Head and neck cancer treatment outcome priorities: A multi-perspective concept mapping study.

With the increasing focus on patient-centred care, this study sought to understand priorities considered by patients and healthcare providers from their experience with head and neck cancer treatment, and to compare how patients' priorities compare to healthcare providers' priorities. Group concept mapping was used to actively identify priorities from participants (patients and healthcare providers) in two phases. In phase one, participants brainstormed statements reflecting considerations related to their experience with head and neck cancer treatment. In phase two, statements were sorted based on their similarity in theme and rated in terms of their priority. Multidimensional scaling and cluster analysis were performed to produce multidimensional maps to visualize the findings. Two-hundred fifty statements were generated by participants in the brainstorming phase, finalized to 94 statements that were included in phase two. From the sorting activity, a two-dimensional map with stress value of 0.2213 was generated, and eight clusters were created to encompass all statements. Timely care, education, and person-centred care were the highest rated priorities for patients and healthcare providers. Overall, there was a strong correlation between patient and healthcare providers' ratings (r = 0.80). Our findings support the complexity of the treatment planning process in head and neck cancer, evident by the complex maps and highly interconnected statements related to the experience of treatment. Implications for improving the quality of care delivered and care experience of head and cancer are discussed.

Patient satisfaction with access to a student-run free-service dental clinic.

Background: The Student Health Initiative for the Needs of Edmonton (SHINE) dental clinic is a student-volunteer-operated clinic offering free oral care to low-income individuals. However, little is known about how SHINE impacts access to care. Drawing on Penchansky and Thomas' theory of access, this study assessed patient satisfaction to measure access. For further context, patient-reported oral health concerns and alternative oral care options if SHINE were not available were recorded. Methods: The University of Alberta's Research Ethics Board (Pro 00101981) approved the study. Surveys adapted from Penchansky and Thomas were distributed over 12 weeks to all presenting patients. Survey data were triangulated with observations. Data were represented using descriptive statistics, and variables were compared using Chi-squared tests of independence. Results: A response rate of 77% (140/170) was achieved. The survey revealed that patients were generally satisfied with access to SHINE. However, observations revealed physical accessibility barriers. Dissatisfaction was correlated with attending SHINE without receiving treatment. Patients primarily presented to SHINE for pain (55%, 76/139). If SHINE were not available, 38% (46/121) of patients reported they would seek care from an alternative oral health professional, 32% (39/121) through an emergency department or physician, and 27% (33/121) would not attain oral health care at all. Conclusion: SHINE could be seen as addressing the need for access to oral health care services. The remaining barriers to care include long waiting times and clinic capacity to deliver care. A faster triage process may reduce waiting times. However, SHINE cannot provide more oral health care due to clinic capacity. Lastly, access to clinics such as SHINE may reduce visits to emergency departments for oral health care.

