Asunto(s)

RESUMEN

OBJECTIVES: Sedation is commonly utilized for individuals otherwise unable to receive dental treatment, such as those with disabilities, medically complex conditions, and dentophobics. The aim was to characterize the profiles of patients receiving various types of sedation and assess the corresponding success rates. METHOD AND MATERIALS: This was a 5-year records-based retrospective study. Data regarding the indication for sedation, medical history, sedation type, and treatments performed were recorded. RESULTS: In total, 103 patients underwent 389 treatment sessions under sedation; 42.7% of the patients were disabled. The most commonly administered sedation was moderate sedation, (49.4%), followed by deep (36.8%) and inhaled sedation (13.9%). Successful treatment results were achieved in 96.1% of sessions, with no adverse effects noted during recovery. The high success rates were independent of patient age, sex, and sedation type. There was a positive association between the indication for sedation and the type of sedation. The medically complex patients and the dentophobic patients received mainly moderate sedation (85.3% and 58.2%, respectively), whereas the disabled patients received deep sedation (51.2%). In total, 94% of patients were returning (re-visiting) patients. A statistically significant association was found between the type of sedation administered and the success rate during the first and last sessions (P < .001). The success rate at the first session may be predictive of the success in subsequent sessions. CONCLUSION: A significant positive correlation was found between patient characteristics and the chosen sedation type leading to a high success rate across the various sedation modalities.

Asunto(s)

RESUMEN

Objetivo: Pacientes com necessidades especiais são aqueles indivíduos que necessitam de cuidados especiais por tempo indeterminado ou por toda a vida. O presente estudo tem como objetivo abordar o atendimento odontológico de pacientes com necessidades especiais em uma instituição privada de ensino superior da cidade de São Paulo. Material e Métodos: Foi realizado um estudo descritivo, retrospectivo, para análise de 210 prontuários odontológicos de pacientes com necessidades especiais atendidos no Departamento de Odontologia para Pacientes Especiais da Universidade Cruzeiro do Sul entre 2012 e 2018. Dados sobre sexo, idade, diagnóstico da condição debilitante, motivo da consulta, uso continuado de medicamentos, imagens radiográficas e tratamentos odontológicos prestados foram todos coletados e posteriormente submetidos à análise estatística descritiva e inferencial (teste do qui-quadrado) ao nível de significância de 5%. Resultados: Quanto aos tipos de procedimentos odontológicos avaliados no presente estudo, dos 210 pacientes, 24% necessitaram de tratamentos curativos dentários em que a terapia periodontal foi o tipo mais prevalente, enquanto os tratamentos endodônticos tiveram a menor prevalência, representando apenas 4%. Houve alta prevalência de doenças crônicas sistêmicas, acometendo 56% dos casos, cuja faixa etária era superior a 40 anos. Conclusão: Check-ups odontológicos regulares devem ser priorizados em pacientes com necessidades especiais para evitar intervenções mais invasivas como em nosso grupo (AU)

Objective: Patients with special needs are those individuals who need special care for an undetermined period of time or for lifetime. The present study is aimed to address the dental care of special needs patients at a private higher education institute in the city of São Paulo. Material and Methods: A descriptive, retrospective study was performed for analysis of 210 dental records of special needs patients who were treated at the Dental Department for Special Patients of the Cruzeiro do Sul University between 2012 and 2018. Data on gender, age, diagnosis of the debilitating condition, reason of the consultation, continued use of medications, radiographic images and dental treatments provided were all collected before being submitted to descriptive and inferential statistical analysis (chi-square test) at a significance level of 5%. Results: As for the types of dental procedures assessed in the present study, of the 210 patients, 24% needed dental curative treatments in which periodontal therapy was the most prevalent type, whereas endodontic treatments had the lowest prevalence, representing 4% only. There was a high prevalence of chronic systemic diseases, affecting 56% of the dental records, whose age group was above 40 years old. Conclusion: Regular dental check-ups should be prioritized in patients with special needs to avoid more invasive interventions as found in our group (AU)

Asunto(s)

RESUMEN

The article considers results of studying the quality of life of disabled patients because of diseases of peripheral nervous system. The significantly low level of indices of quality of life self-assessment was established on all scales of SF-36 questionnaire that are from 3 to 7 times lower than similar indices in population of Russia. The assessment of quality of life of disabled patients is necessary to determine effectiveness of applied rehabilitation measures and application of obtained results in planning further rehabilitation and habilitation activities.

