Impact of cough and mucus on COPD patients: primary insights from an exploratory study with an Online Patient Community.

Background: Qualitative research provides real-life information on patients' condition and facilitates informed design of future clinical studies. Objective: We used Online Communities as a qualitative research tool to evaluate the effect of cough and mucus on COPD patients. Methods: Two 2-week Online Communities were run in parallel in the UK and in the USA, including COPD patients with persistent cough and excessive mucus. Patients anonymously posted their responses to pre-assigned tasks, supervised and guided by a trained moderator. Five themes around the impact of cough and mucus were explored with new questions posted every 2-3 days. On the final day, high-level conclusions were shared with patients for feedback. Data were analyzed following the principles of grounded theory. Results: Twenty COPD patients (UK, n=10; USA, n=10) participated in the Online Communities. We found that cough and mucus disrupted COPD patients' lives at functional, emotional, social and economic levels. Patients created daily rituals and adjusted their lifestyle to cope with the impact of these symptoms. Patients identified themselves with our conclusions and saw the Online Community as an effective forum to share their experiences. Conclusion: Findings of our study add to the body of evidence on the negative impact of COPD symptoms and unmet needs of these patients.

Investigating the effect of regional native accents on sentence comprehension in children with language impairment.

PURPOSE: Research has shown that accent variation can affect typically developing (TD) children's understanding of language, as well as that of children with speech difficulties, neuro-typical adults and those with aphasia and dementia. This study aims to investigate the effect of regional native accents on sentence comprehension in children with language impairment (LI), an area not previously explored. METHOD: Forty-three children with LI (mean age 6.04) and forty-five younger TD children (mean age 4.10), matched on a measure of sentence comprehension, completed a sentence comprehension task spoken in three regional accents. Instructions were spoken in the children's local Irish accent, a neutral-Irish accent and an unfamiliar Northern-Irish (NI) accent. Instructions were adapted from the Token Test and were matched on syllable length and complexity. RESULT: The two groups performed similarly overall on the task. Children had significantly greater difficulty understanding instructions spoken in the NI accent than in either of the other two accents. The ability to process accent variation was significantly associated with receptive language and phonological short term memory ability. CONCLUSIONS: Variation in regional accents may be negatively impacting the performance of children on language comprehension assessments. Potential effects on diagnostic or clinical decisions will require further exploration.

The effect of different speaker accents on sentence comprehension in children with speech sound disorder.

There is substantial evidence that a speaker's accent, specifically an unfamiliar accent, can affect the listener's comprehension. In general, this effect holds true for both adults and children as well as those with typical and impaired language. Previous studies have investigated the effect of different accents on individuals with language disorders, but children with speech sound disorders (SSDs) have received little attention. The current study aims to learn more about the ability of children with SSD to process different speaker accents. Fifteen children with SSD aged between 4;01 and 5;11 years, and 16 typically developing children matched on language ability, age, socioeconomic status, gender and cognitive ability participated in the current study. A sentence comprehension task was carried out with each child, requiring them to follow instructions of increasing length spoken in three different accents - (i) a local Irish (Cork) accent, (ii) a regional North American accent and (iii) a non-native Indian English accent. Results showed no significant group difference and speaker accent did not significantly impact children's performance on the task. The results are discussed in relation to factors that influence accent comprehension, and their implications for children's underlying phonological representations.

The relationship between information carrying words, memory and language skills in school age children with specific language impairment.

The receptive language measure information-carrying word (ICW) level, is used extensively by speech and language therapists in the UK and Ireland. Despite this it has never been validated via its relationship to any other relevant measures. This study aims to validate the ICW measure by investigating the relationship between the receptive ICW score of children with specific language impairment (SLI) and their performance on standardized memory and language assessments. Twenty-seven children with SLI, aged between 5;07 and 8;11, completed a sentence comprehension task in which the instructions gradually increased in number of ICWs. The children also completed subtests from The Working Memory Test Battery for children and The Clinical Evaluation of Language Fundamentals- 4. Results showed that there was a significant positive relationship between both language and memory measures and children's ICW score. While both receptive and expressive language were significant in their contribution to children's ICW score, the contribution of memory was solely determined by children's working memory ability. ICW score is in fact a valid measure of the language ability of children with SLI. However therapists should also be cognisant of its strong association with working memory when using this construct in assessment or intervention methods.

