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1.
Acta Odontol Latinoam ; 32(2): 57-64, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31664294

RESUMO

Lack of communication between the medical and dental professions impacts healthcare quality, especially in hospitals. Different authors have described the oral status of inpatients. Following that line of research, the current study set the following aims: to characterize the dynamics of medical-dental healthcare interaction at a university hospital and to describe oral status and identify need for dental treatment in a sample of 150 inpatients at a hospital in Buenos Aires City, Argentina.A descriptive study was conducted on patients who were referred to dentistry by their physicians. The following variables were surveyed: personal data, medical history, oral health status, need for dental treatment and oral self-care habits.Patient median age was 60 years, 60.7% were male, 68.7% had diseases of the circulatory system, average number of medications per day was 7, of which 28.1% were for the cardiovascular system. Seventy percent of the referrals came from the Cardiology Service and 48% were requested for preoperative evaluation. Percentage of visible plaque was 73.6% and bleeding on probing 75.4%. DMFT was 19.9; 57.3% of patients had periodontal pockets deeper than 4 mm, and 97.2% required surgery, endodontic or prosthetic rehabilitation treatments. The frequency of daily brushing decreased during hospitalization: 28.7% reported not brushing daily and only 5.3% reported brushing 3 times a day. Referrals to dentistry came mainly from the cardiology service in pre-surgical situations. Inpatients presented high levels of oral pathology and need for dental treatment.


Assuntos
Relações Interprofissionais , Saúde Bucal , Padrões de Prática Médica , Encaminhamento e Consulta , Idoso , Idoso de 80 Anos ou mais , Argentina , Comunicação , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Inquéritos e Questionários
2.
Acta odontol. latinoam ; 32(2): 57-64, Aug. 2019. graf, tab
Artigo em Inglês | LILACS-Express | ID: biblio-1038159

RESUMO

Lack of communication between the medical and dental professions impacts healthcare quality, especially in hospitals. Different authors have described the oral status of inpatients. Following that line of research, the current study set the following aims: to characterize the dynamics of medical-dental healthcare interaction at a university hospital and to describe oral status and identify need for dental treatment in a sample of 150 inpatients at a hospital in Buenos Aires City, Argentina.A descriptive study was conducted on patients who were referred to dentistry by their physicians. The following variables were surveyed: personal data, medical history, oral health status, need for dental treatment and oral self-care habits.Patient median age was 60 years, 60.7% were male, 68.7% had diseases of the circulatory system, average number of medications per day was 7, of which 28.1% were for the cardiovascular system. Seventy percent of the referrals came from the Cardiology Service and 48% were requested for preoperative evaluation. Percentage of visible plaque was 73.6% and bleeding on probing 75.4%. DMFT was 19.9; 57.3% of patients had periodontal pockets deeper than 4 mm, and 97.2% required surgery, endodontic or prosthetic rehabilitation treatments. The frequency of daily brushing decreased during hospitalization: 28.7% reported not brushing daily and only 5.3% reported brushing 3 times a day. Referrals to dentistry came mainly from the cardiology service in pre-surgical situations. Inpatients presented high levels of oral pathology and need for dental treatment.


La desarticulación entre la profesión médica y odontológica es un fenómeno que impacta en la calidad de atención de las personas, especialmente en ámbitos hospitalarios. Diferentes autores describieron el estado bucal de pacientes internados. Siguiendo esta línea de investigación, este trabajo estableció los siguientes objetivos: caracterizar la dinámica de la interacción medicina-odontología en un hospital universitario, conocer el estado bucal e identificar la necesidad de tratamiento odontológico en una muestra de 150 pacientes internados en un hospital de la Ciudad de Buenos Aires, Argentina. Se realizó un estudio descriptivo de los pacientes que los médicos derivaron a odontología y relevaron variables de las siguientes dimensiones: datos personales, antecedentes médicos, estado de salud bucal, necesidad de tratamiento odontológico y hábitos de autocuidado bucal. La mediana de edad fue de 60 años, el 60,7 % pertenecían al género masculino. El 68,7 % tenían enfermedades del sistema circulatorio, la media de medicamento administrada fue de 7 y el 28,1 % correspondía a medicación del sistema cardiovascular. El 70% de las derivaciones provino del servicio de Cardiología y el 48 % respondieron a evaluación prequirúrgica. El porcentaje de placa visible alcanzó 73,6 % y la hemorragia al sondaje 75,4 %. El CPOD fue de 19,9. El 57,3 % de los pacientes tenía bolsasperiodontales superiores a 4 mm, y el 97,2 % requerían tratamientos de cirugía, endodoncia y rehabilitación de prótesis. La frecuencia de cepillado diario bajó durante la internación: el 28,7 % refirió no realizar cepillado diariamente y solamente el 5,3 % mencionó cepillarse 3 veces/día. Las derivaciones a odontología provinieron principalmente del servicio de cardiología en situaciones prequirúrgicas. Los pacientes internados presentaron elevados niveles de patología bucal y necesidad de tratamiento odontológico.

