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PMC11278612_p7
|
PMC11278612
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sec[0]/p[7]
|
Introduction
| 3.931641 |
biomedical
|
Study
|
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Recent studies showed very good agreement between positive CT parameters and MRI to detect PLC injury. Aly et al. reported an independent positive relation between vertebral translation, facet joint malalignment, spinous process fracture, horizontal laminar fracture and interspinous widening with PLC injury on MRI . In another paper, Aly et al. also demonstrated that using appropriate CT criteria, we will be able to correctly classify 90% of fractures comparing with MRI .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278612_p8
|
PMC11278612
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sec[0]/p[8]
|
Introduction
| 3.898438 |
biomedical
|
Study
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Our aim is to expedite the clinical decision by evaluating the diagnostic value of CT parameters and creating a reproducible score using combined CT parameters in the diagnosis of nonobvious PLC injury.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p9
|
PMC11278612
|
sec[1]/p[0]
|
Methods
| 4.121094 |
biomedical
|
Study
|
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A retrospective analysis of all patients who underwent CT and MRI of the thoracic or lumbar spine at the ED of a single institution between January 2016 and 2022 was conducted. Inclusion criteria included history of acute thoracolumbar trauma, CT and MRI performed within 72 h, one acute vertebral body fracture, thoracic or lumbar (T1-L4), detected on CT and age greater than 18 years. We have included geriatric patients because they represent a substantial sample of patients evaluated in ED context. Exclusion criteria included neurological deficits, multiple vertebral body spine fractures, previous spine surgery, translation/rotation injuries, pathological fractures, inadequate coverage by MRI or CT images or motion artifacts in MRI. Patients with neurological deficits were excluded because, independently of the PLC status, they will need surgical treatment and ideally MRI study. Demographic and injury characteristic data (age, sex, mechanism of injury, number of vertebral body spine fractures, levels of the fractures and neurological status) were collected.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p10
|
PMC11278612
|
sec[1]/sec[0]/p[0]
|
CT and MRI imaging Acquisition
| 4.09375 |
biomedical
|
Study
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CT images were acquired on a 64-slice CT scanner (Somatom go.All, Siemens Healthcare) in a helical mode using the following parameters: 120/220 kV/mA, radiation doses of 19.7 mGy and 607 mGy*cm, rotation time of 1.00 s, and a pitch of 0.80. The slice thickness for multiplanar reformatted images of bone algorithm was less than 1.5 mm. MRIs were performed on three different scanners: on a 3 T MRI scanner (Magnetom Skyra, Siemens Healthcare) and two 1,5 T MRI scanners (Magnetom Avanto, Siemens Healthcare and Achieva Pulsar, Philips Healthcare). The spine trauma protocol included sagittal T2-weighted and T1-weighted images, sagittal short tau inversion recovery (STIR) images and axial T2-weighted and T1-weighted images in the affected area.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p11
|
PMC11278612
|
sec[1]/sec[1]/p[0]
|
Imaging analysis
| 3.742188 |
biomedical
|
Study
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Four investigators (JAA, CGM, NO, BDS) assessed CT and MRI images. After receiving consensus training to standardize the measurement and evaluation of each CT parameter, each investigator independently analyzed every CT image. During data collection, investigators were blinded to clinical information, original interpretation, and other readings. Discordant findings regarding MRI images were resolved by the most experienced spinal surgeon.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p12
|
PMC11278612
|
sec[1]/sec[2]/p[0]
|
CT assessment of PLC injury
| 4.199219 |
biomedical
|
Study
|
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The following CT qualitative parameters were collected: avulsion, oblique or transverse fracture of the spinous process (SPF), facet joint malalignment (FJM), facet joint widening (FJW) and horizontal fracture of the lamina or pedicle (HLPF). The following quantitative CT parameters were measured: anterior vertebral body height (AVH), posterior vertebral body height (PVH), local kyphosis angle (LKA), regional kyphosis angle (RKA), Gardner's segmental deformity angle (GDA), mid-sagittal vertebral canal diameter (MSD), transverse vertebral canal diameter (TD), total canal cross-sectional area (TCA) and interspinous distance (ISD). Each CT parameter was assessed according to the measurement protocol elaborated ( Table 1 ) . Table 1 CT parameters measurement protocol. Table 1 Parameter Definition AVH The measurements are performed on the mid-sagittal CT image. The distance between the anterosuperior corner and anteroinferior corner of the vertebra is measured at three levels: at the fractured vertebra (AVH), at the upper adjacent vertebra (UAVH) and at the lower adjacent vertebra (LAVH). If osteophytosis is present, the measurements should avoid it. UAVH LAVH PVH The measurements are performed on the mid-sagittal CT image. The distance between the posterosuperior corner and posteroinferior corner of the vertebra is measured at three levels: at the fractured vertebra (PVH), at the upper adjacent vertebra (UPVH) and at the lower adjacent vertebra (LPVH). If osteophytosis is present, the measurements should avoid it. UPVH LPVH ISD The measurements are performed on the mid-sagittal image of the CT scan or on the image which better displays the spinous processes. The shorter distance between two adjacent spinous processes is measured at three levels: the biggest distance at the fractured vertebra level (ISD), the upper adjacent level (UISD) and the lower adjacent level (LISD). UISD LISD LKA The measurement is performed on the mid-sagittal image of the CT scan. A line is drawn along the superior and inferior endplates of the fractured vertebra. The angle formed between the lines is measured. Often the posterior aspect of the upper endplate has a ridge that distorts the normally flat surface of the body. In those cases, a line parallel to the flat surface of the body is drawn, ignoring the upper endplate ridge. RKA The measurement is performed on the mid-sagittal image of the CT scan. A line is drawn along the superior endplate of the upper adjacent vertebra and the inferior endplate of the lower adjacent vertebra. The angle formed between the lines is measured. Often the posterior aspect of the upper endplate has a ridge that distorts the normally flat surface of the body. In those cases, a line parallel to the flat surface of the body is drawn, ignoring the upper endplate ridge. GDA The measurement is performed on the mid-sagittal image of the CT scan. A line is drawn along the inferior endplate of the fractured vertebra and the superior endplate of the upper adjacent vertebra. The angle formed between the lines is measured. Often the posterior aspect of the upper endplate has a ridge that distorts the normally flat surface of the body. In those cases, a line parallel to the flat surface of the body is drawn, ignoring the upper endplate ridge. SPF The evaluation is performed on the mid-sagittal image of the CT scan. It is present when a transverse, avulsion or oblique fracture is observed in the spinous process, only at the level of the vertebral body fracture. MSD The measurements are performed on the axial CT image. The distance between the anterior canal border (defined as the posterior border of the mid-vertebral body) and posterior canal border (defined as the convergence of the superior margins of the laminae at the midline of the spinous process) is measure at three levels: at the fractured vertebra (MSD), at the upper adjacent vertebra (UMSD) and at the lower adjacent vertebra (LMSD). The measurements are performed on the axial CT image which correlates to the highest degree of vertebral body posterior retropulsion on the sagittal CT scan image. UMSD LMSD TD The measurement is performed on the axial CT image. The distance between the medial borders of the pedicles at the mid-pedicle level is measure at three levels: at the fractured vertebra (TD), at the upper adjacent vertebra (UTD) and at the lower adjacent vertebra (LTD). The measurements are performed on the axial CT image which correlates to the highest degree of vertebral body posterior retropulsion on the sagittal CT scan image. UTD LTD TCA The measurement is performed on the axial CT image. The total area of the canal is bordered: anteriorly by the posterior border of the vertebral body; posteriorly by the convergence of the superior border of the laminae at the midline of the spinous process; laterally by the medial border of the pedicles. It is measured using an electronic digitizer to outline the perimeter of the spinal canal and to calculate the precise total cross-sectional area at three levels: at the fractured vertebra (TCA), at the upper adjacent vertebra (UTCA) and at the lower adjacent vertebra (LTCA). The measurements are performed on the axial CT image which correlates to the highest degree of vertebral body posterior retropulsion on the sagittal CT scan image. UTCA LTCA FJW The measurement is performed on the axial CT image. The distance between facet(s), unilaterally or bilaterally, is measure. FJM The evaluation is performed on the axial CT image. It is present when, unilateral or bilateral, facet(s) are dislocated, perched, or showing a displaced fracture. HLPF The evaluation is performed on the coronal image of the CT scan. It is present when, unilateral or bilateral, horizontally oriented fracture(s) are observed in the lamina or pedicle. CT Computed Tomography, AVH Anterior Vertebral Body Height, UAVH Upper Anterior Vertebral Body Height, LAVH Lower Anterior Vertebral Body Height, PVH Posterior Vertebral Body Height, UPVH Upper Posterior Vertebral Body Height, LPVH Lower Posterior Vertebral Body Height, ISD Interspinous Distance, UISD Upper Interspinous Distance, LISD Lower Interspinous Distance, LKA Local Kyphosis Angle, RKA Regional Kyphosis Angle, GDA Gardner's Segmental Deformity Angle, SPF Spinous Process Fracture, MSD Mid-Sagittal Vertebral Canal Diameter, UMSD Upper Mid-Sagittal Vertebral Canal Diameter, LMSD Lower Mid-Sagittal Vertebral Canal Diameter, TD Transverse Vertebral Canal Diameter, UTD Upper Transverse Vertebral Canal Diameter, LTD Lower Transverse Vertebral Canal Diameter, TCA Total Canal Cross-Sectional Area, UTCA Upper Total Canal Cross-Sectional Area, LTCA Lower Total Canal Cross-Sectional Area, FJW Facet Joint Widening, FJM Facet Joint Malalignment, HLPF Horizontal Fracture of the Lamina or Pedicle. Fig. 1 CT parameters used for diagnosis of PLC injury. CT sagittal images (A, C, E, G) showing (A) measurement of the UAVH and UPVH (red lines), AVH and PVH (yellow lines), LAVH and LPVH (blue lines); (C) measurement of LK (yellow dashed lines), RK (red dashed lines), GDA (blue dashed lines); (E) ISD >4 mm (yellow line) compared with adjacent levels (red lines); (G) a SPF (yellow circle). CT axial images (B, D, F) showing (B) measurement of the MSD (yellow line), TD (blue line) and direct measurement of TCA (red line); (D) FJW (red circle); (F) bilateral FJM (yellow arrows). CT coronal image (I) showing unilateral horizontal laminar fracture (blue circle). Fig. 1
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p13
|
PMC11278612
|
sec[1]/sec[2]/p[1]
|
CT assessment of PLC injury
| 4.113281 |
biomedical
|
Study
|
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The following CT parameters were then calculated from the measurements previously mentioned: sagittal-to-transverse ratio (STR), percentage of canal occlusion (CO), percentage of anterior vertebral height loss (AVHL) and interspinous distance widening (IDW). The formulas used are present in Table 2 . Table 2 CT parameters formulas protocol. Table 2 Parameter Formula STR M S D T D CO [ U T C A + L T C A 2 − T C A U T C A + L T C A 2 ] × 100 AVHL [ U A V H + L A V H 2 − A V H U A V H + L A V H 2 ] × 100 IDW P r e s e n t i f : [ I S D − U I S D + L I S D 2 ] ≥ 4 CT Computed Tomography, STR Sagittal-to-Transverse Ratio, CO Percentage of Canal Occlusion, AVHL Percentage of Anterior Vertebral Height Loss, IDW Interspinous Distance Widening, MSD Mid-Sagittal Vertebral Canal Diameter, TD Transverse Vertebral Canal Diameter, UTCA Upper Total Canal Cross-Sectional Area, LTCA Lower Total Canal Cross-Sectional Area, TCA Total Canal Cross-Sectional Area, AVH Anterior Vertebral Body Height, UAVH Upper Anterior Vertebral Body Height, LAVH Lower Anterior Vertebral Body Height, ISD Interspinous Distance, UISD Upper Interspinous Distance, LISD Lower Interspinous Distance.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p14
|
PMC11278612
|
sec[1]/sec[3]/p[0]
|
MRI assessment of PLC injury
| 4.042969 |
biomedical
|
Study
|
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The PLC was assessed on MRI and classified as follows: no-disrupted, no MRI signal change or high signal due to ISL edema or facet joint effusion; or injured, identified by a discontinuity of the black stripe defining complete disruption of fibers of the SSL, FL, or ISL on T1-and T2-weighted images .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p15
|
PMC11278612
|
sec[1]/sec[4]/p[0]
|
Statistical analysis
| 1.498047 |
biomedical
|
Other
|
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Data was analyzed with SPSS®, version 26.0.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p16
|
PMC11278612
|
sec[1]/sec[4]/p[1]
|
Statistical analysis
| 3.443359 |
biomedical
|
Study
|
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Comparisons between mechanisms of injury and age were performed with ANOVAs, complemented with Tukey HSD multiple comparisons tests.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p17
|
PMC11278612
|
sec[1]/sec[4]/p[2]
|
Statistical analysis
| 3.980469 |
biomedical
|
Study
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The four investigators interrater reliability of CT assessments for continuous variables was analyzed with intraclass correlation coefficient (ICC) and with Fleiss kappa for categorical variables .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p18
|
PMC11278612
|
sec[1]/sec[4]/p[3]
|
Statistical analysis
| 3.796875 |
biomedical
|
Study
|
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[
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Comparisons between patients with no PLC injury and patients with PLC injury detected in MRI were performed with t-tests for continuous variables and with chi-square tests for categorical variables. Fisher exact test was used as an alternative to chi-square tests when Cochran's rules were not met.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p19
|
PMC11278612
|
sec[1]/sec[4]/p[4]
|
Statistical analysis
| 4.058594 |
biomedical
|
Study
|
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Multivariate logistic regression was implemented to analyze the contribution of all consensus CT measurements, sex, and age, to detect PLC injury observed in MRI. Two risk scores based on the coefficients (β) of multivariate logistic regression were created. The first risk score (RS1) included all variables, the second (RS2) only the statistically significant variables. Quality of the risk scores was evaluated with ROC curves. We also calculated Cohen's K agreement measure between the PLC injury detected by the MRI and the estimate of each score. Statistical significance was set at p < .05.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278612_p20
|
PMC11278612
|
sec[2]/p[0]
|
Results
| 3.955078 |
biomedical
|
Study
|
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154 patients, 94 (61.0%) males and 60 (39.0%) females, with a mean age of 61.42 ± 16.27 (from 18 to 94 years), were enrolled in this study. 40.3% had PLC injury detected on MRI. The most prevalent fracture levels were L1 (38.3%), T12 (16.2%) and L2 (13.0%). The most prevalent mechanism of injury was fall from a height (59.7%) ( Table 3 ). Table 3 Sample characteristics. Table 3 n (%) Sex Female 60 (39.0%) Male 94 (61.0%) Levels of the fracture T2 3 (1.9%) T3 4 (2.6%) T4 1 (0.6%) T6 4 (2.6%) T8 2 (1.3%) T9 5 (3.2%) T10 5 (3.2%) T11 8 (5.2%) T12 25 (16.2%) L1 59 (38.3%) L2 20 (13.0%) L3 9 (5.8%) L4 9 (5.8%) Mechanism of injury Fall from a height 92 (59.7%) Ground level fall 39 (25.3%) Motor vehicle accident 17 (11.0%) Bicycle accident 4 (2.6%) Dive 1 (0.6%) Acts of violence 1 (0.6%) n Absolute Frequency, % Relative Frequency.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p21
|
PMC11278612
|
sec[2]/p[1]
|
Results
| 3.630859 |
biomedical
|
Study
|
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Mechanism of injury was found to be associated with age (p < .001). Younger patients were associated with motor vehicle accidents (mean age of 50.53 ± 16.09) and older patients with fall from a height (mean age of 61.28 ± 15.23). Ground level fall was associated with the highest mean of age (69.64 ± 13.51).
