Frequency of postoperative wound infections: an unsuitable parameter for comparison of hospitals

OBJECTIVE: To evaluate the reliability of registration of wound infections and their contribution to total postoperative morbidity. DESIGN: Prospective. METHOD: During the period from 1 July 1997 through 30 June 1998 of all patients treated in the department of Surgery of the Diaconessen Hospital, Utrecht, the treatment-related complications were recorded during the hospital stay as well as at the first outpatient follow-up. The clinical registration forms were checked and supplemented after discharge, during the transfer and by the hospital hygienist. The precision of registration, the implications of the registered wound infections, and the share of this complication in overall postoperative morbidity were studied. RESULTS: There were 2172 admissions (2004 patients): 996 males and 1176 females (mean age at admission 55 years). The response of registration was 100% during hospital stay and 59.5% in the outpatient department. Postoperative course was complicated in 506 patients (23% of the admissions). Of the 735 registered complications 583 (79%) were recorded during clinical stay. Airway and wound infections were the most frequently registered complications (in 4.4% and 4.3% of the admissions respectively). Of the wound infections 45% were recorded after discharge and 88% fully recovered by conservative means. Both the frequency of wound infections in relation to other postoperative complications and the severity of the registered wound infections varied with the reason of admission. CONCLUSION: The incidence of postoperative wound infections was not reliably measured as a result of low response of registration after hospital discharge. The contribution of wound infections to overall postoperative morbidity and the severity of these infections varied with the reason of admission.     

Estimating induced abortion rates: a review

Legal abortions are authorized medical procedures, and as such, they are or can be recorded at the health facility where they are performed. The incidence of illegal, often unsafe, induced abortion has to be estimated, however. In the literature, no fewer than eight methods have been used to estimate the frequency of induced abortion: the "illegal abortion provider survey," the "complications statistics" approach, the "mortality statistics" approach, self-reporting techniques, prospective studies, the "residual" method, anonymous third party reports, and experts' estimates. This article describes the methodological requirements of each of these methods and discusses their biases. Empirical records for each method are reviewed, with particular attention paid to the contexts in which the method has been employed successfully. Finally, the choice of an appropriate method of estimation is discussed, depending on the context in which it is to be applied and on the goal of the estimation effort.     

Disseminating evidence from health technology assessment: the case of tobacco prevention

OBJECTIVES: The aims of the present study were to investigate the awareness among dentists and dental hygienists of evidence-based reports and guidelines on tobacco cessation activities and the impact these publications had on clinical practice. METHODS: A questionnaire was mailed to dental hygienists and dentists in Stockholm County, Sweden, and the results were compared with a previous investigation. RESULTS: Among the respondents, awareness of a popular science version of a systematic review on smoking and its effect on oral health was reported by 90 percent of the hygienists and 66 percent of the dentists. The information was used in clinical work by 34 percent of the dentists and 54 percent of the hygienists. Reported changes in patterns of practice were more frequent recommendations to use nicotine replacement therapy and a more widespread use of setting quit dates. Approximately one quarter of the dental professionals reported that they had increased tobacco cessation consultation because of the results from the reports. CONCLUSIONS: Changes in patterns of practice were observed after dissemination of evidence-based information on tobacco cessation. Methods that were proven to be effective in the evidence-based report such as discussing quit dates and recommending nicotine replacement therapy were more commonly used after the publication of the report. Short, popular versions of extensive systematic reviews seem to be useful for implementing evidence-based knowledge and changing clinical practice.     

Dental examinations for quality control: peer review versus self-assessment.

This paper reports the dental care norms for restorative dentistry collected from examinations of 1,466 patients in 105 dental offices in Washington State during 1976. These results are part of a larger study, "Assessment of Care and Continuing Dental Education," being conducted by the University of Washington with the endorsement and cooperation of the Washington State Dental Association. Treatments in volunteer offices were evaluated either by colleagues (peer review) or by the practitioner himself (self-assessment). Two hundred twenty-four of 1,196 eligible dentists volunteered for the study. Patients from the practitioners' offices were randomly selected from office files by project staff. The study tests the proposition that, using standardized clinical evaluation procedures and comparable samples of treatment, dentists will be more critical of their own work than that of others. Results suggest a generally high level of care provided by volunteer practitioners and that self-assessments were significantly more critical than peer review.     

