新确诊肿瘤患者的口腔健康评估--我们漏掉了谁?

IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE International journal of paediatric dentistry Pub Date : 2024-09-05 DOI:10.1111/ipd.13246
L. Roocroft, C. Dixon, A. Shepherd, C. Hood
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引用次数: 0

摘要

2 在英国,所有儿童都在指定的专科主要治疗中心(PTC)接受治疗,包括曼彻斯特皇家儿童医院(RMCH),以实现临床治疗和随访的标准化。3 曼彻斯特皇家儿童医院每年接诊来自该地区的约 120 名新恶性疾病患者,他们都需要接受一系列治疗,包括化疗、放疗、质子束疗法、干细胞移植和外科手术治疗。英国皇家外科学院建议,所有被诊断患有癌症的儿童在开始治疗前都应获得牙科护理,包括在确诊时进行全面的初步评估并拍摄X光片。口腔健康状况不佳会对肿瘤治疗产生不利影响,增加发病风险和住院时间。3 此外,癌症根治性治疗后的长期口腔并发症将来可能需要口腔康复方面的专科护理。在对一名患有严重蛀牙的接受癌症治疗的儿童进行紧急全身麻醉手术后,我们发现 RMCH 医院并非所有新诊断的肿瘤患者在确诊时都接受了基线牙科评估。对上个月的分析显示,有多名疼痛患者紧急前往病房进行牙科评估,而这些患者在开始接受癌症治疗之前并不认识该部门,也没有见过牙科医生进行评估。这突显出临床上需要改善对这部分患者的牙科护理,从而推动了采用 "计划-实施-研究"(Plan-Do-Study Act,PDSA)模式开展的质量改进项目。在第 3 个周期中,90%(n = 36)的患儿被转诊,这一进步得益于将直接电子转诊整合到新的全信托电子记录系统(Epic™)中。在第二周期之后,我们实施了一套交叉核对系统,由肿瘤科团队每月提供一份新诊断患者的数字名单。这使 DHU 能够对患者进行核对,找出那些被遗漏的患者,并强调那些需要转诊的患者。此后,我们与肿瘤科团队密切合作,宣传口腔健康基线预防和评估的重要性,以改善这一人群的口腔健康状况。第一周期是在 COVID-19 大流行初期进行的,由于临床工作人员的能力和可用性降低,影响了转诊分流的数量。因此,最初接受牙科评估的转诊比例并不理想。接下来的周期显示,转诊儿童中被分流并获得牙科评估预约的比例有所增加,回顾性数据分别为 90%(n = 26)和 94%(n = 34)。由于每个周期的儿童人数较少,因此在绝对值变化相对较小的情况下,百分比变化却很大。因此,尽管这是一种最佳做法,但要 100%实现既定目标仍具有挑战性。在为期 3 年的项目中,转诊到 DHU 的儿童中约有四分之一有积极的治疗需求,其中三分之一的儿童需要牙科全身麻醉。通常情况下,口腔健康团队与 PTC 是分开的,进一步开展跨医疗学科的合作项目有助于进一步整合患者护理,让口腔回归身体。随着肿瘤团队转诊到口腔科的病人越来越多,口腔科正在努力确保 "迷你口腔护理计划 "得到有效利用。迷你口腔护理计划 "的原则将有助于加强各医疗部门的口腔健康宣传,确保为患者提供全面的护理,并确保在需要时转介适当的牙科人员进行基线评估。我们部门的目标是将口腔健康筛查扩展到其他医疗专科。
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Oral health assessment of newly diagnosed oncology patients—Who are we missing?

An estimated 1:500 children are diagnosed with cancer each year.1 When assessed on a global scale, there is a higher incidence of childhood cancer in countries of a high human development index (HDI), compared to that of a low development index (LDI).2

In the UK, all children are treated at designated specialist Principal Treatment Centres (PTC), including Royal Manchester Children's Hospital (RMCH), to standardise clinical care and follow-up.3 Approximately 120 new malignant disease diagnoses are seen per year at RMCH from across the region, all of whom require a range of treatment modalities including chemotherapy, radiotherapy, proton beam therapy, stem cell transplant and surgical management.4

The Royal College of Surgeons England has recommended that all children diagnosed with cancer should have access to dental care, including a full initial assessment with radiographs at time of diagnosis, before commencement of treatment.4 Paediatric dental units working with oncology centres should have a mechanism of notification for new patients.5

During oncology treatment, oral care can become neglected with changes in oral health routines, particularly for children undergoing inpatient treatments.6 Additional nutritional intake requirements and oral manifestations such as mucositis and opportunistic infections further impact oral health and increase caries risk. Poor oral health can adversely impact oncology treatment, increasing morbidity risk and length of inpatient hospital stays.3 Furthermore, long-term oral complications following curative cancer treatments may require specialist-led care for oral rehabilitation in future.