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p22
|
PMC11278612
|
sec[2]/p[2]
|
Results
| 4.207031 |
biomedical
|
Study
|
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[
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0.0000960230827331543
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For continuous variables, almost all measures had ICC higher than 0.90, therefore excellent interrater reliability. For categorical binary variables, results for FJM (0.649), HLPF (0.716) and IDW (0.729) were between 0.40 and 0.74 (intermediate to good) and >0.75 (excellent) for SPF (0.859). Consensus was established by the most experienced spinal surgeon (investigator 3) ( Table 4 ). Table 4 Descriptive statistics for CT measurements stratified by investigator and interrater reliability analysis. Table 4 Measurement Investigator ICC 1 2 3 4 UAVH 21.83 (3.35) 21.81 (3.34) 22.16 (3.35) 21.49 (3.17) 0.973 AVH 17.41 (4.49) 17.75 (4.66) 17.98 (4.61) 17.29 (4.55) 0.976 LAVH 24.23 (3.55) 24.18 (3.41) 24.59 (3.52) 23.79 (3.39) 0.966 UPVH 23.66 (3.26) 24.22 (3.23) 24.13 (3.38) 23.41 (3.24) 0.964 PVH 21.96 (3.38) 22.58 (3.44) 22.75 (3.37) 21.86 (3.42) 0.954 LPVH 24.99 (3.04) 25.53 (3.03) 25.56 (3.22) 24.70 (3.06) 0.956 UISD 10.55 (4.87) 10.66 (4.71) 10.03 (4.68) 10.52 (4.61) 0.965 ISD 10.58 (5.60) 10.85 (5.50) 10.20 (5.53) 10.82 (5.65) 0.976 LISD 10.08 (5.29) 10.25 (5.12) 9.72 (4.98) 10.39 (5.23) 0.971 LKA 9.23 (6.93) 9.01 (7.09) 9.24 (7.13) 8.70 (6.83) 0.954 RKA 5.54 (12.42) 5.55 (12.63) 6.12 (12.46) 5.38 (12.50) 0.983 GDA 9.82 (8.70) 10.10 (8.60) 10.21 (8.64) 9.25 (8.77) 0.970 SPF No 112 (72.7%) 119 (77.3%) 118 (76.6%) 117 (76.0%) 0.859 (a) Yes 42 (27.3%) 35 (22.7%) 36 (23.4%) 37 (24.0%) UMSD 17.37 (2.08) 17.30 (1.93) 16.95 (2.00) 16.90 (1.97) 0.921 MSD 15.01 (3.64) 14.88 (3.54) 14.96 (3.64) 14.46 (3.60) 0.968 LMSD 17.80 (2.82) 17.60 (2.65) 17.50 (2.79) 17.31 (2.79) 0.951 UTD 21.85 (3.54) 21.94 (3.50) 21.60 (3.50) 21.29 (3.54) 0.971 TD 22.63 (3.84) 22.74 (3.82) 22.46 (3.70) 22.01 (3.63) 0.970 LTD 23.34 (3.67) 23.42 (3.56) 23.01 (3.51) 22.84 (3.50) 0.972 UTCA 268.37 (58.06) 271.92 (58.32) 264.43 (59.03) 263.36 (58.49) 0.976 TCA 230.96 (62.85) 233.48 (63.53) 226.25 (63.91) 225.59 (63.77) 0.973 LTCA 282.44 (62.84) 284.49 (60.91) 277.80 (61.66) 277.67 (59.69) 0.971 FJW 2.29 (1.00) 2.28 (0.98) 1.79 (0.97) 1.84 (1.01) 0.812 FJM No 137 (89.0%) 135 (87.7%) 146 (94.8%) 145 (94.2%) 0.649 (a) Yes 17 (11.0%) 19 (12.3%) 8 (5.2%) 9 (5.8%) HLPF No 131 (85.1%) 113 (73.4%) 119 (77.3%) 128 (83.1%) 0.716 (a) Yes 23 (14.9%) 41 (26.6%) 35 (22.7%) 26 (16.9%) IDW No 88 (57.1%) 91 (59.1%) 84 (54.5%) 100 (64.9%) 0.729 (a) Yes 66 (42.9%) 63 (40.9%) 70 (45.5%) 54 (35.1%) CT Computed Tomography, UAVH Upper Anterior Vertebral Body Height, AVH Anterior Vertebral Body Height, LAVH Lower Anterior Vertebral Body Height, UPVH Upper Posterior Vertebral Body Height, PVH Posterior Vertebral Body Height, LPVH Lower Posterior Vertebral Body Height, UISD Upper Interspinous Distance, ISD Interspinous Distance, LISD Lower Interspinous Distance, LKA Local Kyphosis Angle, RKA Regional Kyphosis Angle, GDA Gardner's Segmental Deformity Angle, SPF Spinous Process Fracture, UMSD Upper Mid-Sagittal Vertebral Canal Diameter, MSD Mid-Sagittal Vertebral Canal Diameter, LMSD Lower Mid-Sagittal Vertebral Canal Diameter, UTD Upper Transverse Vertebral Canal Diameter, TD Transverse Vertebral Canal Diameter, LTD Lower Transverse Vertebral Canal Diameter, UTCA Upper Total Canal Cross-Sectional Area, TCA Total Canal Cross-Sectional Area, LTCA Lower Total Canal Cross-Sectional Area, FJW Facet Joint Widening, FJM Facet Joint Malalignment, HLPF Horizontal Fracture of the Lamina or Pedicle, IDW Interspinous Distance Widening. Results presented as means (M) and standard deviations (SD) for continuous variables, frequencies (n) and percentages (%) for categorical variables; Intraclass correlation coefficient (ICC) calculated to assess interrater observer reliability for continuous variables; (a)Fleiss Kappa agreement calculated to assess interrater observer reliability for categorical variables.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278612_p23
|
PMC11278612
|
sec[2]/p[3]
|
Results
| 4.1875 |
biomedical
|
Study
|
[
0.9990234375,
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[
0.99951171875,
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When comparing consensus measures by PLC injury detected in MRI, significant associations were found for SPF and HLPF (p < 0.001). Patients with PLC injury had higher prevalence of SPF (41.9% vs. 10.9%) and HLPF (45.2% vs. 7.6%) ( Table 5 ). Table 5 Consensus measures compared by PLC injury detected in MRI. Table 5 Consensus measures Total No PLC injury PLC injury Statistical test LKA 9.24 (7.13) 8.75 (6.64) 9.97 (7.81) t (152) = -1.04, p = .302, d = −0.17 RKA 6.12 (12.46) 5.36 (12.42) 7.26 (12.54) t (152) = -0.93, p = .355, d = −0.15 GDA 10.21 (8.64) 9.92 (8.24) 10.65 (9.24) t (152) = -0.52, p = .605, d = −0.09 SPF No 118 (76.6%) 82 (89.1%) 36 (58.1%) χ 2 (1) =19.96, p<.001, φ=0.36 Yes 36 (23.4%) 10 (10.9%) 26 (41.9%) FJW 1.79 (0.97) 1.74 (0.94) 1.87 (1.00) t (152) = -0.82, p = .415, d = −0.13 FJM No 146 (94.8%) 90 (97.8%) 56 (90.3%) p = 0.061, φ = 0.18 (b) Yes 8 (5.2%) 2 (2.2%) 6 (9.7%) HLPF No 119 (77.3%) 85 (92.4%) 34 (54.8%) χ 2 (1) =29.74, p<.001, φ=0.44 Yes 35 (22.7%) 7 (7.6%) 28 (45.2%) IDW No 84 (54.5%) 52 (56.5%) 32 (51.6%) χ 2 (1) = 0.36, p = 0.549, φ = 0.05 Yes 70 (45.5%) 40 (43.5%) 30 (48.4%) STR 0.69 (0.20) 0.71 (0.18) 0.65 (0.22) t (152) = 1.65, p = .101, d = 0.27 CO 15.46 (20.25) 14.70 (17.72) 16.58 (23.63) t (152) = -0.57, p = .573, d = −0.09 AVHL 22.32 (19.98) 20.53 (18.89) 24.99 (21.37) t (152) = -1.37, p = .174, d = −0.22 PLC Posterior Ligament Complex, MRI Magnetic Resonance Imaging, LKA Local Kyphosis Angle, RKA Regional Kyphosis Angle, GDA Gardner's Segmental Deformity Angle, SPF Spinous Process Fracture, FJW Facet Joint Widening, FJM Facet Joint Malalignment, HLPF Horizontal Fracture of the Lamina or Pedicle, IDW Interspinous Distance Widening, STR Sagittal-to-Transverse Ratio, CO Percentage of Canal Occlusion, AVHL Percentage of Anterior Vertebral Height Loss. Results presented as means (M) and standard deviations (SD) for continuous variables, frequencies (n) and percentages (%) for categorical variables; t-tests (t) and chi-square tests ( χ 2 ) performed to compare continuous and categorical variables, respectively; Cohen's d (d) and phi (φ) to assess t-tests and chi-square tests effect size, respectively; (b) Fisher exact test calculated as alternative to chi-square test when Cochran rules were not met.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p24
|
PMC11278612
|
sec[2]/p[4]
|
Results
| 4.179688 |
biomedical
|
Study
|
[
0.9990234375,
0.0005316734313964844,
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[
0.9990234375,
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0.0004363059997558594,
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From our multivariate logistic regression model, we found that younger patients are less likely to have PLC injury detected in MRI, estimating 3% less odds for each year of age (p = 0.032). Patients with HLPF and SPF positive are more likely to have PLC injury detected in MRI (p < 0.001). Lastly, patients with IDW positive have 2.33 more odds of PLC injury detected in MRI (p = 0.045) ( Table 6 ). Table 6 Multivariate logistic regression adjusted for all consensus measurements, sex, and age for outcome PLC injury detected in MRI. Table 6 β S.E. aOR 95% CI for aOR p-value Lower bound Upper bound Sex (male) −0.01 0.46 0.99 0.40 2.43 0.985 Age −0.03 0.01 0.97 0.94 0.99 0.032 LKA 0.06 0.07 1.06 0.93 1.21 0.365 RKA 0.01 0.03 1.01 0.94 1.08 0.779 GDA −0.07 0.06 0.94 0.83 1.06 0.286 SPF (yes) 1.81 0.53 6.08 2.15 17.20 <0.001 FJW 0.15 0.28 1.17 0.68 2.00 0.580 FJM (yes) 1.05 1.15 2.86 0.30 27.26 0.360 HLPF (yes) 2.04 0.58 7.66 2.47 23.76 <0.001 IDW (yes) 0.85 0.42 2.33 1.02 5.35 0.045 STR 0.14 1.60 1.15 0.05 26.53 0.931 CO −0.01 0.01 0.99 0.97 1.02 0.640 AVHL −0.001 0.02 1.00 0.97 1.03 0.977 PLC Posterior Ligament Complex, MRI Magnetic Resonance Imaging, LKA Local Kyphosis Angle, RKA Regional Kyphosis Angle, GDA Gardner's Segmental Deformity Angle, SPF Spinous Process Fracture, FJW Facet Joint Widening, FJM Facet Joint Malalignment, HLPF Horizontal Fracture of the Lamina or Pedicle, IDW Interspinous Distance Widening, STR Sagittal-to-Transverse Ratio, CO Percentage of Canal Occlusion, AVHL Percentage of Anterior Vertebral Height Loss. Multivariate logistic regression was implemented to analyze the contribute of all consensus CT measurements, sex, and age, to detect PLC lesion observed in MRI; β - beta coefficients of multivariate logistic regression; S.E. - standard error; adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated to assess the effect size.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p25
|
PMC11278612
|
sec[2]/p[5]
|
Results
| 4.066406 |
biomedical
|
Study
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[
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[
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Two risk scores were then calculated. ROC curves analysis demonstrated that, for RS1 , a patient's result above −0.3995 has a sensitivity of 72.6% and specificity of 77.2%, with an area under the curve (AUC) of 82.5%. For RS2 , a patient's result above −0.6500 has a sensitivity of 71.0% and specificity of 78.3% with an AUC of 80.8%. Fig. 2 Risk score 1 LKA Local Kyphosis Angle, RKA Regional Kyphosis Angle, GDA Gardner's Segmental Deformity Angle, SPF Spinous Process Fracture, FJW Facet Joint Widening, FJM Facet Joint Malalignment, HLPF Horizontal Fracture of the Lamina or Pedicle, IDW Interspinous Distance Widening, STR Sagittal-to-Transverse Ratio, CO Percentage of Canal Occlusion, AVHL Percentage of Anterior Vertebral Height Loss. Fig. 2 Fig. 3 Risk score 2 SPF Spinous Process Fracture, HLPF Horizontal Fracture of the Lamina or Pedicle, IDW Interspinous Distance Widening. Fig. 3