Introduction: La clinique dentaire « Student Health Initiative for the Needs of Edmonton (SHINE) ¼ est une clinique dirigée par des étudiants bénévoles qui offre des soins buccodentaires gratuits aux personnes à faible revenu. Néanmoins, on sait peu de choses sur l'incidence de la clinique SHINE sur l'accès aux soins. S'appuyant sur la théorie de l'accès de Penchansky et de Thomas, cette étude a évalué la satisfaction des patients pour mesurer l'accès. Pour plus de clarté, les problèmes de santé buccodentaire déclarés par les patients et les autres options de soins buccodentaires, s'ils n'étaient pas offerts par SHINE, ont été consignés. Méthodes: Le comité d'éthique en recherche de l'Université de l'Alberta a approuvé l'étude (Pro 00101981). Des sondages adaptés de la théorie de Penchansky et de Thomas ont été distribués sur 12 semaines à tous les patients qui se sont présentés. Les résultats ont ensuite été corroborés avec des observations. Les données ont été représentées à l'aide de statistiques descriptives, et les variables ont été comparées à l'aide du test d'indépendance chi carré. Résultats: Le taux de réponse a été de 77 % (140/170). Le sondage a révélé que les patients étaient généralement satisfaits de l'accès à SHINE. Toutefois, les observations ont révélé des obstacles physiques à l'accessibilité. L'insatisfaction était corrélée au fait de faire appel à SHINE sans recevoir de traitement. Les patients ont principalement fait appel à SHINE en raison de douleurs (55 %, 76/139). Si SHINE n'était pas disponible, 38 % (46 sur 121) des patients ont déclaré qu'ils iraient chercher des soins auprès d'un autre professionnel de la santé buccodentaire, 32 % (39 sur 121) par l'entremise d'un service d'urgence ou d'un médecin, et 27 % (33 sur 121) n'obtiendraient pas du tout de soins buccodentaires. Conclusion: La clinique SHINE peut être considéré comme une solution au besoin d'accès aux services de soins de santé buccodentaire. Les autres obstacles aux soins comprennent les longs temps d'attente et la capacité du programme à fournir des soins. Un processus de triage plus rapide pourrait réduire le temps d'attente. Toutefois, SHINE ne peut pas fournir plus de soins buccodentaires en raison de sa capacité d'accueil. Enfin, l'accès à des cliniques comme SHINE peut réduire le nombre de visites aux urgences pour des soins buccodentaires.

Insights in interprofessional education: Dental hygiene students' suggestions for collaboration.

Background: Interprofessional education (IPE) promotes team-based approaches to professional practice and lifelong collaboration. However, there is little consensus on its "best practice" in dentistry and dental hygiene curricula. This study aimed to explore dental hygiene students' perceptions and experiences of collaboration with dentistry students in an IPE program that authentically represents private practice settings and work processes. The intent was to identify what students thought would best help prepare them to work collaboratively in an oral health team once they graduated after participating in this experience. Methods: Data were collected from 40 dental hygiene student written reflections and 6 dental hygiene students through a focus group session that was audiorecorded and transcribed. Data were examined using thematic analysis. Results: Five interrelated themes emerged: 1) understanding of roles and responsibilities; 2) hierarchical perceptions and level of experience; 3) team dynamics; 4) instructor and staff involvement and support; and 5) timing and structure of IPE activities. The findings suggest that dental hygiene students need consistent and sustained access to realistic environments in which to practise team roles and work directly with dentistry students. Opportunities to build relationships with dentistry students before working together in professional roles appear to alleviate hierarchical concerns that impede teamwork. Conclusion: IPE should occur throughout students' education as hierarchical perceptions appear to influence collaboration. Informal and/or non-clinical IPE opportunities should be introduced early in students' education to develop a foundation for team dynamics in later formal and/or clinical IPE activities. Students should collaborate in ways that will be reflected in professional expectations after graduation; the environment in which they learn their team role should provide the opportunity to authentically practise it.

