Changes in blood pressure, heart rate, and electrocardiogram during dental treatment with use of local anesthesia

Cardiovascular complications caused by hypertension need to be anticipated during routine dental therapy. Changes in the cardiovascular system before, during, and after treatment were studied for 40 patients undergoing extraction

Validity of a risk-related patient-administered medical questionnaire for dental patients

In this study the validity of a patient-administered risk-related medical questionnaire for dental patients was tested. The answers given on the questionnaire were compared with the results of a verbal history taken by a physician. This verbal history was considered the "gold standard." The sensitivity and specificity of the medical questionnaire appeared to be sufficiently high, and the kappa values of the separate questions were satisfactory. The questionnaire was found to be valid in the registration of medical problems in dental patients, but combination of the two methods is recommende

Treatment of chronic suppurative osteomyelitis of the mandible

Chronic suppurative osteomyelitis of the mandible is often considered difficult to treat and may lead to refractory osteomyelitis. Sixteen patients with chronic suppurative osteomyelitis of the mandible were treated with a relatively simple protocol, consisting of sequestrectomy or decortication and i.v. antimicrobial therapy for one week, followed by oral penicillin for three weeks. Only one case showed recurrence of symptoms, which was treated successfully in a second session. It is concluded that combined surgical and antimicrobial therapy should be sufficient to cure most cases of chronic suppurative osteomyelitis of the mandibl

Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: A systematic review of sensitivity and specificity

Background & aims: A valid, quick-and-easy screening tool to detect undernutrition, is an essential requisite to treat undernutrition. In order to select quick-and-easy screening tools with high analytical accuracy for the general hospital in-, and outpatient population, a systematic review at sensitivity and specificity studies were performed. Methods: The electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Library (SR, DARE and the Central trail register) were searched. Additionally, ESPEN and ASPEN congress posters and abstracts from 2000 till 2005, reference lists and review articles, were hand-searched. There were no limitations made on language or publication date. To finally include a study there were six criteria: The study (1) determined analytical accuracy of a quick-and-easy screening tool in (2) adults with (3) the dichotomous classification: disease-related undernutrition present or absent, versus (4) an acceptable reference standard with (5) data available to abstract sensitivity and specificity. Methodological quality was formally assessed using the QUADAS (checklist for quality assessment in analytical accuracy studies) in those studies with (6) relevant sensitivity and specificity. Results: The search yielded 1513 citations of which finally, nine studies were included. After quality assessment, no studies for the general hospital outpatient population remained. For the general hospital inpatient population only the Short Nutritional Assessment Questionnaire (SNAQ) and the Malnutrition Screening Tool (MST) tool were studied with a high rating to the criteria specified. The analytical accuracy of the MST seemed slightly better than the SNAQ. However, the MST study had a lower QUADAS 'score' for blinding and the cut-off point of the MST for positive screening was defined post-hoc. Conclusion: Their high applicability combined with clinically relevant sensitivity and specificity make the MST and the SNAQ the most accurate nutritional screening tools ready to implement at the general hospital inpatient population found in our systematic review

Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery

BACKGROUND: Several studies reported increased adverse outcomes after cardiac surgery in patients with low body mass index (BMI; in kg/m(2)). Little is known yet, however, about the effect of preoperative unintended weight loss (UWL) in cardiac surgery patients. OBJECTIVE: We explored the prevalence and effect of UWL in view of low BMI and vice versa adjusted for a validated set of preoperative risks, inflammatory activity, and duration of extracorporeal circulation on postoperative adverse outcome. DESIGN: A prospective cohort study was performed. Nutritional data of cardiac surgery patients were collected within 24 h of admission and linked to the standard postoperative complication registration database. RESULTS: The cohort consisted of 331 cases. Multivariate logistic regression analyses showed that preoperative UWL of >or=10% in the past 6 mo (>or=10%UWLin6m) was associated with a prolonged length of stay in the hospital independent from low BMI [odds ratio (OR): 7.06; 95% CI: 1.78, 28.04]. Preoperative BMI or=10%UWLin6m (OR: 4.62; 95% CI: 1.20, 17.82; and OR: 5.27; 95% CI: 1.28, 21.76, respectively). Preoperative undernutrition in cardiac surgery patients (>or=10%UWLin6m or BMI or=10%UWLin6m or BMI <or= 21.0 because both variables are independently related to adverse outcomes. Preoperative referral to a dietitian for further diagnostic assessment and nutritional treatment is strongly recommende

Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: a systematic review of sensitifity and specificity

Background & aims: A valid, quick-and-easy screening tool to detect undernutrition, is an essential requisite to treat undernutrition. In order to select quick-and-easy screening tools with high analytical accuracy for the general hospital in-, and outpatient population, a systematic review at sensitivity and specificity studies were performed. Methods: The electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Library (SR, DARE and the Central trail register) were searched. Additionally, ESPEN and ASPEN congress posters and abstracts from 2000 till 2005, reference lists and review articles, were hand-searched. There were no limitations made on language or publication date. To finally include a study there were six criteria: The study (1) determined analytical accuracy of a quick-and-easy screening tool in (2) adults with (3) the dichotomous classification: disease-related undernutrition present or absent, versus (4) an acceptable reference standard with (5) data available to abstract sensitivity and specificity. Methodological quality was formally assessed using the QUADAS (checklist for quality assessment in analytical accuracy studies) in those studies with (6) relevant sensitivity and specificity. Results: The search yielded 1513 citations of which finally, nine studies were included. After quality assessment, no studies for the general hospital outpatient population remained. For the general hospital inpatient population only the Short Nutritional Assessment Questionnaire (SNAQ) and the Malnutrition Screening Tool (MST) tool were studied with a high rating to the criteria specified. The analytical accuracy of the MST seemed slightly better than the SNAQ. However, the MST study had a lower QUADAS 'score' for blinding and the cut-off point of the MST for positive screening was defined post-hoc. Conclusion: Their high applicability combined with clinically relevant sensitivity and specificity make the MST and the SNAQ the most accurate nutritional screening tools ready to implement at the general hospital inpatient population found in our systematic review