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p26
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PMC11278612
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sec[2]/p[6]
|
Results
| 4.117188 |
biomedical
|
Study
|
[
0.9990234375,
0.00045990943908691406,
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[
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When studying the association of estimated classifications of PLC injury detected by the risk scores and PLC injury detected in MRI, both risk scores yielded similar results, with a total of 75.9% of correct classifications (p < 0.001). A moderate agreement of 0.483 was assessed with Cohen's K. These results show that RS2 is more parsimony than RS1, because with a set of four independent variables, agreement was equal to RS1, despite slightly lower AUC results ( Table 7 ). Table 7 Association of estimated classifications of PLC injury detected by risk scores and PLC injury detected in MRI. Table 7 PLC injury detected in MRI Statistical test PLC injury estimated by risk score 1 No Yes No 80 (51.9%) 25 (16.2%) χ 2 (1) =37.13, p<.001, φ=0.49 Yes 12 (7.8%) 37 (24.0%) Cohen's K = 0.483 PLC injury estimated by risk score 2 No 80 (51.9%) 25 (16.2%) χ 2 (1) =37.13, p<.001, φ=0.49 Yes 12 (7.8%) 37 (24.0%) Cohen's K = 0.483 PLC Posterior Ligament Complex, MRI Magnetic Resonance Imaging. Results presented as frequencies (n) and percentages (%) overall; chi-square tests ( χ 2 ) performed to compare categorical variables; phi (φ) to assess chi-square tests effect size; Cohen's K to assess interrater reliability.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p27
|
PMC11278612
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sec[3]/p[0]
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Discussion
| 2.925781 |
biomedical
|
Other
|
[
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[
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Despite many attempts to obtain more reliable methods, the diagnosis of spinal instability is still considered challenging in the clinical scenario . However, PLC integrity has proven to be a determinant element of spine stability, being increasingly used to determine an appropriate treatment strategy for TLFs .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p28
|
PMC11278612
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Discussion
| 4.082031 |
biomedical
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Study
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In our study, 40.3% of patients had PLC injury detected on MRI. Although being an imperfect reference standard, MRI shows high sensitivity (79–100%) and specificity (53.5–100%) for PCL injury detection, second only to intraoperative findings . We selected patients with CT and MRI performed within 72 h, to attempt preserving MRI sensitivity . The well-defined eligibility criteria allowed us to exclude those with high pretest probability of PLC injury (neurological deficits and rotation/translation injuries), so we managed to focus on nonobvious PLC injuries, enhancing the relevance of our results for decision making .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p29
|
PMC11278612
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sec[3]/p[2]
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Discussion
| 3.998047 |
biomedical
|
Study
|
[
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[
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Study participants were mainly males and middle-aged. The most prevalent levels of fracture were L1, followed by T12 and L2, therefore, consistent with literature, which identifies the thoracolumbar junction as the most affected by trauma . The most prevalent mechanism of injury was fall from a height. The youngest patients were associated with motor vehicle accidents, the oldest with ground level falls. We also found that younger patients were less likely to have PLC injury detected in MRI. Owing to the mechanism of injury, the latter may appear contradictory, since the youngest group of patients is associated with injuries that apparently result from more violent trauma. However, as previously mentioned, we excluded the most concerning cases, explaining less prevalence of PLC injury in this sample subgroup. Unlike prior studies, we included older patients, considering the growing relevance of low-energy falls in the elderly population due to global aging .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p30
|
PMC11278612
|
sec[3]/p[3]
|
Discussion
| 3.675781 |
biomedical
|
Study
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[
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[
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Involving four investigators with different levels of experience in CT reading enhanced result reproducibility. However, by standardizing the methodology of CT measurements, with a consistent definition for each individual CT parameter, we managed to obtain very good to excellent interrater reliability, suggesting the effectiveness of pre-established procedures.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p31
|
PMC11278612
|
sec[3]/p[4]
|
Discussion
| 3.859375 |
biomedical
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Study
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[
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[
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FJM and HLPF had the lowest interrater reliability, even though they were considered intermediate to good. That can be explained by the lack of consensus in literature to define the degree of facet fracture displacement needed to report FJM as positive, which influenced our definition of this parameter, and also by the commonly misinterpretation of HLPF as vertical fracture of the lamina or pedicle (VLPF) .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278612_p32
|
PMC11278612
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sec[3]/p[5]
|
Discussion
| 3.388672 |
biomedical
|
Study
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[
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[
0.99951171875,
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The main focus of our study was to evaluate eleven CT parameters to assess their potential association with PLC injury. To the best of our knowledge, this is the first study to analyze these many CT parameters while combining predominantly excellent results in interrater reliability of four different raters .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p33
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PMC11278612
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sec[3]/p[6]
|
Discussion
| 4.074219 |
biomedical
|
Study
|
[
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[
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Similarly with previous results reported by Aly et al., we found that HLPF and SPF were independently associated with PLC injury . Aly et al. also found significant independent associations between FJM and IDW and PLC injury . Although in our study we did not find an independent association, IDW was positively related with PLC injury, which might be explained by the interference of SPF when evaluating IDW . Although we found no collinearity between these two parameters, the measures of IDW might have been altered in CTs where SPF was also present, which might have underestimated the influence of IDW in our model. Along with the lack of consensus to define FJM, this parameter also had the lowest interrater reliability in our study, both of which might explain our results.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p34
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PMC11278612
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sec[3]/p[7]
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Discussion
| 3.335938 |
biomedical
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Study
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[
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[
0.99072265625,
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Based on recent literature, distinguishing between HLPF and VLPF when analyzing the diagnostic value of laminar fracture helped further strengthen the HLPF's associations with PLC injury, since VLPF has shown to not be independently associated with PLC injury in previous studies .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278612_p35
|
PMC11278612
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sec[3]/p[8]
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Discussion
| 3.324219 |
biomedical
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Study
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[
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[
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Khurana et al. and Aly et al., which found vertebral translation to be a significant predictor of PLC injury, since our goal was to create a score to help in decision-making, we excluded type C fractures, which have a high pretest probability of PLC injury, because independently of PLC status they will require surgical treatment .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278612_p36
|
PMC11278612
|
sec[3]/p[9]
|
Discussion
| 4.058594 |
biomedical
|
Study
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[
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When including all consensus CT measurements in a multivariate logistic regression model, we concluded that CTs reported as HLPF, SPF or IDW positive had significantly higher odds of PLC injury detected in MRI (7.66, 6.08 and 2.33, respectively). Although consistent with previous studies, all parameters proved to have lower odds than those previously reported (12.5, 16.2 and 4.4, respectively) .
