A meta-analysis dealing with the effectiveness of chlorhexidine and silver-sufhadiazine impregnated central venous catheters.
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Anti-Infective Agents, Local↗
Biomedical subjects
W D'Hoore
Publications and source records attributed to W D'Hoore.
The importance of repeated risk assessment for pressure sores in cardiovascular surgery.
BACKGROUND: Patients undergoing cardiovascular surgery are at high risk for sores because of impaired perfusion, the time spent on the operating room table, and restricted mobility in the immediate postoperative period. OBJECTIVE: To identify risk factors for sores. METHODS: In a 900-bed teaching hospital, 163 patients who underwent cardiovascular interventions were enrolled. Risk measurement included skin assessment, Braden and Norton scales, physic and biologic data and specific risk factors. The development of the most severe stages of pressure sores was followed (Stages II and III). RESULTS: Forty-eight (29.5%) patients totalized 75 pressure sores. In univariate analyses, Norton and Braden scores, hemoglobin concentration, presence of ulcers at admission, use of antihypertensive drugs, systemic use of corticosteroids, nosocomial infection, re-intervention and readmission in intensive care units were associated with sores. In a logistic regression model, hemoglobin concentration at admission (p=0.0007), postoperative Braden score (p=0.0002), and postoperative steroid therapy (p=0.020) were the only predictors of sores. Total length of stay was 6 days higher (p=0.03) for patients with pressure sores. CONCLUSIONS: The detection of risks is recommended during the entire stay. Identification of patients at risk is required to provide preventive resources appropriately, which can lessen the incidence of pressure sores and reduce patient discomfort, length and costs of hospital stay.
Aged↗
Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial.
It has been suggested that central venous catheters impregnated with antiseptics such as chlohexidine and silver-sulfadiazine reduce the risk of catheter-related bacteraemia in intensive care patients. Patients suffering from haematologic malignancy treated by chemotherapy through a central venous catheter are at even greater risk of catheter-related bacteraemia. A prospective double-blind randomized controlled trial was performed in order to investigate the effectiveness of chlorhexidine and silver-sulfadiazine impregnated catheters (CH-SS) in these patients. A total of 680 catheters (13,826 catheter days) were inserted, of which 338 were antiseptic impregnated. Bloodstream infection was observed in 105 cases with an overall risk of 7.6 per 1000 catheter days. Thirty-two infections (30.5%) were catheter-related, corresponding to a risk of 2.3 per 1000 catheter days. There was no statistically significant different between the overall rates of bloodstream infection for impregnated and non-impregnated catheters (14.5 vs. 16.3%). The incidence of catheter-related infection was also similar in both groups (5 vs. 4.4%) and there was no difference in the time of the onset of bacteraemia in the two groups. It is concluded that the use of CH-SS catheters in patients with haematologic malignancy reduces neither the overall risk of bloodstream infection, nor the catheter-related infection rate, nor the delay for the occurrence of infection.
Adult↗
Practical considerations on the use of the Charlson comorbidity index with administrative data bases.
To develop a measure of the burden of comorbid disease from the MED-ECHO data base (Québec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in 33,940 patients with ischemic heart disease. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on the predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. From a statistical viewpoint, the best results were obtained when the index was transformed into four dummy independent variables (the area under the receiver-operating curve is then 0.87). In a validation analysis performed on 1990-1991 MED-ECHO data (36,012 admissions with ischemic heart disease), the comorbidity index has the same statistical properties. We conclude that the Charlson index may be an efficient approach to risk adjustment from administrative data bases, although it should be tested on other conditions.
Aged↗
Retreatment or radiographic monitoring in endodontics.