Asunto(s)

RESUMEN

OBJECTIVE: The objectives of this study were to describe poisonings occurring in older or disabled patients residing in structured living facilities, identify risk factors, and propose preventive measures. METHOD: This was a prospective and observational study, covering all cases of poisoning occurring in structured living facilities in the Brittany region of France. All calls were received at the Grand Ouest Poison Control Centre (PCC) of Angers and were recorded from 1 February 2019 to 31 January 2020. The clinical severity of the poisonings was assessed using the Poisoning Severity Score (PSS). Clinical severity was compared by univariate and multivariate analyses using the following dependent variables: PSS score < 2 and PSS ≥ 2. RESULTS: This study included 158 residents with a median age of 83 years (5-116 years old). The average number of residents supervised by a member of the supervisory staff was 11 (+/-10.7). The substance ingested was a personal hygiene product or a cleaning product in 48% and 25% of cases, respectively. The most frequently ingested product was a bar of soap (n = 20). All moderate to severe cases (4.6%, n = 8 including one death) occurred in residents with dementia living in nursing homes for elderly patients, and 9% of residents required hospital treatment. In more than 50% of cases (n = 83), the product was provided by the facility and in 23% (n = 40), it was brought in by the family. Ingestion of a bar of soap or a product brought in by the family was significantly associated with higher poisoning severity (PSS ≥ 2). After adjustment for age, sex and the number of residents per supervisor, the severity of poisoning was significantly greater after ingestion of a bar of soap (OR = 12.33, CI95 [2.12, 71.63], p = 0.005). CONCLUSION: Older adults residing in medical facilities who have a history of dementia and/or cognitive impairment are more at risk of non-medicinal product poisoning. Clinical severity and the hospitalisation rate were greater when bar soap was ingested.

Asunto(s)

RESUMEN

BACKGROUND: This study aimed to examine whether the combination of low-dose ketamine and propofol in deep sedation is clinically useful in controlling the behavior in intellectually disabled patients who are typically extremely noncooperative during dental procedures. METHODS: A total of 107 extremely noncooperative intellectually disabled adult patients were analyzed. In all patients, deep sedation was performed using either propofol alone (group P) or using a combination of propofol and 0.2 mg/kg or 0.4 mg/kg ketamine (groups PK0.2 and PK0.4, respectively). The procedures were performed in the order of insertion of nasal cannula into the nostril, attachment of mouth gag, and mouth cleaning and scaling. The frequency of patient movement during the procedures, mean arterial pressure, heart rate, peripheral oxygen saturation, recovery time, discharge time, and postoperative nausea and vomiting were examined. RESULTS: The three groups were significantly different only in the frequency of patient movement upon stimulation during single intravenous injection of propofol and scaling. CONCLUSION: For propofol deep sedation, in contrast to intravenous injection of propofol alone, prior intravenous injection of low-dose ketamine (0.4 mg/kg) is clinically useful because it neither affects recovery, nor causes side effects and can suppress patient movement and vascular pain during procedures.

RESUMEN

In this paper, we present a new complex electronic system for facilitating communication with severely disabled patients and telemonitoring their physiological parameters. The proposed assistive system includes three subsystems (Patient, Server, and Caretaker) connected to each other via the Internet. The two-way communication function is based on keywords technology using a WEB application implemented at the server level, and the application is accessed remotely from the patient's laptop/tablet PC. The patient's needs can be detected by using different switch-type sensors that are adapted to the patient's physical condition or by using eye-tracking interfaces. The telemonitoring function is based on a wearable wireless sensor network, organized around the Internet of Things concept, and the sensors acquire different physiological parameters of the patients according to their needs. The mobile Caretaker device is represented by a Smartphone, which uses an Android application for communicating with patients and performing real-time monitoring of their physiological parameters. The prototype of the proposed assistive system was tested in "Dr. C.I. Parhon" Clinical Hospital of Iasi, Romania, on hospitalized patients from the Clinic of Geriatrics and Gerontology. The system contributes to an increase in the level of care and treatment for disabled patients, and this ultimately lowers costs in the healthcare system.

Asunto(s)

RESUMEN

AIMS: Although it has been reported that general anesthesia affect the perioperative sleep cycle, no studies have yet evaluated how general anesthesia affects dentally disabled patients. In this study, we investigated the alteration of perioperative sleep cycles in dentally disabled patients receiving dental treatment under general anesthesia. SUBJECTS AND METHODS: The study included 16 patients receiving dental procedures under general anesthesia. Using a sleep monitoring mat, the patients' sleep cycles were measured at home from 5 days before the scheduled surgery date until 5 days after discharge following general anesthesia. The change in all the variables of sleep cycles were analyzed in comparison to the value in preoperative period. Daily differences in these variables were assessed for statistical analysis. RESULTS: The percentage of deep sleep (Stages 3 and 4) decreased significantly on postoperative day 1, and the percentage of light sleep increased. Furthermore, sleep cycles were significantly extended on postoperative day 1. CONCLUSION: The percentage of deep sleep decreased significantly on postoperative day 1 while the percentage of light sleep increased. Sleep cycles were also significantly extended on postoperative day 1. These results reveal that the sleep cycle is somehow affected on the first day following general anesthesia.