3.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(Suppl. 2b): 293-293, Jun. 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1015039

RESUMO

INTRODUÇÃO: A integração da odontologia ao atendimento em pacientes hospitalizados na unidade de terapia intensiva (UTI) minimiza riscos de infecções, lesões bucais, trazendo conforto aos mesmos. RELATO DE CASO: Paciente gênero masculino, 39 anos, com valvopatia mitro-aórtica reumática crônica com três cirurgias cardíacas prévias, atualmente com prótese valvar aórtica e mitral metálica e flutter atrial, internado na UTI de um hospital terceário em precaução de contato e em uso de anticoagulante heparina não fracionada em bomba de infusão continua e em uso de dobutamina. A equipe médica acionou a cirurgia cardíaca com suspeita de herpes labial em uso de aciclovir. No segundo momento, solicitaram a avaliação odontológica por um sangramento intenso de difícil controle. Ao exame físico extraoral, paciente não contactuante, acamado, com sonda nasoenteral, traqueostomizado, limitação de abertura bucal, lábios selados com crostas e sangramento ativo extravasando por comissura labial bilateral. Ao exame físico intraoral, dentado parcial superior e inferior, com lesão ulcerada em lábio inferior lado esquerdo e em lábio superior na região anterior com sangramento ativo e crostas. Como hipótese diagnóstica de úlcera traumática e laceração em lábio com sangramento ativo. Foi realizado limpeza da cavidade oral, anestesia local, sutura e curativo local com antifibrinolítico ácido tranexânico. Nos acompanhamentos, foi feito higienização oral, aplicação de laser vermelho na região de ulcera para analgesia, e também em região de laceração de lábio laser infravermelho para reparação tecidual e prescrito hidratação labial. A evolução do caso seguiu com controle e ausência do sangramento, trazendo alívio para paciente. CONSIDERAÇÕES FINAIS: A importância da atuação do cirurgião-dentista em uma equipe multiprofissional na UTI, que através do atendimento especializado diagnosticou e controlou a hemorragia bucal. (AU)


Assuntos
Humanos , Odontólogos , Cardiopatias , Hemorragia
4.
Pergunta e resposta em Português | SOF - Segunda opinião formativa | ID: sof-41758

RESUMO

-Realizar anamnese detalhada colhendo informações, tais como: queixa principal? ; como, quando e onde começou? ; qual o tratamento já realizado? ; que medicamentos tomou? ; teve febre? ; frio?; enjôos, vômitos?; teve hemorragia?; apresenta ou existem casos na família de hipertensão, cardiopatias, diabetes, hepatite e artrite?; alguma outra doença?; já precisou de internação hospitalar?; já foi submetido a alguma cirurgia?; está sob alguma forma de tratamento?; que medicamentos usa?; é alérgico a algum tipo de medicamento?; já teve asma?; sentiu-se mal alguma vez durante procedimento médico ou odontológico?; já apresentou reação a anestésico local?; hemorragia após extração?; doenças na infância?; doenças na fase adulta? (1,2)

-Ter conhecimento prévio das principais desordens coronarianas (1);

-Firmar interação entre o cirurgião dentista e o médico do paciente em questão (1,3);

-Evitar sessões longas, dolorosas, estresse e liberação de adrenalina endógena (1,2,3);

-Avaliar os sinais vitais, antes e após os procedimentos, em todas as consultas, registrando-os no prontuário odontológico. Esta conduta, além de assegurar o sucesso, garante uma relação de confiança entre as partes (1,2,3);

-Utilizar, para minimizar o estresse, sedativos pré e trans-operatórios, anestesia local potente e analgesia pós-operatória quando necessário (1,2);

-Considerar, durante a escolha do anestésico local, o tipo de comprometimento cardiovascular do paciente. Anestésicos locais contendo a epinefrina e seus derivados como vasoconstritor devem ser utilizados em quantidade mínima — no máximo dois tubetes com concentração 1:100.000, realizando-se aspiração negativa para certificar-se de que não haja injeção intravascular (2);

-Evitar, em pacientes com arritmias cardíacas, anestésicos contendo vasoconstritores do grupo das aminas simpatomiméticas (por exemplo, epinefrina, norepinefrina e levonordefrina). Recomenda-se, nestes casos, assim como para pacientes com histórico de infarto do miocárdio, a aplicação de anestésicos com o vasoconstritor felipressina, ou o uso de mepivacaína 3% sem vasoconstritor em procedimentos de curta duração (2);

