Tsukada Shigemi, Ito Kayoko, Stegaroiu Roxana, Shibata Satoko, Ohuchi Akitsugu
Department of Clinical Technology, Division of Oral Hygiene, Niigata University Medical and Dental Hospital, Niigata, Japan.
Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata, Japan.
Gerodontology. 2017 Jun;34(2):232-239. doi: 10.1111/ger.12255. Epub 2017 Jan 8.
To develop and evaluate, with a dentist as gold standard, an oral health screening tool, the Oral Health Screening Tool for Nursing Personnel (OHSTNP), that assists long-term care facility nursing staff without preliminary training in identifying resident need for dentist referral.
Using an OHSTNP adapted from previous screening tools (Chalmers, J Gerontol Nurs, 2004, 30, 5; Tsukada, J Jpn Soc Dent Hyg, 2012, 7, 43), one of four nurses, one of eight caregivers and a dentist with 15 years' experience screened the oral health/function of 57 long-term care facility residents. The OHSTNP included a question on the need and reasons for dentist referral. Tool reliability and validity were evaluated by determining inter-rater agreement (Cohen's kappa), sensitivity, specificity and accuracy.
For dentist-nurse and dentist-caregiver pairs, kappa was statistically significant and sensitivity was high (≥0.67, nurses; ≥0.71, caregivers) for natural teeth, dentures and oral function-related categories. Specificity for all categories was ≥0.69. Screening by nurses and caregivers for need for referral had low sensitivity (0.05, 0.23), accuracy (0.25, 0.39) and kappa (-0.01, 0.08). However, if nursing staff had been instructed to request a dentist referral in case of alterations in natural teeth/dentures or severe alterations in any other category, the estimated values increased to a sensitivity of 0.86 and 0.91, an accuracy of 0.75 and 0.82 and a kappa of 0.26 and 0.47.
OHSTNP was reliable and valid for screening natural teeth, denture conditions and oral functions. Supplementary guidelines improved estimates of OHSTNP sensitivity, accuracy and reliability for nurse/caregiver assessment of resident need for dentist referral.
以牙医作为金标准，开发并评估一种口腔健康筛查工具——护理人员口腔健康筛查工具（OHSTNP），该工具可帮助长期护理机构的护理人员在未经初步培训的情况下识别居民是否需要转介至牙医处。
使用一种改编自先前筛查工具（查尔默斯，《老年护理杂志》，2004年，第30卷，第5期；冢田，《日本口腔卫生学会杂志》，2012年，第7卷，第43期）的OHSTNP，四名护士中的一名、八名护理员中的一名以及一名有15年经验的牙医对57名长期护理机构居民的口腔健康/功能进行了筛查。OHSTNP包括一个关于转介至牙医处的需求及原因的问题。通过确定评分者间一致性（科恩kappa系数）、敏感性、特异性和准确性来评估工具的可靠性和有效性。
对于牙医 - 护士和牙医 - 护理员配对，在天然牙、假牙及与口腔功能相关的类别中，kappa系数具有统计学意义且敏感性较高（护士≥0.67；护理员≥0.71）。所有类别的特异性均≥0.69。护士和护理员对转介需求的筛查敏感性较低（分别为0.05、0.23）、准确性较低（分别为0.25、0.39）且kappa系数较低（分别为 - 0.01、0.08）。然而，如果指示护理人员在天然牙/假牙出现改变或任何其他类别出现严重改变时请求转介至牙医处，估计值会提高到敏感性分别为0.86和0.91、准确性分别为0.75和0.82以及kappa系数分别为0.26和0.47。
OHSTNP在筛查天然牙、假牙状况和口腔功能方面可靠且有效。补充指南提高了OHSTNP在护士/护理员评估居民转介至牙医处需求时的敏感性、准确性和可靠性估计值。
