De eldres munn- og tannhelse: hva kan årsakene være til at munn- og tannstell hos eldre på sykehjem ofte blir nedprioritert, og hvordan kan sykepleieren bidra til bedre munn- og tannstell hos disse pasientene?

Ifølge en del ulike studier, har mange av dagens eldre dårlig munn- og tannhelse, spesielt beboere på langtidsinstitusjoner. Mange eldre beholder sin naturlige tenner i høy alder, og har derfor større risiko for å utvikle infeksjoner og andre sykdommer i munnhulen. Dårlig eller mangelfullt munnstell kan også føre til sykdommer i andre organer, som for eksempel lunge sykdommer som lungebetennelse og ulike hjerte sykdommer. De fleste pasienter på sykehjem er både fysisk og psykisk svekket, og har derfor behov for hjelp til daglig munnstell. Sykepleierne i sykehjem har ansvar for å ivareta pasientens grunnleggende behov, som da også inkluderer daglig munn- og tannstell. Det er derimot mye som tyder på at munnstell ofte kan bli et nedprioritert gjøremål blant sykepleiere og annet helsepersonell. Jeg ville derfor i denne oppgaven kartlegge årsakene til dette, og dermed foreslå og drøfte aktuelle tiltak som ut i fra studier og vitenskapelige artikler har vist seg å resultere i at munn- og tannstell blir bedre og høyere prioritert. Blant årsaker til årsaker til at munnstell ofte kan bli lavt prioritert i sykehjem, er følgende blitt rapportert i flere artikler; lite kunnskaper, personale og tid, dårlige rutiner, motstand fra enkelte pasienter, ledelsen, ingen eller lite trening i utførelsen av munn- og tannstell, dårlig samarbeid mellom sykepleiere og tannleger, negative holdninger, lite tilgjengelig utstyr og mangelfull opplæring i sykepleieutdannelsen. Det har også vist seg at det er mulig å forbedre munn- og tannhelsen hos de eldre ved å sette enkle tiltak i et system; blant annet ved å heve kompetansenivået hos sykepleiere og annet helsepersonell, utarbeide individuelle pleieplaner og bildebaserte munnstellkort, mer tilgjengelig og tilrettelagt utstyr for munn- og tannstell og identifisering av faste personer som skal ha ansvar for det daglige munnstellet. Dette er tiltak som sykepleiere kan bidra med for å bedre tannhelsen hos eldre pasienter på sykehjem, og dermed forebygge infeksjoner og sykdommer i munnhulen

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

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