Contexte: La formation interprofessionnelle (FIP) favorise les approches basées sur le travail d'équipe en matière d'exercice professionnel et de collaboration tout au long de la vie. Cependant, il y a peu de consensus quant à ses « meilleures pratiques ¼ lorsqu'il s'agit de programmes de dentisterie et d'hygiène dentaire. La présente étude visait à explorer la perception et les expériences des étudiants en hygiène dentaire en matière de collaboration avec les étudiants en dentisterie dans le cadre d'un programme de FIP qui représente de manière authentique les contextes et les processus de travail en cabinet privé. L'intention était de définir ce qui, selon les étudiants, les préparerait le mieux à travailler en collaboration au sein d'une équipe de soins buccodentaires après avoir obtenu leur diplôme. Méthodologie: Des données ont été recueillies à partir de réflexions écrites par 40 étudiants en hygiène dentaire et de 6 étudiants en hygiène dentaire dans le cadre d'une séance de groupe de discussion audio enregistrée et transcrite. Les données ont été examinées par analyse thématique. Résultats: Cinq thèmes interdépendants ont été dégagés : 1) la compréhension des rôles et des responsabilités; 2) les perceptions hiérarchiques et le niveau d'expérience; 3) la dynamique du travail d'équipe; 4) la participation et le soutien des enseignants et du personnel; et 5) le moment choisi et la structure des activités de FIP. Les résultats suggèrent que les étudiants en hygiène dentaire ont besoin d'un accès constant et soutenu aux environnements réalistes dans lesquels ils peuvent assumer les rôles de l'équipe et travailler directement avec des étudiants en dentisterie. Les possibilités de tisser des liens avec les étudiants en dentisterie avant de travailler ensemble dans des rôles professionnels semblent réduire les préoccupations hiérarchiques qui font obstacle au travail d'équipe. Conclusion: La FIP doit avoir lieu tout au long de la formation des étudiants, puisque les perceptions hiérarchiques semblent influencer la collaboration. Les occasions de FIP informelles ou non cliniques doivent être introduites tôt dans la formation des étudiants afin de créer une fondation de dynamique pour l'équipe lors des activités de FIP formelles ou cliniques ultérieures. Les étudiants doivent collaborer de façons qui seront reflétées dans les attentes professionnelles après l'obtention de leur diplôme. L'environnement dans lequel ils apprennent leur rôle au sein de l'équipe devrait leur fournir l'occasion de l'exercer de manière authentique.

Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond.

OBJECTIVES: Poor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake. DESIGN: Qualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed. SETTING: Residential care. PARTICIPANTS: 27 invited researcher and provider experts. RESULTS: Challenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals). CONCLUSIONS: COVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.

Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care.

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

Evaluating Classification Consistency of Oral Lesion Images for Use in an Image Classification Teaching Tool.

A web-based image classification tool (DiLearn) was developed to facilitate active learning in the oral health profession. Students engage with oral lesion images using swipe gestures to classify each image into pre-determined categories (e.g., left for refer and right for no intervention). To assemble the training modules and to provide feedback to students, DiLearn requires each oral lesion image to be classified, with various features displayed in the image. The collection of accurate meta-information is a crucial step for enabling the self-directed active learning approach taken in DiLearn. The purpose of this study is to evaluate the classification consistency of features in oral lesion images by experts and students for use in the learning tool. Twenty oral lesion images from DiLearn's image bank were classified by three oral lesion experts and two senior dental hygiene students using the same rubric containing eight features. Classification agreement among and between raters were evaluated using Fleiss' and Cohen's Kappa. Classification agreement among the three experts ranged from identical (Fleiss' Kappa = 1) for "clinical action", to slight agreement for "border regularity" (Fleiss' Kappa = 0.136), with the majority of categories having fair to moderate agreement (Fleiss' Kappa = 0.332-0.545). Inclusion of the two student raters with the experts yielded fair to moderate overall classification agreement (Fleiss' Kappa = 0.224-0.554), with the exception of "morphology". The feature of clinical action could be accurately classified, while other anatomical features indirectly related to diagnosis had a lower classification consistency. The findings suggest that one oral lesion expert or two student raters can provide fairly consistent meta-information for selected categories of features implicated in the creation of image classification tasks in DiLearn.

Exploring access in a volunteer free-service dental clinic.

Introduction: Marginalized, low-income individuals face many barriers to dental care, including but not limited to cost. The Student Health Initiative for the Needs of Edmonton (SHINE) dental clinic is a student-operated volunteer clinic offering free services to low-income individuals. This study aimed to explore the access to dental care needs of low-income groups, from community health brokers' perspectives. Case description: The study was deemed exempt from ethical approval (Pro00074745). Five semistructured interviews exploring access to dental care were conducted with health brokers purposefully selected from 4 different community outreach centres. Access was defined and analysed using Penchansky and Thomas' theory of access as modified by Saurman. Results: Interviews revealed lack of awareness of the SHINE clinic. Translation and interpretation support was an identified need, and there was concern for clients who fear discrimination in health care settings. Conclusion: Preliminary barriers to care at SHINE were identified. However, further investigation is required to understand how SHINE aligns with population needs.

