Influence of visual acuity, manual dexterity and handgrip strength on oral and denture hygiene ability of non-frail older people: Development of the Gerostomatological Assessment Battery.

BACKGROUND: Due to the heterogeneity of older people, it is difficult to identify reliable factors influencing oral health. OBJECTIVE: The aim was to illustrate the influence of visual acuity, manual dexterity, and handgrip strength on the oral and denture hygiene ability of older non-frail people. METHODS: In a cross-sectional study, conducted at a specialized dental clinic, at baseline, all participants received professional prophylaxis and instruction on daily oral and denture hygiene regimes for a 6-week intervention period. Data on the Quigley and Hein modified plaque index (QHI), respectively, the Denture Hygiene Index (DHI), visual acuity, manual dexterity and handgrip strength in non-frail participants (≥ 65 years) were collected. Recruitment was done within the clinic's patient clientele and within the staff (control cohort). RESULTS: Women showed significantly better manual dexterity than men (Mann-Whitney U, p = .01), while women's mean handgrip strength was significantly lower (Mann-Whitney U, p < .01). Manual dexterity (Mann-Whitney U, p = .003) and handgrip strength (Mann-Whitney U, p = .052) were associated with age. However, visual acuity, manual dexterity and handgrip strength had no influence on oral or denture hygiene. CONCLUSION: Visual acuity, manual dexterity and handgrip strength have no influence on oral and denture hygiene ability in older non-frail people. Further studies should investigate whether these factors also have no influence on oral and denture hygiene in vulnerable older patients. Therefore, an assessment tool for the evaluation of potential influencing factors of oral and denture hygiene is proposed in a dental context. This Gerostomatological Assessment Battery (G-AB) can be used as a helpful tool to check the individual cognitive function and comprehension, dental therapy approaches and their individual adaption.

Validation of a New Measuring Instrument for the Assessment of Bite Force.

BACKGROUND: this study aims to validate two occlusal-force-measuring devices by comparing them to a universal testing machine and assessing their reliability across various dental and prosthetic groups. The research comprised two parts: part 1 assessed the measurement accuracy of the Occlusal Force Meter GM 10® (OFM) (Morita, Nagano Keiki, Higashimagome, Ohta-ku, Tokyo, Japan) and a prototype (PRO) by comparing them to a calibrated universal testing machine (ZWICK). Part 2 involved analyzing the devices' reliability based on clinical bite force measurements from study participants. RESULTS: both devices become more accurate and reliable compared to the ZWICK over time of usage. Additionally, higher deviation from the ZWICK can be observed for higher values of forces applied and vice versa for both devices. The PRO's intraoral alignment influences its mean values compared to the OFM in different dental and prosthetic groups. CONCLUSION: both devices had limitations and required quadratic function calibration, making them suitable only for progression measurements. The study concludes that both the OFM and PRO devices can measure occlusal forces with improved accuracy over time. Intraoral alignment should be considered. Their easy-to-use clinical application would allow a more widespread use of masticatory function diagnosis, which could indicate the need for treatment and improve treatment planning.

On the Necessity of a Geriatric Oral Health Care Transition Model: Towards an Inclusive and Resource-Oriented Transition Process.

People in need of care also require support within the framework of structured dental care in their different life situations. Nowadays, deteriorations in oral health tend to be noticed by chance, usually when complaints or pain are present. Information on dental care is also lost when life situations change. An older person may rely on family members having oral health skills. This competence is often not available, and a lot of oral health is lost. When someone, e.g., a dentist, physician, caregiver, or family member notices a dental care gap, a structured transition to ensure oral health should be established. The dental gap can be detected by, e.g., the occurrence of bad breath in a conversation with the relatives, as well as in the absence of previously regular sessions with the dental hygienist. The aim of the article is to present a model for a structured geriatric oral health care transition. Due to non-existing literature on this topic, a literature review was not possible. Therefore, a geriatric oral health care transition model (GOHCT) on the basis of the experiences and opinions of an expert panel was developed. The GOHCT model on the one hand creates the political, economic, and legal conditions for a transition process as a basis in a population-relevant approach within the framework of a transition arena with the representatives of various organizations. On the other hand, the tasks in the patient-centered approach of the transition stakeholders, e.g., patient, dentist, caregivers and relatives, and the transition manager in the transition process and the subsequent quality assurance are shown.