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p37
|
PMC11278612
|
sec[3]/p[10]
|
Discussion
| 4.117188 |
biomedical
|
Study
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[
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Our best risk score (RS2) was able to estimate a total of 75.9% of correct classifications, with 71.0% of sensitivity and 78.3% of specificity. These results may appear less promising than previous ones. Aly et al. showed only 10% of misclassification using appropriate CT criteria to identify PLC injury . However, this score strength relies on the different weights assigned to the parameters, based on their varied degrees of association (aOR) with PLC injury, rather than only counting each CT parameter as an equal finding. This approach may be closer to the real CT accuracy, yielding more generalizable results. Nevertheless, these results lack more evaluation and future analysis. When comparing the RS2 with the results from Aly et al., the CT parameters alone or combined were more reliable to predict PLC injury . Our results reinforce the conclusions from previous studies about the importance of some CT parameters in helping clinicians to foresee nonobvious PLC lesion, without MRI . Most importantly, our results reinforce the notion that the goal of CT will most certainly never be to replace the MRI, but to tendentially better infer the status of the PLC in scenarios were MRI is not a reality, while being a more accessible, economical, and faster exam. MRI. Overall, MRI should not be dispensed in patients with highly suggestive PLC injury.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p38
|
PMC11278612
|
sec[3]/sec[0]/p[0]
|
Strengths and limitations
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biomedical
|
Study
|
[
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[
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Our study has some limitations, including its retrospective, single-institution design. Inclusion of low-energy trauma cases may have introduced comorbidity bias, but enhanced comprehensiveness due to its growing relevance in the elderly . We did not include patients who were discharged based on negative CT findings without first undergoing MRI, thereby introducing verification bias . The low number of cases with PLC injury (62) is probably the biggest limitation, in part due to the exclusion of patients with neurological deficits, because those cases constitute an independent reason to perform MRI and therefore surgical treatment. The main strength of this work is the study design and well-established methods such as the consecutive recruitment of patients with well-defined eligibility criteria, that helped minimizing selection bias . We had four different raters, which is a larger number compared to previous studies . Our investigators received consensus training to standardize the measurement and evaluation of each CT parameter . However, we acknowledge that this reading might be less reproducible with reviewers with no previous training.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278612_p39
|
PMC11278612
|
sec[4]/p[0]
|
Conclusion
| 4.058594 |
biomedical
|
Study
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[
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[
0.99853515625,
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] |
This study concludes that the standardized procedures pre-established in the CT measurement protocol were effective and can therefore be implemented. Overall, our study strengthened previous results reporting that CTs showing HLPF, SPF and IDW positive are significantly more likely to have PLC injury detected in MRI. Close attention to these three parameters may improve CT accuracy allowing it to play an important part in guiding treatment decisions in emergency settings in patients with lower pretest probability of PLC injury, when MRI is not available or when patients cannot undergo MRI.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278612_p40
|
PMC11278612
|
sec[5]/p[0]
|
Statements and declarations
| 1.003906 |
other
|
Other
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[
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] |
No funds, grants, or other support was received. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
|
[
"Joana Araújo de Azevedo",
"Carolina Garcez Martins",
"Nuno Oliveira",
"Pedro Varanda",
"Bruno Direito-Santos"
] |
https://doi.org/10.1016/j.bas.2024.102855
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278625_p0
|
PMC11278625
|
sec[0]/p[0]
|
1. Introduction
| 4.226563 |
biomedical
|
Study
|
[
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With the emergence of an ultra-aging society, the frequency of osteoporotic vertebral fractures (OVFs) is increasing. OVF affects life expectancy. The 5-year survival rate after OVF is approximately 60%, compared to 40–50% after femoral neck fractures . Moreover, the relative risk of mortality following a fracture occurrence is reported to be 8.6 times higher for vertebral fractures and 6.7 times higher for femoral neck fractures . Treatment for OVF is primarily conservative but is associated with decreased activities of daily living (ADL) and disuse associated with conservative therapy, residual pain due to vertebral compression, pseudoarthrosis, and delayed neurological impairment. As surgical treatments for OVF, minimally invasive procedures like balloon kyphoplasty (BKP), lateral lumbar interbody fusion (LLIF), and anterior vertebral replacement using X-core2 are highly effective. Since BKP has been covered by insurance in Japan since 2011, its use for OVF has become widespread domestically. BKP is a highly advantageous technique characterized by its minimally invasive nature (short surgical duration, small incision, and minimal blood loss) and outcomes like early pain relief, early mobilization, and short hospital stays, with significant complications being rare. BKP, aimed at early pain relief, early mobilization and return to social activities, prevention of further vertebral compression at the fracture site, and maintenance of spinal alignment, is an actively pursued and effective intervention . However, postoperative adjacent vertebral fractures (AVFs) may occur , which can lead to recurrent low back pain, decreased ADL, and disruption of local kyphotic correction, thereby posing issues related to spinal alignment . As many factors contributing to AVF remain unclear, this study retrospectively examined whether performing BKP for an OVF with a minimal vertebral height change in the early stages could reduce the incidence of AVF.
|
[
"Hiromitsu Takano",
"Hidetoshi Nojiri",
"Arihisa Shimura",
"Juri Teramoto",
"Yuta Sugawara",
"Muneaki Ishijima"
] |
https://doi.org/10.3390/medicina60071097
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278625_p1
|
PMC11278625
|
sec[1]/p[0]
|
2. Materials and Methods
| 4.152344 |
biomedical
|
Study
|
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This study included 95 patients (22 males, 73 females) who had undergone BKP at our institution or affiliated hospitals outside the authors’ affiliation between 2021 and 2022 and were followed up for over 1 year postoperatively. The patients were divided into two groups: BKP within 2 weeks after injury (Early group) and BKP > 2 weeks after injury (Non-early group). The date of injury was defined as the date of low back pain or the date of the inferred injury mechanism that caused the OVF, followed by MRI evaluation of a new OVF. Patients with steroid-induced osteoporosis, pathological fractures, traumatic fractures, and diffuse idiopathic skeletal hyperostosis (DISH) were excluded. All patients wore a soft corset for 3 months postoperatively, and osteoporosis treatment, such as parathyroid hormone analogs, anti-sclerostin antibody agents, and anti-RANKL antibody agents, was introduced whenever possible. This study investigated the following parameters: preoperative patient characteristics; fracture level; the presence of old vertebral fractures; the presence of posterior wall injury; the presence of intravertebral cleft; duration of surgery; duration to hospitalization; cement volume; the occurrence of AVF; the timing of AVF occurrence; Numerical Rating Scale (NRS) scores at preoperative, postoperative, and final follow-up assessments; posterior vertebral kyphosis angle of the affected vertebra on plain lateral X-ray; vertebral wedge ratio; local kyphotic angle; and changes in each of these parameters between preoperative and postoperative assessments . Statistical analysis was conducted separately for the Early and Non-early groups using the Mann–Whitney U test, with p < 0.05 considered statistically significant. After univariable analysis, those with p -values less than 0.1 were selected as covariates. A Variance Inflation Factor (VIF) greater than 10 was excluded to exclude multicollinearity among variables. Multivariable logistic regression analysis was performed to evaluate the risk of AVF occurrence. The research ethics committee at the Faculty of Medicine, Juntendo University, waived the need for ethics approval and the need to obtain consent for the collection, analysis, and publication of the retrospectively obtained and anonymized data for this noninterventional study.
|
[
"Hiromitsu Takano",
"Hidetoshi Nojiri",
"Arihisa Shimura",
"Juri Teramoto",
"Yuta Sugawara",
"Muneaki Ishijima"
] |
https://doi.org/10.3390/medicina60071097
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278625_p2
|
PMC11278625
|
sec[2]/sec[0]/p[0]
|
3.1. Patient Characteristics
| 4.097656 |
biomedical
|
Study
|
[
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The mean age was 80.7 years (range, 62–94 years). Among them, 62 patients underwent BKP within 2 weeks after injury (Early group), while 33 patients underwent BKP > 2 weeks after injury (Non-early group). There were 62 cases in the Early group and 33 cases in the Non-early group. The mean age was 81.8 ± 7.3 years in the Early group and 78.5 ± 8.2 years in the Non-early group. The sex ratio (males to females) was 15:47 in the Early group and 7:26 in the Non-early group. There were no cases (0%) of thoracic spine fractures (-T10) in either the Early or Non-early group. Regarding thoracolumbar spine fractures (T11–L2), there were 50 cases (80.6%) in the Early group and 27 cases (81.8%) in the Non-early group. Regarding lumbar spine fractures (L3–L5), there were 12 cases (19.4%) in the Early group and 6 cases (18.2%) in the Non-early group. The presence of old vertebral fractures was observed in 16 cases (25.8%) in the Early group and 14 cases (42.4%) in the Non-early group. Posterior wall injury was present in 25 cases (40.3%) in the Early group and in 14 cases (42.4%) in the Non-early group. Intravertebral cleft was present in 17 cases (27.4%) in the Early group and in 12 cases (36.3%) in the Non-early group. The preoperative NRS score was 9.2 ± 0.7 in the Early group and 9.0 ± 0.7 in the Non-early group, with no significant difference observed. The time from injury to surgery (days) was 8.2 ± 3.0 in the Early group and 46.5 ± 34.1 in the Non-early group, with a significant difference observed in favor of the Early group ( p < 0.05; Table 1 ).
|
[
"Hiromitsu Takano",
"Hidetoshi Nojiri",
"Arihisa Shimura",
"Juri Teramoto",
"Yuta Sugawara",
"Muneaki Ishijima"
] |
https://doi.org/10.3390/medicina60071097
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278625_p3
|
PMC11278625
|
sec[2]/sec[1]/p[0]
|
3.2. Outcomes
| 4.203125 |
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|
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The duration of surgery (minutes) was 24.0 ± 2.4 in the Early group and 23.5 ± 2.5 in the Non-early group, with no complications related to general anesthesia or surgical technique, and the amount of bleeding was minimal and immeasurable. The duration of hospitalization (days) was 32.8 ± 15.7 in the Early group and 29.2 ± 17.7 in the Non-early group, while the cement volume (mL) was 7.65 ± 1.37 in the Early group and 7.42 ± 1.73 in the Non-early group, with no significant difference between the two groups. The postoperative NRS score was 0.4 ± 0.7 in the Early group and 0.8 ± 1.3 in the Non-early group, with no significant difference observed between the two groups. The incidence of AVF was 15.8% (15/95 cases), with a significantly lower rate in the Early group at 6.5% (4/62 cases) compared to the Non-early group at 33.3% (11/33 cases) ( p < 0.05). The time to AVF occurrence (weeks) was 6.5 ± 1.8 in the Early group and 4.1 ± 0.9 in the Non-early group, with AVF occurring significantly earlier in the Non-early group ( p < 0.05; Table 2 ). In terms of NRS, in the Early group, scores improved substantially from preoperative (9.2) to postoperative (0.4) assessments and final follow-up (0.4), while in the Non-early group, scores improved similarly from preoperative (9.0) to postoperative (0.8) assessments and final follow-up (0.8). In terms of evaluation on plain lateral X-ray images, the posterior vertebral kyphosis angle in the Early group changed from 9.2° (95% confidence interval (CI) 7.8–10.5) preoperatively to 4.0° (95% CI 3.2–4.8) postoperatively to 6.6° (95% CI 5.5–7.7) at the final follow-up. The change in posterior vertebral kyphosis angle from preoperative to postoperative was 5.2° (95% CI 4.2–6.2) in the Early group. In the Non-early group, the posterior vertebral kyphosis angle changed from 11.1° (95% CI 9.6–12.6) preoperatively to 5.1° (95% CI 3.5–6.8) postoperatively to 7.0° (95% CI 5.1–9.0) at the final follow-up. The change in posterior vertebral kyphosis angle from preoperative to postoperative was 6.0° (95% CI 4.2–6.9) in the Non-early group. The vertebral wedge ratio in the Early group changed from 76.7% preoperatively to 89.9% postoperatively to 81.8% at the final follow-up, with a change of 13.2% from preoperative to postoperative assessments. In the Non-early group, the vertebral wedge ratio changed from 70.2% preoperatively to 86.7% postoperatively to 80.4% at the final follow-up. The changes in both posterior vertebral kyphosis angle and vertebral wedge ratio were significantly lower in the Early group . The local kyphotic angle changed from 6.0° (95% CI 2.4–9.6) preoperatively to 0.8° (95% CI −2.4–3.9) postoperatively to 4.8° (95% CI 1.4–8.2) at the final follow-up in the Early group. In the Non-early group, the local kyphotic angle changed from 11.0° (95% CI 6.2–15.8) preoperatively to 4.4° (95% CI 0.4–8.4) postoperatively to 8.7° (95% CI 3.9–13.5) at the final follow-up, with no significant difference between the two groups . AVF occurred in 15.8% (15/95 cases), and in the univariate analysis, where patients were divided into the Non-AVF group (80 cases) and the AVF group (15 cases), no significant differences were found in age, presence of old vertebral fracture, cement volume, change in posterior vertebral kyphosis angle, change in vertebral wedge ratio, or change in postoperative local kyphotic angle. However, significant differences were observed in time from injury to surgery, preoperative posterior vertebral kyphosis angle, postoperative posterior vertebral kyphosis angle, final follow-up posterior vertebral kyphosis angle, preoperative vertebral wedge ratio, postoperative vertebral wedge ratio, final follow-up vertebral wedge ratio, preoperative local kyphotic angle, final follow-up local kyphotic angle, and change in local kyphotic angle ( p < 0.05; Table 3 ). Table 4 shows the adjusted odds ratios for time from injury to surgery, preoperative posterior vertebral kyphosis angle, and change in local kyphotic angle with respect to AVF. The adjusted odds ratios for Early BKP or Non-early BKP, change in vertebral wedge ratio, preoperative vertebral wedge ratio, and preoperative local kyphosis angle were 7.663 (95% confidence interval (CI) 1.802–32.582; p = 0.006), 1.058 (95% CI 0.977–1.145; p = 0.164), 1.167 (95% CI 1.036–1.315; p = 0.011), and 0.777 (95% CI 0.571–1.057; p = 0.108), respectively. This suggests that Early BKP or Non-early BKP is associated with a higher risk of AVF occurrence.
