Kingdom Of Saudi Arabia.

Transcription

1 IOSR Journal of Dntal and Mdical Scincs (IOSR-JDMS) -ISSN: -, p-issn: -6Volum, Issu Vr I (Octobr 6), PP - wwwiosrjournalsor Mdical Risk Assssmnt in Dntal Patints: A Cross Sctial KAP[Knowld, Attitud And Practic] Study Amo Dntal Practitirs in Kidom of Saudi Arabia Bailoor Dursh, Al Shamrani Ammar Profssor Of Oral Radioloy And Had Of PBL Systms Assistant Profssor And Vic-Dan Administratifaculty Of Dntistry, Univrsity Of Taif Kidom Of Saudi Arabia Abstract: Backround: With stro mdicatis and improvd mdical dianosis and tratmnts, mor and mor dntal patints will appar dntists door stp with svr mdical compromis This study has attmptd to analyz th knowld, attituds and practics of th dntists and thir involvmnt with mdically compromisd dntal patints Mthods: A total of dntal surs wr randomly survyd and rsps collctd in structurd ool forms Th comptncy of dntist in th dntal practic was assssd critria mntid in th rsults Th statistical analysis was d usi th Dcisi Analyst () softwar Rsults: Th most comm mdical mrncy pisods rportd wr of vasovaal attack and th polycmia and in ctrast, th clinical cditis of ok, advrs racti to LA and Ainal pisod which wr last rportd Fdback was prdominantly from Govrnmnt institutis In aras of mal-practic insuranc, standardizd cas history and thir Basic Lif support[ BLS] traini dntal practitirs from Govrnmnt fard much bttr prcnta wis Cclusi: Th primary aps idntifid in th dntist traini wr; impropr viilanc for xpiry mdicins, lack of tlphic link with physician who can assist in th mdical mrncy and th inability to iv intramuscular /intra-vnous injctis This study hihlihts nd to idntify strths and waknss in th curriculum of dntists and nd to modify th mdical risk assssmnt comptncy in th dntal practitirs of today in th kidom A sns of frustrati was also notd in th dntists in th kidom about ovrsupply of dntists from th local univrsitis Kywords: Educati, Dntal, Lif support car, Basic Lif support(bls); Mdical risk; Saudi Arabia; Dntist frustrati I Introducti Th dntal practitirs form th first lin of dfns aainst th oral disass manamnt in th kidom Saudi Arabia has both Govrnmnt and Privat Univrsitis traini th dntal surs Ths prorams ar in a stat of voluti and this study attmpts to idntify th strths and waknsss of th dntist's traini in domain of mdical risk assssmnt Th cardiopulmary rsuscitati is rarly usd in dntal clinic, but with incrasi incidnc of mdical complxity in th nral populati, its rol in savi critical patint livs bcoms vry important Th Basic Lif Support [BLS] traini mans immdiat rciti of clinical problms of vntilati and circulati, duri th procss of cardiac or rspiratory failur Phillips and Nolan () Quality halth car mans incrasd numbr of dntal patints with mdical risk will b sn in th dntal practic nvirmnt Haas D () This raiss th possibility of incrasd frquncy of mrncis in th dntal clinic and dntal hospital nvirmnt Hndlr and Ros () Th dpndnt variabl in this study is th dntist's comptncy to mana th mdically complx dntal patints and th indpndnt variabls ar - audit of xpird mdicins, dirct communicati with physician, routin us of intramuscular or intravnous injctis, us of mdical rlas form, malpractic insuranc, BLS traini, Us of Adrnalin, Standardizd cas history format, us of oxyn cylindr, ratial us of antibiotic prophylaxis and us of four handd dntistry - traind assistant, ivi obsity rlatd advic to patints Diffrnt mthods of data collcti hav bn usd to assss th lvl of traini availabl for a profssial populati Howvr, a rtrospctiv qustinair is a rasabl and practical way to athr nouh data ovr a sufficintly lo priod of tim to produc maniful informati Athrt t al () DOI: /- wwwiosrjournalsor Pa