Interrater reliability and concurrent validity of oral/dental items in the resident assessment instrument minimum data set 2.0.

OBJECTIVE: To examine interrater reliability and concurrent validity of oral/dental items in the Resident Assessment Instrument Minimum Data Set (RAI-MDS) 2.0. BACKGROUND: RAI-MDS is a standardised instrument used in nursing to determine health status and nursing needs. The extent to which oral/dental items in the RAI-MDS describe dental treatment needs concerning oral health has been questioned. MATERIALS AND METHODS: This study evaluated the interrater reliability (dentist vs. nurse) and validity of oral/dental items in the Swiss version of RAI-MDS 2.0 (areas: K-nutritional status, L-oral/dental status) using professional oral examinations as a benchmark. Data of 168 residents of five long-term care facilities in the canton of Zurich, Switzerland, were collected within 1 year between October 2017 and December 2018. The statistical evaluation used descriptive statistics and Cohen's kappa (95% CI). RESULTS: RAI-MDS items K1a, chewing (κ 0.098, 95% CI: 0.004-0.19); K1c, pain (κ 0.039, 95% CI: -0.03 to 0.11); L1a, debris (κ 0.117, 95% CI: 0.02-0.21); L1c, dental status (κ 0.229, 95% CI: 0.12-0.34); L1d, dental disease (κ 0.129, 95% CI: 0.02-0.24); L1e, periodontal diseases (κ -0.005, 95% CI: -0.07 to -0.03); and L1f, daily cleaning (κ -0.031, 95% CI: -0.05 to -0.01) showed weak or no agreement, whereas L1b, denture status (κ 0.634, 95% CI: 0.52-0.75), showed substantial agreement. CONCLUSION: Oral/dental items in RAI-MDS lack reliability and validity. Recognition of oral health situation/treatment needs by nursing staff does not seem to be possible with the current version of this tool.

A standardized low-cost peer role-playing training intervention improves medical student competency in communicating bad news to patients in Botswana.

OBJECTIVE: The purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news. METHOD: A 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling "good" or "very good" with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.

Neighborhood Deprivation and Childhood Asthma Outcomes, Accounting for Insurance Coverage.

OBJECTIVES: Collecting social determinants data is challenging. We assigned patients a neighborhood-level social determinant measure, the area of deprivation index (ADI), by using census data. We then assessed the association between neighborhood deprivation and asthma hospitalization outcomes and tested the influence of insurance coverage. METHODS: A retrospective cohort study of children 2 to 17 years old admitted for asthma at 8 hospitals. An administrative database was used to collect patient data, including hospitalization outcomes and neighborhood deprivation status (ADI scores), which were grouped into quintiles (ADI 1, the least deprived neighborhoods; ADI 5, the most deprived neighborhoods). We used multivariable models, adjusting for covariates, to assess the associations and added a neighborhood deprivation status and insurance coverage interaction term. RESULTS: A total of 2270 children (median age 5 years; 40.6% girls) were admitted for asthma. We noted that higher ADI quintiles were associated with greater length of stay, higher cost, and more asthma readmissions (P < .05 for most quintiles). Having public insurance was independently associated with greater length of stay (ß: 1.171; 95% confidence interval [CI]: 1.117-1.228; P < .001), higher cost (ß: 1.147; 95% CI: 1.093-1.203; P < .001), and higher readmission odds (odds ratio: 1.81; 95% CI: 1.46-2.24; P < .001). There was a significant deprivation-insurance effect modification, with public insurance associated with worse outcomes and private insurance with better outcomes across ADI quintiles (P < .05 for most combinations). CONCLUSIONS: Neighborhood-level ADI measure is associated with asthma hospitalization outcomes. However, insurance coverage modifies this relationship and needs to be considered when using the ADI to identify and address health care disparities.

