physician; and handling conflicts among patients, relatives, and healthcare professionals.Conclusion: The results provide guidelines for the future development of novel, value-based, person-centered ACP practice for multidisciplinary healthcare professionals.     

Practice nurses and antismoking education

A questionnaire on antismoking activities and education was sent to 369 nurses in general practice. The response rate was 80%. Although most of the nurses sometimes advised patients about smoking, routine antismoking education occurred less frequently. Only a few regularly referred smokers to other agencies for help, recommended aids to stop smoking, or used antismoking literature. Although the nurses thought that they had an important role in helping smokers to give up, they expressed little confidence in their effectiveness, believing that advice from the general practitioner and the smoker's personal determination to give up have more impact. The nurses expressed a need for training in antismoking education. Seventy seven per cent were interested in attending seminars and listed information about smoking, techniques for stopping, and counselling skills as priorities. If practice nurses are to use opportunities in primary care to help smokers there is clearly a need to provide further training and to establish the effectiveness of nurses in their role as smoking educators.     

艮科护士核心能力训练对提高手术患者院内感染控制能力的效果分析

目的探讨眼科护士核心能力训练对眼科手术患者控制院内感染的方法与效果。方法对22名眼科护士进行包括消毒隔离知识、职业防护、洗手执行情况、病房管理等方面的医院感染知识的培训,培训后对院内感染控制的应用效果与培训前对比。结果培训后眼科护士对院内感染控制知识及能力明显优于培训前,眼科手术患者院内感染发生率明显降低,护士对院感知识知晓率明显提高。结论通过对眼科专业护士有目的、有措施、有针对性的核心能力训练能提高眼科护士院内感染控制的知识及能力,有效地控制眼科手术患者院内感染发生率。     

Knowledge,awareness and practice regarding needle stick injuries in dental profession in India: A systematic review

Background:

Hundreds of thousands of healthcare workers remain susceptible to deadly viruses throughout the year, including blood-borne pathogens. Needle stick injuries (NSI) constitute one of the most common occupational health hazards in healthcare profession. Dental professionals are at more risk of acquiring NSI due to their limited and restricted working area. The present systematic review was carried out to determine knowledge, awareness and practice regarding NSI in dental professionals and students in India.

Materials and Methods:

A systematic review of cross-sectional studies available in the literature on the knowledge, attitude and practice among dental professionals and students in India was carried out. We identified relevant articles through electronic and manual search such as Pubmed and MEDLINE. Two investigators independently identified studies that were included in the review.

Results:

Four articles were finally selected for inclusion in the review. All the studies were done involving dental students; 89.23% of the students had correct knowledge about NSI and 91.55% of the students had adequate level of awareness regarding its management in one of the studies. Also, 89% of students in one of the studies were aware of taking post-exposure prophylaxis after accidental NSI. In another study, 44% of the students destroyed the needles using a needle destroyer and 15% destroyed them in puncture-resistant containers.

Conclusion:

The knowledge and awareness of the dental students is adequate, although there is considerable variation in practice and management of NSI among different studies. There is a need for more studies involving dental professionals.     

Communicating information on cardiopulmonary resuscitation to hospitalised patients

AIM: The primary aim of the study was to evaluate two different methods of communicating information on cardiopulmonary resuscitation (CPR) to patients admitted to general medical and elderly care wards. The information was either in the form of a detailed information leaflet (appendix I) or a summary document (appendix II). The study examined the willingness of patients in seeking detailed information on cardiopulmonary issues. SETTING: The study was conducted over three months on a general medical ward and an acute elderly care ward in two district general hospitals. METHODS: A detailed information leaflet on CPR was provided to the nursing staff on the wards. An A4 summary document summarising the CPR decision making process and basic information on cardiopulmonary issues was placed in a folder at the foot of each bed on the elderly care ward. On the general medical ward it was displayed prominently over the head of all beds. RESULTS: Out of the 274 patients admitted to the general medical ward only two requests were received for the detailed information leaflet. On the elderly care ward there were 182 admissions but no patients or their relatives requested the leaflet. CONCLUSIONS: Availability of basic information on cardiopulmonary resuscitation to all patients is practical and does not lead to unnecessary distress or offence to patients or their carers. It makes the decision making process more transparent. Detailed information leaflets are of value for a minority of hospitalised patients.     

