Oral Candidosis in Patients With Research Proposal

Excerpt from Research Proposal :

e. incurable cancer; (2) referral to the Department of Palliative Medicine. The exclusion criteria for the study were: (1) estimated prognosis of less than 1 week; (2) significant cognitive impairment, i.e. unable to provide consent; (3) significant physical impairment, i.e. unable to complete protocol; (4) clinical evidence of dehydration; (5) current/recent (less than 2 weeks) use of antifungal medication. (Davies, Brailsford and Beighton, 2005)

Davies, Brailsford and Beighton (2005) report that the clinical component of the study involved "...completion of a study questionnaire (demographic data and clinical data), completion of the Memorial Symptom Assessment Scale, clinical examination of the oral cavity, measurement of the unstimulated whole salivary flow rate (UWSFR), measurement of the stimulated whole salivary flow rate (SWSFR), and performance of an oral rinse." ( p.698) The study results states that all patients/participants "...had either locally advanced, or metastatic cancer. The prevalence of different cancer diagnoses were: carcinoma breast -- 40%; carcinoma bronchus -- 16.5%; carcinoma of prostate -- 15%; carcinoma colon/rectum -- 6%; others <5%." (Davies, Brailsford and Beighton, 2005, p.699) It is reported that the prevalence of different ECOG performance statuses were as follows: (1) 26.5%; (2) 35.5%; (3) 37.5%. Sixty-nine (57.5%) of the patients were dentate, whilst 51 (42.5%) of the patients had some sort of denture. Seventy-nine (66%) of the patients had microbiological evidence of oral yeast carriage, whilst 36 (30%) of the patients had combined clinical and microbiological evidence of oral candidosis." (Davies, Brailsford and Beighton, 2005, p.700) It is reported that in 69% of patients "there was only one variant of oral candidosis present." (Davies, Brailsford and Beighton, 2005, p. 600) It is reported that 31% of patients that there were "...two or more different variants of oral candidosis present." (Davies, Brailsford and Beighton, 2005, p. 701) Candidosis was confined to only one area of the mouth in 61% of patients with pseudomembranous candidosis...and was multifocal in 39% of patients. It is reported that the presence of oral candidosis was associated with "...with poor ECOG performance status (Mann -- Whitney test; P = 0.001: Fig. 1), and the presence of dentures (Fisher's exact test; P = 0.03). However, it was not associated with age (Mann -- Whitney test; P = 0.85), gender (Fisher's exact test; P =0.81), oral/parenteral antibiotic use within previous 2 weeks (Fisher's exact test; P = 0.48), or oral/parenteral corticosteroid use within previous 2 weeks (Fisher's exact test; P = 0.15)." Davies, Brailsford and Beighton, 2005, p. 702) None of the patients with diabetes were found to have oral candidosis. It is stated to be widely held that "...systemic antibiotics cause oral candidosis. However, this study, and previous studies involving patients with advanced cancer have failed to identify such an association." (Davies, Brailsford and Beighton, 2005, p. 702)

The work of Hilary Southern (2006) entitled: "Oral Care in Cancer Nursing: Nurses' Knowledge and Education" reports a study involving the knowledge and education of nurses as it is related to oral care and oral health assessment for patients who were undergoing treatment for cancer. Stated as specific aims of the study reported by Southern (2006) were those as follows:

(1) To describe nurses' education and knowledge gained during their initial education in relation to oral care and oral health assessment;

(2) to determine nurses' self-rated knowledge of oral care and oral assessment;

(3) to describe any differences between Registered Nurses' and specialist oncology nurses with regard to their knowledge and levels of education in relation to oral care and oral assessment;

(4) to identify how nurses on oncology wards manage oral care; and (5) to explore the influences on nurses' knowledge of oral care and performed oral care. (Southern, 2006, p. 632)

It is reported that the convenience samples "was recruited from one urban healthcare institution in Ireland over a 3-month time frame. The intention was to include all nurses who met the eligibility criterion. The eligibility criterion was that participants must be Registered General Nurses and/or specialist cancer nurses...100 nurses met the eligibility criterion, and 72 returned completed questionnaires." (Southern, 2006, p. 634) It is reported that an oral care questionnaire which was self-administered was developed for the purpose of collecting information concerning the knowledge and education of nurses about oral care and oral care health assessment as well as management of oral care, the influences on oral care of knowledge as well as oral care performed and demographics." (Southern, 2006, p.634) Measurement was through ten semantic differential subscales consisting of bipolar scales with individual scores that range from 1 to 7 with one being non-existent and 7 being excellent. Findings in the study of Southern include that: (1) when compared with general nurses, cancer nurses demonstrated a greater level of knowledge concerning oral care and conducting examination of the oral cavity; (2) there is a need for more education on oral care for patients with cancer; and (3) hospital dentists could provide a resource that is useful for nurses caring for patients in oncology units. (Southern, 2006, p.637)

The work of Sweeney, Bagg, Baxter, and Aitchison (1998) entitled: "Oral Disease in Terminally Ill Cancer Patients with Xerostomia" reports a study with the objective of determining the prevalence of oral signs and symptoms in 70 individual who were terminally ill with cancer. The study was conducted through the taking of imprint cultures for coliforms, yeasts and staphylococci and a swab for culture of herpes simplex virus. It is reported that oral mucosal abnormalities were detected in 45 patients or 65% individuals in the study as follows: (1) 51% reported problems with eating; (2) 40% of denture wearers complained of denture problems; (3) 63 individuals or 90% or participants had clinically dry mouths; (4) 65% had difficulties with talking; and (5) 51% had difficulty eating. (Sweeney, Bagg, Baxter, and Aitchison, 1998, paraphrased) 65% of patients were found to have oral mucosal abnormalities. The study concludes by stating that due to current expansion in palliative medicine, dentists are increasingly likely to be asked to provide advice and treatment for patients with advanced cancer." (Sweeney, Bagg, Baxter, and Aitchison, 1998, p.123) The study is reported to indicate that "some of the common oral problems that are encountered" have contributed "practical advice on the provision of oral care for hospice patients. Relief of oral discomfort is an important element of cancer care and active involvement of the dental profession is an essential part…

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