Introduction: Les personnes marginalisées et à faible revenu sont confrontées à plusieurs obstacles en matière de soins dentaires, y compris, mais sans s'y limiter au coût. La clinique dentaireStudent Health Initiative for the Needs of Edmonton(SHINE) est une clinique gérée par des étudiants bénévoles qui offre des services gratuits aux personnes à faible revenu. La présente étude vise à explorer les besoins d'accès aux soins dentaires de groupes à faible revenu du point de vue des intervenants de la santé communautaire. Description du cas: L'étude a été déclarée exempte de l'approbation éthique (Pro00074745). Cinq entrevues semi-structurées qui explorent l'accès aux soins dentaires ont été réalisées avec des intervenants de la santé, délibérément sélectionnés dans 4 centres d'assistance communautaire différents. L'accès a été défini et analysé au moyen de la théorie d'accès aux soins de Penchansky et Thomas, telle que modifiée par Saurman. Résultats: Les entrevues ont révélé un manque de connaissance de la clinique SHINE. Un soutien en matière de traduction et d'interprétation était un besoin établi et on s'inquiétait des clients qui craignent la discrimination dans les milieux de soins de santé. Conclusion: Des obstacles préliminaires aux soins chez SHINE ont été reconnus. Cependant, une enquête plus approfondie est requise pour comprendre dans quelle mesure SHINE correspond aux besoins de la population.

Effect of diagnostic score reporting following a structured clinical assessment of dental hygiene student performance.

Background: Diagnostic score reporting is one method of providing feedback to all students following a structured clinical assessment but its effect on learning has not been studied. The objective of this study was to assess the impact of this feedback on student reflection and performance following a dental hygiene assessment. Methods: In 2016, dental hygiene students at the University of Alberta participated in a mock structured clinical assessment during which they were randomly assigned to receive a diagnostic score report (intervention group) or an overall percentage grade of performance (control group). The students later reflected upon their performance and took their regularly scheduled structured clinical assessment. Reflections underwent content analysis by diagnostic domains (eliciting essential information, effective communication, client-centred care, and interpreting findings). Results were analysed for group differences. Results: Students performed best on eliciting essential information (92%) and poorest on interpreting findings (42%). The intervention group was more likely to view interpreting findings as a weakness, p = 0.007, while the control group was more likely to view eliciting essential information as a weakness, p = 0.04. No differences were found on the actual assessment scores, p > 0.05. Discussion: Students who received diagnostic score reporting appeared to reflect more accurately upon their weaknesses. However, this knowledge did not translate into improved performance. Modifications and enhancements to the report may be necessary before an effect on performance will be seen. Conclusion: Diagnostic score reporting is a promising feedback method that may aid student reflection. More research is needed to determine if these reports can improve performance.