Inequalities in the conditions of infection control in dentistry offices in a southeastern Brazilian city

The study analyzed infection control conditions in dentistry offices in Cariacica, Espírito Santo, Brazil. Data pertaining to interviewees, location and type of office, setting, equipment, and materials were obtained by direct observation in all the registered services and in twenty unlicensed establishments operated by "non-graduate dentists". For grouped analysis of infection control measurements in each establishment, a composite indicator based on 19 variables was developed, such that the lower its value, the better the infection control. The results referred to 113 offices. Infection control in offices of "non-graduate dentists" (xICI = 23.05, dp = 11.86) was four times worse than for private offices. Public dental care services (xICI = 16.27; dp = 6.96) occupied an intermediate position. Conditions were also four times worse in dentistry offices located in peripheral urban areas. There was a clear-cut division in sanitary conditions within dental care as a whole. A large proportion of the population depending on dental care from unlicensed dentists is exposed to increased risk of cross-infection.     

Implications of AIDS for teachers of medicine to dental students

A plea is made for a significant input on AIDS to the dental undergraduate curriculum by medical teachers. The suspicion is that in some schools the teaching of medicine to dental students is not treated seriously. Figures are quoted depicting the worldwide spread of AIDS. The risk of dentists acquiring HIV in the health care setting is discussed. Mention is made of infection control in the dental environment. The objectives are given of a medical curriculum for dental students. Some of the oral manifestations of AIDS are named. Symptoms and signs (which a dentist should be able to recognize) are given for pulmonary, neurological, gastrointestinal or neoplastic complications that may be found in HIV infection. The role of the dentist is stressed in continuing surveillance of patients with HIV infection.     

Oral health and systemic health

Certain cancers, hypertension, diabetes, leukemia, gastrointestinal disorders, osteoporosis, and HIV and other infectious diseases can manifest themselves in the oral cavity. In addition, some of these conditions and the therapies for them can affect the teeth and mouth. This article outlines what physicians should know about how certain medical conditions and medications can affect dental health and treatment, how dentists can help detect underlying medical conditions, and how the two professions can better serve patients by working together. placement of implants, periodontal surgery, endodontic treatment, or subgingival manipulation. Physicians should be aware of potential complications from dental treatment, inform patients of the risks, and communicate to the patient's dentist about the patient's physical status, the extent to which his or her condition is under control, and how to prevent complications. The following examples illustrate the need for such interaction between physicians and dentists.     

A survey of potential risk factors for HIV transmission through dental practice in Japan

A survey was conducted to find potential risk factors for HIV transmission through dental practice. Self-administered questionnaires were distributed to the members of the dental associations of various prefectures and small cities in Japan. A total of 747 questionnaires was returned by dentists. The findings revealed several problems. Gloves, masks, and other protective garments were generally worn, but most dentists did not always use them during the full course of treatment limiting usage to surgical treatment, and when treating patients in "high-risk groups" and in dental practice the exact percentage of the dentists who reused a used anesthetic liquid cartridge is 12.7%. The effectiveness of the education for dentists regarding AIDS was statistically clarified. It is obviously necessary to provide important information regarding AIDS and HIV transmission to the dentists. Potential risk for HIV transmission through dental practice will be prevented by AIDS education for the dentists.     

Estimating mortality using data from civil registration: a cross-sectional study in India

ObjectiveTo analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data.MethodsWe assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice.FindingsAlthough we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered.ConclusionThe data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state.     

Management of occupational exposures to potentially infectious materials in dentistry

OBJECTIVE: To evaluate whether post-exposure measures referred by dentists and dental assistants are in line with those recommended by Brazilian health authorities. METHODS: An epidemiological survey was carried out in a city of Southern Brazil, in 2003. Subjects (289 dentists and 104 dental assistants) were selected through random systematic sampling. Data were collected through self-reported questionnaires. RESULTS: Washing the exposure site was the most common measure taken by dentists (98.5%) and assistants (89.2%) after sustaining a percutaneous injury. More dentists asked the patients if they carried blood-borne viruses after sustaining a percutaneous injury (44.6%) than a splash to a mucous membrane (14.3%). Taking post-exposure prophylaxis, notifying the accident and requesting blood tests to patients were the least remembered and taken measures by dentists and assistants. After sustaining an occupational exposure to potentially infectious materials, 10.8% of dentists and 2.7% of dental assistants sought medical care. CONCLUSIONS: Based on the Brazilian Ministry of Health recommendations, post-exposure management among the study population was considered, in general, inadequate, especially among dental assistants.     