2 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Rviw of rcnt litratur from Saudi Arabia dpicts that vry littl scintific data is prsnt which tlls us about th awarnss, knowld and attitud of th dntal practitirs towards th mdical risk assssmnt in th dntal clinic Hnc this nati-wid survy study was cductd It is hopd that this data will hlp to improv th traini of futur dntal raduats in schools of dntistry throuh strthni of curriculum c th wak ralms of knowld and aps in traini ar discovrd II Matrials and mthods : A randomizd cross sctial study usi a structurd qustinair with lvn indpndnt variabls which in turn ffctd th dpndnt variabl of clinical comptncy in tratmnt of Mdically complx patints in dntists An anymous intrnt basd circulati of structurd qustinair was d and all th dntists wr also ctactd subsquntly ovr mobil ph to ncoura thm to answr quickly Out of total dntal surs ctactd rspss wr found complt and valid othrs had to b rjctd for incomplt or incohrnt answrs ( 66 of survy instrumnts accptd aftr audit) A softwar Dcisi Analyst () was utilizd to calculat th ' Z' scor Study populati and dsin : Th univrs was th dntal practitirs populati of Kidom of Saudi Arabia and th dsin was cross sctial, randomizd Th hypothsis qusti statd was 'Th dntists traini was not adquat; basd lvn indpndnt variabls' Th structurd qustinair and th rsarchr not knowi about th idntity of th dntist [blindi] was a ood modl for rsarch Th qustinairs wr snt via Gool forms to dntists in diffrnt parts of th kidom All th data collctd was ntrd in Excl sht and analyzd Instrumnt and data collcti : Th structurd survy instrumnt was utilizd for data collcti and a of th dntists rspdd Data analysis: Th Microsoft offic xcl sht was usd for prliminary statistical analysis This rvald candid informati about th attituds and awarnss of th diffrnt dntists in th kidom Ths ar tabulatd in th tabls no, no and no Th 'Z' valu is usd valuat statistically th diffrncs btwn th Mal and fmal dntists and also privat dntal school and ovrnmnt dntal school dntists III Rsults Basic Analysis : A total of dntal surs wr survyd in dpth for basic informati [tabl ], Th fiur Shows th raph of itm analysis of th BLS stps bi practicd by ths dntists, fiur No : This shows an itm analysis of 6 procsss actually d succssfully in dntal clinic To b insrtd Tabl no Fiur no Tabl no Statistical Analysis Th statistical analysis was d usi Dcisi Analyst Th lvn attributs shown in fiur no, hav bn analyzd for two roups of data First th comparis btwn th mal and fmal dntists, and scd btwn th ovrnmnt and privat dntists Insrt hr Tabl no Tabl no IV Discussi On xaminati of th tabl no of our study it is apparnt that th prcnta of statistical diffrnc of th us of audit of xpird mdicins, us of adrnalin and rular us of oxyn cylindr all showd a vry wak Z valu Ths wr idntifid as th aps of traini in th dntist This compard wll with study of Athrt t al (,) Th classical articl by Athrt t al (,) mdical mrncis in nral dntal practic is th study in which about dntal practitirs and about in Wals and in Scotland wr survyd and th rsults wr quit nlihtni Athrt showd that basic drus of mrncy car wr availabl in of th rspdnts This compars with Govrnmnt dntist and Privat coll dntists in our study Th cardiopulmary rsuscitati (CPR) was carrid out in manamnt of to of th vnts in th nral practic not rlatd to GA DOI: /- wwwiosrjournalsor Pa