Asunto(s)

RESUMEN

The present study examined the performance level and its related factors on the process of case management for disabled patients on hemodialysis. Case management performance was evaluated at three stages: patient assessment, making a care plan, and monitoring/evaluation. Candidates for targeting the factors relating to performance included four dimensions: nursing care level, physical malfunction, cognitive malfunction, and barriers to service were used as patient factors; the period of case management for the patient and the knowledge of dialysis emerged as case manager factors; work load was included as an organizational factor; and community resources for these services and communication with surrounding persons were included as system factors. Self-administrated questionnaires were collected from 391 case managers of patients with hemodialysis certified long-term insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. Case managers were asked questions about their management of each individual case. The results indicate, for example, that poor knowledge of dialysis is significantly related to poor patient assessment, inadequate development of a care plan, and lower levels of monitoring/evaluation. In addition, work overload and diabetic nephropathy as the primary kidney disease were also found to be significantly related to poor patient assessment. Increasing the opportunity for case managers to learn about dialysis may be needed for better case management performance in respect of the hemodialysis of disabled patients.

Asunto(s)

RESUMEN

A novel non-contact controller of the electric bed for medical healthcare was proposed in this study. Nowadays, the electric beds are widely used for hospitals and home-care, and the conventional control method of the electric beds usually involves in the manual operation. However, it is more difficult for the disabled and bedridden patients, who might totally depend on others, to operate the conventional electric beds by themselves. Different from the current controlling method, the proposed system provides a new concept of controlling the electric bed via visual stimuli, without manual operation. The disabled patients could operate the electric bed by focusing on the control icons of a visual stimulus tablet in the proposed system. Besides, a wearable and wireless EEG acquisition module was also implemented to monitor the EEG signals of patients. The experimental results showed that the proposed system successfully measured and extracted the EEG features related to visual stimuli, and the disabled patients could operate the adjustable function of the electric bed by themselves to effectively reduce the long-term care burden.

Asunto(s)

RESUMEN

BACKGROUND: The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. METHODS: Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. RESULTS: Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. CONCLUSIONS: With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase.

RESUMEN

BACKGROUND: The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. METHODS: Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. RESULTS: Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. CONCLUSIONS: With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase.

Asunto(s)

RESUMEN

BACKGROUND: The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. METHODS: Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. RESULTS: Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. CONCLUSIONS: With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase.

Asunto(s)

RESUMEN

The design of a novel non-contact multimedia controller is proposed in this study. Nowadays, multimedia controllers are generally used by patients and nursing assistants in the hospital. Conventional multimedia controllers usually involve in manual operation or other physical movements. However, it is more difficult for the disabled patients to operate the conventional multimedia controller by themselves; they might totally depend on others. Different from other multimedia controllers, the proposed system provides a novel concept of controlling multimedia via visual stimuli, without manual operation. The disabled patients can easily operate the proposed multimedia system by focusing on the control icons of a visual stimulus device, where a commercial tablet is used as the visual stimulus device. Moreover, a wearable and wireless electroencephalogram (EEG) acquisition device is also designed and implemented to easily monitor the user's EEG signals in daily life. Finally, the proposed system has been validated. The experimental result shows that the proposed system can effectively measure and extract the EEG feature related to visual stimuli, and its information transfer rate is also good. Therefore, the proposed non-contact multimedia controller exactly provides a good prototype of novel multimedia controlling scheme.

Asunto(s)

RESUMEN

BACKGROUND: Carnitine plays a pivotal role in a variety of cellular functions. Carnitine deficiency often occurs in severely disabled patients, especially under valproic acid administration. However, the possible causative factors underlying carnitine deficiency have not been fully identified. The present study aimed at clarifying the association of various anthropometric and biochemical variables, including dietary intake of carnitine, with carnitine levels in severely disabled patients. METHODS: Twenty-six severely disabled patients (mean age: 14.1 years; s.d. 7.8) were enrolled. Plasma carnitine levels were evaluated by an enzyme cycling assay. Estimation of the dietary intake of carnitine was made based on dietary records over a 3-day period. RESULTS: Plasma total and free carnitine levels in patients were significantly lower than those in controls obtained from the previous report. However, the ratios of free carnitine to total carnitine did not change significantly. Free carnitine levels were well correlated with a nutritional intake of carnitine. Administration of not only valproic acid but also other anti-epileptic drugs was found to cause a significant decrease of free carnitine levels after adjusting the nutritional intake of carnitine. Among various anthropometric or biochemical variables, albumin and uric acid showed a significant correlation with free carnitine levels. CONCLUSIONS: Physicians should be aware of the fact that severely disabled patients are at risk for carnitine deficiency even in the absence of valproic acid administration, and pay more attention to the nutritional intake of carnitine.