Transmission of blood-borne pathogens in US dental health care settings: 2016 update.

BACKGROUND: During the past decade, investigators have reported transmissions of blood-borne pathogens (BBPs) in dental settings. In this article, the authors describe these transmissions and examine the lapses in infection prevention on the basis of available information. METHODS: The authors reviewed the literature from 2003 through 2015 to identify reports of the transmission of BBPs in dental settings and related lapses in infection prevention efforts, as well as to identify reports of known or suspected health care-associated BBP infections submitted by state health departments to the Centers for Disease Control and Prevention. RESULTS: The authors identified 3 published reports whose investigators described the transmission of hepatitis B virus and hepatitis C virus. In 2 of these reports, the investigators described single-transmission events (from 1 patient to another) in outpatient oral surgery practices. The authors of the third report described the possible transmission of hepatitis B virus to 3 patients and 2 dental health care personnel in a large temporary dental clinic. The authors identified lapses in infection prevention practices that occurred during 2 of the investigations; however, the investigators were not always able to link a specific lapse to a transmission event. Examples of lapses included the failure to heat-sterilize handpieces between patients, a lack of training for volunteers on BBPs, and the use of a combination of unsafe injection practices. CONCLUSIONS: The authors found that reports describing the transmission of BBPs in dental settings since 2003 were rare. Failure to adhere to Centers for Disease Control and Prevention recommendations for infection control in dental settings likely led to disease transmission in these cases. PRACTICAL IMPLICATIONS: The existence of these reports emphasizes the need to improve dental health care personnel's understanding of the basic principles and implementation of standard precautions through the use of checklists, policies, and practices.

Children's comprehension of an unfamiliar speaker accent: a review.

BACKGROUND: The effect of speaker accent on listeners' comprehension has become a key focus of research given the increasing cultural diversity of society and the increased likelihood of an individual encountering a clinician with an unfamiliar accent. AIMS: To review the studies exploring the effect of an unfamiliar accent on language comprehension in typically developing (TD) children and in children with speech and language difficulties. This review provides a methodological analysis of the relevant studies by exploring the challenges facing this field of research and highlighting the current gaps in the literature. METHODS & PROCEDURES: A total of nine studies were identified using a systematic search and organized under studies investigating the effect of speaker accent on language comprehension in (1) TD children and (2) children with speech and/or language difficulties. MAIN CONTRIBUTION: This review synthesizes the evidence that an unfamiliar speaker accent may lead to a breakdown in language comprehension in TD children and in children with speech difficulties. Moreover, it exposes the inconsistencies found in this field of research and highlights the lack of studies investigating the effect of speaker accent in children with language deficits. CONCLUSIONS & IMPLICATIONS: Overall, research points towards a developmental trend in children's ability to comprehend accent-related variations in speech. Vocabulary size, language exposure, exposure to different accents and adequate processing resources (e.g. attention) seem to play a key role in children's ability to understand unfamiliar accents. This review uncovered some inconsistencies in the literature that highlight the methodological issues that must be considered when conducting research in this field. It explores how such issues may be controlled in order to increase the validity and reliability of future research. Key clinical implications are also discussed.

Standard and transmission-based precautions: an update for dentistry.

