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健康・医療情報学ジャーナル

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音量 11, 問題 2 (2020)

拡張要約

Dental Education 2018: Relationship between Omission, Commission Errors and Number of Drugs Prescribed - Ibrahim Alowayyed-King Abdul-Aziz Medical City Ministry of National Guard Riyadh

Ibrahim Alowayyed

Prescriptions  are   the   primary   means  for communicating medication instructions between prescribers (healthcare professionals) and pharmacists, therefore; the prescription paper should be complete, legible, precise and unambiguous in its interpretation to minimize drug errors. The global number of prescriptions written increases annually, as well as the number of errors, in which there was a large percentage of outpatient paper prescriptions contain one or more errors, resulting in millions of prescriptions with the potential harm to patients . Errors occur in different stages, so every stage of the medication use process (prescription, dispensation, administration, monitoring of a drug) is vulnerable to errors. Errors are an integral part of human life, therefore the classification of the type of error that occurs, based on an assessment of the actions that led to that error, 5 an unintentional action may lead to an error due to a failure of attention (slip) or memory (lapse) and an intentional action may lead to an error due to a failure or lack of expertise (mistake) or a deliberate rule break (violation). Prescribing errors are worldwide highly prevalent problem in the health care system 1, it is often associated with health professional’s inexperience and lack of knowledge regarding the medication in general (dose, frequency, strength, interaction, etc.) and other factors such as tiredness and lapse of memory. In addition to prescription drugs, consumers self-prescribe and take drugs they buy over the counter. Sometimes these drugs can cause an adverse events particularly when taken with other drugs. Dosing errors are the most common type of prescribing error, it is widely recognize in the prescription errors.

It is difficult to statistic the errors accurately, many of previous studies use the incident reporting to identify the rate of errors1, but the accurate methods for identify and assessing the types and the rates of prescribing errors are different, but according to previous studies, retrospective review of prescriptions by pharmacists is noted to be the most effective method.

This research is explorative the study conducted in security force hospital in Riyadh, to assess the quality of the medications prescribing in the security force clinics. Population and Sampling Populations The population of this study is all outpatients prescriptions arrive to central pharmacy of security force hospital in Riyadh city. Sampling Procedure The researcher will use the convenience sample method. ResearchInstruments. The suitable tool for collecting information of this study is a prospective reviewing which is selected by the researcher. It consists of 2 parts or sections: Section 1: Evaluate the errors of omissions (Quality of prescription form) by researcher. Section 2: Evaluate the errors of commissions (Errors of drugs writing) by specialist pharmacy. Instrument Validity and Reliability To assure the validity, the following procedures were conducted, first review was made of the relevant literature. And the previous instrument were examined to develop drafts, secondly the method was reviewing by professors specialized in same field. Reliability Collection of Prescriptions Achievement of the research involved a collection of 300 prescriptions form during the work hours from central pharmacy, the prescription will include all departments in the hospital. The study was carried out by visiting the hospital and collecting different prescription from 13-9-2015 to 13-12-2015. All information related to patients and hospitals were kept confidential, also all prescriptions were included without exclusion criteria, being these prescriptions obtained from outpatient. Statistical Treatment The prescriptions will be evaluated into two steps and then the data was also analyzed using of SPSS version 20 program descriptive and inferential analysis. Each item was scored one or zero with a total score of 16 for evaluate prescription form and 8 for evaluate the drugs prescription errors. If the omission or commission item was present and clear, it was given a score of zero. If it was absent or not readable, a score of one was given.

Prospective cross-sectional study was performed in the security force clinics in Riyadh, The 300 prescriptions were collected from the central pharmacy with convenience sampling procedure to select the prescriptions and the study used a descriptive and inferential analysis to answer the research questions. Results: A total of 759 drugs were prescribed, in which 4118 errors were discovered in the prescriptions (2408 omissions errors, 1710 commissions errors), the most common omissions errors in the prescription under study was omit patient gender, in which nearly all the prescription didn’t determine the gender of patients, following by omit name of department 298 (99.3%), the most common commission errors was illegible writing 650 (86%) in the prescriptions under study, following by omit strength of drugs 464 (61.4%), omit route of drugs administrations 417 (55.2%), the most common drugs prescribed through the study periods were analgesics 203 (26.9%) and the second highest category of drugs were antibiotics (antibacterial) 136 (18%), the most common drugs subjected to prescribing errors were analgesic 27.10%, antibiotics 15.20% and bronchodilators 10.70%, there is a strong positive correlation between the number of drugs prescribed and the number of commission errors