-Pacientes com prolapso da válvula mitral devem ser protegidos por profilaxia antibacteriana (3);

-O cirurgião dentista deve atualizar-se constantemente com as melhores evidências disponíveis na área (2);

-Motivar o paciente a manter hábitos de higiene bucal satisfatórios e realizar retornos periódicos para evitar a instalação de infecção (1,2);

-Adiar, em pacientes recentemente infartados, as consultas eletivas até que se completem seis meses após o incidente (1,2);

-Preparar-se para lidar com situações emergenciais quando atender pacientes cardiopatas(2). Desta forma, o cirurgião dentista deve conhecer o kit de emergência da Unidade Básica de Saúde e em caso de eventuais situações de natureza emergencial durante o atendimento odontológico desse grupo de pacientes deve-se acionar também a equipe médica e de enfermagem da Unidade.


Assuntos
Assistência Odontológica para Doentes Crônicos , Doenças Cardiovasculares
5.
J Forensic Leg Med ; 65: 105-107, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132726

RESUMO

Distinguishing between ante-mortem and post-mortem domestic dog injuries is fundamental in order to correctly find the cause of the death. Although fatal aggressions are chiefly perpetrated by pit bull-type dogs, small dogs are responsible for a significant share of animal bites and can cause high-degree injuries. On the other side, indoor and outdoor scavenging can hinder forensic investigation, consuming parts of the body where crucial forensic features like bruises and wounds have been inflicted. In the case we present, a man died after falling down his house stairs because of a traumatic intracranial haemorrhage. His dog, a Jack Russel Terrier, scavenged a significant portion of his facial superficial and deep tissues, suggesting to the investigators the hypothesis of a brutal aggression. In this paper, we showed how the application of advanced 3D processing and modelling techniques can give a crucial contribution to detect the injuries certainly caused by animal teeth.


Assuntos
Mordeduras e Picadas/patologia , Simulação por Computador , Cães , Comportamento Alimentar , Imagem Tridimensional , Dente/diagnóstico por imagem , Acidentes por Quedas , Adulto , Animais , Traumatismos Faciais/etiologia , Traumatismos Faciais/patologia , Odontologia Legal , Patologia Legal , Humanos , Masculino , Lesões do Pescoço/etiologia , Lesões do Pescoço/patologia , Fotogrametria , Fraturas Cranianas/patologia , Hemorragia Subaracnóidea/patologia
6.
Cient. dent. (Ed. impr.) ; 16(1): 17-25, ene.-abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183377

RESUMO

La enfermedad o disfunción hepática puede deberse a numerosas causas como infecciones adquiridas, patologías congénitas o el abuso de drogas. Cuando esta disfunción y el daño hepático se prolongan a lo largo del tiempo, puede desembocar en una cirrosis hepática, cuadro irreversible y de graves repercusiones para el enfermo. Las dos patologías hepáticas más frecuentes y principales causas de la cirrosis son la hepatitis o inflamación hepática, la cual se puede deber a numerosos factores siendo el más frecuente las infecciones por virus, y la enfermedad hepática alcohólica, provocada por el abuso de alcohol continuado durante un largo período de tiempo. El manejo odontológico de un paciente con alteraciones hepáticas supone un verdadero reto, ya que el hígado juega un papel vital en numerosas funciones metabólicas, como la secreción de bilis o la excreción de bilirrubina procedente del metabolismo de la hemoglobina. Un fallo en la función hepática puede suponer alteraciones en el metabolismo de aminoácidos, amoníaco, proteínas, hidratos de carbono y triglicéridos. Un paciente con patología hepática tendrá un metabolismo alterado de numerosos fármacos empleados habitualmente por el dentista, tendrá un mayor riesgo de hemorragia debido a anomalías en la síntesis de diferentes factores de coagulación, siendo además un paciente con mayor riesgo de infecciones. La gran repercusión de la enfermedad hepática, así como el notable desconocimiento de muchos profesionales odontólogos en su manejo, justifican este artículo donde se talla tanto las generalidades más importantes de esta entidad como sus principales manifestaciones orales y consideraciones en el manejo odontológico