Assessment of mitral valve area during percutaneous mitral valve repair using the MitraClip system: comparison of different echocardiographic methods.

BACKGROUND: Quantification of the mitral valve area (MVA) is important to guide percutaneous mitral valve repair using the MitraClip system. However, little is known about how to best assess MVA in this specific situation. METHODS AND RESULTS: Immediately before and after MitraClip implantation, comprehensive 3-dimensional (3D) transesophageal echocardiography data were acquired for MVA assessment by the pressure half-time method and by two 3D quantification methods (mitral valve quantification software and 3D quantification software). In addition, transmitral gradients by continuous-wave Doppler (dPmeanCW) were measured to indirectly assess MVA. Data are given as median (interquartile range). Thirty-three patients (39% women) with a median age of 77.1 years (12.4 years) were studied. Before intervention, the median MVAs by the pressure half-time method, mitral valve quantification software, and 3D quantification software were 4.4 cm(2) (2.0 cm(2)), 4.7 cm(2) (2.4 cm(2)), and 6.2 cm(2) (2.4 cm(2)), respectively (P<0.001). After intervention, MVA was reduced to 1.9 cm(2) (0.7 cm(2)), 2.1 cm(2) (1.1 cm(2)), and 2.8 cm(2) (1.1 cm(2)), respectively (P=0.001). The median values for dPmeanCW before and after intervention were 1.0 mm Hg (1.0 mm Hg) and 3.0 mm Hg (3.0 mm Hg; P<0.001), respectively. At discharge, the median dPmeanCW was 4.0 mm Hg (3.0 mm Hg). In multivariate regression analyses including body surface area, the 3 different MVA methods, and dPmeanCW, a post-dPmeanCW ≥5 mm Hg was the best independent predictor of an elevated transmitral gradient at discharge. CONCLUSIONS: Transmitral gradients by continuous-wave Doppler are quick, feasible in all patients, and superior to direct peri-interventional assessment of MVA. A postinterventional transmitral gradient by continuous-wave Doppler of ≥5 mm Hg best predicted elevated transmitral gradients at discharge.

Organic and conventional fertilisation procedures on the nitrate, antioxidants and pesticide content in parts of vegetables.

Different parts of plant foods are generally discarded by consumers such as peel, stalk and leaves, which could however possess a nutritional value. However, few studies have analysed the composition of these marginal foods. The phenolic compound, flavonoid, polyamine, nitrate and pesticide contents of parts of vegetables that are usually discarded--but which were cultivated according to conventional and non-conventional procedures--were analysed to provide suggestions on how to improve the consumption of these parts and to reduce the production of urban solid waste. Few, but significant, differences between the two manuring procedures were observed. Higher nitrate content and the presence of organochlorine pesticides were found in conventional cultivated papaya peel, lemon balm leaves, jack fruit pulp, and beet stalk and peel. Discarded parts of plant foods such as stalk, leaves and peels can be used as a source of antioxidant compounds, such as phenolic compounds.

Left ventricular dyssynchrony assessment by phase analysis from gated PET-FDG scans.