A total of 759 drugs were prescribed, in which 4118 errors were discovered in the prescriptions (2408 omissions errors, 1710 commissions errors), the most common omissions errors in the prescription under study was omit patient gender, in which nearly all the prescription didn’t determine the gender of patients, following by omit name of department 298 (99.3%), the most common commission errors was illegible writing 650 (86%) in the prescriptions under study, following by omit strength of drugs 464 (61.4%), omit route of drugs administrations 417 (55.2%), the most common drugs prescribed through the study periods were analgesics 203 (26.9%) and the second highest category of drugs were antibiotics (antibacterial) 136 (18%), the most common drugs subjected to prescribing errors were analgesic 27.10%, antibiotics 15.20% and bronchodilators 10.70%, there is a strong positive correlation between the number of drugs prescribed and the number of commission errors. Conclusion: Application of modification prescriptions forms, structured prescribing training program, strict legislation measures relating to drugs prescriptions and development of system by applying CPOE and CDSS are among the necessary interventions that may reduce the prescription errors, increase the patient safety and protect them from medication errors.

Note: This work is partly presented at 22nd International Conference on Dental Education April 09-10, 2018 held at Amsterdam, Netherlands.

拡張要約

Dental Education 2018: Restoring Congenitally Missing Mandibular Central Incisor Using Lithium Disilicate Based Resin Bonded Prostheses: A Case Report- Elifnur Guzelce -Gazi University Emek

Elifnur Guzelce

Oral health plays a key role in public health.

 

Dental treatments like orthodontic, prosthodontic and surgical treatments are expensive. Some of the frequent dental anomalies need an expensive treatments. One of them is congenitally missing teeth which is generally called as Hypodontia, a highly common dental anamoly. CMT has an occurrence of the dental germ developing after the surrounding tissues have closed the space needed for the tooth development. Other studies demonstrated that delays in tooth development and reductions in tooth size correlate with advanced CMT. Both of these might accord with the terminal reduction theory. It is suggested that anterior agenesis may depend more on genes while posterior missing might be sporadic. It usually occurs in females and in the permanent dentition as well as it tends to occur more in the maxilla or mandible. Patients with missing permanent teeth suffer from an unfavorable appearance as malocclusion periodontal damage, lack of alveolar bone growth, reduced chewing ability, inarticulate pronunciation, changes in skeletal relationships. Different therapeutic approaches for missing mandibular incisors includes resin-bonded fixed dental prosthesis (RBFDP), orthodontic treatment, full- veneer fixed dental prosthesis (FDP), dental implant for a single tooth replacement, extraction of one or more incisors and restoration with an implant supported FDP, extraction of one or more teeth and restoration with an FDP, extraction of one or more teeth and restoration with a removable dental prosthesis (RDP). Implant restorations in the anterior maxillary region is the most difficult challenge in treating CMT. The combination of aesthetic demands, biomechanical/functional issues, and phonetic challenges require implant placement. The incisive foramen is the exit site of the nasopalatine canal where as the terminal branch of the descending palatine artery and 

nasopalatine  nerve   pass   through   the oral

 

cavity. When Implant treatment is not satisfactory, resin-bonded fixed dental prosthesis (RBFDP) is used with the two retainers design for a replacement of missing teeth, which was introduced by Brochette in 1963. In Ceram Alumina which is used in the initial practices of all ceramic RBFPDs.

 

Different ceramic materials including reinforced with leucite, lithium disilicate and zirconium oxide have been used in producing of RBFPDs . Lithium disilicate, acts as a dental restorative material. Currently, it has been updated and improved, and named as the IPS e.max Press system. Primarily, this system includes two phases, phase I which has homogeneously distributing lithium disilicate crystals and lithium orthophosphate in a glass matrix that creates phase II. Existence of these crystals in the structure highly increase the mechanical properties of the material.

  1. 17-year-old female had congenitally missing mandibular right central incisor. After clinical examination, study casts were performed. After the evaluation, the RBFPD was designed to maintain the patient's aesthetic and dental unity. This design was made with IPS E-max press. Initially, the process began with the Teeth Preparation. The diagnostic cast was waxed to assess the size and morphology of mandibular incisors. The preparation edges were drawn. Later it is reported on teeth limited only at enamel boundaries. The mandibular right lateral incisor and left central incisor teeth were examined and prepared. 1mm supragingival reduction extends to the centre of the interproximal contact, with an incisal finish line 2mm short of the incisal edge and 0,5-mm lingual reduction of the enamel. Lithium disilicate glass-ceramics derived from the SiO2–Li2O system. It was first investigated by Stookey at Corning Glass Works in the year 1950. They contain highly of fine rod-like entangled Li2Si2O5 crystals, and a minor amount of lithium orthophosphate (Li3PO4) crystals which are randomly oriented

and uniformly dispersed in the glassy matrix.