Asunto(s)

RESUMEN

BACKGROUND: Patients were subjected to post-discharge follow-up (by telephone) in order to investigate the potential complications of outpatient general anesthesia or deep sedation that could develop in disabled dental patients discharged from the hospital. The ultimate aim of this study was to establish an appropriate response measure for such complications. METHODS: The caregivers of 79 disabled patients who underwent dental procedures under general anesthesia at our outpatient clinic were interviewed over telephone. Necessary care instructions were provided during the phone calls when required. The patient satisfaction level regarding the telephonic follow-up care was surveyed by additional telephone calls. RESULTS: Most of the patients did not suffer any serious complications; however, some reported fever and bleeding. The data obtained in this study can be utilized towards the development of caregiver education pertaining to the ambulatory general anesthesia of dental patients with disabilities. CONCLUSIONS: Additionally, we hope that the findings of this study will help minimize the effects of complications experienced by disabled dental patients undergoing ambulatory general anesthesia, as well as increase the overall patient satisfaction level.

RESUMEN

BACKGROUND: Patients were subjected to post-discharge follow-up (by telephone) in order to investigate the potential complications of outpatient general anesthesia or deep sedation that could develop in disabled dental patients discharged from the hospital. The ultimate aim of this study was to establish an appropriate response measure for such complications. METHODS: The caregivers of 79 disabled patients who underwent dental procedures under general anesthesia at our outpatient clinic were interviewed over telephone. Necessary care instructions were provided during the phone calls when required. The patient satisfaction level regarding the telephonic follow-up care was surveyed by additional telephone calls. RESULTS: Most of the patients did not suffer any serious complications; however, some reported fever and bleeding. The data obtained in this study can be utilized towards the development of caregiver education pertaining to the ambulatory general anesthesia of dental patients with disabilities. CONCLUSIONS: Additionally, we hope that the findings of this study will help minimize the effects of complications experienced by disabled dental patients undergoing ambulatory general anesthesia, as well as increase the overall patient satisfaction level.

Asunto(s)

RESUMEN

INTRODUCTION: Studies in several countries have shown that dental students need an improved educational programme concerning management of disabled patients. We aimed to study the effect of providing a course entitled 'Oral health care of disabled patients' on knowledge and attitudes of senior dental students at Tehran University. MATERIALS AND METHODS: A total number of 70 students (n=70) were asked to fill in a questionnaire regarding their background, knowledge and attitudes, before and after the programme. The intervention group of 36 students (n=36) received a four-session course consisting of lectures, group discussion, screening and fluoride varnish provision for disabled patients. Statistical analysis was performed using the Mann-Whitney U-test, the chi-square test and linear regression modelling. RESULTS: Amongst all the participants, 36% had previously treated a disabled patient and 58% believed that merely specialists should treat disabled patients. Twenty-seven percentage of participants believed that hospital is the only proper facility for treating disabled patients. A considerable improvement in both knowledge and attitudes of students was observed following the intervention (P<0.05). CONCLUSIONS: Our findings indicate that a short-term training programme on oral health care has an immense impact on students' adherence to treating disabled patients. These results provide evidence to support the necessity of enrichment of the dental curriculum regarding oral health care for disabled patients.

Asunto(s)

RESUMEN

Several reports described various mosaic chromosomal syndromes characterized by alterations originated by either an excess or deficit in the number of chromosomes. A case of mosaic trisomy 8 and monosomy 18 with significant involvement of the oral cavity is described, both in terms of general medicine and from a dental-oral perspective, and the treatment plan was planned and discussed.Regular follow-up visits enabled to verify significant improvement in all parameters of the patient's oral health, which urged us to press on with our quest to protect the right to health of patients affected by disabilities.

RESUMEN

UNLABELLED: This study is concerned with the educational intervention layout proposed as a possible answer for the disparities in healthcare services for disabled persons. MATERIAL AND METHODS: The data sampling was performed on individuals in Rome, affected by psychophysical disabilities, living in residential care facilities. Participants were randomly divided into two groups: Study and Control Group, consisting of patients who did or did not participate in the Educational Phase. All the caregivers participated in an educational course. Screening period: September 2008 - March 2009. Examinations were performed using Visible Plaque Index (VPI), Gingival Bleeding Index (GBI) and Microbiological Analysis. RESULTS: The total number of patients utilized for the study was 36 (18 in each group). The final sample amounted to 70% (14/20) in the Study Group and to 75% (15/20) in the Control Group. In both examined groups Oral Hygiene, Gingival Health State and Microbiological Analysis show an overall improvement of the indices, compared with the initial status, mostly at a follow-up after 4 weeks. However, Study Group show a significantly better improvement. Conversely, after 6 months the overall clinical indices worsened again. CONCLUSION: The difference in the significant improvements of the groups, even if only over a short-time evaluation, endorses that the participation of the patients as well as tutors in the educational phase is an effective strategy for the short-term.