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Biomedical subjects

J S Hand

Publications and source records attributed to J S Hand.

18 recordsLinked to original sources
PubMed1997

Geriatric patient simulations for dental hygiene.

The rapidly increasing number of this country's elderly requires that dental hygiene students practice the clinical problem-solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer-based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer-based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer-based simulations are an effective instructional method as measured by pre/post-tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics.

Aged↗
PubMed1994

Factors influencing the future need for treatment of root surfaces.

This paper discusses the current status of root surface caries in the elderly population and the need for treatment of this condition in the future. Although root surface exposure and root caries have been reported for adults at all ages, the people at greatest risk for these conditions are the elderly. In the United States, life expectancy and the population aged 65 years and older has increased substantially, and the proportion of the elderly population who are dentate has increased and is projected to increase further. Utilization of dental services by the elderly is similar to that of employed adults. Interpretation of studies of the prevalence and incidence of root surface caries are difficult due to differences in sampling, definition of lesions, and reporting conventions. Root surface caries prevalence is related to age and continues to be a significant problem for this population as they age. Factors that may affect the future need for treatment are explored.

Aged↗
PubMed1991

Five-year incidence of tooth loss in Iowans aged 65 and older.

The prevalence of missing teeth has been described for US adults, but little is known about the incidence of tooth loss in any segment of the population. This study investigated the 5-yr incidence of tooth loss in a random sample of Iowans aged 65 yr and older residing in two rural counties. These people had an average of 20 teeth at baseline and approximately 40% lost at least one tooth in the subsequent 5 yr. The incidence of tooth loss was highest for mandibular molars and lowest for mandibular canines. Men were more likely than women to lose teeth. Although we were able to identify a number of statistically significant potential risk factors for tooth loss, the multivariate models that incorporated all these factors were not good predictors of which people were at highest risk for tooth loss.

Aged↗
PubMed1988

Incidence of coronal and root caries in an older adult population.

Incidence rates for new root caries and new coronal caries in noninstitutionalized older adults are unknown. In this study, a representative sample of 451 elderly Iowans received dental examinations at the start of the study and again after 18 months. This dentate cohort had a mean of 0.87 new surfaces of coronal decay per person per year and a mean of 0.57 new surfaces of root decay per person per year. Coronal caries occurred at an annual rate of 1.4 surfaces per 100 susceptible coronal surfaces. Root caries occurred at an annual rate of 2.6 surfaces per 100 susceptible root surfaces. This study shows that both coronal and root caries were active in this older population, indicating a need for emphasis on the prevention and treatment of dental caries in older adults.

Aged↗
PubMed1988

Incidence of tooth loss among elderly Iowans.

This study investigated the 18-month incidence of tooth loss in a random sample of 451 dentate noninstitutionalized Iowans aged 65 and older residing in two rural counties. They had a mean of 19.0 teeth at baseline and lost an average of 0.4 teeth during the subsequent 18 months. Twenty-one per cent of the population lost at least one tooth. Four people had all their teeth extracted. Of the teeth present at baseline, 1.9 per cent subsequently were extracted. The highest incidence of tooth loss occurred among mandibular molars (3.7 per cent), followed by maxillary premolars and canines (3.1 per cent each). The best predictors of tooth loss were previous coronal and root caries.

Aged↗
PubMed1987

The choice of health insurance plans by university employees.

This study presents the results of a survey of university employees to determine the factors that were important in the choice between two health insurance plans (CHIP vs traditional). The major differences between the plans were their coverage of hospital services, physician office visits, and routine dental services. Separate analyses were conducted for employees of departments associated with the health professions and employees of other departments. The majority of employees selected the CHIP plan, which included coverage of routine dental services. Employees who chose the traditional plan were more likely to have other medical or dental insurance coverage than those who chose CHIP. Multiple regression analyses and discriminant function analyses indicated that the ranking of the importance of coverage of routine dental services and physician office visits were the most important factors in the choice of health insurance plan. These findings indicate that employees may be willing to trade the coverage of other health benefits to secure coverage of routine dental services and physician office visits.