Contexte: Le suivi de la notation des diagnostics est une des méthodes utilisées pour fournir de la rétroaction aux étudiants à la suite d'une évaluation clinique structurée, mais ses effets sur l'apprentissage n'ont pas été étudiés. La présente étude visait à évaluer l'effet de cette rétroaction sur la réflexion et la performance des étudiants à la suite d'une évaluation en hygiène dentaire. Méthodologie: Les étudiants en hygiène dentaire de l'Université de l'Alberta ont participé à une évaluation clinique structurée fictive pendant laquelle ils étaient désignés de façon aléatoire pour recevoir un suivi de la notation des diagnostics (groupe d'intervention) ou une note globale en pourcentage de leur performance (groupe témoin). Les étudiants ont plus tard réfléchi à leur performance et ont fait leur évaluation clinique structurée déjà à l'horaire. Une analyse de contenu a été effectuée sur les réflexions selon les domaines de diagnostics (obtention de renseignements essentiels, communication efficace, prestation de soins axés sur le client et interprétation des constatations). Les résultats ont été analysés pour déterminer les différences entre les groupes. Résultats: Les étudiants ont le mieux réussi sur l'obtention d'information essentielle (92 %) et ont le moins bien réussi sur l'interprétation des constatations (42 %). Le groupe d'intervention était plus susceptible de réfléchir à l'interprétation des constatations en tant que faiblesse, p = 0,007, alors que le groupe témoin était plus susceptible de réfléchir à l'obtention de l'information essentielle en tant que faiblesse, p = 0,04. Aucune différence n'a été trouvée sur les notations actuelles de l'évaluation, p > 0,05. Discussion: Les étudiants qui ont reçu un suivi de la notation des diagnostics semblaient réfléchir plus précisément sur leurs faiblesses. Cependant, cette connaissance ne s'est pas traduite par une performance améliorée. Des modifications et des améliorations du suivi peuvent être nécessaires avant qu'un effet sur la performance soit constaté. Conclusions: Le suivi de la notation des diagnostics présente une méthode de rétroaction prometteuse qui pourrait aider à la réflexion des étudiants. D'autres recherches sont nécessaires pour déterminer si ces rapports peuvent améliorer la performance.

Development of diagnostic score reporting for a dental hygiene structured clinical assessment.

Background: Structured clinical assessments capture key information about performance that is rarely shared with the student as feedback. The purpose of this review is to describe a general framework for applying diagnostic score reporting within the context of a structured clinical assessment and to demonstrate that framework within dental hygiene. Methods: The framework was developed using current research in the areas of structured clinical assessments, test development, feedback in higher education, and diagnostic score reporting. An assessment blueprint establishes valid diagnostic domains by linking clinical competencies and test items to the domains (e.g., knowledge or skills) the assessment intends to measure. Domain scores can be given to students as reports that identify strengths and weaknesses and provide information on how to improve. Results: The framework for diagnostic score reporting was applied to a dental hygiene structured clinical assessment at the University of Alberta in 2016. Canadian dental hygiene entry-to-practice competencies guided the assessment blueprinting process, and a modified Delphi technique was used to validate the blueprint. The final report identified 4 competency-based skills relevant to the examination: effective communication, client-centred care, eliciting essential information, and interpreting findings. Students received reports on their performance within each domain. Discussion: Diagnostic score reporting has the potential to solve many of the issues faced by administrators, such as item confidentiality and the time-consuming nature of providing individual feedback. Conclusion: Diagnostic score reporting offers a promising framework for providing valid and timely feedback to all students following a structured clinical assessment.

Contexte: Les évaluations cliniques structurées saisissent des renseignements clés sur la performance qui est rarement partagée avec les étudiants à titre de rétroaction. L'objectif de la présente étude est de définir une structure générale pour établir le suivi de la notation des diagnostics dans le cadre d'une évaluation clinique structurée et pour mettre en évidence ce cadre au sein de l'hygiène dentaire. Méthodologie: Le cadre a été créé à l'aide de la recherche actuelle dans les domaines d'évaluations cliniques structurées, d'élaboration de tests, de la rétroaction en éducation supérieure, et du suivi de la notation des diagnostics. Un plan d'évaluation détermine les domaines diagnostiques valides en liant les compétences cliniques et les éléments de tests aux domaines (p. ex., les connaissances ou les habiletés) que l'évaluation prévoit de mesurer. La notation des domaines peut être donnée aux étudiants sous forme de rapports qui précisent les forces et les faiblesses, et fournissent de l'information sur la façon de s'améliorer. Résultats: Le cadre de suivi de la notation des diagnostics a été appliqué à une évaluation clinique structurée en hygiène dentaire de l'Université de l'Alberta en 2016. Les compétences canadiennes d'entrée en pratique en hygiène dentaire ont guidé le processus de planification de l'évaluation et une technique modifiée de Delphi a été utilisée pour valider le plan. Le rapport final a ciblé quatre habiletés fondées sur des compétences, pertinentes à l'examen : communication efficace, soins axés sur le client, obtention des renseignements essentiels, et interprétation des constatations. Les étudiants ont reçu des rapports sur leur performance dans chaque domaine. Discussion: Le suivi de la notation des diagnostics a le potentiel de résoudre plusieurs des enjeux auxquels sont confrontés les administrateurs, comme la confidentialité des éléments et le temps demandé pour la rétroaction individuelle. Conclusion: Le suivi de la notation des diagnostics offre un cadre prometteur pour fournir une rétroaction valide et rapide à tous les étudiants à la suite d'une évaluation clinique structurée.

