The oral health status, behaviours and knowledge of patients with cardiovascular disease in Sydney Australia: a cross-sectional survey.

BACKGROUND: Periodontal disease is a risk factor for atherosclerotic cardiovascular disease and it is recommended internationally that patients with cardiovascular disease should engage in preventative oral health practices and attend regular dental care visits. This study aimed to explore the oral health status, behaviours and knowledge of patients with cardiovascular disease. METHODS: A cross-sectional questionnaire containing 31 items was administered to patients with cardiovascular disease from cardiac rehabilitation and outpatient clinics in Sydney Australia in 2016-2017. RESULTS: Of the 318 patients surveyed, 81.1% reported having at least one oral health problem. Over a third (41.2%) of participants had not seen a dentist in the preceding 12 months and 10.7% had received any oral healthcare information in the cardiac setting. Those with valvular conditions were more likely to have received information compared to those with other cardiovascular conditions (40.6% versus 7.4%, p < 0.001). Only half of the participants had adequate oral health knowledge. CONCLUSIONS: Despite a high incidence of reported oral health problems, many patients lacked knowledge about oral health, were not receiving oral health information from cardiac care providers and had difficulty accessing dental services. Further research is needed to develop oral health strategies in this area.

Oral health and cardiovascular care: Perceptions of people with cardiovascular disease.

MAIN OBJECTIVE: The aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health. METHOD: A needs assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis. RESULTS: Results suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants. RELEVANCE TO CLINICAL PRACTICE: The lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in their practice. Affordable and accessible dental care services for people with cardiovascular disease should be considered and offered by health services in Australia.

Implantable cardiac defibrillators and end-of-life care--time for reflection, deliberation and debate?

Heart failure (HF) is a common condition associated with high rates of morbidity and mortality. Implantable cardiac defibrillators (ICDs) are an important management strategy in HF management and decrease mortality for both primary and secondary prevention. An emerging body of literature identifies the challenges of managing ICDs at the end of life. This report discusses a critical incident experienced by a HF team in a referral centre and outlines the issues to be considered in advancing discussion and debate of managing ICDs at the end of life. Engaging in debate, discussion and consensus guidelines is likely to be crucial in minimising distress and burden for clinicians, patients and their families alike.

[Prescription and use of antibiotics at a pediatric intensive care unit in Buenos Aires City]. / Prescripción y uso de antibióticos en una unidad de cuidados intensivos pediátricos de la Ciudad de Buenos Aires.

INTRODUCTION: Antibiotics are the most prescribed drugs in pediatric intensive care units (PICU) with high impact in pathogens resistance and costs. OBJECTIVES: Evaluate prescription patterns and consumption of antibiotics. MATERIALS AND METHODS: From July 2006 to January 2007, monthly cross-sectional cuts were done on antibiotics use at the 1st and 7th days of prescription. A monthly antibiotics consumption average was then calculated. RESULTS: Of 81 patients, 41 received antibiotics, of which 34 were treated for at least seven days. INDICATORS: 1. Mean antibiotics / patient: 83 antibiotics were used at the initial empirical treatment (meropenem 18%, vancomycin 16.8%, amikacin 16.8%, cefotaxime 13.2%, ceftazidime 6%, clarithromycin 6%, piperacillin-tazobactam 4.8%, colistin 4.8%). mean: 2 antibiotics/patient. 98 antibiotics were used at the 7th day (vancomycin 17.3%, meropenem 16.3%, amikacin 9.8%, minocycline 9.8%, colistin 9.1%, amphotericin 6.1%, trimethoprim-sulfamethoxazole 4%, ceftazidime 5.1%). Mean: 2.8 antibiotics/patient. 2. Percentage of specimen obtained: Blood culture 100%, tracheal aspirate 68%, catheter culture 54.5% 3. Percentage of patients with positive culture: Pathogens were isolated in 56.1%, of which: Bacteria in 94.3%, Gram negative non fermenting strains, in 60.6%, Enterobacteriaceae in 24.2%, Gram positive cocci in 15% and Fungi in 5.7%. 4. Percentage of adjusted antibiotic scheme: 52%. 5. Percentage of interrupted antibiotics with negative culture: 22.2%. Monthly average of consumption was: meropenem 13.44; vancomycin 10.2; cefotaxime 3.6; ceftriaxone 2.20; piperacillin-tazobactam 7.38, amikacin 2.3. CONCLUSIONS: Vancomicyn and carbapenems were the antibiotics of greater use as initial empirical treatment. The initial empirical scheme would have to be adjusted to the microbiological results in order to obtain a more prudent antibiotic use.

Prescripción y uso de antibióticos en una unidad de cuidados intensivos pediátricos de la Ciudad de Buenos Aires / Prscription and use of antibiotics at a pediatric intensive care unit in Buenos Aires City

Los antibióticos son los medicamentos de mayor prescripción en terapia intensiva pediátrica(UTIP) con impacto en la resistencia bacterianay los costos.Objetivos. Evaluar patrones de prescripción y consumo de antibióticos. Material y métodos. Desde julio de 2006 hasta enerode 2007, se realizaron cortes de prevalencia mensualessobre uso de antibióticos al 1º y 7º día de la prescripción. Se calculó un promedio de consumo mensual para cada antibiótico. Resultados. De 81 pacientes, 41 recibieron antibióticos y, de ellos, 34 cumplieron al menos 7 días. Indicadores: 1. Promedio antibiótico por paciente: 83 antibióticos fueron utilizados en el esquema empírico(meropenem 18 por ciento, vancomicina 16,8 por ciento, amicacina16,8 por ciento, cefotaxima 13,2 por ciento, ceftazidima 6 por ciento, claritromicina 6 por ciento, piperacilina-tazobactam 4,8 por ciento, colistin4,8 por ciento). Promedio: 2 antibióticos/paciente; 98 antibióticosfueron relevados al 7o día (vancomicina17,3 por ciento, meropenem 16,3 por ciento, amicacina 9,8 por ciento, minociclina 9,8 por ciento, colistin 9,1 por ciento, anfotericina B 6,1 por ciento, cotrimoxazol4 por ciento, ceftazidima 5,1 por ciento). Promedio: 2,8 antibióticos/paciente.2. Porcentaje toma de muestras: hemocultivos 100 por ciento,aspirados traqueales 68 por ciento, catéteres 54,5 por ciento.3. Porcentaje de pacientes con aislamiento: presentaronaislamiento el 56,1 por ciento del total. Los hallazgos fueron:bacterias 94,3 por ciento, bacilos gramnegativos no fermentadores60,6 por ciento, enterobacterias 24,2 por ciento, cocos grampositivos15 por ciento, hongos 5,7 por ciento.4. Porcentaje de ajuste de esquemas antibióticos segúnmicrobiología: 52 por ciento.5. Porcentaje de suspensión antibiótica con cultivosnegativos: 22,2 por ciento .El promedio mensual de consumofue: meropenem 13,44; vancomicina 10,2; cefotaxima3,6; ceftriaxona 2,20; piperacilina-tazobactam 7,38 yamicacina 2,3