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Background Dentists are high prescribers of antibiotics for both treatment and prevention of infection, although there are few guidelines to aid clinicians. Given the worldwide concerns about unnecessary use of antibiotics, there is a need for a better understanding of dentists’ use of these drugs for antibiotic prophylaxis (AP) to prevent distant site infections (i.e., infective endocarditis and prosthetic joint infection). Objective The aim of this study was to develop and implement an effective, self-reporting, cross-sectional, survey instrument that optimized the response rate and maximized reliability and validity for determining the beliefs and behaviors of a large and nationally representative group of generalist and specialist dentists concerning their use of AP. Study Design A 15-question survey (58 items) was developed in a structured process by a multidisciplinary team and configured for automated online dissemination to 3584 national Dental Practice-Based Research Network (DPBRN; hitherto referred to as “Network”) practitioners. The implementation phase consisted of 3 waves of greater than 1000 Network members. Additionally, 47 randomly selected dentists were surveyed twice to assess test–retest reliability. Results Of 3584 eligible Network members, 2169 (60.5%) completed the survey. The age and geographic distributions of responders was similar to those of dentists in the 2019 American Dental Association census. Furthermore, test–retest weighted kappa values for the survey were acceptable (median 0.56; interquartile range 0.42–0.64). Conclusions We developed a highly structured survey with a high response rate and good reliability that will allow us to obtain unique data on dentists’ beliefs and practices regarding AP prescribing.

Patient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings.This quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation.Violent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation.Using an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.

Universities typically offer residential students a variety of fast-food dining options as part of the student meal plan. When residential students make fast-food purchases on campus there is a digital record of the transaction which can be used to study food purchasing behavior. This study examines the association between student demographic, economic, and behavioral factors and the healthfulness of student fast-food purchases. The 3781 fast-food items sold at the University of North Carolina at Charlotte from fall 2016 to spring 2019 were given a Fast-Food Health Score. Each student participating in the university meal plan was given a Student Average Fast-Food Health Score; calculated by averaging the Fast-Food Health Scores associated with each food and beverage item the student purchased at a fast-food vendor, concession stand, or convenience store over a semester. This analysis included 14,367 students who generated 1,593,235 transactions valued at $10,757,110. Multivariate analyses were used to examine demographic, economic, and behavioral factors associated with Student Average Fast-Food Health Scores. Being of a low income, spending more money on fast-food items, and having a lower GPA were associated with lower Student Average Fast-Food Health Scores. Future research utilizing institutional food transaction data to study healthy food choices is warranted.

Patients with dementia and their caregivers need ongoing educational and psychosocial support to manage their complex diagnosis. This mixed methods study evaluated the impact of a memory clinic with an embedded dementia navigator on the experiences and health outcomes of patients with dementia and their caregivers. At the 12-month follow-up, patients receiving memory clinic services ( n = 238) had higher emergency department visits than a matched cohort with dementia ( n = 938), although hospitalizations did not differ. Patient quality of life and caregiver burden scores also did not differ between baseline and 12-months. Interviews revealed that caregivers ( n = 12) valued the educational and social support components of the memory clinic and perceived that the clinic had a positive impact on their experiences. Findings suggest that this embedded navigator model is useful for addressing caregiver needs and may have potential to stem increases in caregiver burden and patient quality of life that occur with disease progression.

Objectives We sought to analyze the types and quantity of dry mouth products patients use as well as the reported dry mouth symptom severity and frequency in relation to salivary flows. We hypothesized that respondents with higher stimulated flow would report better responses to products that stimulate flow. Methods Patients with complaints of dry mouth who had documented unstimulated and stimulated whole salivary flows (UWS and SWS, respectively) completed a questionnaire to assess dry mouth products used, current symptoms, and response to therapy. Statistical analyses included descriptive analyses and associations between dichotomized (low/normal) salivary flow levels, and symptom severity was assessed using nonparametric Wilcoxon rank-sum tests. Results Eighty-seven patients completed the questionnaire; 38 patients had a diagnosis of Sjogren syndrome. More than half of patients (55%; n = 48) reported using 4 or more dry mouth products. The most common product used was water (n = 78), followed by rinses (n = 54) and lozenges (n = 48). Twenty-five patients (29%) reported use of parasympathomimetics. More than half (56%) of patients using parasympathomimetics reported that their mouth felt “much better” compared with less than one-third of patients using other methods: water (29%), gum (23%), lozenges (27%), candies (4%), rinse (26%), spray (24%), or gel (20%). Among parasympathomimetic users with normal SWS, 71% reported their mouth felt “much better” compared with 36% of those with low SWS. For water, gum, lozenges, candies, and sprays, greater than 50% of respondents reported improvement lasting less than 1 hour. Regarding rinses, gels, and parasympathomimetics, greater than 50% of respondents reported improvement lasting greater than or equal to 1 hour. The dichotomized level of UWS rate was not associated with any measures of symptom severity, whereas the low SWS rate was associated with the following measures: dryness of the mouth (P = .004), difficulty speaking due to dryness (P = .03), and difficulty swallowing due to dryness (P = .004). Conclusions Different treatment categories for dry mouth symptoms provided varying degrees of relief. Patients with normal vs low stimulated flow who used parasympathomimetics reported the greatest treatment response and longest relief of dry mouth symptoms. Assessment of salivary flow levels may be a useful guide for more targeted recommendations of dry mouth products.

What Children Need to be Happy, Confident and Successful is aimed at parents and professionals who work with children and wish to utilise the findings of positive psychology to support children to ...

by Brooke Ingersoll and Anna Dvortcsak, New York, The Guilford Press, 2010, 131 pp., £16.00 (paperback), ISBN 978‐1‐60623‐440‐2 This book is written by two American based authors, a psychologist an...