Effect of Detailed OSCE Score Reporting on Learning and Anxiety in Medical School.

INTRODUCTION: There is growing literature on increasing feedback from Objective Structured Clinical Examinations (OSCEs) and one approach is a score report. The purpose of this study was to implement and evaluate a score report for a second and fourth-year medical school OSCE. METHODS: We developed an electronic OSCE score report that displayed comments and performance by domain within and across stations (checklist items and rating scales were tagged to each domain). Our initial pilot released the score report after pass/fail decisions but subsequent iterations released the score report the same day as the exam. Our evaluation approach included both student surveys and focus groups. RESULTS: Students felt the OSCE score report was accurate, identified strengths and weaknesses, and would likely cause them to take future action, with second-year students more likely to act on the report than fourth year students. The thematic analysis revealed barriers and enablers to utilizing feedback as well as the power of the score report to reduce anxiety. CONCLUSIONS: Our OSCE score report was simple to develop and implement the same day as an OSCE with an overall positive response from students with respect to accuracy and ability to use the information for future learning.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium.

BACKGROUND: The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS: Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS: Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS: The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes-Part II.

OBJECTIVE: To evaluate the response process validity of the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items and the organisational processes for assessing nursing home (NH) residents' oral/dental status. BACKGROUND: Although care aides provide most direct care to NH residents, including oral care, they are not directly involved in structured care planning activities, including RAI assessments. This most likely affects the accuracy of RAI assessments, as well quality of care. However, we neither know how well regulated and unregulated care staff understand the RAI oral/dental items, nor what processes are used in completing oral/dental assessments. METHODS: We conducted nine focus groups with 44 care aides, nurses, allied health providers, clinical specialists and managers. We discussed randomly selected RAI oral/dental assessments with focus group participants, including participants' understanding of the items and why the options were selected. Participants also explained the communication and process for completing the RAI. RESULTS: Participants' perceptions of the oral/dental items aligned fairly well with the item definitions. However, responses primarily focused on severe oral/dental problems with obvious physical characteristics (eg black teeth denoting caries). For non-visual oral problems, such as pain, staff relied on resident verbalisation. No formal mechanisms were described for care aides to update nurses on residents' oral health needs. CONCLUSIONS: Performance problems of RAI oral/dental items are largely rooted in poor communication between care aides and nurses and not integrating care aides in assessment processes. We need policies that address these problems in order to improve NH residents' poor oral health.

Oral care practices of long-term care home residents and caregivers: Secondary analysis of observational video recordings.