UNLABELLED: The aim of this clinical study was to assess 1032 endodontically treated roots in relation to: (i) the success rate of retreatment (612 roots)--only cases that had recall examinations of 6 months or longer were evaluated; (ii) the influence of various factors on the technical and clinical results of the retreatment; and (iii) the consequences of radiographic monitoring of 420 asymptomatic roots when the root filling was radiographically deficient (short, overextended and/or permeable root fillings). Technical assessment of the retreatment showed that the root was adequately sealed in 52.3% of cases, the root filling was improved in 33.8%, was identical with the initial treatment in 11.1% and was worse than the first treatment in 2.8% of the canals. Clinical assessment of the retreatment of symptomatic roots showed that 71.8% of the retreatments were judged successful, 18.9% showed some healing and 9.3% had failed. The initial size of the periapical lesion, the use of rubber dam, the root filling technique and the apical level of the root filling had a statistically significant influence on the result of the retreatment. Monitoring radiographically (median time span 6 years) led to maintenance of the status quo in 94.8% of cases, healing in 2.4% and failure in 2.8% of the canals. Retreatment is clearly indicated when periapical radiolucency, clinical signs and/or symptoms are present with relative success of up to 91%. When no or little radiographic evidence of periapical pathology was present, when clinical signs and symptoms were absent or when the root filling was radiographically deficient, radiographic monitoring led to complications in only a limited number of cases. KEYWORDS: clinical decision, endodontic retreatment, radiographic evaluation.
Adult↗
Sex bias in the management of coronary artery disease in Quebec.
This study tests the hypothesis that, given the absence of financial barriers to major coronary procedures in Quebec, women are as likely as men to undergo such procedures. The use of coronary procedures in 33,940 patients with ischemic heart disease, admitted during 1 year to 78 Quebec hospitals, was analyzed. The male-to-female age- and severity-adjusted odds ratios for the use of these procedures were 1.47 for diagnostic procedures, 1.38 for therapeutic procedures, and 1.26 for diagnostic and therapeutic procedures. These results suggest that differences in the use of coronary procedures by sex are influenced by factors other than financial accessibility.
Aged↗
Risk adjustment in outcome assessment: the Charlson comorbidity index.
To measure the burden of comorbid diseases using the MED-ECHO database (Quebec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in a group of 62,456 patients having one of the following conditions: ischemic heart disease, congestive heart failure, stroke, or bacterial pneumonia. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. When gender, age, comorbidity and the principal diagnoses were taken into account, the area under the receiver-operating curve was 0.83. Therefore, the Charlson Index is a useful approach to risk adjustment in outcomes research from administrative databases.
Aged↗
Benefits and risks of fluoride supplementation: caries prevention versus dental fluorosis.
To assess the risks (dental fluorosis) and the benefits (caries prevention) of fluoride (F) tablets and F toothpaste, we surveyed 2003 schoolchildren aged 5-20 years old (mean = 10.82, SD = 3.40). Children were scored for dental caries by means of the decayed, missing, filled teeth index (DMFT index). Frequent use of F toothpaste (toothbrushing frequency) is poorly linked to caries (Spearman r = 0.05, P = 0.02) and dental fluorosis (r = 0.05, P = 0.03). Children who use F tablets regularly and appropriately exhibit mild fluorosis more often than non- or occasional users (odds ratio = 9.58), and have a mean DMFT index 50% lower than other children. We conclude that using F tablets is an effective means of preventing caries. When used appropriately in non fluoridated areas, using F tablets results in minor damage.
Adolescent↗
[Rational basis for resumption of treatment in endodontics. Should it be "down to the root" in order to be satisfied in endodontics?].
Any endodontic treatment showing a symptomatology should be retreated or corrected. Should we start the asymptomatic treatments over again when the x-ray does not show a filling that is complete, hermetically sealed, biological and under control? When the case arises, the decision to resume the treatment will depend on the state of the crown restoration: should it be redone for any reason? 1. When the crown filling does not need to be removed and redone, watchful waiting is recommended. 2. When the crown filling is deficient, and has to be redone, it would be advisable to resume or try to resume all the canal treatments that are not hermetically sealed, when an opening to the canal has to be worked out. Several experiences show that the rate of success of endodontic treatments that have been resumed is lower than that of endodontic treatments that have been carried out for the first time. Should radiographically inadequate but asymptomatic endodontic treatments not be resumed, it would result in problems only in a very small number of cases, as long as the state of intracanal balance is not broken.