Dental knowledge of educators and healthcare providers working with children with autism spectrum disorders

Objectives:

To evaluate dental knowledge and attitudes toward oral health care among healthcare providers and educators working with children with autism spectrum disorders (ASD) in central Saudi Arabia.

Methods:

There were 305 questionnaires distributed to 7 special-needs centers between September and November 2014. A total of 217 questionnaires were collected with a response rate of 71.1%. The study took place in the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Results:

Approximately 50.2% of the participants did not offer any toothbrushing advice, and 73.3% never recommended dental checkup visits to parents, and 75.6% never performed dental examinations to children under their care. Ten percent thought that children should have their first dental visit after 6 years of age. Almost all participants agreed that children should practice oral hygiene, and 60.4% think they should brush twice per day. In general, the participants choose toothbrushes and toothpaste as the main tools to perform oral hygiene. There were 35% of participants who believed that parents should be responsible for the children’s oral hygiene, and a few participants mentioned teachers and therapists to be responsible. Most of the participants (71.4%) did not receive any dental information from dental professional resources, only 14.3% of participants believed bacteria to be the cause of dental cavities.

Conclusion:

There is a clear lack of dental knowledge and attitudes, and its practical application among the participating group of healthcare providers working with children with ASD in Riyadh.Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability that affects children at a young age. Children with ASD usually show multiple, complicated deficiencies in their social, emotional, and communicative skills.1 Because of the multiple signs and symptoms of ASD, a multidisciplinary team is required to diagnose and offer comprehensive medical care for affected children. These teams usually include different specialists and subspecialists, such as general practitioners for primary diagnoses, and lead to referrals to relevant professionals or pediatricians who are able to confirm, or refute the ASD diagnosis. Clinical psychologists, psychiatrists, and psychotherapists (who are able to confirm the diagnosis of autism and introduce a customized individual behavior management plan), dieticians (who can provide advice and information concerning nutrition and diet), special educators (who can assess children’s educational needs), social workers (who can assess the care needs of children with ASD and their families), speech and language therapists (who can assess speech, language, and communication abilities), audiologists (who can evaluate possible hearing impairments), opticians (who can assess any visual difficulties that the children might have), in addition to specialists in oral health (OH [such as, pediatric dentist, who can perform early check-ups and introduce both primary and comprehensive preventive and therapeutic oral care]).2 From a medical point of view, the recognition and diagnosis of ASD in its early stages is significant. Early intervention and treatment can control, and in many cases improve, the symptoms.3,4 From a dental point of view, early examinations for intervention and prevention among children in general (and those with special needs specifically) are strongly recommended by major dental academies.2,5 However, because children with ASD have multiple medical issues, their dental issues might not receive equal consideration from healthcare providers (HCPs) trying to provide the best comprehensive care. In addition, several well-documented national and international studies have observed a lack of dental knowledge among primary HCPs,6-15 and educators16-20 who work with children. Most published studies have reported data collected from HCPs who work with healthy children, or those with disabilities, such as cerebral palsy, or Down syndrome, however, no studies have been conducted to assess the dental knowledge of educators and HCPs that interact with children diagnosed with ASD. Therefore, because of the unique characteristics of children with ASD, this study evaluated the dental knowledge of, and attitudes toward oral healthcare among different HCPs and educators interacting with children with ASD in Riyadh, Kingdom of Saudi Arabia (KSA).     