|
[
"Hiromitsu Takano",
"Hidetoshi Nojiri",
"Arihisa Shimura",
"Juri Teramoto",
"Yuta Sugawara",
"Muneaki Ishijima"
] |
https://doi.org/10.3390/medicina60071097
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278625_p4
|
PMC11278625
|
sec[3]/p[0]
|
4. Discussion
| 4.234375 |
biomedical
|
Study
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Previously, the treatment principle for OVF leaned towards conservative treatment, with orthosis therapy being a common choice. However, regardless of whether rigid or soft corsets were used, there was no significant difference in preventing vertebral deformity, improving QOL, or providing pain relief, with approximately 36% of OVF cases progressing to progressive vertebral compression and around 14% developing pseudoarthrosis . Moreover, 21.3% of cases experienced a decline in ADL 6 months after injury . Hence, there are cases where early surgery is desirable. BKP enables early mobilization due to early pain relief and reduces mortality rates . Early BKP is recommended for cases of OVF with poor pain improvement because it not only improves pain but also helps maintain ADL and prevents medical complications . Nowadays, there is a tendency to perform early BKP, especially when magnetic resonance imaging (MRI) shows prognostic factors like extensive T1 hypointensity, T2 hypointensity, or localized T2 hyperintensity . However, even in cases of OVF considered to have a good prognosis on MRI, residual lower back pain was observed in 29.1% of cases at 6 months, indicating a poor prognosis . The study was not randomized, and all new OVF patients with pain were treated with BKP. The incidence of AVF was reported to be around 14–35.7% ; in this study, the AVF incidence was 15.8%, which is consistent with previous reports. However, in the Early group, the AVF incidence was significantly lower at 6.5% compared to the Non-early group. The 1-year repeat fracture rate in the natural course after an OVF is 19.2% , and the AVF rate is not necessarily higher than the postoperative AVF rate after BKP, suggesting that early BKP may prevent secondary vertebral fractures. In addition, it has been reported that postoperative AVF is a risk factor for prolonged pain and reoperation . Postoperative AVF after BKP often occurs within 2 months . When comparing the incidence of AVF after BKP, it is not necessarily higher. On the contrary, some have argued that performing early BKP may prevent subsequent vertebral fractures. Early BKP not only enables an early return to society but also helps maintain spinal alignment and reduces the occurrence of secondary fractures like AVF . The AVF risk consists of five preoperative factors: (1) intravertebral instability (≥5 mm), (2) focal kyphosis (≥10°), (3) duration of symptoms (≥30 days), (4) intravertebral cleft, and (5) previous history of vertebral fracture . The risk factors for AVF include excessive correction of kyphosis and residual kyphotic deformity . In OVF, if treated early, there is minimal change in vertebral height and maintenance of vertebral height, whereas delayed treatment often leads to significant changes in vertebral height and worsening alignment. Our treatment strategy for OVF involves performing BKP in all cases of new OVF, regardless of the prognostic factors on MRI. Early BKP for OVF is controversial because the treatment principle for OVF is conservative treatment. Even in cases that would have been cured by BKP in the early stage, patients may choose conservative treatment, resulting in their vertebrae being crushed, and requiring major surgery such as an anterior vertebral body replacement or posterior osteotomy. In addition, most patients are elderly, and the role of early BKP to immediately relieve pain and improve ADL is very significant. In this study, the changes in vertebral kyphotic angle and vertebral wedge ratio were lower in the Early group, suggesting that early BKP reduces changes in vertebral height before and after surgery, decreases stress on adjacent vertebrae, and consequently reduces the incidence of AVF. On the other hand, it has been reported that BKP of a single vertebral body corrects local kyphosis but does not have the ability to correct global alignment . Local kyphosis correction also fails when AVF occurs . Anabolic agents could improve pain and strongly reduce the risk of upcoming subsequent fractures . In this study, anabolic agents were also introduced after BKP to the extent possible. Although percutaneous vertebroplasty (PVP) is considered a relative contraindication to treatment of vertebral plana, good results have been reported with reduction in pain by percutaneous cement augmentation . In this study, BKP was also performed on vertebral plana that had remaining space that could be filled with cement, with good results. However, for vertebral plana that are severely crushed and difficult to cement, anterior reconstruction such as an anterior vertebral body replacement or posterior osteotomy may be necessary, and careful consideration is required. The reason why the average length of hospitalization was as long as one month was because all cases in this study were at a community-based regional hospital, and many elderly patients tended not to wish to be discharged early but to stay for a long period of time, including rehabilitation. A limitation of this study is the lack of long-term follow-up, which prevents the evaluation of the frequency of AVF and clinical outcomes after the study period. The follow-up period may also vary from case to case. However, AVF after BKP often occurs within 2 months postoperatively , and therefore, the results of this study are considered sufficiently informative. Furthermore, all cases in this study were BKP cases and did not include cases treated conservatively. Although BMD assessment is extremely important when BKP is performed , in this study, BMD assessment was performed using radial DXA and was not performed in all cases, so it was omitted from the study items. Additionally, strong preoperative pain might have hindered the evaluation of overall spinal alignment. Moving forward, extending the study period and increasing the number of cases for further examination are warranted.
|
[
"Hiromitsu Takano",
"Hidetoshi Nojiri",
"Arihisa Shimura",
"Juri Teramoto",
"Yuta Sugawara",
"Muneaki Ishijima"
] |
https://doi.org/10.3390/medicina60071097
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278625_p5
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PMC11278625
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sec[4]/p[0]
|
5. Conclusions
| 4.101563 |
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|
Study
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We divided patients into an Early group, who had undergone BKP within 2 weeks after injury, and a Non-early group, who had undergone BKP > 2 weeks after injury, to retrospectively investigate whether performing BKP early with minimal vertebral height change reduces the incidence of AVF. The AVF incidence was lower in the Early group compared to the Non-early group, and further analysis of the AVF incidence revealed that the time from injury to surgery was a risk factor for AVF development. We recommend performing BKP early with minimal vertebral height change for OVF. A multidisciplinary and tailored approach remains the best manner to obtain long-term benefits for osteoporotic patients in terms of primary and secondary prevention of fragility fractures .
|
[
"Hiromitsu Takano",
"Hidetoshi Nojiri",
"Arihisa Shimura",
"Juri Teramoto",
"Yuta Sugawara",
"Muneaki Ishijima"
] |
https://doi.org/10.3390/medicina60071097
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p0
|
PMC11278638
|
sec[0]/p[0]
|
1. Introduction
| 1.821289 |
biomedical
|
Other
|
[
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[
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Dementia is one of the most common diseases in the elderly population. According to the WHO, the number of people diagnosed with this disease is constantly increasing. It is estimated to reach 75 million by 2030, and a large proportion of cases of this disease are undiagnosed . According to the Hygiene Institute, in 2023, 41,689 residents with dementia were registered in Lithuania .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278638_p1
|
PMC11278638
|
sec[0]/p[1]
|
1. Introduction
| 3.496094 |
biomedical
|
Other
|
[
0.99609375,
0.002384185791015625,
0.0012865066528320312
] |
[
0.00859832763671875,
0.9033203125,
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0.001834869384765625
] |
Dementia is a result of a variety of diseases and injuries that affect the brain. Alzheimer’s disease is the most common form of dementia and may contribute to 60–70% of cases . Dementia is a progressive neurodegenerative disease characterized by the impairment of cognitive functions such as spatial perception, memory and thinking, as well as difficulties in performing routine tasks in daily activities. The aging population and the emergence of co-morbidities, such as dementia, prompt action to ensure the well-being of this population. One of the main goals of preventive dentistry is to preserve the healthy teeth of elderly patients .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p2
|
PMC11278638
|
sec[0]/p[2]
|
1. Introduction
| 3.941406 |
biomedical
|
Review
|
[
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0.0028514862060546875
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[
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0.0013990402221679688
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The oral health of the elderly is in a critical state and, in most cases, there is a lack of attention to this area. Elderly people and people with special needs often suffer from oral diseases. The most common problems, such as poor chewing and speaking functions, xerostomia and bad breath, can affect self-esteem and communication. Elderly people with dementia often present with a greater burden of oral diseases, with the prevalence of the latter more so evident in the advanced stages of the condition. Evidence demonstrates a higher incidence of dental caries, periodontal disease, increased pain and other related dental problems in dementia. People with mental disorders lose their independence in everyday life. It is important for such patients to constantly monitor their oral health status, so the help of other people, caregivers or health care professionals is needed to timely notice changes in oral health status, to ensure the proper personal oral hygiene care of patients with dementia, but many studies have shown that individual care workers fail to understand the importance of oral health . Educational programs for individual care workers should be created and implemented by dental hygienists for the purposes of preventive oral care .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p3
|
PMC11278638
|
sec[0]/p[3]
|
1. Introduction
| 1.891602 |
biomedical
|
Other
|
[
0.92138671875,
0.050018310546875,
0.0287628173828125
] |
[
0.003459930419921875,
0.994140625,
0.0006132125854492188,
0.002017974853515625
] |
Adapting communication to the needs of individuals with reduced cognitive ability, as well as involving familiar caregivers, can prove challenging in everyday dental practice .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p4
|
PMC11278638
|
sec[0]/p[4]
|
1. Introduction
| 2.087891 |
biomedical
|
Other
|
[
0.890625,
0.00426483154296875,
0.1051025390625
] |
[
0.4228515625,
0.5712890625,
0.004398345947265625,
0.0013170242309570312
] |
There is a lack of research on the experiences of individual care workers in the work environment. More attention is paid to the role of nurses and the burden they experience at work. However, nursing assistants are an integral part of the health care system, as they supervise and care for patients, as well as devote a lot of effort to those who cannot or can only partially care for themselves. Individual care workers are also responsible for the oral care of dementia patients. However, their knowledge, attitude on this issue and the obstacles they face in the oral care of patients with neurodegenerative and other serious diseases have not been extensively studied abroad, and no such studies have been conducted in Lithuania so far.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p5
|
PMC11278638
|
sec[0]/p[5]
|
1. Introduction
| 2.150391 |
biomedical
|
Study
|
[
0.96337890625,
0.005741119384765625,
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[
0.99365234375,
0.005405426025390625,
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0.0004305839538574219
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The aim of this study was to reveal the experiences of individual care workers performing oral care for dementia patients.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p6
|
PMC11278638
|
sec[1]/p[0]
|
2. Materials and Methods
| 3.394531 |
biomedical
|
Study
|
[
0.9970703125,
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] |
[
0.9990234375,
0.0009136199951171875,
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0.00005936622619628906
] |
A qualitative research method, applying semi-structured interviews, was used to collect research data. This method was expected to reveal, as accurately as possible, the experiences, knowledge, and attitudes of individual care workers towards the importance of oral cavity care and oral hygiene habits of patients with dementia. The questionnaire was created based on a scientific study conducted by Weening-Verbree et al. . The content analysis was conducted to analyze the research data.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p7
|
PMC11278638
|
sec[1]/p[1]
|
2. Materials and Methods
| 1.983398 |
biomedical
|
Study
|
[
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[
0.99365234375,
0.005523681640625,
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0.00033664703369140625
] |
This study was conducted in June–October 2023. A total of 10 individual care workers (all of them female) who provide personal care to patients with dementia (in social care institutions) agreed to participate in this study ( Table 1 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p8
|
PMC11278638
|
sec[1]/p[2]
|
2. Materials and Methods
| 1.503906 |
other
|
Study
|
[
0.12078857421875,
0.0011997222900390625,
0.8779296875
] |
[
0.7099609375,
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0.0014276504516601562,
0.001209259033203125
] |