Following an urgent general anaesthetic procedure for a child receiving cancer treatment with severe dental decay, it became apparent that not all newly diagnosed oncology patients at RMCH were referred for a baseline dental assessment at time of diagnosis. Analysis of the previous month highlighted multiple urgent ward visits for dental assessments for patients in pain who were unknown to the department and had not seen a dental practitioner for assessment prior to commencing cancer treatment. This highlighted a clinical need to improve dental care for this cohort, and thus provided stimulus for this quality improvement project which was conducted using the Plan-Do-Study Act (PDSA) model.

Improvements were made in each PDSA cycle for referral of children to the DHU at the point of cancer diagnosis, with an overall improvement of 48%. With 90% (n = 36) of children referred in Cycle 3, this improvement was felt to be supported by the integration of direct electronic referral into the new Trust wide electronic record system (Epic™). Previous cycles required an electronic document referral to be sent via email to the dental secretary, which provided a significant administration burden to the referrer and potential for missed patient referrals.

Following the Cycle 2, we implemented a cross-checking system whereby the oncology team provide a digital list of newly diagnosed patients each month. This allows the DHU to check patients, identifying those who have been missed and highlight those who need referrals. We have since worked closely with the oncology team to promote the importance of oral health baseline prevention and assessment to improve oral health in this population.

Cycle 1 was conducted during the initial COVID-19 pandemic, which influenced the number of referrals being triaged due to reduced capacity and availability of clinical staff. As a result, the proportion of referrals receiving a dental assessment was initially suboptimal. Further cycles demonstrate a proportionate increase in referrals being triaged and offered a dental assessment appointment, 90% (n = 26) and 94% (n = 34) retrospectively. Low numbers of children in each cycle result in a significant percentage change following relatively modest absolute changes. Subsequently, it is acknowledged that is will be challenging to obtain 100% compliance in the objectives set, although this presents best practice. Consistently over the 3-year project, approximately one in four children referred to the DHU had an active treatment need, with a third of these children requiring dental general anaesthetic.

Often oral health teams are separate from PTCs, and further collaborative projects across medical disciplines can help to further integrate patient care putting the mouth back in the body. With increased referrals to the department from the oncology team, the DHU is working hard to ensure the Mini Mouth Care Matters initiative is being utilised effectively. The principles of Mini MCM will help reinforce oral health promotion across medical departments, ensuring a holistic approach to patients' care, and ensuring appropriate dental referral for baseline assessment when needed. Our department aims to expand oral health screening to other medical specialities.6

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来源期刊
CiteScore
5.50
自引率
2.60%
发文量
82
审稿时长
6-12 weeks
期刊介绍: The International Journal of Paediatric Dentistry was formed in 1991 by the merger of the Journals of the International Association of Paediatric Dentistry and the British Society of Paediatric Dentistry and is published bi-monthly. It has true international scope and aims to promote the highest standard of education, practice and research in paediatric dentistry world-wide. International Journal of Paediatric Dentistry publishes papers on all aspects of paediatric dentistry including: growth and development, behaviour management, diagnosis, prevention, restorative treatment and issue relating to medically compromised children or those with disabilities. This peer-reviewed journal features scientific articles, reviews, case reports, clinical techniques, short communications and abstracts of current paediatric dental research. Analytical studies with a scientific novelty value are preferred to descriptive studies. Case reports illustrating unusual conditions and clinically relevant observations are acceptable but must be of sufficiently high quality to be considered for publication; particularly the illustrative material must be of the highest quality.
期刊最新文献
Dental Caries and Extrinsic Black Tooth Stain in Children With Primary, Mixed and Permanent Dentitions: A Cross-Sectional Study. ResNet-Transformer deep learning model-aided detection of dens evaginatus. ChatGPT for parents' education about early childhood caries: A friend or foe? Evaluation of high-power laser therapy as treatment of chemotherapy-induced oral mucositis in paediatric patients with oncohematological diseases-Dr Morankar. Evaluating high power laser therapy (HPLT) as treatment for chemotherapy-induced oral mucositis in paediatric patients with oncohematological diseases- Dr Jin.
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