3 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Our study rflcts th cclusi of Chapman's (6) rlatd work in Australia which also throws a vritabl liht th stat of affairs in th Australian dntal landscap as rards to th choic of mrncy drus and quipmnt H polld rspdnts dntal practitirs and found that in ( ) had to rsuscitat a patint in thir dntal clinic This fiur appars to b tn tims th data obtaind from Athrt's work So obviously som oraphic diffrncs ar bound to appar in diffrnt parts of th world In Saudi Arabia w found our dntists both of ovrnmnt and privat colls obsrvd th us of oxyn cylindrs in practic and th diffrnc statistically btwn thm was wak This dntist study dpicts that wak Z valus us of intramuscular and intravnous mdicatis and us of oxyn cylindr, which mans w shar th opinis of Sharr J t al (), who xprssd som vry stro opinis about allowi th dntists to us th art of cscious sdati and anxity ctrol Thy opind that thy did not fl that it was appropriat for th dntists to us it in any form, vn th simplst typ of cscious sdati Thy () wr probably ccrnd about thir ability to mana mrncis as and whn thy occurrd In our sris of th Govrnmnt intrns and of th Privat intrns took th traini for Basic lif support BLS and displayd thir crtificats Sharr J t al () had anothr srious ccrn, that th typs of trainis availabl in th British Isls wr vry varid; csisti of short trm courss and in dpth courss which may lad to Mastrs in sdati [MSc], availabl in Ld Csidri this variati of traini vn in an stablishd acadmic nvirmnt of UK, it is asy to s why Sharr t al () not vry rat champis of allowi th dntal surs into cscious sdati and advancd mrncy tratmnt ara, without propr comptncy traini In th kidom ly lvl of BLS crtificat ivn by th rd cross, was availabl Coplans and Grn () ar with th work of Sharr J t al () that th us of cscious dntistry is frauht with th risks that ar taibl, in trms of mdical mrncis in th clinic Th findis of this sris of dntists data ars with that of Robrts and Rothman (), who hav analyzd th awarnss of mdical mrncis in th dntal offic in th dntist populati Thy analyzd dntist rspss to com to thir cclusis In this study 6 rportd rcivi th Basic Lif Support [BLS] and said that mdical mrncis wr sn and manad by thm of ths dntists rspdd positiv for discovri aiodma in thir practic and had sn Aina thir dntal chair An intrsti fact that cam from this study was that prfrrd pr-mdicati in th dntal patints with known history of Epilpsy About half th numbr of Govrnmnt dntists and third of th privat dntists in our sris tratd mrncis usi adrnalin routinly O' Hallaran() has ivn a clar map of th clinical approach in his discussi and statd that th systms rviw, mdical history and physical xaminati, includi th body mass indx (BMI), should mak th dntist dtrmin th mdical risk, thn rad th patint as pr th ASA Amrican Socity of Ansthsioloists (ASA) Physical Status Classificati Systm It is nrally ard up that ASA and th ASA ar tratd in th dntal clinic with last complicatis Maisa O t al () hav studid th prpardnss of th privat dntal clinics in Jddah and found that dficincy in prsnl traini, availability of drus, and mrncy quipmnt in th survyd dntal clinics Our study was prdominantly d with data from th wstrn parts of th kidom and w rport an intrsti study by Alhamad t al () () who hav workd in th astrn provinc of Saudi Arabia Thir findis of vasovaal attack and hypoycmia bi th most commly ncountrd complicatis is shard compltly by our study Thy () () furthr opind that mdical mrncy situatis wr comm in dntal clinics, but a csidrabl proporti of dntists did not fl at as to handl mdical mrncy cditis Th lvl of BLS traini in kidom is availabl at ly lvl, that is providd for thr days by th Rd Cross Th facilitis of Govrnmnt and Privat clinics compard wll with ach othr In this study mor dntists from ovrnmnt av fdback as compard with privat dntal colls In th rmarks scti which was last blank ivn to dntists out of flt that thr wr too many dntists raduati from th dntal schools in th kidom and that alrady a lut of dntists was causi frustrati in th kidom of Saudi Arabia Arab Nws ( ) () V Cclusi From th abov study ths cclusis may b summarizd Th Us of traind nurs, a mdico-lal rlas form and a standardizd cas history form wr wll documntd in th Govrnmnt dntal schools and vry much lss in th privat dntal schools, hnc vry stro statistical diffrncs in thir occurrnc Th us of Oxyn cylindr and antibiotic prophylaxis wr mor in th ovrnmnt facilitis, both in trms of availability, obsrvanc and usa DOI: /- wwwiosrjournalsor Pa