Prior to conducting this study, permissions were obtained from the administrations of two social care institutions, X and Y. According to the principle of justice, all informants participated in the survey voluntarily. Interviews were conducted respecting informed consent and confidentiality principles. All audio recordings were available only to the researchers. Individual interviews lasted for 15 min on average, were recorded and later transcribed.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p9
|
PMC11278638
|
sec[1]/p[3]
|
2. Materials and Methods
| 3.197266 |
biomedical
|
Study
|
[
0.99072265625,
0.0019388198852539062,
0.007480621337890625
] |
[
0.9970703125,
0.0026702880859375,
0.00020766258239746094,
0.00011289119720458984
] |
The interview consisted of 12 questions: 1 introductory question, 9 in-depth questions, 1 closing question and 1 question to find out contextual, socio-demographic data. The questions can be divided into four parts according to the topics: − The first part aims to reveal the experience of individual care workers in performing oral cavity care for patients with dementia (questions 1–4); − The second part aims to assess the oral hygiene habits of dementia patients (questions 5–7); − The third part aims to determine the knowledge and attitude of individual care workers towards the importance of care of the oral cavity of patients with dementia (questions 8–11); − The fourth part aims to find out the socio-demographic indicators of the study participants—age, gender, work experience in the field (years), and education in obtaining the qualification of an individual care worker (question 12).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278638_p10
|
PMC11278638
|
sec[2]/sec[0]/p[0]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 1.313477 |
other
|
Other
|
[
0.10186767578125,
0.0012302398681640625,
0.89697265625
] |
[
0.432373046875,
0.56396484375,
0.0023097991943359375,
0.0014791488647460938
] |
At the beginning of the conversation, informants were asked “How do you feel today?” Three subcategories are distinguished according to the answers given and supporting statements ( Table 2 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p11
|
PMC11278638
|
sec[2]/sec[0]/p[1]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 1.106445 |
other
|
Other
|
[
0.01041412353515625,
0.0009264945983886719,
0.98876953125
] |
[
0.143798828125,
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] |
Most informants assessed their well-being positively (6). It is emphasized that this work requires feeling good so that employees can perform their tasks properly, and this is confirmed by the answer of the informant (M1): “I feel very good because we have to feel good during our work”. Other informants confirmed negative or ambivalent opinions (4). One person said that “well-being is good, but at the same time fatigue is also felt, because the work is really hard”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p12
|
PMC11278638
|
sec[2]/sec[0]/p[2]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 2.0625 |
biomedical
|
Study
|
[
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[
0.994140625,
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0.00028252601623535156
] |
The aim of this study was to find out what challenges individual care workers face in oral care for dementia patients. In the analysis of the data from this study, five main supporting statements were identified ( Table 3 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p13
|
PMC11278638
|
sec[2]/sec[0]/p[3]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 2.291016 |
biomedical
|
Study
|
[
0.7783203125,
0.1326904296875,
0.0887451171875
] |
[
0.79833984375,
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] |
Individual care workers were most often faced with the reluctance of patients (6) to perform oral care. Individual care workers said that dementia patients do not accept help and some of them are hostile. They do not understand why they need to open their mouth or what is required of them. Physically, they could do it themselves, but due to their illness, it is difficult to do it. Four supporting statements were made in the subcategory that the performance of oral care is aggravated by patients’ fears. Residents protect their removable dentures, and they may hide them from staff, because they think that they will take them away. In addition, patients’ fear of water was mentioned. Two individual care workers said that the behaviors depend on the mood swings of the patients (2). This is reflected in the answer of the informant (M8): “one day the mood is good, and the next day he refuses to clean up”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p14
|
PMC11278638
|
sec[2]/sec[0]/p[4]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 1.849609 |
biomedical
|
Study
|
[
0.9658203125,
0.005157470703125,
0.0288543701171875
] |
[
0.97705078125,
0.0215606689453125,
0.000698089599609375,
0.0007090568542480469
] |
We wanted to know how the study participants dealt with problems that arose during oral care. The answer options provided by the individual care workers are grouped into five subcategories and supporting statements ( Table 4 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p15
|
PMC11278638
|
sec[2]/sec[0]/p[5]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 2.300781 |
biomedical
|
Study
|
[
0.90673828125,
0.058013916015625,
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] |
[
0.67919921875,
0.3125,
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] |
Most informants indicated that they were dealing with problems related to the maintenance of the oral care in patients with dementia by trying to adapt to the timings of their better moods (4). This is confirmed by the answer of the informant (M5): “We try to approach patients when their mood is better.” Another way of solving the problem is persuading (3). Since individual care workers are faced with the problem that some patients do not understand how to brush their teeth and how to rinse, two informants used the method of interpretation (2). When a patient does not agree to accept help in oral care, the help of other persons is used (1) or dentures are picked up for cleaning when a patient is eating (1).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p16
|
PMC11278638
|
sec[2]/sec[0]/p[6]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 2.054688 |
biomedical
|
Study
|
[
0.9921875,
0.00312042236328125,
0.00461578369140625
] |
[
0.990234375,
0.00833892822265625,
0.0005764961242675781,
0.0006113052368164062
] |
In our study, there was interest in how often patients with dementia can independently take care of their oral health. When analyzing the data of the study, patients’ abilities were divided into three subcategories with supporting statements ( Table 5 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p17
|
PMC11278638
|
sec[2]/sec[0]/p[7]
|
3.1. Experiences of Individual Care Workers in Oral Cavity Care for Dementia Patients
| 2.113281 |
biomedical
|
Other
|
[
0.93115234375,
0.00943756103515625,
0.059600830078125
] |
[
0.464111328125,
0.52880859375,
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0.0024204254150390625
] |
The informants report that most dementia patients already have an advanced stage of the disease when administered to the social care institution and are fully dependent on help (4); a smaller number of patients partially require help or are self-sufficient (4). This is confirmed by the answer of the informant (M1): “<…> perhaps 10 percent of the dementia patients would be able to do everything by themselves, when the disease is not far advanced <…>”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p18
|
PMC11278638
|
sec[2]/sec[1]/p[0]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 1.822266 |
biomedical
|
Study
|
[
0.9638671875,
0.0030918121337890625,
0.0328369140625
] |
[
0.84228515625,
0.153564453125,
0.0027446746826171875,
0.0012445449829101562
] |
Informants were asked to describe oral hygiene habits for dementia patients. According to the given answers, two categories were distinguished. The first describes oral hygiene habits and the second one discusses the tools used. We see the answers of the informants with the supporting statements in Table 6 .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p19
|
PMC11278638
|
sec[2]/sec[1]/p[1]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 2.402344 |
biomedical
|
Study
|
[
0.9345703125,
0.028350830078125,
0.03717041015625
] |
[
0.9208984375,
0.07684326171875,
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0.0018663406372070312
] |
It was revealed that all individual care workers perform dental cleaning twice a day (10) “In the morning and in the evening”. Individual care workers were asking patients who wear removable dentures to remove them for cleaning (6). Eight informants reported mouthwashes being used in patients’ daily routines. This is confirmed by the answer of the informant (M8) “Who needs, who wants a relative brings mouthwashes”. And individuals who do not have mouthwash are usually offered to rinse or brush with tap water. This is supported by the informant’s (M7) statement: “I suggest rinsing with water <…>”. Patients’ behavior often complicates the process of dental cleaning causing a lack of interdental care (2). This is reflected in the informant’s (M1) response: “We don’t use the dental floss for those who have teeth because they refuse to use it”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p20
|
PMC11278638
|
sec[2]/sec[1]/p[2]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 3.542969 |
biomedical
|
Study
|
[
0.97265625,
0.00997161865234375,
0.01751708984375
] |
[
0.9892578125,
0.00951385498046875,
0.0008931159973144531,
0.0005159378051757812
] |
One of the main tools for dental care is toothpaste (10). Several examples of them were also cited as: “Colgate”, “Blend a med”, “Sensodyne”, and “Ecodenta”. Some individual care workers describe them as “<…> standard <…>”, “<…> the simplest and cheapest <…>”, and a few considered good pastes. However, one informant (M6) gave the answer that when there are patients in the social care institution who also use more expensive toothpastes, they have anti-inflammatory, anti-bleeding and other good active ingredients. The supporting statement for this is as follows: “One elderly woman with dementia is very much cared for by her son, he takes her to dentists and dental hygienists, brings her better toothpastes, like Parodontax”. Unfortunately, this is observed only in patients whose relatives are engaged more in their care. The results showed that toothpastes and toothbrushes were the tools with which dentures were cleaned (3). Four informants say that soft and hard toothbrushes are used. We noticed that the tools for oral care are provided by relatives of patients who often don’t pay attention to the quality/type of the toothbrush. The supporting statement of the subject (M1) is as follows: “<…> tools are bought by relatives, and they buy it just to be new and do not pay attention, if it is a soft or hard toothbrush. But when we ask to buy it, then discuss which one is better”. However, we see that there is an opportunity to ask relatives who are responsible for their family members to buy a soft brush, especially when there are bleeding gums. Although the subjects indicated that soft and hard toothbrushes are used in their institution, their opinions are that the toothbrush should be soft, because, as they note, such patients have gum problems. There have also been a couple of informants who reported that they usually use or at least try to use a soft toothbrush. One nurse’s assistant also gave examples of mouthwashes, like Eludril and Listerine. Because there are a lot of elderly people living in social care institutions and the majority wear removable dentures, patients with dementia may not be able to say that they have problems with it. This results in wounds and aches that employees are trying to heal. The informant (M5) explains how such a problem is solved: “If the removable dentures cause wounds, we wait until it heals and use the ointments <…>”. There are also particularly difficult cases when it is very difficult for a patient to carry out brushing their teeth, but cleaning is still necessary, so individual care workers resort to non-routine cleaning measures that are not even adapted for cleaning the dentures or mouth. Supporting this is the informant’s (M6) statement: “<…> with gauze and toothpicks because you’re still trying somehow to get out of the situation”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p21
|
PMC11278638
|
sec[2]/sec[1]/p[3]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 1.870117 |
biomedical
|
Study
|
[
0.90283203125,
0.002635955810546875,
0.09454345703125
] |
[
0.7939453125,
0.2025146484375,
0.0022487640380859375,
0.0010232925415039062
] |
This part discusses the use of additional tools such as denture glue and dissolving tablets for cleaning removable dentures. Considering the statements, three subcategories were formed. The informants’ answers to these questions are given in Table 7 .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p22
|
PMC11278638
|
sec[2]/sec[1]/p[4]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 1.779297 |
biomedical
|
Study
|
[
0.61572265625,
0.01200103759765625,
0.372314453125
] |
[
0.50244140625,
0.493896484375,
0.0014619827270507812,
0.0019521713256835938
] |
Most informants said they use denture glue (9). And as we can see from the answers given, it is often emphasized that not everyone uses them, because not everyone has them. The supporting statement of the informant (M1) is as follows: “For some patients, we use Corega denture glue if they have it”. We also note that Corega glue of the same type of removable dentures is usually used. Half of the individual care workers indicated that they were using these tablets. And the others claimed the opposite about their use, as indicated by the statement of the informant (M8): “We do not soak with tablets”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p23
|
PMC11278638
|
sec[2]/sec[1]/p[5]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 1.827148 |
biomedical
|
Study
|
[
0.8828125,
0.005512237548828125,
0.11175537109375
] |
[
0.66845703125,
0.327392578125,
0.002552032470703125,
0.0016956329345703125
] |
The next question was to find out if care is taken to ensure patients’ dental examinations and professional dental hygiene. According to the statements, two subcategories were formed. We see the responses of the informants with supporting statements in Table 8 .
