Methodology An e-mailed questionnaire with follow-up was sent to 198 deans of dental/medical schools, 1,628 directors of residency programs in nine medical/dental residency programs, 427 medical students in 12 medical schools, and 368 health related organizations, facilities and programs.Results More than half (58%) of the responding deans of medical schools and 50% of the deans of dental schools reported that a curriculum for patients with disabilities was not a high priority at their school. A majority (61%) of deans of medical schools, and 47% of the deans of dental schools, reported that their graduates were competent to treat patients with disabilities. However, majorities of dental/ medical school seniors and graduates expressed inadequate competency in the care of these patients. A majority of the directors of medical/dental residencies indicated a need for additional training for their residents. ConclusionThere is need for increased didactic and clinical preparation of dental/medical school graduates in the care of individuals with special health needs. The interest expressed by health profession educators in an effort to develop appropriate curriculum modules provides an opportunity to prepare new graduates for the care of an increasing population of individuals with disabilities.
Recent reports by Special Olympics International and the U.S. Surgeon General have revealed significant disparities and unmet health needs encountered by persons with mental retardation and other developmental disabilities (MR/DD). Factors contributing to these disparities include deinstitutionalization, increased survival of individuals with MR/DD, lack of appropriately trained providers, and inadequate financing of dental services. To address these problems, a group of academically oriented dentists and physicians formed the American Academy of Developmental Medicine and Dentistry (AADMD). The mission of the AADMD is to improve the quality of health services provided to persons with MR/DD by improving dental and medical schoolbased training of dentists and enhancing clinically relevant research. A central theme of the AADMD is full collaboration between physicians and dentists in meeting its goals. The National Action Strategy developed by the AADMD focuses on creating a series of university-based Developmental Medicine and Dentistry Programs (UDMDPs) in medical and dental schools, which collaborate in service, teaching, and research with community-based primary care clinics, community hospitals, intermediate care facilities, and other private service delivery systems such as the Special Olympics Healthy Athletes Program that serve these patients. Oral-systemic interactions will receive special emphasis by the training and research programs.
Dental inspections of MR/DD patients are incomplete if radiographs are excluded. Whilst the mini-panel approach could be considered incomplete, it is better than no radiographs at all. 91% of images were excellent to satisfactory in diagnostic quality and a majority of patients' treatments were modified because of the radiographic information.
Background: The spread of pathogens via the airborne route is often underestimated, and little is known about the extent to which airborne microbial contamination levels vary throughout the day and night in hospital facilities. Aims: To evaluate airborne contamination levels within intensive care unit (ICU) isolation rooms over 10e24-h periods in order to improve understanding of the variability of environmental aerial bioburden, and the extent to which ward activities may contribute. Methods: Environmental air monitoring was conducted within occupied and vacant inpatient isolation rooms. A sieve impactor sampler was used to collect 500-L air samples every 15 min over 10-h (08:00e18:00 h) and 24-h (08:00e08:00 h) periods. Samples were collected, room activity was logged, and bacterial contamination levels were recorded as colony-forming units (cfu)/m 3 air. Findings: A high degree of variability in levels of airborne contamination was observed across all scenarios in the studied isolation rooms. Air bioburden increased as room occupancy increased, with air contamination levels highest in rooms occupied for the longest time during the study (10 days) (mean 104.4 cfu/m 3 , range 12e510 cfu/m 3 ). Counts were lowest in unoccupied rooms (mean 20 cfu/m 3 ) and during the night. Conclusion: Peaks in airborne contamination were directly associated with an increase in activity levels. This study provides the first clear evidence of the extent of variability in microbial airborne levels over 24-h periods in ICU isolation rooms, and found direct correlation between microbial load and ward activity.
Background The aim of this study was to examine, by means of a postal questionnaire, the experience of all grades of doctors caring for patients dying in an acute hospital in Scotland. Method A postal questionnaire was sent to 306 doctors working in inpatient medical and surgical specialties, emergency medicine, anaesthetics and intensive care medicine in an acute hospital. Results There was an overall 41% response rate (127/306). Of responding doctors 55% had cared for 10 or more patients in the previous year. A quarter of respondents had personal experience of bereavement outside of clinical practice within the previous year. A total of 65% of responding doctors agreed that their most memorable patient death had had a strong emotional impact upon them. Responding doctors reported benefit from peer support. There was no association between length of time as a doctor and difficulty rating for talking to patients about death (p-value: 0.203). There was no association between difficulty rating and length of time working as a doctor when talking to relatives about death and dying (p-value: 0.205). We considered the questionnaire responses in relation to Scottish Government policy and initiatives associated with the care of the dying, and the future training and support of doctors caring for this group of patients and their relatives. Conclusion Doctors describe similar experiences in terms of communication difficulties and emotional effects of caring for dying patients irrespective of their length of time working as a doctor.
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