4 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Th malpractic insuranc is a mandatory for all practitirs hnc w found both ovrnmnt and privat intrns had covrd thmslvs with it and btwn to Th mdical mrncy cabint was auditd and chckd by to dntists in th kidom and throuh traini, this was prcivd as a ap and nds to b improvd It is th findi of this study that BLS, Malpractic insuranc and th standardizd Cas history form should b mad mandatory if th mdical risk of dntal patints nd to b improvd dramatically in th comi yars Th traini aps of dntists in mdical risk domain may vary with th ris of kidom survyd hnc mor studis must b attmptd and spcific aps idntifid and filld as a part of dsini thir curriculum in th comi yars 6 A hih prcnta of dntists wr frustratd [] du to inability to t jobs attributd to ovrsupply of dntists from th local univrsitis in th Saudi Arabia Arab nws () () Cflict of intrst: Th author has no cflict of intrst to dclar Rfrncs [] Phillips PS, Nolan JP Traini in basic and advancd lif support in UK mdical schools: Qustinair survy BMJ Jul ;():- dxdoior/6/bmj [] Haas D: Automatd xtrnal dfibrillator us in dntistry J Can Dnt Assoc () :, doi:6/jdnabs [] Barry H Hndlr, Louis F Ros Comm mdical mrncis: a dilmma in dntal ducati Th Journal of th Amrican Dntal Associati volum issu pas to dxdoior//jadaarchiv Athrt GJ, McCaul JA, Williams SA Mdical mrncis in nral dntal practic in Grat Britain Part : thir prvalnc ovr a -yar priod Br Dnt J ;6(): dxdoior//sjbdja [] Athrt GJ, McCaul JA, Williams SA Mdical Emrncis in nral dntal practic in Grat Britain Part :Drus and quipmnt possssd by GDPs and usd in th manamnt of mrncis British Dntal Journal volum 6 issu pas to dxdoior//sjbdj [] Chapman PJ Mdical mrncis in dntal practic and choic of mrncy drus and quipmnt: a survy of Australian dntists Aust Dnt J Apr;():- dxdoior//j-tbx [6] J Sharr, K E Wils & N M Girdlr A survy of th opinis of csultant anasthtists in Scotland of sdati carrid out by dntists British Dntal Journal 6, - Publishd lin: January dxdoior//sjbdj [] M P Coplans and R A Grn Anasthsia and sdati in dntistry: Editd by Pp, illustratd Oxford, Elsvir doi:6/-()6- [] Robrs JB(), Rothman CM Call -- now and start tratmnt Dnt Today ;():, - PMID : [] O'Halloran Michal Th us of anasthtic ants to provid anxiolysis and sdati in dntistry and oral surry- Australas Md J ; 6(): Publishd lin Dc dxdoior/66/amj6 [] Maisa O Al-Sbai, Moayyad A Alkayyal, Abdullah H Alsulimani, Othman S Alsulaimani, Wam T Habib Th prpardnss of privat dntal offics and polyclinics for mdical mrncis A survy in Wstrn Saudi Arabia Saudi Md J ; Vol 6 (): - doi: /smj [] WWW Dcisianalystcom Vrsi Fr download from this sit A fr statistical softwar for basic statistics [] Alhamad M, Alnahwi T, Alshayb H, Alzayr A, Aldawood O, Almarzouq A, Nazir MA Mdical mrncis ncountrd in dntal clinics: A study from th Eastrn Provinc of Saudi Arabia J Fam Community Md ;:- DOI: /- 6 [] Joblss Saudi dntist burns crtificatarab NEWS Publishd Tusday May 6: Muhana Saud burns his dntist crtificat in frustrati - Tabl No This tabl shows th basic dmoraphics of th sampl of dntists who rspdd Thy wr prdominantly from Govrnmnt dntal schools and Mal of th rspss cam from th Wstrn ri of th Saudi Kidom Bailoor and Al-Shamrani 6 Sx Mal Fmal Rmarks Data [] [6] Prdominantly mal Typ of dntal school Govrnmnt Privat [] [] Prdominantly Govrnmnt Ri North of th dntal school South 6 Wst Sampl was wihtd to th wst ri East 66 Middl DOI: /- wwwiosrjournalsor Pa

5 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Foot not: This nati wid study of Saudi Arabia dpicts th sx distributi, ovrnmnt vs Privat distributi and th rial distributi of th sampld dntists Bailoor and Al-Shamrani 6 Fiur No This dpicts th fact that us of traind nurs, cas history format, csnt form and display of basic lif support crtificat, all wr sn uniformly in all clinics; whras th lctd aras wr th lack of obsity rlatd advis, ativ attitud towards th voluntary work, doi xtracurricular work and sports, and th ability to iv Intra vnous and intramuscular injctis Th thirtn charactristics analyzd othr issus lik xpird mds audit, dirct ph lin to physician and us of antibiotic uidlins wr in th ra of to prcnt Foot not: Givi of Obsity rlatd advis, and attitud towards th community srvic was th worst numrically polld Bailoor and Al Shamrani 6 Tabl No : This shows an itm analysis of mdical risk and th 6 procsss actually d succssfully by a st of dntal surs survyd in th kidom of Saudi Arabia Th thr most comm and succssfully manad in this sris was th Syncop, bldi pisods and us of prophylactic antibiotics ; th rar cut off point usd was prcnt and it cstitutd of ainal attacks, pilptic fits, anaphylactic attack, Post road traffic accidnt, rnal dialysis, corary attack, racti to LA, ok and hyprlycmic shock Showi th incidnts analyzd in th dntal clinics catorizd into Comm = - ; Can Happn =- ; Rar = -, This will hlp th dntists to b prpard for th comm as wll as th rar Bailoor and Al Shamrani 6 DOI: /- wwwiosrjournalsor Pa