Liver disease or dysfunction may be due to numerous causes such as acquired infections, congenital pathologies or drug abuse. When this dysfunction and liver damage are prolonged overtime, it can lead to hepatic cirrhosis, an irreversible condition and serious repercussions for the patient. The two most frequent liver diseases and major causes of cirrhosis are hepatitis or hepatic inflammation, which may be due to numerous factors being the most frequent virus infections, and alcoholic liver disease, caused by alcohol abuse continued during A long period of time. The dental management of a patient with liver disorders is a real challenge, since the liver plays a vital role in many metabolic functions, such as bile secretion or excretion of bilirubin from hemoglobin metabolism. A failure in liver function can lead to alterations in the metabolismof amino acids, ammonia, proteins, carbohydrates and triglycerides. A patient with liver disease will have an altered metabolism of numerous drugs commonly used by the dentist, will have a greater risk of hemorrhage due to abnormalities in the synthesis of different coagulation factors, being also a patient with a higher risk of infections. The great repercussion of liver disease, as well as the remarkable lack of knowledge of many dental professionals in its management, justify this article where it is detailed both the most important generalities of this entity as its main oral manifestations and considerations in dental management


Assuntos
Humanos , Hepatite Viral Humana/complicações , Hepatite Crônica/complicações , Hepatopatias Alcoólicas/complicações , Doenças da Boca/complicações , Doenças da Boca/terapia , Assistência Odontológica para Doentes Crônicos/métodos , Odontopatias/complicações , Odontopatias/terapia
7.
BMC Pregnancy Childbirth ; 19(1): 91, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866846

RESUMO

BACKGROUND: Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage. STUDY DESIGN: We performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded. RESULT: The response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques. CONCLUSION: An alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH.


Assuntos
Competência Clínica/estatística & dados numéricos , Ginecologia/educação , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência/estatística & dados numéricos , Obstetrícia/educação , Hemorragia Pós-Parto/cirurgia , Adulto , Feminino , França , Humanos , Histerectomia , Artéria Ilíaca , Ligadura , Masculino , Inquéritos e Questionários , Artéria Uterina
8.
Cien Saude Colet ; 24(3): 953-961, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892516

RESUMO

The goal was to assess the access and factors connected to dental visits in children up to age five in the city of Porto Alegre, Brazil. The cross-sectional study was conducted in 10 Basic Health Units through a questionnaire and clinical examination on 560 children. Clinical (visible plaque, gingival bleeding and defs), socio-demographic, and visit access variables were assessed. Poisson Regression was used to calculate the Prevalence Ratios (PR), with a 95% confidence interval. Results showed that 68.2% of children had never gone to a dentist. The main reason reported for not visiting a dentist was not feeling the need (48.7%) and difficult access to a health clinic (15.8%). The purpose of going to the dentist was for prevention/revision (55.8%), and the most sought-after places for visits were the private office (43.9%) and health clinic (39.5%). The final multivariate model showed that age of the child (95%CI, PR = 1.03 (1.02-1.05)), household income (PR = 1.05; (1.01-1.08)), and the mother having completed high school (PR = 1.69 (1.15-2.56)) were associated with seeking dental consultation. Thus, it is crucial to recognize the importance of the family setting during the first years of life.


Assuntos
Assistência Odontológica para Crianças/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Acesso aos Serviços de Saúde , Saúde Bucal/estatística & dados numéricos , Adulto , Fatores Etários , Brasil/epidemiologia , Pré-Escolar , Estudos Transversais , Serviços de Saúde Bucal/organização & administração , Placa Dentária/epidemiologia , Escolaridade , Feminino , Hemorragia Gengival/epidemiologia , Humanos , Renda , Lactente , Masculino , Análise Multivariada , Distribuição de Poisson , Inquéritos e Questionários , Adulto Jovem
9.
Spec Care Dentist ; 39(2): 173-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30773677

RESUMO

INTRODUCTION: Optimal delivery of dental care for adults with congenital bleeding disorders (CBD) requires close collaboration between hemophilia treaters and dentists. AIM: To explore U.K. hemophilia treaters' knowledge of dental procedures and associated hemostatic management in adults with CBD. METHOD: Staff (N = 180) from N = 60 hemophilia facilities in the United Kingdom were invited to participate in a questionnaire-based study using a web-based tool. The questionnaire assessed participants' knowledge, adherence and appropriateness of application of U.K. guidance on hemostatic management of common dental procedures. RESULTS: The response rate was 23% of treaters (n = 41) from 62% (n = 32) hemophilia facilities. Individual participants (87%; n = 34) reported they adhered to guidelines, though knowledge of guidance was poor with only 36% (n = 15) applying guidance appropriately in 3 common dental scenarios. There was a tendency for participants to assign the use of systemic hemostatic measures independent of the agreed bleeding risk associated with the proposed dental procedure. CONCLUSION AND RECOMMENDATIONS: While hemophilia treaters were aware of current guidelines, their knowledge of the guidelines and ability to risk assess dental procedures was poor. There was a tendency to overprescribe systemic hemostatic measures for dental procedures. Education initiatives to aid decision making are needed.