Impact of the "Guidelines for infection prevention in dentistry" (2006) by the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch-Institute (KRINKO) on hygiene management in dental practices - analysis of a survey from 2009

Aim: To assess trends in hygiene management in dental practices in comparison to an earlier survey in 2002/2003 and to point out key aspects for future efforts. Method: The infection prevention management of all dental practices in Greifswald (n=35) was determined by a questionnaire in a personal interview in 2008/2009.Results: 26% of the dentists did not use sufficient personal protective equipment during the general examination of the patient. In conservative and prosthetic dentistry, 15% still did not use adequate measures and 9% did not even in surgical interventions. Vaccination coverage was clearly too low, as only 35% of dentists were vaccinated against influenza and coverage with other vaccinations was also quite low. 11% of the dentists did not perform a documented anamnesis and in 29% of the dental practices no appointment system for risk patients existed.There were significant deficiencies in the reprocessing of medical devices and in the equipment needed for reprocessing. The opportunity to participate in further training in this field was rejected by 23% of the dentists.In 10 dental practices, the colony count in the dental unit water-conducting system was five times higher than the limit. A contamination with P. aeruginosa was discovered in 4 practices. All units were renovated.Discussion: Overall, both the hygiene management and hygiene equipment in the practices have improved considerably compared to the previous survey in 2002/2003. This demonstrates the positive effect of the KRINKO guidelines from 2006. However, the survey again showed relevant deficiences in the hygiene management of dental practices, which agrees with a Germany-wide online survey from 2009.Conclusion: While the study revealed persistent deficiencies in hygiene management, especially in reprocessing, it confirms that the KRINKO guidelines for dental practices from 2006 led to significant improvements in hygiene management. Doubts about the impact of the guidelines are not backed by evidence.     

Vaccination status of medical and dental students

Infectious diseases are still a worldwide health problem, and hence physicians are responsible for providing the population with sufficient vaccinations. Until now, however, comprehensive studies on vaccination behaviour in German medical/dental students, the future physicians/dentists, are lacking. The study analysed vaccinations of medical/dental students against tetanus, diphtheria, poliomyelitis, hepatitis A + B and tried to find possible influences on the vaccination behaviour. 126 medical and 99 dental students participated by working on an anonymous questionnaire related to sociodemographic data, smoking/drinking habits, drug abuse and vaccinations. The response rate was between 76 and 85%. Altogether, the investigated students were not sufficiently vaccinated. Nevertheless, they were better vaccinated than a normal reference sample. Except for a significantly better immunisation against hepatitis B in dental students, no differences between medical and dental students were found. In comparison to male students, female students presented better immunisation. On the other hand, students from the former West Germany, smoking students and students who are taking illegal drugs, were more insufficiently immunised than the other students. To optimise vaccinations in future physicians and dentists, medical/dental education should focus more on infectious diseases and knowledge about vaccinations. This would help to protect future physicians and dentists against preventable infectious diseases. Additionally, they are better skilled to prevent infectious diseases by providing the population with information and vaccinations.     

Calculating dental fees--a 1988-1999 trend analysis

German GOZ (Gebührenordnung für Zahn?rzte, catalogue of dental services) allows multipliers within a range from 1.0 to 3.5 for each fee, and it also prescribes medical arguments if dentists want to justify multipliers beyond 2.3. The authors analyze formal and material developments in these medical arguments of more than 3500 invoices from 1988 to 1999. Since 1988--amendment of GOZ--a development can be seen away from more general and patient-focussed towards arguments dealing with new dental materials and new forms of dental treatment. The authors analyse the way dentists (private ones and dentists of health insurance system), orthodontists, maxillo-facial- and oral surgeons charge their fees.     

TQM in dental practice.

Society now expects more from its doctors and dentists, and these increasing demands can be summed up in one relatively new term for the medical profession: "quality management" (QM). Doctors and dentists formerly took the view that their performance could be assessed solely on the basis of their technical skills, ethics and expertise, but are now confronted with a new social imperative, from outside the profession--quality management. The author, prize-winner of the European Quality Award 2000 describes his approach to introduce the European Foundation for Quality Management (EFQM) Excellence Model in his dental practice. He shows that the EFQM model is well suited as a basis for a quality management system in healthcare.     