6 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Mdical Emrncy / Risk obsrvd Numbr Prcnta How oftn ncountrd Syncop Comm Bldi pisods Comm Idntifyi nd Comm for antiobiotic prophylaxis Mdical Can Happn compromis of multi-systm ncountrd Asthamatic attack dntal chair Can Happn Aio-dma and Can Happn allric ractis Hypolycmic Shock 6 Can Happn Ainal pisods Rar duri dntal tratmnt Epilptic attach Rar dntal chair Anaphylaxis in th dntal clinic Rar Road traffic, Rar accidnt and Post RTA shock Rnal dialysis Rar patiints comi as OPD dntal Corary Attack Rar duri th tratmnt Advrs racti to 6 Rar Local Ansthsia duri xtracti/biopsy Foot Not : Incidnts occurri in - prcnta wr shown as comm, - prcnta wr shown to as Can Happn and blow prcnta wr dmd to b rar Bailoor and Al Shamrani 6 Fiur No : Fiur showi raphically th diffrnt mdical mrncy pisods in th dntal clinics of Saudi Arabia as pr this cross sctial study Bailoor and Al Shamarani 6 DOI: /- wwwiosrjournalsor 6 Pa

7 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Foot not: Th thr mrncis prdominatd in this sris th syncop[ vaso-vaal attack ], bldi pisods, and dianosis of cditis that rquir antibiotic prophylaxis- Bailoor and Al Shamrani 6 Tabl No : Shows th diffrncs btwn th Mal and Fmal dntists in lvn factor itm analysis th softwar Dcisi Analyst was usd to dtrmin th statistical sinificanc btwn th mals and fmals Itms, us of mdico-lal rlas form and usa of standardizd history format showd a stro diffrnc btwn th mals and th fmals Itms, Rular audit for xpird mds, Adrnalin us, and routin us of assistant and four handd dntistry showd no sinificant diffrnc and all othr itms showd a wak diffrnc in applicatis of ths critria in th routin dntal practic in th domain of mdical risk assssmnt Crit ria Obs ity rlat d advis Com muni ty srvi c attitu d Hav you cti nud th sam Nu m ric al M al Nu m ric al F ma l M a l 6 Rou Mod DOI: /- wwwiosrjournalsor Pa F m a l P O S D Diff rn c Sin ifica nc Wa k o Wa k

8 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud ntin ly iv IM and IV injc tis Expi rd mdi cin audit qtrly Us of oxy n cylin dr in clini c Do you do xtra curri cular -lik sport s rat Mod rat o Wa k Dir ct ph lin to phys ician dia nos th nd for antib iotic prop hyla xis Crti fid nurs in hand d work Stan dard cas form at Cs nt and mdi co rla s 6 6 o o o Wa k o DOI: /- wwwiosrjournalsor Pa

9 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud Disp lay BLS crtif icat * * It is com puls ory so all displ ayd POSD = Prcnta of statistical diffrnc Foot not : o diffrncs mrd btwn th mal and fmal dntists in ths aras : Community srvic attitud, Us of oxyn cylindr, dirct ph accss to physician, dianos th nd for antibiotic prophylaxis, crtifid assitant for four handd dntistry, Us of csnt form and mdico-lal rlas form Bailoor and Al Shamrani 6 Tabl no: is tabl shows th lvn itm analysis btwn th Dntists worki for Govrnmnt and Privat Crtain ms showd a sinificant statistical diffrnc Th wakst diffrnc in Govrnmnt [] and Privat[] Dntists mrd in community srvic and obsity rlatd mdical advic Crit ria Obs ity rlat d advi s Attit ud towa rds com muni ty srvi c Hav you cti nud th sam aftr starti pract ic Rout inly iv im Nu mr ical Go vt Num rical Privat DOI: /- wwwiosrjournalsor Pa Pri va t 6 Z val u 6 6 R ma rks ab out dif fr nc W ak W ak Mo dr at Mo dr at

10 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud and iv injc tis Expi rd mdi cin audit d quart rly Oxy n cylin dr us Invo lvm nt in xtra - curri cular activ itis lik sport Dir ct ph lin to phys ician Dia nos th nd for antib iotic prop hyla xis Cs nt and mdi co lal rla s Stan dard cas form W ak DOI: /- wwwiosrjournalsor Pa

11 Mdical Risk Assssmnt In Dntal Patints : A Cross Sctial KAP [Knowld, Attitud at Crti fid assis tant hand d dnti stry Disp lay BLS train i crti ficat 6 ** Its co mp uls ory in th kin d om so all dis pla y POSD= Prcnta of statistical diffrnc Th followi showd a stro diffrnc btwn th ovrnmnt and privat traind dntists : Expird mdicins audit, us of oxyn cylindr, xtracurricular activitis, dianos th nd for antibiotic prophylaxis, Propr us of csnt and mdicolal rlas, standardizd cas history format, and th ccpt of four handd dntistry Bailoor and Al Shamrani 6 DOI: /- wwwiosrjournalsor Pa