Assuntos
Assistência Odontológica para Doentes Crônicos/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Hemofilia A/complicações , Hemorragia Bucal/etiologia , Hemorragia Bucal/prevenção & controle , Médicos , Adulto , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Hemostasia , Humanos , Masculino , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Reino Unido
10.
Gen Dent ; 67(1): 61-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30644834

RESUMO

Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.


Assuntos
Hemorragia Gengival/prevenção & controle , Transfusão de Plaquetas , Trombastenia , Ácido Tranexâmico/uso terapêutico , Assistência Odontológica para Doentes Crônicos , Feminino , Hemorragia Gengival/etiologia , Humanos , Trombastenia/complicações , Extração Dentária/efeitos adversos
11.
J Pediatr Adolesc Gynecol ; 32(2): 128-134, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30453029

RESUMO

STUDY OBJECTIVE: We sought to improve emergency care for adolescents with abnormal uterine bleeding (AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect on quality of care. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: A stakeholder engagement group designed a CEG algorithm for emergency AUB management. Pediatric residents received CEG training and their knowledge and attitudes were assessed using pre- and post intervention surveys. International Classification of Diseases ninth and 10th revision codes identified electronic health record data for patients who presented to the pediatric emergency department for AUB 6 months before and after CEG implementation. A weighted, 20-point scoring system consisting of prioritized aspects of history, laboratory studies, and management was developed to quantify the quality of care provided. MAIN OUTCOME MEASURES: Descriptive statistics, χ2 test, Wilcoxon rank sum test, and a run chart were used for analysis. RESULTS: Pediatric residents reported higher confidence and knowledge scores post CEG implementation. Of the 91 patients identified, 62 met inclusion criteria. Median score was 14 ± 7 before CEG implementation and 15.5 ± 6 after. The Wilcoxon rank sum test showed a difference in AUB evaluation and management scores (P = .09) after implementation of the CEG. Run chart data showed no shifts or trends (overall median score, 14 points). Pre- and post implementation, points were deducted most frequently for not assessing personal/family clotting disorder history. The largest improvements in care were with appropriate medication dosing and disposition. CONCLUSION: We designed a CEG and educational intervention for AUB management in a pediatric emergency department. These findings suggest our CEG might be an effective tool to improve emergency AUB care for adolescents and could increase trainees' confidence in managing this condition, although additional cycles are needed.


Assuntos
Competência Clínica/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência/métodos , Hemorragia Uterina/terapia , Adolescente , Algoritmos , Feminino , Humanos , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Resultado do Tratamento
12.
Clin Oral Investig ; 23(1): 477-484, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29696419

RESUMO

OBJECTIVE: Several novel oral anticoagulants (NOACs) are currently prescribed for patients suffering from atrial fibrillation, pulmonary thromboembolism, and venous thrombosis. However, there is no clinical guideline for dental treatment in patients taking NOACs. This study investigated bleeding events related to various dental treatments. MATERIALS AND METHODS: This retrospective study included 120 patients (153 cases) who were prescribed NOACs and received dental procedures in the Department of Advanced General Dentistry at Yonsei University Dental Hospital from January 2014 to June 2017. The indication for NOACs, initiation of NOACs, duration of discontinuance, creatinine clearance, and type of dental treatment were investigated. Bleeding events were assessed at a follow-up visit to the clinic. RESULTS: Postoperative bleeding occurred in only 9 of the 153 included cases; they comprised 2 cases of scaling, 3 cases of simple extraction, 3 cases of the first stage of implant surgery, and 1 case of resin filling. The creatinine clearance (P = .111) and duration of discontinuance (P = .222) did not differ significantly between the groups with and without bleeding events. CONCLUSIONS: Our data indicate that most dental treatments may be performed in patients taking NOACs without an increased likelihood of bleeding events regardless of the discontinuance duration. Moreover, any postoperative bleeding can be stopped by applying compressive pressure or local hemostatic agents. CLINICAL RELEVANCE: Our study suggests that patients taking NOACs who need dental treatments may have a bleeding tendency based on our retrospective data. Preoperative history taking and treatment modification should therefore be considered before performing dental surgery.


