Predictors of cognitive dysfunction after major noncardiac surgery.

BACKGROUND: The authors designed a prospective longitudinal study to investigate the hypothesis that advancing age is a risk factor for postoperative cognitive dysfunction (POCD) after major noncardiac surgery and the impact of POCD on mortality in the first year after surgery. METHODS: One thousand sixty-four patients aged 18 yr or older completed neuropsychological tests before surgery, at hospital discharge, and 3 months after surgery. Patients were categorized as young (18-39 yr), middle-aged (40-59 yr), or elderly (60 yr or older). At 1 yr after surgery, patients were contacted to determine their survival status. RESULTS: At hospital discharge, POCD was present in 117 (36.6%) young, 112 (30.4%) middle-aged, and 138 (41.4%) elderly patients. There was a significant difference between all age groups and the age-matched control subjects (P < 0.001). At 3 months after surgery, POCD was present in 16 (5.7%) young, 19 (5.6%) middle-aged, and 39 (12.7%) elderly patients. At this time point, the prevalence of cognitive dysfunction was similar between age-matched controls and young and middle-aged patients but significantly higher in elderly patients compared to elderly control subjects (P < 0.001). The independent risk factors for POCD at 3 months after surgery were increasing age, lower educational level, a history of previous cerebral vascular accident with no residual impairment, and POCD at hospital discharge. Patients with POCD at hospital discharge were more likely to die in the first 3 months after surgery (P = 0.02). Likewise, patients who had POCD at both hospital discharge and 3 months after surgery were more likely to die in the first year after surgery (P = 0.02). CONCLUSIONS: Cognitive dysfunction is common in adult patients of all ages at hospital discharge after major noncardiac surgery, but only the elderly (aged 60 yr or older) are at significant risk for long-term cognitive problems. Patients with POCD are at an increased risk of death in the first year after surgery.

Assessing Faculty Development Needs among Florida's Allied Dental Faculty.

PURPOSE: Professional schools rarely prepare prospective academic faculty for the responsibilities of college and university teaching. Without this training, faculty are often left to discover on their own and to varying degrees of success what is expected of them once they enter the academy. At the same time, universities and colleges recognize that retention of faculty depends on the successful transition of academics into the related roles and responsibilities of the professoriate. The purpose of this study was to assess the faculty development needs among allied dental faculty, specifically the state of Florida's dental hygiene and dental assisting faculty, by measuring the following: the relationship between their knowledge and priorities for further training, their level of satisfaction with current faculty development opportunities and mentoring, and their perceptions of what additional training and resources might advance their careers. METHODS: Two hundred and four full-time and part-time faculty were invited to participate in this survey research study. McNemar's test for paired binary data was used to analyze the level of agreement between knowledge and indicated priority. Responses to open ended questions were coded and categorized thematically. RESULTS: There were 115 responses (n=204, 74%). There were statistically significant differences between participants' ratings of knowledge and priorities for further training on many items related to teaching, scholarship and leadership skills. Participants also identified 5 categories of unmet needs. CONCLUSION: The findings suggest that universities and colleges need to offer learning experiences aimed at strengthening the teaching, scholarship and leadership skill needs of their allied dental faculty. Additionally, professional schools might consider offering a program track that provides prospective allied dental faculty with the types of opportunities that develops teaching, scholarship and mentoring skills prior to graduation.

Assessing Cultural Competence among Florida's Allied Dental Faculty.

PURPOSE: The Commission on Dental Accreditation requires that dental, dental hygiene and dental assisting schools offer educational experiences to ensure that prospective dental health care providers become culturally competent, socially responsible practitioners. To assert that these mandates are met requires that the faculty are knowledgeable and capable of providing this type of training. Currently, little is known about the cultural competence of the state of Florida allied dental faculty. The purpose of this study was to assess the cultural competence among the dental hygiene and dental assistant faculty in the state of Florida. METHODS: One hundred ninety-three faculty were invited to take the Knowledge, Efficacy and Practices Instrument (KEPI), a validated measure of cultural competence. Respondents included 77 (74%) full-time and 27 (26%) part-time faculty. Data were analyzed descriptively and reliabilities (Cronbach's alpha) were computed. RESULTS: Mean scores and internal estimates of reliability on the KEPI subscales were: knowledge of diversity 3.3 (ɑ=0.88), culture-centered practice 3.6 (ɑ=0.88) and efficacy of assessment 2.9 (ɑ=0.74). The participant's score of 3.6 on the culture-centered practice exceeds scores among dental students and faculty who participated in previous studies suggesting the allied dental faculty have a greater awareness of sociocultural and linguistically diverse dental patients' oral health needs. Participants' score on knowledge of diversity subscales suggests a need for moderate training, while their score on the efficacy of assessment subscale indicates a need for more intense training. CONCLUSION: Assessing faculty beliefs, knowledge and skills about cultural competency is critically important in ensuring that accreditation standards are being met and represents one step in the process of ensuring that faculty demonstrate the type of sensitivity and responsiveness, which characterizes behaviors associated with cultural competence.

The knowledge, efficacy, and practices instrument for oral health providers: a validity study with dental students.

Valid and reliable instruments to measure and assess cultural competence for oral health care providers are scarce in the literature, and most published scales have been contested due to a lack of item analysis and internal estimates of reliability. The purposes of this study were, first, to develop a standardized instrument to measure dental students' knowledge of diversity, skills in culturally competent patient-centered communication, and use of culture-centered practices in patient care and, second, to provide preliminary validity support for this instrument. The initial instrument used in this study was a thirty-six-item Likert-scale survey entitled the Knowledge, Efficacy, and Practices Instrument for Oral Health Providers (KEPI-OHP). This instrument is an adaption of an initially thirty-three-item version of the Multicultural Awareness, Knowledge, and Skills Scale-Counselor Edition (MAKSS-CE), a scale that assesses factors related to social justice, cultural differences among clients, and cross-cultural client management. After the authors conducted cognitive and expert interviews, focus groups, pilot testing, and item analysis, their initial instrument was reduced to twenty-eight items. The KEPI-OHP was then distributed to 916 dental students (response rate=48.6 percent) across the United States to measure its reliability and assess its validity. Both exploratory and confirmatory factor analyses were conducted to test the scale's validity. The modification of the survey into a sensible instrument with a relatively clear factor structure using factor analysis resulted in twenty items. A scree test suggested three expressive factors, which were retained for rotation. Bentler's comparative fit and Bentler and Bonnett's non-normed indices were 0.95 and 0.92, respectively. A three-factor solution, including efficacy of assessment, knowledge of diversity, and culture-centered practice subscales, comprised of twenty-items was identified. The KEPI-OHP was found to have reasonable internal consistency reliability to warrant its use for baseline and repeated measures in assessing changes in dental students' growth in cultural competence across four-year dental curricula.