P2O5     plays

a  key

role  and  acts  as  a

heterogeneous

 

nucleating

agent

which

promotes

volume nucleation of

the

lithium silicate phases.

The

mechanism

of crystallization

involves

a

volume

           

 

crystallization where the crystals nucleate and grow throughout the glass. Crystallization of lithium disilicate is heterogeneous and this can be achieved through two different processing 2 to 3 stages. Glass-ceramic is intended to be used as a machinable block for the CAD/CAM milling technique or as a pressable ingot for the lost wax hot pressing technique. The parent glass is formed into glass blocks or ingots by pressure-casting into a steel mold, a glass melt of synthetic raw materials that

 

contains quartz, lithium oxide, phosphor oxide, alumina, potassium oxi de, and color-imparting oxides. Before cooling down to room temperature, the poured melt is transferred into a pre-heated furnace at 450– 550°C to relax the glass block and avoid stress build-ups in the glass. At this stage, the glass block can be kept in the furnace at the same temperature for about 1 hour and nucleation of the lithium silicate phases begins. Lithium disilicate-based ceramic provides an ideal aesthetics. The RBFPD produced with IPS e.max Press. The retainers of the bridge were then provided with hydrofluoric acid and concentration 9.5% and silane was applied. The teeth, under dam, were etched with 37% orthophosphoric acid and rinsed with distilled water and dried with air and then the bridge was cemented with a dual-cure resin cement. Finishing results in an aesthetic and functional successful outcome. The patient was followed-up clinically for one year. The survival rate of RBFPDs is less than conventional fixed partial dentures. The main reason for failure is possible debonding of the framework from the abutment teeth. Studies revealed that, where cementation was performed under dam or with the simple use of cotton rolls, the estimated survival probability for the debonding or failure. The use of dental dam during cementation reduced the risk of debonding by ten times. Many studies have proven that the success rate of single-retainer all-ceramic RBFDPs made from glass-infiltrated alumina ceramic, observed for 10 years, success rate was found 94.4%. 35 RBFPDs with substructures fabricated from IPS Empress or IPS e. max Press and veneered with IPS e.max 

Ceram were performed. Research Studies reported 100% survival rate approximately 4-year clinical follow-up of 35 anterior RBFPDs fabricated from IPS e.max Press. Also studies performed a randomize clinical trial on thirty anterior zirconia ceramic RBFPDs were in the follow-up period two debondings happened. 100% survival rate was reported after three years observation. RBFPD indicates a minimally invasive, better aesthetic and durable treatment modality in young patients with single missing teeth when implant therapy is not satisfactory. By selecting the most suitable material, all-ceramic RBFPDs provides aesthetic and minimally invasive restorations and when following a suitable clinical procedure, the survival rate of the RBFDPs is comparable to conventional FDPs.

Note: This work is partly presented at 22nd International Conference on Dental Education April 09-10, 2018 held at Amsterdam, Netherlands

拡張要約

Dental Education 2018: The Evaluation of Smile Design by Lay People and Dentists in the UAE- Asmaa Al Shamsi-Mohammed Bin Rashid University of Medicine and Health Sciences

Asmaa Al Shamsi

Dental appearance    is   considered  as    the

main feature to determine the attractiveness of face thus it influences the human social interactions .A patient’s smile expresses a feeling of success, affection, sensuality and courtesy that reveals self-confidence. The smile is considered as a sign of communicating that relates to the socialization and attraction. Different factors that affects the smile which includes tooth shape, position, and quality of restoration, color and general arrangement of dentition, Smile has been classified as high, average and low. High smile shows complete display of cervico-incisal length of maxillary incisors along with contiguous band of gingiva whereas low smile has less than 75% of display. In an average smile there is 75 to 100% display of maxillary incisors with the incise curvature of the maxillary anterior teeth paralleling the inner curvature of lower lip.

 

Certain attractive smile is the most significant social holding motion and key to your expert improvement. With the coming of new materials and procedures in the field of esthetic dentistry, individuals have changed their concept of smile and how it's structured. In the present time we have computerized smile structure as a multipurpose advanced instrument with certain clinically important favorable circumstances.

 

 

 

 

 

 

Nowadays people are concerned more about smile, it is not just a facial expression, but has a lot of benefits. Smile makes people more attractive, an attractive smile plays a major role in voting and judge decisions, job recruitment and other social interactions. Attractive people are considered to be at high social standing, more interesting and more intelligent. Studies show that we are more trustful of others when they smile. In one study done by Schliemann JPW, et al. participants were more trusted by others if they were smiling. This study found that a smile increases the people’s willingness to trust. Attractive smiles not only influence other people’s perceptions but also affect the psychosocial well-being of individual as well as their behavior.

