scholarly journals Dental and Periodontal Care at the Bedside Using a Portable Dental Unit in Hospitalized Special Needs Patients: The Experience of an Italian Pediatric Hospital

2021 ◽  
Vol 18 (15) ◽  
pp. 7987
Author(s):  
Angela Galeotti ◽  
Massimiliano Ciribè ◽  
Giorgio Matarazzo ◽  
Giancarlo Antonielli ◽  
Paola Festa ◽  
...  
Keyword(s):  
Special Needs ◽  
Heart Surgery ◽  
Oral Care ◽  
Open Heart Surgery ◽  
Hospitalized Patients ◽  
Pediatric Hospital ◽  
Oral Diseases ◽  
Developmental Problems ◽  
Increased Risk ◽  
Patients With Special Needs

Patients with special needs (SNPs) include individuals who are disabled due to physical limitations, medical complications, developmental problems, and cognitive impairments. SNPs may be at an increased risk of oral diseases throughout their lifetime. These patients have difficulties in accessing traditional dental studios or clinics. Moreover, orodental problems may cause local and generalized infections, leading to worrisome complications when not properly treated. In this paper, we describe the preliminary experience of treating dental problems in a series of nine hospitalized patients with special needs. This innovative protocol at the Bambino Gesù Children’s Hospital (Rome, Italy) provides an introduction to a portable dental unit in order to perform oral care for hospitalized patients at the bedside. A multidisciplinary team composed of pediatric dentists, dental hygienists, nursing staff, and the patient’s case manager was involved in the operative protocol. The SNPs described were affected by congenital heart or oncohematological diseases and neurodisabilities, and they were all hospitalized for different reasons: Open heart surgery, chemotherapy, organ transplantation, and rehabilitation. The oral evaluation was mandatory for ruling out or treating problems that could cause complications. Dental extractions, caries and fracture fillings, sealing, and oral hygiene procedures were performed at the bedside of the patients in the reference unit of their pediatric hospital. The results of this protocol confirm the feasibility of dental procedures at patients’ bedside with portable dental units, encourage implementation of their use, and may represent an actionable model for oral care management in hospitalized SNPs.

scholarly journals Nurses’ educational needs in the oral health of inpatients at Yazd Province in Iran: a Delphi study

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Seyed Hosein Tabatabaei ◽  
Fatemeh Owlia ◽  
Fatemeh Ayatollahi ◽  
Fahimeh Rashidi Maybodi ◽  
Hakimeh Ahadian ◽  
...  
Keyword(s):  
Oral Health ◽  
Delphi Study ◽  
Descriptive Analysis ◽  
Oral Care ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Educational Needs ◽  
Hospitalized Patients ◽  
Oral Diseases ◽  
School Of Dentistry

Abstract Background Oral hygiene is an integral part of general health of a person. Nurses qualified about oral care can play an important role in improving the quality of oral health in hospitalized patients. This study investigated the educational needs of nurses in the field of oral health of hospitalized patients. Methods The study used the modified Delphi method in three rounds. Fifty faculty members of the School of Dentistry and Nursing were selected via purposive sampling. The data collection tool was a demographic form and an open-ended questionnaire in the first round and a structured questionnaire in the next rounds. The analysis was performed using both content and descriptive analysis techniques. Results The top ten oral health education priorities for nurses were greater than 75% with a consensus level: oral anatomy and physiology, learning the signs and symptoms of common oral diseases, learning of oral medications and administration, learning the drugs that cause damage to the mouth and teeth, training in managing dental emergencies, patient education for tooth brushing and taking care of the mouth, especially in the elderly patient, providing oral and dental care, training for unconscious and fasting patients, undergoing chemotherapy and radiotherapy, and hospitalization in intensive care unit. Conclusion The findings of the study emphasized the need for interdisciplinary cooperation between nursing and dental professionals for the development of an oral health curriculum for nurses to promote and improve oral health and prevent dental diseases in hospitalized patients and the community.