BACKGROUND: The outcome of patients with severe ischaemic left ventricular (LV) dysfunction is determined by the extent of myocardial viability and the presence of LV dyssynchrony. We aimed at assessing both parameters from the same imaging method, i.e. gated positron emission tomography (PET) F18-fluorodeoxyglucose (FDG) scans. METHODS: Phase analysis from Emory Cardiac Toolbox was applied on gated PET-FDG scans to assess histogram bandwidth and standard deviation (SD) as a measure of LV dyssynchrony in 30 heart failure patients (mean ejection fraction: 30.2% ± 13.8%) referred for the evaluation of myocardial viability. Cut-off values from single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) best predicting cardiac resynchronization therapy (CRT) response served as standard of reference (bandwidth < 135°; phase SD < 43°). Severe LV dyssynchrony was diagnosed if both SPECT-MPI values were above these limits. Intraclass correlation and clinical agreement in detection of severe LV dyssynchrony by PET vs SPECT were assessed. RESULTS: There was a significant correlation between PET-FDG and SPECT-MPI for bandwidth (r = 0.88, P < .001) and phase SD (r = 0.88, P < .001) resulting in an excellent clinical agreement between the two methods of 93%. CONCLUSIONS: Accurate LV dyssynchrony assessment by phase analysis of gated PET-FDG scans is feasible, allowing assessing myocardial viability and severe LV dyssynchrony in one scan.

Long-term prognostic value of left ventricular dyssynchrony assessment by phase analysis from myocardial perfusion imaging.

OBJECTIVE: To assess the value of left ventricular (LV) dyssynchrony, using phase analysis of nuclear single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) as independent predictor of cardiac events. METHODS: Phase analysis using Emory Cardiac Toolbox was applied on gated rest MPI scans to assess LV dyssynchrony in a total of 202 patients. Follow-up was obtained in 197 patients (97.5%). Major adverse cardiac events (MACE) (cardiac death and hospitalisation for any cardiac reasons, including worsening of heart failure, non-fatal myocardial infarction, unstable angina and coronary revascularisation) were determined using the Kaplan-Meier method. Cox proportional hazard regression was used to identify independent predictors of cardiac events. RESULTS: At a median follow-up of 3.2 ± 1.2 years, 41 patients had at least one event, including 5 cardiac deaths. LV dyssynchrony (n = 35) was associated with a significantly higher incidence of MACE (p<0.001) and proved to be an independent predictor of cardiac events. CONCLUSION: LV dyssynchrony assessed by phase analysis of gated SPECT-MPI is a strong predictor of MACE independent of other known predictors such as perfusion defects or decreased LV ejection fraction.

Rapid cardiac hybrid imaging with minimized radiation dose for accurate non-invasive assessment of ischemic coronary artery disease.

BACKGROUND: Ischemic coronary artery disease (CAD) is a major cause for morbidity and mortality resulting in a continuously increasing number of diagnostic interventions. We have validated a new hybrid imaging method using minimized radiation dose for rapid non-invasive prediction of invasive coronary angiography (CA) findings with regard to coronary lesion detection and revascularization. METHODS: Forty patients referred for elective invasive coronary angiography (CA) due to suspected CAD were prospectively enrolled to undergo a low-dose CTCA with prospective ECG-triggering and a stress-only SPECT-MPI scan administering half of the standard low-dose stress (99m)Tc-tetrofosmin activity. The latter was acquired immediately after adenosine stress (omitting the standard 30-60 min waiting time). After fusing CTCA and SPECT-MPI decisions towards conservative management versus revascularization strategy based on hybrid images were compared to the decisions taken by the interventional operator in the catheterization laboratory based on CA. The latter served as standard of reference. RESULTS: Hybrid images yielded sensitivity, specificity, positive and negative predictive values and accuracy of 100%, 96.0%, 100%, 93.8% and 97.5% for predicting coronary revascularization. The estimated mean effective radiation doses were significantly lower for hybrid imaging (4.7 ± 1.0 mSv) than for invasive CA (8.7 ± 4.2 mSv; P<0.001 vs. hybrid). Total non-invasive protocol time was below 60 min, comparing favourably to standard SPECT protocols. CONCLUSIONS: Rapid cardiac hybrid imaging allows accurate prediction of invasive CA findings and of treatment decision despite minimized radiation dose and protocol time.

Ultrafast assessment of left ventricular dyssynchrony from nuclear myocardial perfusion imaging on a new high-speed gamma camera.