Decision Trees↗
[Dental caries in a Belgian school population of 5-to-21-year-olds].
During the last 20 years, existing data show that caries activity has decreased in some industrialized countries, while marked increases have occurred, often rapidly, in developing countries. Changes in the prevalence of a multifactorial disease like dental caries are difficult to explain but seem to coincide either with increased intake of refined sugar-containing feeding or with the widespread availability of fluorides from many sources, more particularly in the tooth-pastes. The combination of fluorides with different other factors must be considered to explain the reduction in caries prevalence in the 1970's, but only the cariostatic effect of fluorides can be measured significantly. In spite of few studies in Belgium, a trend to a reduction of caries prevalence has been observed in temporary and permanent dentition. The aims of this study are to assess: 1. the oral health in a population of 5 to 21 old schoolchildren 2. and the effect of water naturally fluoridation on the dental caries prevalence. The dental caries prevalence is determined in each age group using the dft, dfs, D (2-4) MFT and D (2-4) MFS indices. The situation in this population is not satisfactory and there is a marked need for better oral health. The D (2-4) MFT increases from 1.67 to 11.29 between 6 and 20 years of age. In each age group, the numbers of carious and untreated surfaces in temporary and permanent dentition are more important than the number of filled surfaces. The percentage of children with caries-free teeth decreases from 27.0 to 0% between 5 and 20 years of age. A relation is recorded between the caries indices and the socio-economic category of the father, with the lowest indices among the higher educational group. The results show that the prevalence of dental caries is significantly lower in lifetime residents of the fluoridated community (Mouscron). Fluoridation reduces but does not eliminate social inequalities. The benefits of water fluoridation have been demonstrated in most countries but fluoridation alone is not sufficient to achieve total prevention.
Adolescent↗
[From epidemiology to social epidemiology in dentistry. The example of caries].
Today, we know the caries aetiology and prevention rather well. We also know that caries-related levels of dental health are inequitably distributed among social classes: on the average, disadvantaged people experience higher DMFS then privileged people. This difference can be explained by a differential access to health care, which can be shown by the study of components of the DMFS index: proportion of filled surfaces (F/DMFS), proportion of missing surfaces (M/DMFS), and proportion of recurrent caries (secondary caries/filled surfaces). Though we are able to describe the social distribution of levels of dental care, we cannot "explain" the differences we observe. The explanation of those differences defines the field of social epidemiology. This consists in determining the social aetiology of diseases, starting from social determinants of attitudes and behaviors influencing health.
Adolescent↗
[Dental caries, urinary fluorides and enamel opacities].
The aim of this study was to analyse with different statistic models the relation between fluoride urinary concentration, fluorosis and dental caries in terms of water fluoridation. 3237 schoolchildren aged 5 to 21 years were examined by a single dentist in accordance with the guidelines of the World Health Organization and following the standardized system for diagnosing, recording and analyzing dental caries data of Möller & Poulsen (1973). The index of Thylstrup & Fejerskov (1978) was applied to measure the prevalence and severity of dental fluorosis. Urinary fluoride concentration in 3022 children and water fluoride concentration were measured. The results of this study show a close relation between a high percentage of urinary fluoride, the presence of opacities and a low caries index.
Age Factors↗
[Application of the tracer method in the evaluation of the quality of dental care in 3237 Belgian schoolchildren].
In this paper, we describe the social distribution of levels of quality of the care to dental caries in 3237 Belgian schoolchildren aged 5 to 21. First, one decayed surface in 4 is filled. The index of filled surfaces of privileged children and of those who regularly consult the dentist is 50% higher than in disadvantaged children and in those who consult for cure. Secondly, one filled surface in 3 is threatened. The index of recurrent caries of privileged children is 30% lower than the one of disadvantaged children. A similar difference is observed between the groups defined by their use of dental services. Thirdly, one decayed surface in 25 is missing. The proportion of missing surfaces is not negligible in disadvantaged children and in those who consult the dentist for cure. We conclude that the system of dental care does not favor equity nor maintenance of dental health.