scholarly journals Perioperative Endocarditis Management in a Patient with Homozygous Sickle Cell Disease

2019 ◽  
Vol 08 (01) ◽  
pp. e1-e4 ◽  
Author(s):  
Malgorzata Gozdzik ◽  
Sergio Mariotti ◽  
Michele Genoni ◽  
Alicja Zientara
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Cell Disease ◽  
Coagulase Negative Staphylococci ◽  
Right Heart ◽  
Double Valve Replacement ◽  
Increased Risk ◽  
Homozygous Sickle Cell Disease

Background Homozygous sickle cell disease (SCD) compounded with bacterial endocarditis makes open-heart surgery a multidisciplinary challenge. Case description A 45-year-old African male patient with homozygous SCD presented with right heart decompensation, tricuspid regurgitation, and endocarditis of the aortic valve. Blood coulters were positive for coagulase-negative staphylococci. An emergent double valve replacement was successfully performed involving a multidisciplinary team. Conclusion Homozygous SCD is associated with an increased risk of preoperative vaso-occlusive complications. Surgery with cardiopulmonary bypass can be performed, if hypothermia, hypoxia, acidosis, or low-flows are being avoided. Due to the lack of data, the adequate approach is still intuitive and requires standardization.

Sternal Anomalies in Asymptomatic Patients after Median Sternotomy and Potential Influencing Factors

2017 ◽  
Vol 66 (06) ◽  
pp. 517-522
Author(s):  
Simon Sündermann ◽  
Hatem Alkadhi ◽  
Michele Genoni ◽  
Francesco Maisano ◽  
Maximilian Emmert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Surgery ◽  
Plate Fixation ◽  
Treatment Options ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Patient Specific ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Potential Risk Factors

Background We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA. Methods Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV) procedures via median sternotomy. Sternal bone healing was analyzed for SA and their exact location. Results In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6, p = ns). The distance between wire placement to the proximal edge of the manubrium in normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA. Conclusion At least 30% of patients were at an increased risk for SA after receiving a median sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial in such patients.

Postoperative administration of tranexamic acid as approach to reduce blood loss after open-heart surgery

2020 ◽  
Vol 76 (1) ◽  
pp. 43-49
Author(s):  
Florian Meissner ◽  
Katrin Plötze ◽  
Klaus Matschke ◽  
Thomas Waldow
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Postoperative Blood Loss ◽  
Open Heart ◽  
Reduce Blood Loss ◽  
Perioperative Bleeding ◽  
Increased Risk ◽  
Postoperative Administration

BACKGROUND: Tranexamic acid (TXA) reduces perioperative bleeding among patients undergoing heart surgery. It is uncertain whether its postoperative administration, after prior administration before cardiopulmonary bypass (CPB), has an additional benefit. OBJECTIVE: Our study aimed to evaluate whether the postoperative administration of TXA reduces the blood loss after heart surgery. METHODS: In a retrospective cohort study at the University Heart Center Dresden, patients who underwent on-pump open-heart surgery and received 1 g TXA before CPB were included. Patients with postoperative administration of 1 g TXA were compared to patients without. Primary endpoint was the postoperative blood loss within 24 hours. RESULTS: Among 2,179 patients undergoing heart surgery between 1 July 2013 and 31 October 2014, 92 (4.2%) received TXA postoperatively. After matching, 71 patients with postoperative administration of TXA were compared to 71 without (n = 142). Postoperative administration of TXA did not result in decreased blood loss (MD 146.7 mL; p = 0.064). There was no evidence of an increased risk for thromboembolic complications. CONCLUSIONS: The postoperative administration of TXA did not reduce blood loss. The use of TXA was shown to be safe in terms of thromboembolic events and hospital mortality. Unless there is no clear evidence, the postoperative administration of TXA should be restricted to patients with massive blood loss and signs of hyperfibrinolysis only.

scholarly journals Endovascular Embolization of Intracranial Infectious Aneurysms in Patients Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate

2017 ◽  
Vol 6 (1-2) ◽  
pp. 82-89 ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Seby John ◽  
Mark Bain ◽  
Gabor Toth ◽  
Thomas Masaryk ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Heart Surgery ◽  
Short Interval ◽  
Open Heart Surgery ◽  
Cleveland Clinic ◽  
Endovascular Embolization ◽  
Open Heart ◽  
Aneurysm Embolization ◽  
Increased Risk ◽  
Mycotic Aneurysms

Introduction: Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Methods: Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Results: Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Conclusions: Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible.

scholarly journals Factors Affecting Post Open-Heart Surgery Outcomes for Hospitalized patients

2020 ◽  
Vol 11 (1) ◽  
pp. 41-58
Author(s):  
Mohamed Mousa Elsaed ◽  
Asmaa Hamdi Mohamed ◽  
Mona Nadr Ebrahim
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Hospitalized Patients ◽  
Open Heart ◽  
Factors Affecting ◽  
Surgery Outcomes

Elevated Preoperative Fasting Serum Glucose Levels Increase the Risk of Postoperative Mediastinitis in Patients Undergoing Open Heart Surgery

2003 ◽  
Vol 24 (10) ◽  
pp. 776-778 ◽  
Author(s):  
Stephen J. Wilson ◽  
Daniel J. Sexton
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Serum Glucose ◽  
Open Heart ◽  
Preoperative Fasting ◽  
Fasting Serum ◽  
Fasting Serum Glucose ◽  
Glucose Levels ◽  
Increased Risk ◽  
The Relationship

AbstractWe conducted a case-control study to investigate the relationship between preoperative fasting serum glucose and postoperative mediastinitis in patients undergoing open heart surgery. Multivariate analysis revealed that a glucose level of 126 mg/dL or greater was associated with a significantly increased risk of mediastinitis (OR, 5.25; P = .002).

scholarly journals Dexmedetomidine-Associated Hyperthermia: A Retrospective Cohort Study of Intensive Care Unit Admissions between 2009 and 2016

2017 ◽  
Vol 45 (6) ◽  
pp. 727-736 ◽  
Author(s):  
K. E. D. Grayson ◽  
A. E. Tobin ◽  
D. T. K. Lim ◽  
D. E. Reid ◽  
M. Ghani
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Increased Risk

Dexmedetomidine-associated hyperthermia has not been previously studied. Analysis is warranted to determine whether this potentially dangerous complication is more prevalent than previously realised. We aimed to examine the association between dexmedetomidine and temperature ≥39.5°C, including patient characteristics, temporality and potential risk factors. We conducted a retrospective cohort study of all intensive care unit (ICU) admissions between 1 July 2009 and 31 May 2016 in a tertiary ICU in Australia. Temperature data was available for 9,782 ICU admissions. Dexmedetomidine was given intravenously to 611 (6.3%) patients at a dose of 0 to 1.5 g/kg/hour. Temperatures ≥39.5°C were recorded in 341 (3.5%) patients. Overall hospital mortality was 10.8% for all admissions and 29.3% for patients with temperatures ≥39.5°C. Dexmedetomidine exposure was more frequent in patients with temperature recordings ≥39.5°C compared to those with temperatures <39.5°C, 11.94% versus 2.94% (odds ratio [OR] 4.49; 95% confidence intervals [CI] 3.37, 5.92; P <0.001). The association was stronger for patients post-open heart surgery (OHS) with temperatures ≥39.5°C (OR 12.9; 95% CI 5.01, 31.62; P <0.001). Multivariate analysis showed an independent association between dexmedetomidine and a temperature ≥39.5°C in two particular patient groups: OHS (OR 2.72; 95% CI 1.1, 6.9; P <0.001), and obesity (OR 3.44; 95% CI 1.5, 7.9; P <0.001). Dexmedetomidine exposure is associated with an increased risk of hyperthermia. Possible risk factors are open heart surgery and obesity.

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