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p24
|
PMC11278638
|
sec[2]/sec[1]/p[6]
|
3.2. Oral Hygiene Habits of Dementia Patients
| 2.091797 |
biomedical
|
Study
|
[
0.97900390625,
0.0146942138671875,
0.006381988525390625
] |
[
0.93505859375,
0.06097412109375,
0.0011425018310546875,
0.0029811859130859375
] |
The data of this study revealed that patients with dementia are rarely taken to oral care specialists preventatively (2). Most often, such patients visit these specialists when acute problems arise (3); this is confirmed by the answer of the informant (M8): “We take patients to dentists, dental hygienists, when the problem appeared, or hurts”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p25
|
PMC11278638
|
sec[2]/sec[2]/p[0]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 2.556641 |
biomedical
|
Study
|
[
0.9814453125,
0.004253387451171875,
0.014373779296875
] |
[
0.98583984375,
0.012969970703125,
0.0006589889526367188,
0.0003719329833984375
] |
We asked if individual care workers had interacted with a dental hygienist by gaining knowledge about the peculiarities of oral care for dementia patients. If the answer was no, then they were asked to comment on who provided this knowledge. Based on the provided options, two categories were formed. The first category characterizes the experience of individual care workers in communicating with the dental hygienist, from which two subcategories are distinguished. The second category is comprised of other sources of information that provided knowledge about the care of the oral cavity of patients, divided into three subcategories with its supporting statements ( Table 9 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p26
|
PMC11278638
|
sec[2]/sec[2]/p[1]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 2.349609 |
biomedical
|
Study
|
[
0.96044921875,
0.007190704345703125,
0.032318115234375
] |
[
0.99365234375,
0.005558013916015625,
0.00024437904357910156,
0.0003249645233154297
] |
The results showed that while some individual care workers claimed to be visiting oral care professionals, six informants reported that they were not inclined to consult on this issue. One of this study’s informants (M1) gave the statement: “I visit the dental hygienist, but I have not been able to communicate on this issue”. Four informants were consulted by dental hygienist on the matter. The informants are willing to expand their knowledge by attending seminars and using their own or colleagues’ experiences (6). As one of the informants (M1) states, “We have certain seminars held, not every year, but our institution sends us to improve ourselves in certain courses. It happens that we learn something in the courses”. Three informants obtained qualifications needed for oral care in professional school (3). According to one of the study participants (M4), “During my professional training I was taught about oral care of people with dementia<…>”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p27
|
PMC11278638
|
sec[2]/sec[2]/p[2]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 2.316406 |
biomedical
|
Study
|
[
0.94091796875,
0.00592041015625,
0.052947998046875
] |
[
0.95263671875,
0.045501708984375,
0.0010662078857421875,
0.0005846023559570312
] |
During the interview, individual care workers were asked if they had enough knowledge of the peculiarities of oral care for dementia patients, as well as whether they would like to receive additional training from a dental hygienist in order to gain more knowledge. According to the data provided by the individual care workers, two categories were formed. The first category describes the opinion of individual care workers about the amount of their knowledge related to the peculiarities of oral care for dementia patients. The next category discusses the need of individual care workers to receive additional training from a dental hygienist to gain more knowledge. Both categories have two subcategories each, with supporting statements ( Table 10 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p28
|
PMC11278638
|
sec[2]/sec[2]/p[3]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 1.856445 |
biomedical
|
Study
|
[
0.77587890625,
0.0160675048828125,
0.2080078125
] |
[
0.5009765625,
0.494873046875,
0.002239227294921875,
0.001995086669921875
] |
Four informants claimed to have enough knowledge, but six expressed the need to be additionally trained about the peculiarities of oral care for dementia patients. One informant’s (M3) response confirms as follows: “I wouldn’t want to, there’s enough knowledge. Because we use what relatives bring. We won’t go and buy those tools ourselves”. Another informant’s (M9) supporting statement was as follows: “It would be good to have more of them. Especially about the care of dentures”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p29
|
PMC11278638
|
sec[2]/sec[2]/p[4]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 2.058594 |
biomedical
|
Study
|
[
0.9404296875,
0.00740814208984375,
0.052154541015625
] |
[
0.92431640625,
0.0728759765625,
0.0018129348754882812,
0.000946044921875
] |
All individual care workers understand the importance of oral health (M1–M10). According to their responses, two categories have been formed. The first presents the opinions of informants about the importance of daily care of the patient’s oral health. The second category describes how individual care workers understand the need for daily oral care for patients with dementia ( Table 11 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p30
|
PMC11278638
|
sec[2]/sec[2]/p[5]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 3.267578 |
biomedical
|
Study
|
[
0.9765625,
0.017303466796875,
0.006328582763671875
] |
[
0.97314453125,
0.020782470703125,
0.00518035888671875,
0.0010824203491210938
] |
The informants gave many reasons as to why oral care was necessary. Nine informants emphasized the importance of daily oral care for dementia patients. Most often in this subcategory it was noted that the goal is to avoid bad breath. The second most common reason was due to the comfort of the patient and their proper quality of life (7). The main focus was to preserve the remaining teeth of patients and their ability to chew. The supporting statement for this is as follows: “<…> because when patients arrive, we see, that the teeth wasn’t brushed at all, then these people have a lot of problems, and we have to fix them, they have brought it to us and we have to do everything: to do new dentures, to heal the teeth”. One informant’s (M5) statement reveals that there is a sense of duty, a responsibility for each patient to take care of their oral cavity, and at the same time an understanding of what patients feel and how much it affects their quality of life. Several informants claimed that it is important for prevention and the reduction of health problems (3). These arguments were associated with a reduction in the risk of developing inflammatory processes.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p31
|
PMC11278638
|
sec[2]/sec[2]/p[6]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 1.991211 |
biomedical
|
Study
|
[
0.97900390625,
0.004367828369140625,
0.0166015625
] |
[
0.98193359375,
0.016448974609375,
0.001007080078125,
0.0005593299865722656
] |
At the end of the interview, the informants were asked what factors could improve the quality of oral care for dementia patients. When analyzing the data from this study, the listed factors of informants were divided into four subcategories with supporting statements ( Table 12 ).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p32
|
PMC11278638
|
sec[2]/sec[2]/p[7]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 1.806641 |
biomedical
|
Study
|
[
0.7216796875,
0.005924224853515625,
0.2724609375
] |
[
0.77685546875,
0.22021484375,
0.0017528533935546875,
0.0012073516845703125
] |
Five informants suggested that appropriate tools for dental hygiene should be provided. The second suggestion was to reduce the workload (4). Additional organization of training (3) for individual care workers was also a relevant topic. We have already discussed the situation about training ( Table 9 ). However, a few informants also mentioned that it would certainly be useful if more training could be organized. And the other three informants in this study stated that nothing needs to be changed.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p33
|
PMC11278638
|
sec[2]/sec[2]/p[8]
|
3.3. Knowledge and Attitude of Individual Care Workers about the Oral Care of Dementia Patients
| 3.335938 |
biomedical
|
Study
|
[
0.986328125,
0.0027866363525390625,
0.01081085205078125
] |
[
0.99755859375,
0.0019159317016601562,
0.0004239082336425781,
0.00014507770538330078
] |
Answering the main question of this study about the experience of individual care workers with dementia patients in oral care, it can be concluded that the main obstacles that arise are related to patients’ behavioral and cognitive disorders that interfere with the performance of oral care. Even more challenging, such individuals no longer understand why they need to open their mouths or what is required of them, and unreasonable fears and mood swings appear. It was revealed that informants are under too much workload pressure. All these factors interfere with the proper performance of individual oral hygiene and other tasks. When discussing the knowledge and attitude of individual care workers to the importance of oral care for dementia patients, it was found that the workers quite correctly understand and approve of the importance of performing daily oral care.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p34
|
PMC11278638
|
sec[3]/p[0]
|
4. Discussion
| 2.138672 |
biomedical
|
Study
|
[
0.9736328125,
0.006282806396484375,
0.0201263427734375
] |
[
0.9736328125,
0.0237884521484375,
0.0020275115966796875,
0.0007104873657226562
] |
The majority of the informants said that they felt good when they were asked about their experiences while taking care of dementia patients (6). According to Eisenmann et al. , taking care of people with dementia is becoming more and more challenging with time, not only for the family members but also for the health care workers. This was also confirmed by several informants of this study (3), who said they felt good, but at the same time they felt tired because their work was difficult.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p35
|
PMC11278638
|
sec[3]/p[1]
|
4. Discussion
| 2.880859 |
biomedical
|
Study
|
[
0.990234375,
0.00629425048828125,
0.003448486328125
] |
[
0.98876953125,
0.00923919677734375,
0.0013513565063476562,
0.0004677772521972656
] |
The main obstacles while performing oral care procedures for patients with dementia, as stated by the individual care workers, were analyzed. The obstacle most frequently named by the informants was the unwillingness (6) of patients to perform oral care. The other obstacles were the lack of patients’ thinking and reduced skills (4). The patients needed much explanation about how to rinse or reminding how to place the toothbrush in the mouth. These statements are corroborated by the findings of other scientists , which have revealed that a major part of being an individual care worker is having a challenging experience while working with patients with cognitive impairment.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p36
|
PMC11278638
|
sec[3]/p[2]
|
4. Discussion
| 1.926758 |
biomedical
|
Study
|
[
0.95849609375,
0.0022106170654296875,
0.03948974609375
] |
[
0.9775390625,
0.0206451416015625,
0.001209259033203125,
0.0004875659942626953
] |
The results of our study are similar to the findings of other researchers , which have concluded that individual care workers have heavy workloads (2).
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278638_p37
|
PMC11278638
|
sec[3]/p[3]
|
4. Discussion
| 2.068359 |
biomedical
|
Other
|
[
0.9375,
0.0164947509765625,
0.045928955078125
] |
[
0.0228424072265625,
0.970703125,
0.0052947998046875,
0.00124359130859375
] |
According to Van Manen et al. , the only way for nursing staff to meet the needs of persons with cognitive impairment is efficient communication and well-developed nonverbal communication skills.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p38
|
PMC11278638
|
sec[3]/p[4]
|
4. Discussion
| 2.472656 |
biomedical
|
Study
|
[
0.99462890625,
0.0015850067138671875,
0.0038967132568359375
] |
[
0.994140625,
0.004703521728515625,
0.0006594657897949219,
0.0003097057342529297
] |
Our study revealed that the greatest factor in patients’ inability to take care of themselves independently was the advanced stage of dementia. It has also been confirmed by other scientists that the ability to take care of themselves is dependent on the stage of disease.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11278638_p39
|
PMC11278638
|
sec[3]/p[5]
|
4. Discussion
| 2.425781 |
biomedical
|
Study
|
[
0.99755859375,
0.0009899139404296875,
0.0012216567993164062
] |
[
0.9755859375,
0.0227203369140625,
0.0010833740234375,
0.0006957054138183594
] |
It was confirmed by Gao et al. that efficient dental hygiene was one of the most important means to prevent the development of periodontal diseases. The results of our study revealed that individual care workers were brushing patients’ teeth twice per day (10), “In the morning and in the evening”.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p40
|
PMC11278638
|
sec[3]/p[6]
|
4. Discussion
| 2.90625 |
biomedical
|
Study
|
[
0.99853515625,
0.0006647109985351562,
0.0009503364562988281
] |
[
0.99658203125,
0.0024166107177734375,
0.0005984306335449219,
0.00018537044525146484
] |
The findings of our study, showing that patients were experiencing difficulties while using an interdental brush, were in line with Gao et al.’s study, which concluded that patients with dementia frequently experience difficulties while performing individual dental hygiene, due to the symptoms of dementia.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p41
|
PMC11278638
|
sec[3]/p[7]
|
4. Discussion
| 2.556641 |
biomedical
|
Study
|
[
0.9970703125,
0.0011539459228515625,
0.0015621185302734375
] |
[
0.994140625,
0.004657745361328125,
0.0007033348083496094,
0.0003414154052734375
] |
The results of our study showed that the most frequent reason why dementia patients were taken to the dentist was related with urgent needs for treatment, not prevention. This could be explained and confirmed by the findings of Geddis-Regan et al. , saying that systemic diseases progress alongside dementia, and it also worsens oral health status.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278638_p42
|
PMC11278638
|
sec[3]/p[8]
|
4. Discussion
| 2.054688 |
biomedical
|
Other
|
[
0.9814453125,
0.0027027130126953125,
0.0157623291015625
] |
[
0.16357421875,
0.8232421875,
0.0113677978515625,
0.0017557144165039062
] |
According to Weening-Verbree et al. , in most cases individual care workers are taking care of dementia patients’ oral care; however, in most cases, the dental hygiene status of the patients with dementia is insufficient.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p43
|
PMC11278638
|
sec[3]/p[9]
|
4. Discussion
| 2.169922 |
biomedical
|
Study
|
[
0.98193359375,
0.0015172958374023438,
0.0166015625
] |
[
0.8740234375,
0.11981201171875,
0.0054779052734375,
0.0007891654968261719
] |
The majority of informants (7) said that they had enough knowledge; however, some of the informants (3) said they could have more information about oral health care. It was also confirmed by Manchery et al. that the efficient education of nursing staff about the relation between oral care and development of oral diseases could improve the attitude of nursing staff towards oral care importance.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278638_p44
|
PMC11278638
|
sec[3]/p[10]
|
4. Discussion
| 2.126953 |
biomedical
|
Study
|
[
0.98388671875,
0.0023784637451171875,
0.01349639892578125
] |
[
0.98388671875,
0.01442718505859375,
0.0011682510375976562,
0.0004627704620361328
] |
The results of our study were in line with the study of Weening-Verbree , which revealed that the staff of nursing homes understood the importance of oral care.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278638_p45
|
PMC11278638
|
sec[3]/p[11]
|
4. Discussion
| 2.255859 |
biomedical
|
Study
|
[
0.99365234375,
0.0017194747924804688,
0.004856109619140625
] |
[
0.77978515625,
0.21337890625,
0.0052947998046875,
0.0014734268188476562
] |
Options for improving the quality of the oral health care of dementia patients was analyzed in our study, and it was revealed, and also confirmed by other researchers, that supply of the proper tools for oral care (5) is important, as well as a reduced workload (4) for those who are taking care of the dementia patients.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278638_p46
|
PMC11278638
|
sec[3]/sec[0]/p[0]
|
Study Limitations
| 1.945313 |
biomedical
|
Other
|
[
0.90087890625,
0.001277923583984375,
0.09765625
] |
[
0.24853515625,
0.73828125,
0.0123443603515625,
0.0009622573852539062
] |
Future research could explore similar research questions with larger sample sizes to enhance the robustness and applicability of the findings.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278638_p47
|
PMC11278638
|
sec[4]/p[0]
|
5. Conclusions
| 2.839844 |
biomedical
|
Study
|
[
0.986328125,
0.0033550262451171875,
0.01007843017578125
] |
[
0.9921875,
0.0073089599609375,
0.00043487548828125,
0.00025010108947753906
] |
The results of this study showed that, in the informants’ opinions, it is crucial to address the daily needs of dementia patients’ oral health. The main obstacles of individual care workers in performing oral care for dementia patients are related to their cognitive disorders. For this reason, unreasonable fears of patients may arise, which will also affect the proper performance of individual oral hygiene and other tasks assigned to employees. According to the opinion of the individual care workers, most of them claimed that the knowledge they have gained is enough, but they would not mind receiving additional training from an oral hygienist in order to gain more information.
