Effects of Perioperative Oral Management in Patients with Cancer

Perioperative oral management (POM) is used to prevent pneumonia in patients with cancer. However, the factors that expose hospitalized patients to increased risk of developing pneumonia remain unclear. For example, no study to date has compared the incidence of pneumonia in hospitalized patients by cancer primary lesion, or POM implementation, or not. We determined which patients were most likely to benefit from POM and examined the effects of POM on pneumonia prevention and mortality. In a total of 9441 patients with cancer who underwent surgery during hospitalization, there were 8208 patients in the No POM group, and 1233 in the POM group. We examined between-group differences in the incidence of pneumonia and associated outcomes during hospitalization. There was no significant between-group difference in the incidence of pneumonitis, however, patients with lung, or head and neck cancers, demonstrated a lower incidence of postoperative pneumonia. Among patients with lung and pancreatic cancers, mortality was significantly lower in the POM group. POM appears effective at reducing the risk of postoperative pneumonia in patients with certain cancers. Further, mortality was significantly lower in patients with lung and pancreatic cancers who received POM; hence, POM may be an effective adjuvant therapy for patients with cancer

A new oral care gel to prevent aspiration during oral care

目的：口腔細菌は，誤嚥性肺炎を含めた全身の疾患と密接に関係していると考えられている．誤嚥性肺炎の予防には口腔ケアが極めて重要であるが，その方法は施設や術者により様々であり，中には誤嚥のリスクを伴う口腔ケア方法も存在する．口腔ケア中の誤嚥性肺炎起炎菌を含む洗浄水の誤嚥のリスクを低下させるため，本研究では，水を使わない口腔ケアに必要かつ適正な物性を持つジェルを開発し，その物性およびプラークの除去，咽頭への流入しにくさについて評価・検討を行った．方法：ジェルの物性評価は，医療従事者31名を評価者とし，VASを用いた主観的物性評価と口腔内官能評価から，試作ジェル3種類（A～C）と市販の保湿ジェル3種類（D～F）を比較した．プラーク除去効果の評価は，健常者20名を対象とし，物性評価において最も評価が高かったジェルをジェル使用時，水道水を水使用時とし，歯科衛生士によるブラッシングにより評価を行った．評価はModified PCR を用い，ブラッシング前後のプラークの減少率を比較した．また，ブラッシング時の吸引回数をカウントし，咽頭への流入しにくさについてジェル使用時と水使用時における差を評価した．結果：物性評価において，試作ジェルBはその他5種類のジェルに比べ，有意に評価が高かった．プラークの除去効果において，Modified PCRの減少率はジェル使用時の方が水使用時よりも有意に高かった．また，吸引回数はジェル使用時の方が有意に少なかった．結論：新規に開発した試作品ジェルBは物性評価にて良好な結果を得た．さらにプラークの除去効果や咽頭への流入しにくさにて有効性を確認した．洗浄水ではなくジェルBを使用することにより口腔ケア時に流入しにくくなる可能性があるため，今後の臨床試験に期待したい．Aim: Although oral care is important in the prevention of aspiration pneumonia, the different institutions and practitioners employ various oral care methods, some of which are associated with the risk of aspiration. We have developed a new gel with the physical properties needed for waterless oral care. In the present study, we evaluated and investigated the properties and effectiveness of this gel. Methods: The physical properties of the trial gel and commercial moisturizing gels were compared using a VAS scale. The effects of plaque elimination were evaluated in healthy volunteers. Brushing was carried out by a dental hygienist using the gel and water. The number of throat suctions performed during brushing was also counted, and the difference was evaluated. Results: In the evaluation of physical characteristics, trial Gel B showed a significantly higher rating than the other gels. In plaque elimination, the rate of decrease in a modified PCR was significantly greater with the gel trial. Suctioning was also performed significantly fewer times with the trial gel. Conclusions: Good results were obtained with the newly developed trial Gel B with regard to the physical properties and the sensory evaluations. Its effectiveness was also confirmed in plaque elimination and in the evaluated risk of aspiration. The use of Gel B may have the potential to decrease the risk of aspiration during oral care and reduce the occurrence of aspiration pneumonia

Preventive Effects of Sustainable and Developmental Perioperative Oral Management Using the “Oral Triage” System on Postoperative Pneumonia after Cancer Surgery

Perioperative oral management is widely recognized in the healthcare system of Japan. Conventionally, the surgeon refers patients with oral problems to a dental or oral surgery clinic in the hospital. However, frequent in-house referrals were found to increase the number of incoming patients resulting in unsustainable situations due to an insufficient workforce. In 2011, the Center for Perioperative Medicine was established at our hospital to function as a management gateway for patients scheduled to undergo surgery under general anesthesia. The “oral triage” system, wherein a dental hygienist conducts an oral screening to select patients who need preoperative oral hygiene and functional management, was established in 2012. A total of 37,557 patients who underwent surgery at our hospital from April 2010 to March 2019 (two years before and seven years after introducing the system) were evaluated in this study. The sustainability and effectiveness of introducing the system were examined in 7715 cancer surgery patients. An oral management intervention rate of 20% and a significant decrease in the incidence of postoperative pneumonia (aOR = 0.50, p = 0.03) indicated that this system could be useful as a sustainable and developmental oral management strategy to manage surgical patients with minimal human resources

Rheology for Safe Swallowing 2

International audienceIn aged society, the number of persons with difficulty in mastication and swallowing is increasing, and the aspiration-induced pneumonia is one of the top causes of death in the elderly. Although the detailed mechanism of aspiration is still not well understood, great efforts have been done to prevent the aspiration, and thickening of bolus has been found effective to reduce the risk of aspiration. It was pointed out earlier that excessive thickening reduces the palatability and the intake of fluids leading to dehydration and malnutrition and to formation of the residue as a risk of aspiration. In the present review, the physiological aspects of food oral processing conducted in the mouth by teeth, tongue, saliva have been introduced, and practical evaluation methods of rheological properties used in hospitals and nursing care facilities are described. Viscosity of commonly used polysaccharide-based thickening agents is described in relation with yield stress, thixotropy together with tribological aspects which play important roles in swallowing. To improve the control of texture, new thickening agents and modifying methods of rheological properties are described. Emerging methods to study the swallowing process have been also discussed. Finally, the importance of integration and collaboration of different disciplines is emphasized