基于基尼系数的吉林省口腔医疗机构人力资源公平性分析

目的通过对吉林省口腔医疗机构的人力资源现状的数据进行整理与分析,探讨存在的问题,为优化吉林省口腔医疗机构人力资源配置、提高口腔医疗机构卫生服务公平性、相关部门决策提供参考和依据。方法采用描述性分析、洛伦兹曲线和基尼系数,分析2020年吉林省口腔医疗机构人力资源配置公平性及其变化趋势。结果 2020年吉林省口腔医疗机构人力资源严重不足,非公立口腔医疗机构优于公立口腔医疗机构的公平性,配置较公平。各地方口腔医师人力资源分配相对公平。结论各地口腔医师分布较好,鼓励医师到各级口腔医疗机构出诊,非公立口腔医疗机构服务能力及整体素质有较大提升空间。     

建档立卡贫困户住院患者医保资金使用分析及建议

目的对建档立卡贫困户住院患者的医保结算费用进行聚类分析,为医保资金合理使用提供参考。方法以大同市某三级医院2018年1月1日-2020年12月31日建档立卡贫困户住院患者为研究对象,采用K-Means方法对其医保结算费用进行聚类分析。结果患者聚为5类:第1类为过度转诊患者;第2类为疾病在基层医疗机构无法确诊,需要向上转诊已明确诊断的患者;第3类为常见慢性病患者;第4类为反复住院的终末期患者;第5类为医保资金使用的重点人群。费用支付以基本医疗保险、大病保险和医保兜底保障为主。5类患者的年龄、性别、住院次数、诊断个数、危重程度、是否手术、住院天数和住院总费用以及分类医保结算费用的差异均有统计学意义（P＜0.05）。结论建档立卡贫困户的医疗保障政策在减轻患者疾病经济负担的同时,存在医保资金使用不合理问题。建议相关机构加强医保资金使用监督力度,规范患者就医行为,并通过多方努力,逐步建立医疗救助、商业保险、社会救助相结合的健康扶贫制度。     

Impact of Dental Referral Prior to Elective Surgery on Postoperative Outcomes

ObjectivesOral bacteria may contribute to postoperative infectious complications including postoperative pneumonia or surgical site infection. The aim of this study was to investigate the impact of preoperative dental care on postoperative outcomes among surgical patients under general anesthesia.DesignRetrospective cohort study.Setting and ParticipantsWe analyzed clinical records of major surgical patients at a university hospital between 2016 and 2018. Subjects were categorized into either the preoperative dental care group, those being referred to dentists by their surgeons based on an individual surgeon's judgment for dental care before surgery, or the control group.MethodsThe primary outcome was postoperative infectious complications. Secondary outcomes were postoperative inflammation markers (C-reactive protein and fever), and economic outcomes (postoperative length of hospital stay and medical expenses). As the main analysis, the average treatment effects of the preoperative dental care were obtained from the augmented inverse-probability weighting (AIPW) method with consideration of demographics and perioperative risk factors to estimate causal effect of the intervention from the observational data. Then, stratified analyses by age and surgical sites were conducted with the inverse-probability weighting and linear regression methods, respectively.ResultsIn the AIPW estimation, compared with the control group, the care group saw a significantly lower rate of postoperative infection (average treatment effect ?3.02) and shorter fever duration (?2.79 days). The stratified analysis by age revealed significant positive impact of dental care in all age groups, including the highest treatment effects observed among patients younger than 60. Also, treatment effect was observed in wider surgical sites than previously known.Conclusion/ImplicationsThis study indicates a significant impact of preoperative dental care on preventing postoperative infection and inflammation. Along with old age or certain types of surgeries in which advantages of dental referral have been already known, preoperative dental referral could be beneficial for broader types of patients.     

To protect the public: professionalism vs competence in dentistry

This paper uses evidence from reports in the British Dental Journal from 1958 to 1979 of disciplinary charges against dentists in the United Kingdom to question the General Dental Council's (GDC) claim that it is protecting the public in relation to the competence of dental practitioners. In that 20-year period only one charge out of 86 heard by the GDC Disciplinary Committee had to do with a possible lack of professional competence, whereas 47% of the charges were for fraud and other criminal offences, 18% were for drug-related offences, 18% were for sex offences and 16% were for breaches of professional ethics or discipline. The paper argues that the GDC has been much more concerned with developing a professional image and style for dentists than it has been with assuring an adequate level of dental care for patients by dentists once they graduate. Although the data used to support the argument are fom Britain and from dentistry, the argument may be extended to all professional occupations and countries where there is a State-enforced medical monopoly in relation to clients.