PURPOSE: To validate the ultrafast assessment of left ventricular (LV) dyssynchrony by phase analysis using high-speed nuclear myocardial perfusion imaging (MPI) on a new gamma camera with cadmium-zinc-telluride (CZT) solid-state detector technology. METHODS: In 46 patients rest MPI with 960 MBq (99m)Tc-tetrofosmin was acquired on a dual-head detector SPECT camera (Ventri, GE Healthcare) and an ultrafast CZT camera (Discovery NM 530c, GE Healthcare) with acquisition times of 15 and 5 min, respectively. LV dyssynchrony was assessed using the Emory Cardiac Toolbox with established values for histogram bandwidth (male <62.4°; female <49.7°) and standard deviations (male <24.4°; female <22.1°) as the gold standard. Evaluating CZT scan times of 0.5, 1, 2, 3 and 5 min (list mode) in 16 patients revealed the preferred scan time to be 5 min, which was then applied in all 46 patients. Intraclass correlation and the level of agreement in dyssynchrony detection between the CZT and Ventri cameras were assessed. RESULTS: In LV dyssynchrony the mean histogram bandwidths with the CZT camera (n = 8) and the Ventri camera (n = 9) were 123.3 ± 50.6° and 130.2 ± 43.2° (p not significant) and 42.4 ± 13.6° vs. 43.2 ± 12.7° (p not significant). Normal bandwidths and SD obtained with the CZT camera (35.9 ± 7.7°, 12.6 ± 3.5°) and the Ventri camera (34.8 ± 6.6°, 11.1 ± 2.1°, both p not significant) excluded dyssynchrony in 38 and 37 patients, respectively. Intraclass correlation and the level of agreement between the CZT camera with a 5-min scan time and the Ventri camera were 0.94 (p < 0.001, SEE 14.4) and 96% for histogram bandwidth and 0.96 (p < 0.001, SEE 3.9) and 98% for SD. CONCLUSION: This ultrafast CZT camera allows accurate assessment of LV dyssynchrony with a scan time of only 5 min, facilitating repeat measurements which would potentially be helpful for parameter optimization for cardiac resynchronization therapy.

Non-invasive assessment of coronary artery disease with CT coronary angiography and SPECT: a novel dose-saving fast-track algorithm.

PURPOSE: To validate a new low-dose and rapid stepwise individualized algorithm for non-invasive assessment of ischemic coronary artery disease by sequential use of prospectively ECG-triggered low-dose CT coronary angiography (CTCA) and low-dose single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). METHODS: Forty patients referred for elective invasive coronary angiography (CA) were prospectively enrolled to undergo a comprehensive non-invasive evaluation with low-dose CTCA and a dose-reduced stress/rest SPECT-MPI scan (using dedicated reconstruction algorithms for low count scans). The following algorithm was reviewed: CTCA first, followed by a stress-only MPI if a coronary stenosis (> or = 50% diameter narrowing) or equivocal findings were observed. Only abnormal stress MPI scans were followed by rest MPI. The accuracy of the individualized algorithm to predict coronary revascularization and its mean effective radiation dose were assessed. RESULTS: CTCA documented CAD in 18 and equivocal findings in two patients, thus, requiring additional stress MPI scans. Of these, 16 were abnormal, therefore requiring a rest MPI scan, revealing ischemia in 15 patients. Sensitivity, specificity, negative and positive predictive value, and accuracy of the individualized algorithm for predicting coronary revascularization was 93.3%, 96.0%, 96.0%, 93.3% and 95.0% on a per-patient base. The mean effective radiation dose was significantly lower for the individualized (4.8 +/- 3.4 mSv) versus the comprehensive method (8.1 +/- 1.5 mSv) resulting in a total population radiation dose reduction of 132.6 mSv. CONCLUSION: This new individualized low-dose algorithm allows rapid and accurate prediction of invasive CA findings and of treatment decision with minimized radiation dose.

Dental practice during a world cruise: treatment needs and demands of crew.