Adult↗
PubMed1986

The prevalence of oral mucosal lesions in an elderly population.

In a population of 629, 145 elderly subjects had at least one mucosal lesion; 27% of denture wearers had a denture-related lesion. Lesions were found most commonly on the palate, followed by the lips. Increasing age was the only significant factor in the risk of soft tissue enlargement.

Age Factors↗
PubMed1985

Prevalence of root and coronal caries in a noninstitutionalized older population.

This paper describes the prevalence of coronal caries and root caries in a sample of 520 people representative of the noninstitutionalized, dentate population older than age 65 in two rural Iowa counties. The subjects were examined in their homes by trained dental examiners. All prevalence rates were age- and gender-adjusted. Both types of caries were prevalent in the population age 65 and older. If projections of increased numbers of older people and increased retention of teeth are reasonably accurate, caries in older populations may become a significantly greater dental problem, and increased prevention and treatment of caries will be needed for these people.

Aged↗
PubMedDate not supplied

Family member and guardian acceptance of dental services for nursing home residents.

The decision to utilize dental treatment often rests with a nursing home resident's family member or guardian, and factors associated with family member/guardian acceptance of dental services for residents have not been identified. This paper reports the results of a study which found that nearly 66% of nursing home residents' next of kin identified themselves as being primarily responsible for making health care decisions for the residents. Among these 109 resident/next of kin pairs, utilization of dental services by the residents was associated with younger next of kin, next of kin with higher levels of education, and next of kin who perceived dental need for the resident. In addition, residents who were female, physically mobile, not mentally alert, dentate, and had fewer years of education had dental services accepted for them at a higher rate than did residents who were male, physically immobile, alert, edentulous, or had more years of education. Findings suggest that more effort should be directed at educating the next of kin of nursing home residents in the value of dental care among the elderly.

Age Factors↗
PubMedDate not supplied

Factors related to acceptance of dental treatment services in a nursing home population.

This study reports on factors related to acceptance of restorative, oral surgery, and prosthodontic dental treatment services by a population of nursing home residents. Lower cost treatment plans and eligibility for Medicaid benefits were associated with acceptance of all treatment, and for the categories of oral surgery and prosthodontic services. Acceptance of routine restorative procedures was more strongly associated with female residents. It is concluded that financial concerns appear to pose the greatest barrier in providing dental treatment services to nursing home residents.

Aged↗
PubMedDate not supplied

Medical and functional status changes among nursing facility residents: implications for dentistry.

This paper reports the results of a study that investigated changes in the medical and functional status of nursing facility residents over a 2.9 year period. Sixty-seven residents from 10 nursing facilities were included in the study, which demonstrated that the resident's medical and functional status deteriorated during this period. These changes adversely affected the residents' ability to receive recommended dental treatment, suggesting that early, definitive, and often aggressive treatment approaches be used in providing services to these individuals.

Aged↗
PubMedDate not supplied

Dental record documentation in selected ambulatory care facilities.

Having recognized the differences in financial incentives between institutional providers and private practitioners participating in the Medicaid program, the New York State Health Department developed a streamlined mechanism of prior approval for 13 selected institutional providers of dental care. As part of the evaluation of this process, a retrospective audit of 316 dental records was conducted to assess the level of documentation present in the dental record. A followup audit was conducted 3 months after implementation of a plan to correct any deficiencies identified. More than 50 percent of the facilities were unable to present all the records requested at the time of the initial audit. Few of the audited records were free of deficiencies, and documentation of the results of the intra-oral examination was lacking in most facilities. The followup audit demonstrated statistically significant improvement in the level of record documentation. These results demonstrate that, even when good recordkeeping procedures were identified and agreed to by these institutional dental providers, performance was inadequate. However, the study also demonstrates that adequate records can be kept if sufficient incentives are provided. Efforts to evaluate retrospectively the delivery of dental care that are dependent on the dental record as a primary data source are unlikely to succeed unless incentives to encourage good recordkeeping are incorporated. Further research is needed to develop appropriate incentives that would operate in other practice settings.

Dental Clinics↗