Assuntos
Anticoagulantes/administração & dosagem , Assistência Odontológica para Doentes Crônicos , Hemorragia Pós-Operatória/induzido quimicamente , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
13.
J Formos Med Assoc ; 118(1 Pt 2): 354-361, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29936106

RESUMO

BACKGROUND AND AIMS: During coronary artery bypass graft (CABG) surgery, the residual hemostasis procedures, from weaning cardiopulmonary bypass to closing sternotomy, are always completed by residents and supervised by attending surgeons. We want to evaluate the teaching effectiveness for residents under the supervision of attending surgeons with different levels of seniority. MATERIALS AND METHODS: Between January 1st 2001 and December 31st 2010, 2279 consecutive CABG surgeries were performed in our medical center. In total, 83 patients underwent a reexploration for postoperative bleeding. All causes of bleeding were identified and recorded. Competent attending surgeons were defined as having >3 years' experience and young attending surgeons with ≦3 years' experience. We compared the reexploration rate and aimed to identify the common sources of bleeding by the two groups. We also assessed the impact of attending experience on the outcomes and major complications after reexploration. RESULTS: There were 36 surgical bleeding and 17 non-surgical bleeding in the young group and 16 surgical bleeding and 14 non-surgical bleeding in the competent group. The young group experienced more mediastinal drainage before a reexploration and a longer time interval to a reexploration. However, both are without statistical significance. Furthermore, the young group has a significant longer hospital stay. The most common intra-pericardium surgical bleeding included two-stage cannulation, side branch of the left internal mammary artery (LIMA), and side branch of vein grafts. The most common extra-pericardium surgical bleeding included a puncture hole by sternal wires, LIMA bed, and fragile sternum. CONCLUSION: Young attending surgeons indeed had both higher incidence of reexploration and surgical bleeding after a CABG. However, the supervisor experience only impacted hospital stay, not major complications or mortality after a reexploration. This might imply the competent attending surgeons provide higher teaching effectiveness for the hemostasis procedure after CABG.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/educação , Internato e Residência , Hemorragia Pós-Operatória/epidemiologia , Reoperação/estatística & dados numéricos , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Competência Clínica , Ponte de Artéria Coronária/mortalidade , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à Saúde , Medição de Risco , Taiwan/epidemiologia
14.
PLoS One ; 13(10): e0204564, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30304017

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a preclinical oral prophylaxis education program by examining the effectiveness of the teaching module on changes to the students' attitudes towards their individual hygiene behaviors with interdental brushes (IDBs). METHODS: As being part of a new didactic program on oral interproximal prophylaxis, all preclinical third-year students (n = 96) enrolled in the 2014/15 academic year received theoretical, preclinical, and clinical lessons on interproximal prophylaxis. The evaluation of educational outcomes was linked to observed changes in students' hygiene behaviors using interdental brushes. Knowledge, skills, attitudes, satisfaction, competence and performance were also explored. The evaluation interviews were recorded at each recall, i.e., 1 week, 1 month, 3 months and 1 year after baseline. RESULTS: Motivation to use IDBs is clearly related to the perception of the effectiveness of the brushes and the perception of bleeding reduction. At one week, 89.6% of subjects reported using IDBs. Individual use decreased significantly from one week to one month (-26%, p = 0.006) while a non-significant upward trend occurred between one month and three months. Among students reporting usage of IDBs at 1 year (20.8%), only 2.0% used IDBs daily. Most students would recommend IDBs to other people at the beginning (69.8%). However, this share dropped to 50% at 3 months. IDB-users prescribed more than non-users. DISCUSSION AND PUBLIC HEALTH IMPLICATIONS: The implementation of a module on interdental hygiene practices in the oral health program is strongly recommended. However, corrective measures should be considered regarding the organization and frequency of recall periods in order to improve the performance of the curriculum.


Assuntos
Currículo , Dispositivos para o Cuidado Bucal Domiciliar , Educação em Odontologia , Saúde Bucal , Estudantes de Odontologia , Sucesso Acadêmico , Biofilmes , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Hemorragia , Humanos , Entrevistas como Assunto , Masculino , Motivação , Estudantes de Odontologia/psicologia , Fatores de Tempo , Adulto Jovem
15.
Dimens Crit Care Nurs ; 37(6): 285-293, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30273212