AIMS: To describe dental treatment needs and demands of crew on a cruise ship during a world cruise. METHODS: The routine dental documentation of a two months period at sea on a cruise ship carrying 999 crew was analysed. Age, gender, diagnosis, treatment performed, percentage of emergency and routine procedures, number of appointments, duration of appointment and time since last visit to the dentist were recorded. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile. RESULTS: Subjects were n = 56 crew with a mean age of 37 (+/- 12.0) years. Out of 114 patient contacts n = 29 (25%) were for emergency treatment. Caries and its sequelae accounted for 85% of time spent treating emergencies and 50% of routine treatment time. The two most frequent treatment options during emergency appointments were extractions and endodontics. In routine cases fillings and periodontal treatment were dominating. Per 1000 persons per month crew required 14.5 emergency plus 42.5 routine appointments. 80 % of crew had seen a dentist within 12 months before their shipboard dental appointment. Oral health-related quality of life was most impaired in case of emergency patients with a particular emphasis on the diagnosis of pulpal disease. CONCLUSION: High numbers of dental emergencies largely due to caries indicated that International Labour Organisation (ILO) recommendations requiring seafarers to be dentally fit were not adhered to. It is suggested that some doctors performing pre-sea medical examinations may not adequately diagnose caries. A pre-sea examination by a dental professional has the potential to reduce the number of emergency port referrals to dentists. Treatment costs and attitude to preventive dental care were identified as barriers impeding the access of low-wage crew to the ship's dental clinic. Cosmetic dentistry and prophylaxis attracted those crew with an interest in prevention and the ability to pay the fees. In large cruise ships there is a substantial demand for both emergency and routine dental care among crew.

[Foster care for adolescents with severe psychic disorders]. / Familienpflege für Jugendliche mit ausgeprägten psychischen Störungen.

An introduction to the concept and practical implementation of a project entitled "Care in families for young people with mental disorders" is presented. In a project five adolescents were placed in fostering families. Continuous care is provided by a professional family care team and the treatment as out-patients at the Department of Child und Adolescent Psychiatry and Psychotherapy, in which they were previously treated, is continued.

Assessment of different preservation and storage conditions on aortic valves: introduction of a quantitative measuring method of the integrity of endothelial cells.

The fate of human allogeneic aortic valves depends mainly on their histological and immunological condition at the time of transplantation. A screening test making novel use of Alcian Blue was used to determine the integrity of endothelial cells as a prerequisite to their function. The dye uptake into the nucleus was measured quantitatively. The test was used to compare the effect of different storage mediums and temperatures (+4 degrees C, -30 degrees C, -80 degrees C, DMSO, FCS, RPMI, antibiotic solution) on aortic valves of rats. The cell integrity decreased with increasing storage time and higher storage temperature. The cryoprotective agent DMSO had no essential effect on the maintenance of cell integrity.

Assessment of coronary and aortic anastomoses after anatomic correction of transposition of the great arteries.

Anatomic correction of transposition of the great arteries always entails circumferential anastomoses of the aorta and coronary arteries. Long-term success of this procedure is predicted on adequate growth of these anastomotic sites. To assess the size of these arteries, we performed one or two cardiac catheterization on 25 children from 1 to 53 months (mean 18.8 months) following anatomic correction. Early studies (mean 12 months) were performed in 23 patients and late studies (mean 30 months) in 13 patients. Age at repair ranged from 2 to 168 months (mean 25.5 months) and 15 patients were less than a year of age. Fifteen patients had undergone previous pulmonary artery banding in preparation for anatomic repair. Postoperative catheterizations showed no area of narrowing at the aortic or coronary anastomoses and no kinking of the proximal coronary arteries. Almost all normalized diameters of the aortic root were larger than normal. There were no differences between early and late measurements after anatomic correction. No patient had a pressure gradient across the aortic anastomosis. It is, therefore, concluded that the coronary and aortic anastomoses allow for satisfactory growth even when there has been previous pulmonary artery banding.