Characterization of dentin surface after application of desensitizing agents: SEM analysis

Objective: To analyze the morphology of dentin after application of desensitizing agents. Materials and Methods: Ten third molars were sectioned to obtain 2mm thick dentin disks and divided into 4 groups (n = 5): G0 – cut with a diamond disk, G1 – Colgate® Sensitive Pro-relief™ toothpaste; G2 – Du­raflur® Fluoride varnish; G3 – biosilicate aqueous solution (Biosilicato®). After storage in dehydrated silica-gel (37°C/24h), the samples were placed on aluminum supports, coated with gold-palladium and observed under a scanning electron microscope. Post-treatment photomicrographs were obtained of the dentin. Results: In the G1 group the smear layer was observed; in the G2 and G4 groups, both the desensitizing agents and the smear layer and in the G3 group, a film of varnish. Conclusions: Different morphologies of dentin were observed after the proposed treatments for dentin hypersensitivity.

TÉCNICAS DE ESCOVAÇÃO DENTÁRIA

Introduction: The mechanical removal of biofilm by flossing and brushing techniques from the dental surfaces should be individually applied to each patient in order to maintain the oral health. Objective: This study aimed at reviewing the literature on toothbrushing techniques, identify and describe them according to the oral health condition and also differentiate the step-by-step procedures and show the data in a synoptic table. Methodology: The search strategy used the descriptors “oral hygiene” or “tooth brushing” and “techniques” in three databases. Articles from the last twenty years published in Portuguese and available as full text were selected. The inclusion criteria considered purpose and indication of brushing technique; position, inclination and direction of brush bristles; type and duration of brush movement. Results: Forty-eight articles were found but only two of them described the tooth brushing technique. The exploratory analysis considered twenty-one technical documents. The descriptive analysis analysed twenty-three documents but two of them were discarded because they did not attend at least three inclusion criteria listed above. Conclusion: There was disagreement on the informations found, probably due to the scarcity of a technical document on this subject. Further studies must be done to describe the importance, the indication and the way of performing the toothbrushing techniques.Introducción: La extracción mecánica del biofilm de las superficies dentales mediante cepillado, asociada al uso de hilo dental, debe ser individualizada para cada paciente para mantener la salud bucal. Objetivo: el objetivo fue revisar la literatura sobre técnicas de cepillado dental, identificar y describir las técnicas encontradas en la literatura según el estado de salud bucal, diferenciar su ejecución paso a paso y presentar los datos en un cuadro sinóptico. Metodología: La estrategia de búsqueda utilizó los descriptores "higiene bucal" o "cepillado de dientes" y "técnicas" en tres bases de datos. La investigación ha reclutado artículos de los últimos veinte años publicados en portugués y disponibles en Internet como texto completo. Los criterios de inclusión observados fueron: objetivo e indicación de la técnica de cepillado; posición, inclinación y dirección de los bristers de cepillo; tipo y duración del movimiento del pincel. Resultados: Se encontraron cuarenta y ocho artículos, pero sólo dos describieron la técnica de cepillado de dientes. Veintiún documentos técnicos fueron incluidos en el análisis exploratorio. Veintitrés documentos fueron analizados en el análisis descriptivo, pero dos fueron excluidos porque no cumplían con el mínimo de tres criterios de inclusión. Conclusión: Hubo divergencia en la información encontrada en la literatura, posiblemente debido a la escasez de un documento técnico sobre el tema, y se necesitan más estudios para reforzar la importancia, indicación y modo de realización de las técnicas de cepillado dental.Introdução: A remoção mecânica do biofilme das superfícies dentárias pela escovação, associada ao uso do fio dental, deve ser individualizada para cada paciente a fim de manter a saúde bucal. Objetivo:  revisar a literatura sobre técnicas de escovação dentária, identificar e descrever as técnicas encontradas conforme a condição de saúde bucal, diferenciar o seu passo a passo de execução e apresentar os dados em quadro sinóptico. Metodologia: A estratégia de busca usou os descritores “higiene bucal” ou "escovação dentária" e "técnicas" em três bases de dados. A pesquisa recrutou artigos dos últimos vinte anos publicados em português e disponíveis na internet com o texto completo. Os critérios de inclusão observados foram: objetivo e indicação da técnica de escovação; posição, inclinação e sentido das cerdas da escova; tipo e duração do movimento da escova. Resultados: Quarenta e oito artigos foram encontrados, mas apenas dois descreveram a técnica de escovação dentária. Na análise exploratória foram incluídos vinte e um documentos técnicos. Na análise descritiva vinte e três documentos foram analisados, mas dois foram excluídos por não atenderem o mínimo de três critérios de inclusão. Conclusão: Houve divergência nas informações encontradas na literatura, possivelmente pela escassez de documento técnico sobre o assunto, sendo necessário mais estudos que reforcem a importância, a indicação e o modo de realização das técnicas de escovação dentária