Adolescent↗
[Caries prevalence and dental hygiene in a group of school-age children].
The results of a cross-sectional study of the prevalence of caries in a sample of 3,237 children aged 5 to 21 are described in relation to some objectives of the WHO program. The prevalence of caries is high in the sample: 1. 31.5% of the children aged 5 to 6 are free of caries (according to the WHO objectives, 50% of the children aged 5 to 6 should have no caries), 2. the mean number of decayed, missing and filled permanent teeth (DMF/T index) in children aged 11 to 12 is 6.6 (The DMF/T should be less than or equal to 3). The frequency of toothbrushing is distributed as follows: 23% of the children brush their teeth once a week or less, 46% brush their teeth once a day, and 31% brush their teeth twice a day or more. The purpose and the frequency of the consultations at the dentist's office have been examined: 15% of the children never consult the dentist, 44% consult the dentist in case of toothache, and 41% go to the dentist's office for screening or control. Only 3.2% of the children use regularly and appropriately fluoride tablets. Since the variance of the results is large, it is difficult to distinguish explaining variables or determinants. However, the data indicate that social groups show differences in DMF indices as well as in the behaviors associated with dental hygiene and prevention.
Adolescent↗
[Plea for the training and continuing education of physicians in biostatistics. Results of a survey among Belgian physicians].
In order to test physicians' knowledge of statistics, a survey was conducted with a questionnaire in a sample of 250 doctors registered in the province of Brabant. The questionnaire consisted of two parts: a 9-item self-assessment test, and an opinion questionnaire about the importance of biostatistics and of its teaching. Forty-six physicians completed the two parts (18.4% of the sample); two other physicians only completed the second part of the questionnaire. For each subject, a score was computed: this score, ranging from 0 to 9, represents a simple sum of the right answers to the questionnaire. The median score is 2 (mean = 2.4; standard deviation = 1.8). No difference in the scores were found between groups defined by sex, the university of graduation, by the practice, general or specialized. The scores were not correlated to age, nor to graduation. The data from the opinion questionnaire show that the problem of biostatistics is considered important by 69% of the physicians, and that 88% of them think that this problem justifies training. With such training, physicians should be able to read the biomedical literature with discrimination, which supports the viewpoint of several authors. Although the small size of the sample and the small rate of answers might bias these results, we believe that physicians should be trained in statistics, which has become a pillar of medicine.
Attitude of Health Personnel↗
[Evaluation of the quality of medical care: analysis of methods].
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Consumer Behavior↗
The impact of the new hospital concept on the doctor's education: the place for physician-executives.
Health care cost containment and the involvement of physicians in the hospital management are features spreading throughout the Western nations. In fact, physician-executives are needed to preserve an optimal level of care while achieving the aims of the cost containment policies. Belgium is no exception: the new hospital law outlines the physician's status in relation to the hospital management and provides for the implementation of a prospective payment system. An important point is examined in this paper: the problem of the physician's management skills. In order to solve this problem, two methods were used to collect data. First, an analysis of the tasks provided in the law and its commentary was helpful to determine the main skills needed if physicians want to act as hospital managers. Second, market research in management education was carried out to discern the number and the characteristics of physicians who could be interested in receiving management training. A physician-dedicated curriculum was developed from the first approach. The second approach revealed that half the hospital doctors are willing to train as managers, providing they are actually involved in hospital management. Therefore, universities and their Schools of Medicine should develop such curricula. Nonetheless, studies should be conducted to clarify the relationship between physician-executives and other physicians and to assess the impact of the presence of physician-executives on the hospital organization and on the quality of care.
Attitude of Health Personnel↗