面部疼痛研究进展

本文重点介绍面部疼痛的临床研究进展.面部疼痛的患者往往面临着困难选择:该去看口腔科医生还是去看内科医生,这种选择决定了最后采取的治疗方式.有证据表明许多非牙源性疼痛患者也接受了牙齿的相关治疗.许多患者对疼痛不能缓解充满失望,经过多次就医,才得到正确的治疗.     

Preventive dentistry. II. Periodontal diseases, malocclusion, trauma, and oral cancer

This is the second of two articles reviewing the recommendations of the US Preventive Services Task Force for interventions by physicians, nurses, and other clinicians to prevent the major oral diseases and conditions. Physicians and other health professionals should be aware of their many opportunities to assist in preventive oral health care and should take appropriate action in collaboration with the patient's dentist.     

浙江省某市三级医院医护人员健康教育知信行调查

目的了解浙江省某市三级医院医护人员健康教育知识、信念、行动情况，分析医护人员健康教育工作中存在的问题，并提出合理建议。方法采用分层随机抽样方法，运用自编问卷对医院的322名医护人员进行调查。结果不同学历、职业的医护人员健康教育知识知晓率存在差异（P〈0．05）。322名被调查者中，92．8％的被调查者认为在医护活动中实施健康教育很重要，60．5％的被调查者在医护工作中经常给病人讲解疾病预防的知识，57．1％的人会经常对病人的不良行为进行干预，参加过医院或专门健康教育机构组织的培训班的占73．6％，94．1％的被调查者愿意进一步接受专门的健康教育培训。结论很有必要提高医护人员健康教育培训率和广大医务人员的健康教育水平。     

Internet Use by Hospice Families and Providers: A Review

This literature review explores the current evidence related to use of the Internet by hospice patients or families and palliative care/hospice professionals. The research questions guiding this study pertain to the current Internet-based interventions in hospice and palliative care and the evidence of their effectiveness. Six studies were identified as a result of an extensive literature review. These studies included research about web-based clinical interventions for patients, and patients’, caregivers’ and hospice/palliative care providers’ use of the Internet. The majority of interventions involve accessing information via the Internet. Participants among the studies included patients, caregivers/family members, and health care professionals. Findings overall indicate effectiveness of Internet-based interventions. Both patients and professionals are using the Internet to find answers to healthcare questions, communicate, and/or deliver healthcare interventions.     

侵入性护理操作时护士行为的模式研究

目的探讨侵入性护理操作时护士行为与患者应激反应的相关性,了解患者对护士行为的需求,寻求规范的护士行为模式。方法采用描述性相关性研究,自设测量表对250例首次接受侵入性护理操作患者进行问卷调查,采用单因素Logistic回归法分析,确定侵入性护理操作时护士行为与患者应激反应有无相关性。结果 250例接受侵入性护理操作的患者应激反应中焦虑239例和恐惧11例,其中护士对侵入性护理操作是否解释、护士的操作技术、护士的表情语气、护士的动作与患者的应激反应相关（P〈0.001）,与护士仪表仪容不相关。结论侵入性护理操作时护士行为与患者的应激反应相关,因此在侵入性护理操作时护士应具备同理心,有良好的职业态度,在语言、动作、表情上规范自己行为,减少患者不良心理反应,获得患者心理认同。     

The prevalence of drivers in acute geriatric wards.

An audit of 150 patients on five acute geriatric wards found that 28 (19%) still drove. Forty-three (28%) used to drive but had given up, whilst 79 (53%) (76 of whom were female) had never driven. Former drivers gave the main reason for stopping as cost. No driver could recall being advised about driving by a doctor. Twenty-two drivers (79%) had a significant clinical condition that could affect driving, ranging from blackouts to arthritis. It is recommended that all elderly patients should be asked if they drive and any clinical conditions they might have that would adversely affect their driving be sought. Appropriate advice should be given by doctors to their elderly patients in order to safeguard them and the public from road traffic accidents.     

The knowledge of hospital patients about vascular diseases and their risk factors.