TÉCNICAS DE ESCOVAÇÃO DENTÁRIA

Introduction: The mechanical removal of biofilm by flossing and brushing techniques from the dental surfaces should be individually applied to each patient in order to maintain the oral health. Objective: This study aimed at reviewing the literature on toothbrushing techniques, identify and describe them according to the oral health condition and also differentiate the step-by-step procedures and show the data in a synoptic table. Methodology: The search strategy used the descriptors “oral hygiene” or “tooth brushing” and “techniques” in three databases. Articles from the last twenty years published in Portuguese and available as full text were selected. The inclusion criteria considered purpose and indication of brushing technique; position, inclination and direction of brush bristles; type and duration of brush movement. Results: Forty-eight articles were found but only two of them described the tooth brushing technique. The exploratory analysis considered twenty-one technical documents. The descriptive analysis analysed twenty-three documents but two of them were discarded because they did not attend at least three inclusion criteria listed above. Conclusion: There was disagreement on the informations found, probably due to the scarcity of a technical document on this subject. Further studies must be done to describe the importance, the indication and the way of performing the toothbrushing techniques.Introducción: La extracción mecánica del biofilm de las superficies dentales mediante cepillado, asociada al uso de hilo dental, debe ser individualizada para cada paciente para mantener la salud bucal. Objetivo: el objetivo fue revisar la literatura sobre técnicas de cepillado dental, identificar y describir las técnicas encontradas en la literatura según el estado de salud bucal, diferenciar su ejecución paso a paso y presentar los datos en un cuadro sinóptico. Metodología: La estrategia de búsqueda utilizó los descriptores "higiene bucal" o "cepillado de dientes" y "técnicas" en tres bases de datos. La investigación ha reclutado artículos de los últimos veinte años publicados en portugués y disponibles en Internet como texto completo. Los criterios de inclusión observados fueron: objetivo e indicación de la técnica de cepillado; posición, inclinación y dirección de los bristers de cepillo; tipo y duración del movimiento del pincel. Resultados: Se encontraron cuarenta y ocho artículos, pero sólo dos describieron la técnica de cepillado de dientes. Veintiún documentos técnicos fueron incluidos en el análisis exploratorio. Veintitrés documentos fueron analizados en el análisis descriptivo, pero dos fueron excluidos porque no cumplían con el mínimo de tres criterios de inclusión. Conclusión: Hubo divergencia en la información encontrada en la literatura, posiblemente debido a la escasez de un documento técnico sobre el tema, y se necesitan más estudios para reforzar la importancia, indicación y modo de realización de las técnicas de cepillado dental.Introdução: A remoção mecânica do biofilme das superfícies dentárias pela escovação, associada ao uso do fio dental, deve ser individualizada para cada paciente a fim de manter a saúde bucal. Objetivo:  revisar a literatura sobre técnicas de escovação dentária, identificar e descrever as técnicas encontradas conforme a condição de saúde bucal, diferenciar o seu passo a passo de execução e apresentar os dados em quadro sinóptico. Metodologia: A estratégia de busca usou os descritores “higiene bucal” ou "escovação dentária" e "técnicas" em três bases de dados. A pesquisa recrutou artigos dos últimos vinte anos publicados em português e disponíveis na internet com o texto completo. Os critérios de inclusão observados foram: objetivo e indicação da técnica de escovação; posição, inclinação e sentido das cerdas da escova; tipo e duração do movimento da escova. Resultados: Quarenta e oito artigos foram encontrados, mas apenas dois descreveram a técnica de escovação dentária. Na análise exploratória foram incluídos vinte e um documentos técnicos. Na análise descritiva vinte e três documentos foram analisados, mas dois foram excluídos por não atenderem o mínimo de três critérios de inclusão. Conclusão: Houve divergência nas informações encontradas na literatura, possivelmente pela escassez de documento técnico sobre o assunto, sendo necessário mais estudos que reforcem a importância, a indicação e o modo de realização das técnicas de escovação dentária

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)