Esthetics are characterized by the smile, however, the smile comprises of dental arch. Dental smile design likings differ from one person to other based on different factors such as: social level, economic level, education level and ethnic origin. There is a lack of similar studies in the UAE.

The purpose of this study is to determine which features of smile are attractive that are rated by the people of dental professionals of UAE. The participants were not randomly selected and were not a representative sample of the UAE population but a convenience sample. The 

participants were all adults above the age of 17 years. The questionnaire had 7 separate aesthetic features with between 3 to 6 different standardized computer generated images for each feature. The different features include the how much amount of tooth is exposed? lip line height, buckle corridor and midline position.

 

Results: There were total 380 participants between age of 28.6 years (SD 7.9) of which 228 (60%) were female. Significantly more females compared to males preferred a convex smile irrespective of whether the upper teeth contacted the lower lip. Females tends to prefer low lip line compared to males but this was at the borderline of significance (p=0.067).

 

Interestingly, more married respondents preferred the low lip line, whereas unmarried respondents were evenly distributed among an average and low lip line (p<0.05). The coincidence of dental and facial midlines would be expected as the preferred choice for both dental professionals and as well as for lay people but significantly more lay people preferred the smile that deviated towards the right. Whereas, dentists preferred midlines to be

coincident (p<0.001). Furthermore, residents of Abu Dhabi, Dubai and Sharjah preferred the coincidence of midlines. Whereas, the lay people from Fujairah preferred the right deviation of the dental midline. Over all half of the unmarried respondents had a significantly greater preference for midline coincidence but married respondents were more evenly split regarding this aspect of smile design (p<0.05). There was no preference

 

Extended Abstract

 

 

differences for the smile design features as it is judged by dentists and lay people.

 

Conclusion and Recommendations

 

Beauty must be considered and assessed to improve the quality of treatment provided to dental patients. The opinions and perceptions on lay people and dental professionals regarding beauty and attractiveness of smile were similar, except two variables known as smile line and the relation were of inter incise line to the facial mid line.

 

The majority of lay people and dental professionals preferred that more than half tooth is shown at rest. An Incise curve which is convex to the lower lip, smile width with ten visible teeth, a wide labial corridor and a Colusa plane that is parallel to the commissural line. This can be considered as the preferred esthetic smile among the UAE community.

The significant differences between lay people and dental professionals in this study is line height, where the lay people preferred a low smile line and dental professionals preferred an average smile line.

Other significant differences between lay people and dental professionals in this study was regarding the inter incise slime related to the facial midline, which shows that dental professionals prefers the inter incise line to coincide with the midline while lay people prefers the inter incise line that deviated to the right of the facial midline.

Keywords: Esthetic; Lay people; Dentists; Smile design; UAE population; Lip line

Note:  This work is partly presented  at 22nd International Conference on Dental Education   April   09-10,   2018    held    at Amsterdam, Netherlands

研究論文

Assessment of Knowledge, Perception and Practices about Malaria in Some Rural Communities of South West Region, Cameroon

Bonaventure Tientche*, Jerome Fru-Cho, Damian Nota Anong, Hermann Ngouakam and Theresa K Nkuo-Akenji

Background: Understanding local knowledge about malaria can help in designing sustainable community-based malaria control programs. Thus, the purpose of this study was to generate information on knowledge, perceptions and practices and the preventive measures as regards to malaria in the rural farming community.

Methods: A cross-sectional survey was conducted September to October 2013 among 851 households from 9 villages in Ekondo Titi Subdivision using structured questionnaire. Questions assessed knowledge, perceptions and practices about malaria among tribal villagers. The data were analyzed using SPSS 20.0 statistical software program.

Results: Most of the respondents 58.2% attributed malaria to mosquito bites. However, some of the respondents (28.8%) mentioned drinking dirty water, midges and standing in the sun as the causes of malaria transmission. Avoiding stagnant water (60.9%) and Clearing of bushes (71.5%) were the most frequently mentioned malaria preventive measures perceived and practiced by the respondents. Only 11.05% of 851 participants owned at least one long lasting insecticide treated net (LLIN). Thirty-nine point nine (39.9%) of respondents indicated that they experienced the last malaria episode more than three months ago. Malaria chemoprophylactic treatment was related to the educational status of the participants (p=0.001)

Conclusions: Despite this fair knowledge and good attitudes, practices towards malaria prevention and control were poor. A considerable proportion had misconceptions about the cause and transmission of malaria suggesting the necessity of health education. To close the gap between knowledge about transmission and ownership and use of bed nets as a preventive measure, there is the need to re-energize the CHWs activities and implement the concept of night watch in the rural communities.

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