The knowledge of 28 stroke patients on the nature, consequences, treatment and risk factors of stroke and ischaemic heart disease was examined using a questionnaire and compared with that of 26 patients with ischaemic heart disease and 41 controls without evidence of vascular disease. Information was also collected on the patients'' willingness to change their life-style, the information and advice they had received and their desire for more information. It was found that about half of the elderly stroke and heart disease patients had a reasonable knowledge of the condition and its related risk factors. Only eight (14%) patients remembered receiving information and advice in relation to their condition during their hospital stay compared with one (2%) control. There was a significant difference between the number of stroke and heart disease patients who wanted to know more about their condition compared with the control group (32 vs 14; p = 0.03). A quarter of the patients and half of the controls knew that fruit and vegetables were good for you and excessive fat and alcohol were less inducive to good health. Most patients with a risk factor were willing to exercise more, stop smoking, cut down on their drinking, or lose weight. These results suggest that elderly hospital patients have a reasonable basic knowledge about vascular diseases, but that a significant number want to know more and would be willing to change their life-style.     

基于钻石模型理论的医养结合型养老服务供给侧改革研究

随着我国人口老龄化程度的不断加深,老龄人口的健康问题与日俱增,传统的养老服务已经难以满足老年人需求,因此推行医养结合型养老服务成了社会的必然选择。但是,我国的医养结合型养老服务市场供给侧问题重重,专业型服务人员匮乏、社会资本整合不足、供给没有与需求精准匹配、资源配置不平衡、竞争环境不公平等,这些问题的出现均需要对医养结合型养老服务市场进行的供给侧改革重新审视。本文运用迈克尔-波特的钻石模型理论对医养结合型养老服务市场的供给侧改革进行科学分析,总结出我国医养结合型养老服务市场供给侧改革需要从政府角色转变、加强人才培养、利用高新科技等途径来提高医养结合效力,提升医养结合型养老服务市场整体服务水平。     

对住院糖尿病患者开展优质护理示范服务的效果分析

[目的]评价优质护理服务措施的可行性和效果,为今后护理工作提供指导和借鉴.[方法]对开展优质护理服务前后护士(n=6)从事各类护理工作的时间进行观察和记录;对80例2型糖尿病患者进行问卷调查,分为干预组(n=40)和对照组(n=40),干预组为开展优质护理服务组,对照组为开展前组.[结果]开展优质护理服务后患者的满意度上升;护士停留在病房为患者进行生活护理和健康教育的时间延长;患者的疾病相关知识得分提高.[结论]开展优质护理服务有利于护士责任意识的增强,有利于患者的疾病知识和自我管理水平提高,值得进一步深入开展和推广.     

Medical restrictions to driving: the awareness of patients and doctors

The study was set up to investigate the awareness of elderly patients and medical doctors of medical restrictions to driving. Separate questionnaires were completed by patients and doctors. All were interviewed face-to-face, without prior warning and their immediate answers were recorded. In total, 150 elderly patients from the acute elderly care wards, rehabilitation wards and day hospital, and 50 doctors (including all grades from consultant to junior house officer) were interviewed. The main outcome measures were numbers of patients currently driving and previously driving; patients' awareness of how their medical condition affected their ability to drive; doctors' spontaneous knowledge of medical conditions which restrict driving, current licensing policy, and restrictions for five specific medical conditions (epilepsy, myocardial infarction, stroke, 5-cm abdominal aortic aneurysm, and diabetes). Only 21 patients were current drivers, and six of these should not have been driving. While 103 perceived themselves eligible to drive, 46 had medical restrictions to driving. Seventeen of the 47 patients who perceived themselves not eligible to drive possibly did not have restrictions to driving. Doctors' knowledge of the current licensing policy and action to be taken if a patient was not eligible to drive was very poor. Knowledge of medical restrictions to driving was scanty, with few doctors giving the correct driving restrictions for the five specific conditions. We recommend that education of doctors regarding medical restrictions to driving should begin at an undergraduate level and be continued throughout their postgraduate career.