BACKGROUND: Standard Precautions are the foundation of all infection control programs and include infection control practices that apply to all patients and situations regardless of whether the infection status is suspected, confirmed or unknown. METHODS: The author reviewed Standard Precautions, including two new elements introduced by the Centers for Disease Control and Prevention in 2007: safe injection practices and respiratory hygiene and cough etiquette. Standard Precautions sometimes are referred to as the first tier of precautions because for some diseases and circumstances, transmission cannot be interrupted completely with Standard Precautions alone and it is necessary to use second-tier Transmission-Based Precautions. The author reviewed the three categories of Transmission-Based Precautions--Airborne, Droplet and Contact--with an emphasis on their use in dental health care outpatient settings. CONCLUSIONS AND CLINICAL IMPLICATIONS: Dental health care personnel (DHCP) should update their infection control programs to ensure that safe injection practices and respiratory hygiene and cough etiquette measures are used routinely. In addition, with the emergence of new pathogens, re-emergence of variant organisms and more patients seeking care in ambulatory care facilities, DHCP need to be aware of additional measures to take when treating patients in their offices who are actively infected with certain organisms to protect fully other patients, their staff members and themselves.

Instrument cassettes for office safety and infection control.

The goal of a dental infection control program is to provide a safe working environment that will reduce the risk of health care-associated infections among patients and occupational exposures among staff members. Minimizing the potential for percutaneous sharps injuries is a primary focus for a comprehensive infection control program. This article will review the advantages of using instrument cassettes, as well as provide an overview of engineering and work practice controls and instrument processing, to emphasize how appropriate use of instrument cassettes can improve office safety and infection control.

Statistical modeling of dental unit water bacterial test kit performance.

OBJECTIVE: While it is important to monitor dental water quality, it is unclear whether in-office test kits provide bacterial counts comparable to the gold standard method (R2A). Studies were conducted on specimens with known bacterial concentrations, and from dental units, to evaluate test kit accuracy across a range of bacterial types and loads. METHODOLOGY: Colony forming units (CFU) were counted for samples from each source, using R2A and two types of test kits, and conformity to Poisson distribution expectations was evaluated. Poisson regression was used to test for effects of source and device, and to estimate rate ratios for kits relative to R2A. RESULTS: For all devices, distributions were Poisson for low CFU/mL when only beige-pigmented bacteria were considered. For higher counts, R2A remained Poisson, but kits exhibited over-dispersion. Both kits undercounted relative to R2A, but the degree of undercounting was reasonably stable. Kits did not grow pink-pigmented bacteria from dental-unit water identified as Methylobacterium rhodesianum. CONCLUSION: Only one of the test kits provided results with adequate reliability at higher bacterial concentrations. Undercount bias could be estimated for this device and used to adjust test kit results. Insensitivity to methylobacteria spp. is problematic.

Characteristics of infection control programs in U.S. Air Force dental clinics: a survey.

BACKGROUND: National organizations and regulatory agencies have issued a number of guidelines on proper infection control procedures in dentistry. The objective of the authors' research was to gather information about current infection control practices in U.S. Air Force (USAF) Dental Corps clinics for the purpose of updating previously issued guidelines and developing infection control training programs. METHODS: The authors mailed a 60-item self-administered survey to the commanders of all USAF dental clinics located in the United States and overseas (n=82). The survey used primarily fixed-response questions to gather information about aspects of the clinics' infection control programs. The authors obtained descriptive statistics of the returned data by means of a statistical software package. RESULTS: The results indicated a high degree of compliance with existing USAF dental infection control guidelines. All clinics had personnel assigned to manage their programs, had a written exposure control plan and took measures to improve dental unit water quality. Facilities used a number of approaches to achieve and monitor compliance and exhibited a considerable amount of variation in infection control procedures when specific guidelines did not exist. CONCLUSIONS: In general, USAF dental clinics reported high levels of compliance with current infection control policies and procedures. Recurrent training, continual oversight, a highly motivated staff and teamwork are essential for reaching and maintaining these levels. Clinical Implications. Although compliance with recommended infection control guidelines is challenging, the results of this survey indicate that compliance is achievable, even in large group practices.

Guidelines for infection control in dental health care settings--2003.