AIMS AND OBJECTIVES: To describe the proportion of toothbrushing task steps, long-term care residents had an opportunity to complete; the duration and quality of toothbrushing by both residents and caregivers; and the feedback caregivers provided. BACKGROUND: Poor oral health is widespread among older adults in long-term care homes; however, little is known about their actual oral health practices. DESIGN: Secondary analysis of video recordings. METHODS: A total of 58 video-recorded sessions were analysed from two long-term care homes in Canada. Eligible residents had at least one natural tooth, required oral care assistance, had Alzheimer's disease and understood English. Eligible caregivers spoke English and had worked for at least 1 year with people with dementia. Toothbrushing success was identified by the resident's participation in, and completion of, nine toothbrushing steps. Total time spent brushing teeth was calculated by summing the duration of time spent brushing teeth. Quality was described by time spent brushing the facial versus the lingual or occlusal surfaces. Caregiver verbal feedback was pulled from transcripts and analysed using content analysis. STROBE guidelines were used in reporting this study. RESULTS: The two step residents most frequently completed or attempted were brushing their teeth (77% complete, 7% attempt) and rinsing their mouth (86% complete, 2% attempt). The average time spent brushing teeth was 60.33 s (SD = 35.15). In 66% of observed videos, toothbrushing occurred only on the facial tooth surfaces, with no time spent brushing the lingual or occlusal surfaces. CONCLUSION: Caregivers are supporting residents to independently complete toothbrushing; however, the duration and quality of toothbrushing are not sufficient to ensure optimal oral health. RELEVANCE TO CLINICAL PRACTICE: Clear, detailed guidelines are required to ensure adequate oral care for long-term care residents. Staff need to be aware that all surfaces should be brushed to ensure proper oral health.

If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes-Part I.

OBJECTIVE: To compare Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items collected by nursing home (NH) care staff to (a) assessments collected by trained research assistants (RAs) and (b) "gold standard" clinical assessments by dental hygienists (DHs). BACKGROUND: Routine collection of RAI oral/dental items is mandatory in most Canadian NHs. However, the performance of these items is less than optimal and oral/dental problems are severely under-reported. Accurate assessment is a prerequisite for preventing, detecting and treating oral health problems. Not knowing the reasons for performance problems is a barrier to improving performance of the RAI oral/dental items. MATERIALS AND METHODS: We included 103 NH residents from 4 NHs in Edmonton, Alberta, Canada. Using Kappa statistics, we compared the agreement of residents' last (no older than 90 days) RAI assessment with RAI assessments completed by trained RAs and "gold standard" clinical assessments by DHs. We also assessed the inter-rater reliability (IRR) of RA and DH assessments. RESULTS: Care staff assessments had poor agreement with RA and DH assessments (Kappa < 0.2 for most items). RAs and DHs identified more oral/dental problems than care staff. However, IRR of RA assessments was low (Kappa < 0.7 for 7/9 items). IRR of DH assessments was acceptable (Kappa > 0.7) for most items. CONCLUSIONS: The quality of RAI oral/dental assessments can be improved by better training care staff and ensuring appropriate time to do the assessments. However, remaining problems-even with trained RAs-suggest that rewording some of the items or supplementing them by more robust tools may be required.

Oral health status of long-term care residents in Canada: Results of a national cross-sectional study.

OBJECTIVE: To describe the oral health and oral prosthetic status of long-term care residents in four Canadian provinces. BACKGROUND: Oral health can have significant impact on the health and quality of life of older adults. Seniors in long-term care are highly dependent on care staff for basic activities of daily living and are at risk for poor oral health. MATERIALS AND METHODS: Five hundred and fifty-nine randomly selected residents were examined from thirty-two long-term care homes in Alberta, Manitoba, Ontario and New Brunswick, Canada. Four experienced registered dental hygienists, one in each province, completed a standardised oral health examination with each participant, examining lip health, breath odour, saliva appearance, natural teeth count, gingival inflammation, tooth and jaw pain, denture status, mucosal status and oral health abnormalities. RESULTS: Of the examined residents, 57.6% were dentate, with an average of 16.4 (SD = 8.0) teeth. Most dentate residents had moderate or severe inflammation on at least one tooth (79.6%). Sixty per cent of residents wore dentures, and 43.2% of edentulous residents had poor hygiene of their dentures. Nine per cent of residents required urgent dental treatment for oral health problems such as broken teeth, infection, severe decay and ulcers. CONCLUSION: This study provides an estimate of the prevalence of oral health problems in residents living in long-term care homes across Canada and indicates that improvement in oral health care is needed. Future work on development strategies aimed at optimising oral health for long-term care residents is required.

