Smiles for success: restoring functional dentition one mouth at a time.

Edentulism is the outcome of a multifactorial process involving biological factors and patient-related factors. Prosthodontics serves as a solution. Tooth replacement through prosthetic devices may be prohibitive for the underserved population due to barriers such as cost and lack of transportation. A community service project was developed as a response strategy to address these concerns in Fort Wayne, Indiana. With the help of Indiana University Purdue University (IPFW) Dental Laboratory Technology students and local dental professionals, the Smiles for Success: Restoring Functional Dentition One Mouth at a Time project assisted the underserved of Fort Wayne. Success was accomplished through the repair or reline of existing dentures, as well as the creation of new partial and complete oral prosthetic appliances. Working within the existing healthcare framework of an inner city clinic and local health fair for the underserved, the project completed work on 29 dentures and restored 22 patients to functioning dentitions. While the prosthetic appliances bring about new and restored smiles, it leads to a lifetime of new opportunities and improved health.

M-OSCE as a method to measure dental hygiene students' critical thinking: a pilot study.

Educators in all academic disciplines have been encouraged to utilize assessment strategies to evaluate students' critical thinking. The purpose of this study was to assess the viability of the modified objective structured clinical examination (m-OSCE) to evaluate critical thinking in dental hygiene education. This evaluation utilized a convenience sample of senior dental hygiene students. Students participated in the m-OSCE in which portions of a patient case were revealed at four stations. The exam consisted of multiple-choice questions intended to measure students' ability to utilize critical thinking skills. Additionally, there was one fill-in-the-blank question and a treatment plan that was completed at the fifth station. The results of this study revealed that the m-OSCE did not reliably measure dental hygiene students' critical thinking. Statistical analysis found no satisfactory reliability within the multiple-choice questions and moderately reliable results within the treatment planning portion of the examination. In addition, the item analysis found gaps in students' abilities to transfer clinical evidence/data to basic biomedical knowledge as demonstrated through the multiple-choice questioning results. This outcome warrants further investigation of the utility of the m-OSCE, with a focus on modifications to the evaluation questions, grading rubric, and patient case.

The history of dental hygiene in South Korea.

This historical narrative highlights the origin and development of the dental hygiene profession in South Korea. The legacy of early American missionaries to Korea includes profound and long-lasting contributions in medicine, education and theology. Many of Korea's top universities today have their roots in the missionary schools of the late nineteenth century, including Yonsei University, home of the first dental hygiene program in Korea. From Yonsei in Seoul, the dental hygiene profession spread throughout the country, includingtheAmerican missionary-based program in Kwangju in 1977. Contributions included clinical and didactic education, as well as professional leadership and development. American dental missionaries developed the profession of dental hygiene in Korea, and provided guidance to Korean dentists and hygienists for its growth and expansion.

Therapeutic hypothermia for management of neonatal asphyxia: what nurses need to know.

Birth asphyxia can induce a cascade of reactions that result in altered brain function known as hypoxic-ischemic encephalopathy. Possible outcomes for survivors of birth asphyxia vary widely, from a normal outcome to death, with a wide range of disabilities in between, including long-term neurodevelopmental disability, cerebral palsy, neuromotor delay, and developmental delay. Treatment of hypoxic-ischemic encephalopathy has centered on dampening or blocking the biochemical pathways that lead to death of neuronal cells. The reduction of body temperature by 3ºC to 5ºC less than normal body temperature can reduce cerebral injury. At Mount Sinai Hospital in Toronto, Ontario, the goal of therapeutic hypothermia is to achieve a rectal temperature of 33ºC to 34ºC, and the protocol is started within 6 hours after birth. The hypothermia is maintained for 72 hours, and then the infant is gradually warmed to normal body temperature (36.8ºC-37ºC). The protocol and nursing implications are presented.

Clothes encounter: patient perception of nursing attire in a behavioral health unit.

BACKGROUND: In an acute behavioral health unit, patients' perceptions of nurses can be influenced by the type of clothing they wear. OBJECTIVES: The purposes of this study were to determine if mental health patients had preferences related to nursing attire, to determine if patient preference varied with age, and to determine if nursing attire affected patients' thoughts on approachability, competence, and professionalism. STUDY DESIGN: A six-question survey was distributed to patients who met specific criteria between August and December 2008. RESULTS: Overall, patients did not have a preference for the type of attire worn by staff. Identification of nurses was a concern for many. More than half of the respondents indicated approachability was not affected by attire; however, 29% said that street clothes made the nurse less approachable. Attire did not affect patient perception of competence or professionalism. CONCLUSION: As behavioral health care changes, staff attire may need to be reconsidered.

Clinical practice guideline: benign paroxysmal positional vertigo.