BACKGROUND: The Centers for Disease Control and Prevention, or CDC, is the lead federal agency for disease prevention in the United States. It has been 10 years since CDC infection control guidelines for dental health care settings were last published. During those 10 years, new technologies and issues have emerged, and other CDC infection control guidelines for health care settings have been updated. RESULTS: In light of these developments, CDC collaborated with experts in infection control to revise its infection control recommendations for dental health care settings. Existing guidelines and published research pertinent to dental infection control principles and practices were reviewed. This article provides background information, describes the process used to create these guidelines, and lists the new recommendations. CLINICAL IMPLICATIONS: CDC believes that dental offices that follow these new recommendations will strengthen an already admirable record of safe dental practice. Patients and providers alike can be assured that oral health care can be delivered and received in a safe manner.

Looking inside the 2003 CDC dental infection control guidelines.

On Dec. 19, 2003, the Centers for Disease Control and Prevention published updated infection control guidelines for dentistry. The guidelines provide comprehensive information on all aspects of dental infection control. The recommendations are designed to prevent or reduce the potential for disease transmission from patient to dental health care personnel, from dental health care personnel to patient, and from patient to patient. Most recommendations will be familiar and are already practiced routinely. This article highlights major updates and additions in the CDC guidelines and provides additional information to assist readers in applying the latest guidelines. Almost a year ago, the CDC and Prevention published updated dental infection control guidelines in a supplement to the Morbidity and Mortality Weekly Report. The Guidelines for Infection Control in Dental Health Care Settings--2003 represent a collaborative effort between leading experts in infection control from other federal agencies, public health, and hospital epidemiology and infection control. Unlike regulatory agencies such as the Occupational Safety and Health Administration, the U.S. Food and Drug Administration, or the U.S. Environmental Protection Agency, the CDC cannot mandate certain practices; it can only recommend. However, the CDC is recognized as the nation's disease prevention agency and develops a broad range of guidelines intended to improve health care and to inform clinicians and the public. As a result, many dental licensing boards adopt CDC's recommendations, or variations of them, as the infection control standard for dental practice in their states. In contrast to the 1986 and 1993 CDC dental infection control recommendations, the 2003 CDC publication includes more background information and the scientific rationale for the recommendations. Also, readers will notice that each recommendation has a rank assigned to it categorizing the recommendation on the basis of existing scientific data, theoretical rationale, and applicability (Table 1). Most recommendations will be familiar and already are practiced routinely. As with previous CDC recommendations, the guidelines are designed to prevent or reduce the potential for disease transmission from patient to dental health care personnel; from dental health care personnel to patient, and from patient to patient. The following is an overview highlighting major updates and additions in the 2003 CDC guidelines. It is not intended to be a comprehensive review. Readers can access the complete document (Figure 1) by visiting www.cdc.gov/oralhealth/ infectioncontrol.

Sterilization update 2003.

Instrument processing is a key part of the office infection control program. Each step in the process must be performed correctly to help ensure patient safety. The instrument processing area must be organized so that contaminated items are not confused with sterilized items, and so that sterilized items do not accidentally become recontaminated. Instruments need to be cleaned completely of visible debris using an ultrasonic cleaner or instrument washer. The cleaned instruments are packaged before sterilization to protect them from recontamination until they are opened for use for the next patient. Processing the packaged instruments through a heat sterilizer (steam, dry heat, or unsaturated chemical vapor) kills any microbes that remain on the instruments. The sterile packages are handled and stored in a manner that preserves the integrity of the packaging material. The use and functioning of the sterilizer is monitored by mechanical, chemical, and biological means, and records are kept to document these evaluations. Sterilization failures are addressed carefully so that patient safety can be maintained.

Guidelines for infection control in dental health-care settings--2003.

This report consolidates previous recommendations and adds new ones for infection control in dental settings. Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories). These recommendations were developed in collaboration with and after review by authorities on infection control from CDC and other public agencies, academia, and private and professional organizations.