Prevalence of inadequate micronutrient intakes of Canadian long-term care residents.

This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50-70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.

Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care.

OBJECTIVE: Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake. DESIGN: Multisite cross-sectional study. SETTING: Thirty-two nursing homes from 4 provinces in Canada. PARTICIPANTS: From a sample of 639 residents (20 randomly selected per home), 628 with complete data were included in analyses. MEASUREMENTS: Three days of weighed food intake (main plate, estimated beverages and side dishes, snacks) were completed to measure energy and protein intake. Health records were reviewed for diagnoses, medications, and diet prescription. Mini-Nutritional Assessment-SF was used to determine nutritional risk. Oral health and dysphagia risk were assessed with standardized protocols. The Edinburgh-Feeding Questionnaire (Ed-FED) was used to identify eating challenges; mealtime interactions with staff were assessed with the Mealtime Relational Care Checklist. Mealtime observations recorded duration of meals and assistance received. Dining environments were assessed for physical features using the Dining Environment Audit Protocol, and the Mealtime Scan was used to record mealtime experience and ambiance. Staff completed the Person Directed Care questionnaire, and managers completed a survey describing features of the home and food services. Hierarchical multivariate regression determined predictors of energy and protein intake adjusted for other covariates. RESULTS: Average age of participants was 86.3 ± 7.8 years and 69% were female. Median energy intake was 1571.9 ± 411.93 kcal and protein 58.4 ± 18.02 g/d. There was a significant interaction between being prescribed a pureed/liquidized diet and eating challenges for energy intake. Age, number of eating challenges, pureed/liquidized diet, and sometimes requiring eating assistance were negatively associated with energy and protein intake. Being male, a higher Mini-Nutritional Assessment-Short Form score, often requiring eating assistance, and being on a dementia care unit were positively associated with energy and protein intake. Energy intake alone was negatively associated with homelikeness scores but positively associated with person-centered care practices, whereas protein intake was positively associated with more dietitian time. CONCLUSION: This is the first study to consider resident, unit, staff, and home variables that are associated with food intake. Findings indicate that interventions focused on pureed food, restorative dining, eating assistance, and person-centered care practices may support improved food intake and should be the target for further research.

Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review.

BACKGROUND: Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two major barriers to providing appropriate oral care are residents' responsive behaviors to oral care and residents' lack of ability or motivation to perform oral care on their own. OBJECTIVES: To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents' responsive behaviors to oral care, or enable/motivate residents to perform their own oral care. MATERIALS AND METHODS: We searched the databases Medline, EMBASE, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science for intervention studies assessing the effectiveness of eligible strategies. Two reviewers independently (a) screened titles, abstracts and retrieved full-texts; (b) searched key journal contents, key author publications, and reference lists of all included studies; and (c) assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results. RESULTS: We included three one-group pre-test, post-test studies, and one cross-sectional study. Methodological quality was low (n = 3) and low moderate (n = 1). Two studies assessed strategies to enable/motivate nursing home residents to perform their own oral care, and to studies assessed strategies to prevent or overcome responsive behaviors to oral care. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems. CONCLUSIONS: Potentially promising strategies are available that nursing home care providers can apply to prevent/overcome residents' responsive behaviors to oral care or to enable/motivate residents to perform their own oral care. However, studies assessing these strategies have a high risk for bias. To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies.

Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis.

BACKGROUND: Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. METHODS: We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. RESULTS: We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%). CONCLUSIONS: We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes.

BACKGROUND: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. METHODS: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. DISCUSSION: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02800291 , retrospectively registered June 7, 2016.