|
[
"Evelina Daugėlienė",
"Karolina Skučaitė",
"Jurgita Andruškienė",
"Šarūnė Barsevičienė",
"Eglė Žymantienė"
] |
https://doi.org/10.3390/medicina60071087
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278650_p0
|
PMC11278650
|
sec[0]/p[0]
|
1. Introduction
| 3.658203 |
biomedical
|
Other
|
[
0.990234375,
0.0086517333984375,
0.00118255615234375
] |
[
0.00933074951171875,
0.876953125,
0.11041259765625,
0.00308990478515625
] |
Antibiotic resistance has become a global health concern, increasing morbidity, mortality, and healthcare costs . The indiscriminate use of antibiotics without antibiograms can lead to the development of antibiotic-resistant bacteria and negatively impact patient outcomes . Therefore, it is vital to implement appropriate stewardship programs that monitor and control antibiotic use to minimize the risk of resistance development and ensure optimal patient outcomes.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278650_p1
|
PMC11278650
|
sec[0]/p[1]
|
1. Introduction
| 3.910156 |
biomedical
|
Review
|
[
0.9951171875,
0.00284576416015625,
0.001888275146484375
] |
[
0.01308441162109375,
0.0034332275390625,
0.98291015625,
0.0004267692565917969
] |
One strategy to promote appropriate antibiotic use is the availability and utilization of antibiograms, which provide local data on antibiotic susceptibility patterns . A recent systematic review study conducted in the United States included 37 studies that found a positive impact of the use of antibiograms on antibiotic consumption, appropriateness of prescribing, and treatment costs. Antibiograms allow healthcare providers to make evidence-based decisions regarding antibiotic prescribing, improving patient outcomes, and decreasing antibiotic resistance .
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278650_p2
|
PMC11278650
|
sec[0]/p[2]
|
1. Introduction
| 4.136719 |
biomedical
|
Review
|
[
0.99560546875,
0.0033855438232421875,
0.001018524169921875
] |
[
0.10089111328125,
0.315185546875,
0.57958984375,
0.004161834716796875
] |
The antibiogram offers a significant advantage over molecular platforms by providing a comprehensive, phenotypic assessment of a pathogen’s antibiotic resistance profile. While molecular platforms can rapidly identify the presence of specific resistance genes, they may miss novel or unexpected resistance mechanisms not covered by their assays . In contrast, antibiograms are based on the actual growth of bacteria in the presence of various antibiotics, offering a direct measure of susceptibility and resistance . This phenotypic approach not only detects resistance conferred by known genes but also captures resistance due to unknown or emerging mechanisms, ensuring more accurate and reliable guidance for effective antimicrobial therapy .
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278650_p3
|
PMC11278650
|
sec[0]/p[3]
|
1. Introduction
| 3.9375 |
biomedical
|
Other
|
[
0.96484375,
0.032562255859375,
0.0028228759765625
] |
[
0.0117340087890625,
0.88037109375,
0.1016845703125,
0.006412506103515625
] |
Antibiograms are invaluable tools in clinical practice for guiding the selection of appropriate antimicrobial therapy. By providing a localized summary of antimicrobial susceptibilities for prevalent bacterial pathogens, antibiograms enable healthcare providers to make informed decisions about empiric treatment before specific culture and sensitivity results are available . This is particularly crucial in the context of rising antibiotic resistance, as it helps to optimize antibiotic use, reduce the risk of treatment failure, and minimize the development of further resistance . Additionally, antibiograms support infection control efforts by identifying trends in resistance patterns, thereby aiding in formulating hospital antibiograms and stewardship policies that promote the judicious use of antibiotics .
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11278650_p4
|
PMC11278650
|
sec[0]/p[4]
|
1. Introduction
| 4.054688 |
biomedical
|
Review
|
[
0.9912109375,
0.00689697265625,
0.0020198822021484375
] |
[
0.0614013671875,
0.410400390625,
0.525390625,
0.0029544830322265625
] |
A diverse population of health professionals, including microbiologists, pharmacists, infection control nurses, and epidemiologists, is essential for effectively utilizing antibiograms. While doctors play a crucial role in diagnosing and treating infections, the successful implementation and interpretation of antibiograms require a multidisciplinary approach. Microbiologists provide the expertise in identifying pathogens and determining their resistance patterns, while pharmacists offer critical insights into antimicrobial stewardship and the pharmacodynamics of antibiotic therapies. Infection control nurses are pivotal in monitoring and preventing the spread of resistant organisms within healthcare settings, ensuring that the data from antibiograms are applied to improve infection control practices. Epidemiologists contribute by analyzing resistance trends and guiding public health interventions. This collaborative approach ensures that antibiograms are not only used to inform individual patient care but also to shape institutional policies and public health strategies, thereby optimizing antibiotic use and combating antimicrobial resistance more effectively.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11278650_p5
|
PMC11278650
|
sec[0]/p[5]
|
1. Introduction
| 3.837891 |
biomedical
|
Study
|
[
0.9970703125,
0.0019063949584960938,
0.0008745193481445312
] |
[
0.9990234375,
0.00046443939208984375,
0.0002237558364868164,
0.00011581182479858398
] |
This study aims to assess the impact of antibiogram availability and utilization on antibiotic use among healthcare providers in Saudi Arabia. Specifically, it seeks to determine whether antibiogram data and utilization influence the appropriateness of antibiotic prescribing practices.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278650_p6
|
PMC11278650
|
sec[1]/sec[0]/p[0]
|
2.1. Study Design
| 3.560547 |
biomedical
|
Study
|
[
0.99755859375,
0.0017328262329101562,
0.0007452964782714844
] |
[
0.9990234375,
0.0004074573516845703,
0.0002237558364868164,
0.00015985965728759766
] |
This study employed a cross-sectional design to evaluate the effect of antibiogram availability and utilization on antibiotic use among healthcare providers in Saudi Arabia. Data were collected through a survey distributed to physicians, pharmacists, and other healthcare providers across various healthcare settings, including hospitals, clinics, and primary care centers.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278650_p7
|
PMC11278650
|
sec[1]/sec[1]/p[0]
|
2.2. Subject Selection
| 2.271484 |
biomedical
|
Study
|
[
0.9921875,
0.005603790283203125,
0.0020503997802734375
] |
[
0.994140625,
0.004894256591796875,
0.0005183219909667969,
0.0005507469177246094
] |
This study included healthcare providers involved in prescribing and using antibiotics, including physicians and pharmacists. Non-healthcare providers, health administrators, maintenance staff, and those not directly involved in antibiotic prescriptions or working in non-clinical settings were excluded.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278650_p8
|
PMC11278650
|
sec[1]/sec[2]/p[0]
|
2.3. Instrumentation
| 2.214844 |
biomedical
|
Study
|
[
0.96142578125,
0.002346038818359375,
0.036163330078125
] |
[
0.99365234375,
0.00597381591796875,
0.0003254413604736328,
0.00021767616271972656
] |
This study utilized a self-administered survey distributed online via Google Forms . During the survey development, a content and face validity process was conducted to ensure that the survey was valid and relevant to the subject matter. This process involved soliciting feedback from five healthcare providers with relevant experiences in the field. The survey was carefully reviewed and evaluated, and comments and suggestions for improvements were provided.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11278650_p9
|
PMC11278650
|
sec[1]/sec[2]/p[1]
|
2.3. Instrumentation
| 1.739258 |
biomedical
|
Study
|
[
0.9208984375,
0.0026226043701171875,
0.07647705078125
] |
[
0.7392578125,
0.25830078125,
0.001522064208984375,
0.0008654594421386719
] |
Based on their feedback, the survey was modified to ensure that it accurately captured the relevant information and was easy for the study population to understand. The final version of the survey was then distributed to the study population to ensure that it accurately reflected the subject matter and met the needs of the research project.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11278650_p10
|
PMC11278650
|
sec[1]/sec[3]/p[0]
|
2.4. Data Collection
| 1.964844 |
biomedical
|
Study
|
[
0.94287109375,
0.002880096435546875,
0.0540771484375
] |
[
0.98388671875,
0.015380859375,
0.0003561973571777344,
0.00034999847412109375
] |
Data collection spanned 90 days, from 1 December 2023 to 29 February 2024. Researchers emailed the survey to Saudi hospitals and healthcare providers, focusing on different regions sequentially: the Eastern Region in the first 30 days, the Central and Western Regions in the next 30 days, and the Northern and Southern Regions in the final 30 days. Reminders were sent to ensure that participants completed the survey. The online version of the survey was distributed using social media platforms such as Facebook , WhatsApp , and X . The study investigators visited some hospitals in person and gave healthcare providers a QR code to complete the survey.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11278650_p11
|
PMC11278650
|
sec[1]/sec[4]/p[0]
|
2.5. Data Analysis
| 2.642578 |
biomedical
|
Study
|
[
0.998046875,
0.0009369850158691406,
0.0012416839599609375
] |
[
0.99658203125,
0.0030727386474609375,
0.00039315223693847656,
0.0001875162124633789
] |
Descriptive statistics were used to summarize the participants’ characteristics, including demographics, professional experience, and knowledge of antibiograms. Data were analyzed based on geographical region, participants’ positions, and other predetermined differences. The results are presented as frequencies and percentages and interpreted accordingly.
|
[
"Haytham A. Wali",
"Hassan Ali Alhajji",
"Ridha Alsaeed",
"Abdullah Aldughaim",
"Rakan Almutairi",
"Amira S. Radwan"
] |
https://doi.org/10.3390/microorganisms12071444
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |