ABSTRACT
BACKGROUND: Liver transplantation has become commonplace for patients with end-stage liver disease. The liver is a bodily organ of great importance, and its dysfunction can cause significant complications throughout the body. Patients with hepatic disease should be able to acquire knowledge of the physiology of the liver via the dental profession, and it is also necessary to modify some aspects of dental treatment even in healthy patients. Problems such as excessive bleeding and hepatotoxicity caused by some of the drugs used in dental treatment can lead to a decrease in systemic health. Otherwise, patients with liver disease will have poorer oral health than the general population. Thus, it is important to have well-established routine dental care in this patient group and offer management of oral health in view of the effects of liver disease. METHODS: The objective of this work was to undertake a bibliographic review of the dental approaches to patients with liver disease and liver transplant recipients and to propose a dental care routine for such patients in an outpatient setting. RESULTS: A search was carried out on the main scientific databases (PubMed, Medline, and SciELO) for publications related to this subject and, particularly those published after 2010. The articles selected describe poor oral hygiene among patients, independent of the etiology of their liver disease. These patients also had a high index of xerostomia, caries, periodontal disease, apical lesions, and fungical infections. To control bleeding during and after surgery, hemostatic measures must be understood and adopted. CONCLUSION: There are no data about routine dental care among liver disease/transplantation patients. Thus, our findings will hopefully encourage other services to structure their approaches and consider enhancing their dental care protocols for patients with liver-related complications.
Subject(s)
Dental Care for Chronically Ill/organization & administration , End Stage Liver Disease/physiopathology , Liver Transplantation/adverse effects , Periodontal Diseases/therapy , Postoperative Complications/therapy , Adult , Dental Caries/etiology , Dental Caries/therapy , End Stage Liver Disease/surgery , Female , Humans , Male , Oral Health , Outpatients , Periodontal Diseases/etiology , Postoperative Complications/etiology , Postoperative Period , Xerostomia/etiology , Xerostomia/therapyABSTRACT
BACKGROUND: The relevance that adherence to treatment plays in liver transplantation, and the impact this factor may have on the success of treatment, are fundamental in assessing the variables which affect patient adherence during the pretransplantation period. OBJECTIVES: This study aims to determine factors that affect liver transplant candidates' adherence to treatment, and analyze the association between adherence, socioeconomic and demographic factors, clinical characteristics, and patient understanding about the disease and liver transplantation. METHODS: This epidemiological, observational, and prospective study included 62 patients registered in the technical database of the Universidade Federal de São Paulo during the period November 2012-May 2014. The dependent variable was adherence to treatment among liver transplantation candidates, and the independent variables included understanding the disease and the transplantation process, and depression and anxiety symptoms among liver transplantation candidates. RESULTS: Work situation (P = .038), understanding about the disease (P = .002), and use of laxatives (P = .045) were the factors related to statistically significant adherence, and it can be concluded that implementation of an educational program may increase adherence up to 3.48 times in the pretransplantation phase, as adherence was 3.48 times lower in patients who reported little or no knowledge of the disease or the procedure.
Subject(s)
Liver Transplantation , Patient Compliance/statistics & numerical data , Patient Education as Topic , Adult , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Kidney transplantation is considered to be the best treatment for people with chronic kidney failure, because it improves the patients' quality of life and increases their length of survival compared with patients undergoing dialysis. The kidney transplantation process in Brazil is defined through laws, decrees, ordinances, and resolutions, but there is no visual representation of this process. The aim of this study was to analyze official documents to construct a representation of the kidney transplantation process in Brazil with the use of business process modeling notation (BPMN). The methodology for this study was based on an exploratory observational study, document analysis, and construction of process diagrams with the use of BPMN. Two rounds of validations by specialists were conducted. The result includes the kidney transplantation process in Brazil representation with the use of BPMN. We analyzed 2 digital documents that resulted in 2 processes with 45 total of activities and events, 6 organizations involved, and 6 different stages of the process. The constructed representation makes it easier to understand the rules for the business of kidney transplantation and can be used by the health care professionals involved in the various activities within this process. Construction of a representation with language appropriate for the Brazilian lay public is underway.