RESUMO

INTRODUCTION: Oral care, using either a mouth rinse, gel, toothbrush, or combination of them, together with aspiration of secretions, may reduce the risk of ventilator-acquired pneumonia in intubated patents. Oral care procedure in patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) may cause bleeding due to the systemic anticoagulation required. PURPOSE: The aim of this study was to investigate the rate of bleeding episodes during oral care in patients supported by VV-ECMO. METHODS: A retrospective observational study was performed. All patients admitted to an Italian ECMO center during 2014 were included in the study. RESULTS: Data from 14 patients were analyzed. The median intensive care unit length of stay was 39.0 days (interquartile range, 27.3-83.3 days), and median days on VV-ECMO was 19.5 (10.3-46.0). There were 440 ECMO days, with 1320 oral care maneuvers. In 7 patients, bleeding episodes occurred: 2 with orotracheal intubation and 5 initially managed with orotracheal intubation, thereafter via Translaryngeal tracheostomy tube (according to Fantoni's technique). In 61 oral care procedures (4.6%), bleeding was detected during or after the maneuver, whereas the total numbers of days with at least 1 bleeding episode were 35 (8%).The presence or absence of bleeding during ECMO days was statistically significant for international normalized ratio (1.01 [0.95-1.11] vs 1.13 [1.03-1.25], P < .0001), platelets (163 000 [93 500-229 000] vs 61 000 [91 00-100 000], P < .0001), and mouth care score (6 [5-7] vs 8 [7-9], P < .001). CONCLUSION: Oral care can cause bleeding in patients on VV-ECMO. Implementation of protocols for daily oral care in patients on ECMO may reduce risks. As recommended by the literature, this category of patients should be treated in selected centers distinguished by a regular volume of ECMO activity and the presence of dedicated ECMO specialist nurses.


Assuntos
Assistência Odontológica para Doentes Crônicos/enfermagem , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/enfermagem , Hemorragia/epidemiologia , Hemorragia/enfermagem , Doença Iatrogênica/prevenção & controle , Avaliação em Enfermagem , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Adulto , Feminino , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
Int. j. odontostomatol. (Print) ; 12(3): 225-227, Sept. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-975737

RESUMO

ABSTRACT: Pain is a major symptom in many dental procedures. Studies show consistently that pain, including dental pain, is not effectively treated; management of pain is a critical and challenging component in dentistry. Improvement and efficacy on the treatment depends on knowing which treatments are the most effective. Knowing how well an analgesic works and its associated adverse effects is fundamental to clinical decision. The aim of this review is to provide information to the dentistry field on the treatment of dental pain specifically with COX-2 inhibitors providing a useful guide to dentist on controlling pain. Therefore, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, COX2 selective inhibitors (Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties.


RESUMEN: El dolor es un síntoma principal en muchos procedimientos dentales. Los estudios demuestran consistentemente que el dolor, incluido el dolor dental, no se trata de manera efectiva; el manejo del dolor es un componente crítico y desafiante en odontología. La mejora y la eficacia en el tratamiento depende de saber qué tratamientos son los más efectivos. Saber qué tan bien funciona un analgésico y sus efectos adversos asociados es fundamental para la decisión clínica. El objetivo de esta revisión es proporcionar información al campo de la odontología sobre el tratamiento del dolor dental específicamente con los inhibidores de la COX-2, proporcionando una guía útil para el control del dolor por parte del dentista. Por lo tanto, los fármacos antiinflamatorios no esteroideos (AINE) son los agentes analgésicos más comúnmente prescritos en pacientes ambulatorios quirúrgicos. Las principales limitaciones de los AINE son los eventos adversos gastrointestinales (perforación, ulceración y hemorragia), deterioro de la función hemostática e insuficiencia renal (con terapia a largo plazo). Una nueva clase de AINE, los inhibidores selectivos de la COX-2 (Coxibs), se han desarrollado con el objetivo de reducir los eventos adversos gastrointestinales de los AINE tradicionales mientras se mantienen sus propiedades antiinflamatorias y analgésicas efectivas.

17.
J Obstet Gynaecol Can ; 40(9): 1170-1177, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30007802

RESUMO

OBJECTIVE: The effect of resident involvement during obstetrics and gynaecology (OB/GYN) surgery on surgical outcomes is unclear. This study sought to review the evidence systematically for the influence of resident participation in OB/GYN surgery on (1) operative time, (2) estimated blood loss, and (3) perioperative complications. METHOD: Published studies were identified via searches of PubMed, Embase, Cochrane Central Register, Web of Science, and ClinicalTrials.gov databases. The study included randomized or observational studies that compared outcomes for OB/GYN surgery performed by attending surgeons alone or with residents. Risk ratios or mean differences were extracted from the studies. A random effect model was performed for each outcome, with subgroup analysis by type of surgery and study quality. RESULTS: A total of 13 studies were included in the meta-analysis, comprising 40 968 patients in seven countries. Surgical procedures performed only by attending surgeons had shorter operative times (mean difference 18.20 minutes; 95% CI 13.58-22.82), whereas surgical procedures with resident involvement were associated with an increased risk of blood transfusion (risk ratio 1.23; 95% CI 1.08-1.41). There were no observable differences in risk of estimated blood loss, wound infection, urologic injury, viscus injury, or return to the operating room. Significant heterogeneity (I2 >50%) was present in one of seven outcomes. CONCLUSION: Resident participation in OB/GYN surgery is associated with longer operative times and increased risk of blood transfusion; however, other perioperative complications are not increased.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , Procedimentos Cirúrgicos Obstétricos/estatística & dados numéricos , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Complicações Intraoperatórias/etiologia , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia
18.
BMC Oral Health ; 18(1): 84, 2018 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-29747622

RESUMO

BACKGROUND: General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. METHODS: From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. RESULTS: Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. CONCLUSION: Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.