OBJECTIVES: This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. PURPOSE: The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal medicine, neurology, nursing, otolaryngology-head and neck surgery, physical therapy, and physical medicine and rehabilitation. RESULTS: The panel made strong recommendations that 1) clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver. The panel made recommendations against 1) radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines. The panel made recommendations that 1) if the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to assess for lateral semicircular canal BPPV; 2) clinicians should differentiate BPPV from other causes of imbalance, dizziness, and vertigo; 3) clinicians should question patients with BPPV for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support, and increased risk for falling; 4) clinicians should treat patients with posterior canal BPPV with a particle repositioning maneuver (PRM); 5) clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution; 6) clinicians should evaluate patients with BPPV who are initial treatment failures for persistent BPPV or underlying peripheral vestibular or CNS disorders; and 7) clinicians should counsel patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The panel offered as options that 1) clinicians may offer vestibular rehabilitation, either self-administered or with a clinician, for the initial treatment of BPPV and 2) clinicians may offer observation as initial management for patients with BPPV and with assurance of follow-up. The panel made no recommendation concerning audiometric testing in patients diagnosed with BPPV. DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance in managing benign paroxysmal positional vertigo. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgement or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

Survey for teaching patient education in the dental hygiene curriculum.

PURPOSE: The primary objective of this descriptive study was to assess if and when dental hygiene curricula provide practice opportunities to students in teaching patient/client oral health self-care techniques and whether that experience was prior to their first clinical experience. METHODS: Data were collected through the use of descriptive research utilizing a two-page questionnaire containing some open-ended items. The survey was mailed to all 255 accredited dental hygiene programs in the United States and Puerto Rico in August 2000; 174 were returned. There was no pilot testing. The primary mailing resulted in a 68.2% return rate so a second mailing was not deemed necessary. Program administrators were asked to fill in their responses or pass the survey to faculty members in the program who teach preventive dentistry. The participating respondents were asked to describe the preventive dentistry portion of their curriculum by checking lists in the questionnaire and/or by writing responses in space provided. Specifically, respondents were asked to indicate how their program evaluated students on teaching patients self-care techniques in a preclinical and clinical setting. RESULTS: Based on this survey, almost half of all dental hygiene programs provide a preventive dentistry course. The other half incorporates the appropriate information in a preclinical course. Approximately 80% of all programs responding offer a unit in their curriculum that focuses on patient education, and almost 80% evaluate students' patient education technique before they begin working in a clinical setting. The results of the survey revealed that nearly all programs view patient education as highly important and would strongly agree that patients should be able to demonstrate mastery of their newly learned techniques. CONCLUSION: The results indicate that competency in student's teaching patient/client oral health self-care techniques is a priority for dental hygiene programs.

Accuracy of referring psychiatric diagnosis on a consultation-liaison service.

The authors determined the accuracy of the initial psychiatric diagnosis of primary medical providers requesting psychiatric consultation in a general medical inpatient setting. A retrospective review of 346 consecutive psychiatric consultations was conducted in which the initial diagnostic impression of primary medical providers was compared with the final psychiatric diagnosis. Accuracy rates for cognitive disorders, substance use disorders, and depressive disorders were 100%, 88.9%, and 53.6%, respectively. Thus, initial diagnoses of a cognitive or substance use disorder by primary medical providers are likely to be accurate, whereas an initial diagnosis of a depressive disorder will be inaccurate in approximately half of the cases.

Insomnia in a post-acute brain injury sample.

OBJECTIVE: The purpose was to establish the frequency of insomnia within the post-acute TBI population and compare it with insomnia rates among other rehabilitation outpatients. DESIGN: A prospective study was undertaken of 50 consecutive post-acute TBI admissions and a comparison group of 50 rehabilitation outpatients evenly divided between spinal cord injury (SCI) and musculoskeletal (MSK) cases. SETTING: Subjects were recruited at various outpatient clinics of a major rehabilitation hospital. PATIENTS: Among the TBI subjects, the predominant cause of injury was motor vehicle accident; both mild and severe injuries were well represented in the sample; and, on average, patients were almost 4 months post-injury. The comparison and TBI groups did not differ significantly with respect to education or marital status. However, the MSK group was older and a higher proportion of the SCI group was female. MEASURES: The Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and sleep diaries were administered to the TBI group. Only the PSQI and BDI were completed by the comparison group. RESULTS: Thirty per cent of the patients were found to suffer from insomnia. Sleep initiation was a problem almost twice as often as sleep duration. An additional 12% did not meet the DSM-IV criteria for insomnia but, nevertheless, experienced a degradation of sleep quality, as measured by the PSQI. Conversely, only slightly more than half (58%) of the TBI sample reported sleep to be relatively normal and satisfactory. Insomnia was also commonly reported by the patients in the rehabilitation comparison groups. They generated significantly higher mean PSQI Global Scores relative to the TBI group and the frequency of poor sleep quality was elevated significantly above the TBI rate. Relative to the TBI cases, twice as many comparison group patients were classified by the PSQI as insomniacs. CONCLUSION: Poor sleep quality and insomnia were definitely problems for the TBI group, although the magnitude of these problems was much greater for the rehabilitation comparison group. Degraded and disordered sleep may represent widespread challenges within the rehabilitation population in general.