Assuntos
Anestesia Geral/efeitos adversos , Assistência Odontológica para Crianças/métodos , Dor Pós-Operatória , Hemorragia Pós-Operatória , Criança , Pré-Escolar , Assistência Odontológica para Crianças/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
19.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(2): 138-143, mar. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174380

RESUMO

Se ha constatado en el embarazo la asociación entre problemas de salud oral y complicaciones obstétricas. Por ello, el objetivo principal de este trabajo es evaluar en embarazadas la percepción de salud oral, hábitos y creencias relativas. Se diseñó un cuestionario para obtener información de las embarazadas que acudían a la consulta de Obstetricia del Hospital Comarcal Valdeorras y Odontología de atención primaria del Centro de Salud Valle Inclán (n=96). Se encontró que la percepción propia de muchas gestantes era padecer algún problema en la cavidad oral. Además, se reflejó que las gestantes tenían hábitos relativos a salud oral adecuados; en adición, creían que su embarazo iba a traer implícitamente problemas a su boca. Las gestantes son capaces de comprender la relación entre su salud oral, su salud sistémica y la de su futuro hijo. Se detectaron una serie de hábitos y creencias en las que sería conveniente incidir para reducir problemas sanitarios


An association has been found between oral health problems and obstetric complications during pregnancy. The main aim of this study was to assess the perception by pregnant women on their oral health and related habits and beliefs. A questionnaire was designed in order to obtain information from 96 pregnant women attending the Valdeorras Local Hospital and the primary health dental practice in the Valle Inclan Health Center. It was found that many pregnant women perceived they were suffering from some kind of problem affecting their mouth. It was shown that pregnant women had adequate habits regarding oral health, but they believed that their pregnancy would implicitly cause them to have mouth problems. Pregnant women are able to understand the impact of their oral health on their general well-being and the health of their unborn child. It has been detected that a series of habits and beliefs would ideally need to be acted upon in order to reduce health problems


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Hábitos , Saúde Bucal , Atenção Primária à Saúde/métodos , Odontologia Preventiva/métodos , Profilaxia Dentária/métodos , Gengivite/epidemiologia , Avaliação em Saúde , Nível de Saúde , Periodontite/epidemiologia , Inquéritos e Questionários , Estudos Transversais/métodos , População Urbana/estatística & dados numéricos , Hemorragia Gengival/complicações
20.
Int J Gynaecol Obstet ; 141(2): 261-267, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29330842

RESUMO

OBJECTIVE: To explore long-term transfer (application of acquired knowledge and skills on the job) after postpartum hemorrhage simulation training based on either instructional design (ID) principles or conventional best practice. METHODS: In this qualitative study, semi-structured interviews with obstetrics and gynecology healthcare practitioners were conducted between August 7 and September 26, 2015, in Recife, Brazil. The participants were randomly selected from each of two postpartum hemorrhage simulations attended 2 years earlier (one ID and one conventional best practice). Thematic analysis was used to explore (1) residents' perceptions of long-term transfer of learning, (2) ID elements influencing the perceived long-term transfer, and (3) differences in the participants' perceptions according to the type of simulation attended. RESULTS: There were 12 interview participants. After either simulation format, residents perceived long-term transfer effects. Training design factors influencing transfer were, in their opinion, related to trainees' characteristics, simulation design, and workplace environment. Trainees who participated in the ID-based simulation perceived better communication skills and better overall situational awareness: "I didn't do that before." CONCLUSION: All residents perceived long-term transfer after simulation training for postpartum hemorrhage. Those who attended the ID format additionally perceived improvements in communication skills and situational awareness, which are fundamental factors in the management of postpartum hemorrhage.


Assuntos
Internato e Residência , Hemorragia Pós-Parto/terapia , Treinamento por Simulação , Adulto , Conscientização , Brasil , Competência Clínica , Feminino , Ginecologia/educação , Humanos , Aprendizagem , Masculino , Obstetrícia/educação , Percepção , Gravidez , Pesquisa Qualitativa , Autoimagem
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