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Master's Dissertation
DOI
10.11606/D.23.2010.tde-18082010-143726
Document
Author
Full name
Letícia Mello Bezinelli
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2010
Supervisor
Committee
Crosato, Edgard Michel (President)
Eduardo, Carlos de Paula
Hamerschlak, Nelson
Title in Portuguese
O atendimento odontológico no transplante de medula óssea: impacto clínico e econômico
Keywords in Portuguese
Atendimento Odontológico
Custo- Minimização
Custo-Benefício
Custo-Efetividade
Custo-Utilidade
Mucosite Oral
Transplante de Medula Óssea
Abstract in Portuguese
A Mucosite Oral é uma das principais e mais debilitantes complicações do Transplante de Medula Óssea. (Schubert et al., 1986; Borowski et al., 1994; Sonis, 1998; Peterson, 2004; Sonis, 2004; Scully, 2006; Sonis, 2009). Nessa terapia sua incidência varia entre 75-100%. (Wardley et al., 2000; Barasch; Peterson, 2003; Schubert et al., 2007; Blijlevens, 2008; Vokurka et al., 2009 ). A extensão e a severidade da Mucosite Oral estão significativamente correlacionadas com dias de narcótico injetável, alimentação parenteral, febre, risco de infecção importante, dias de hospitalização, custos hospitalares e mortalidade. (Sonis et al., 2001; Vera-Llonch et al., 2007). Nosso trabalho trata-se de um estudo de avaliação clínica e econômica, retrospectivo, de pacientes submetidos ao transplante de medula óssea no Hospital Israelita Albert Einstein, entre os anos de 2000 e 2008. Foram avaliados 167 pacientes, que foram divididos em dois grupos: Grupo I, composto por 91 pacientes que receberam atendimento odontológico e Laserterapia durante o TMO e Grupo II, composto por 76 pacientes que não receberam atendimento odontológico nem Laserterapia. Dados como idade, sexo, diagnóstico da doença de base, protocolo quimioterápico, tipo de transplante, uso de medicação para dor, dias de febre, utilização de alimentação parenteral, dias de internação, presença de infecção e grau de mucosite oral, com e sem atendimento odontológico, foram coletados e analisados. Uma análise descritiva, com base em tabelas de frequências e testes Qui-quadrado (ou exato de Fisher, quando este se mostrou mais apropriado), foi feita com o objetivo de verificar a associação estatística entre as variáveis de interesse. Estimativas dos riscos relativos, com intervalos de confiança de 95%, foram calculadas para avaliar a associação entre o desfecho (grau máximo) e as variáveis explicativas de interesse e o tempo médio de internação (em dias) nos diferentes grupos e tipos de transplantes foi comparado por meio de um modelo de análise de variância. Valores de p menores que 0,05 foram considerados como estatisticamente significantes. Pudemos concluir com esse trabalho que a extensão e a severidade da Mucosite Oral foram maiores no grupo sem atendimento Odontológico, sendo que o risco do paciente desse grupo apresentar grau III ou IV foi de 13 vezes maior que o grupo com Cirurgião-Dentista. Além disso, observamos que atendimento odontológico durante o TMO, quando praticado da forma descrita nesse estudo, é custo-efetivo, sendo capaz de reduzir as morbidades clínicas do TMO e que os benefícios do atendimento odontológico excederam os custos e, portanto, devem ser adotados. Foi constatado também que os pacientes que tiveram o acompanhamento do Cirurgião-Dentista apresentaram melhor qualidade de vida durante TMO e que o atendimento odontológico durante o TMO gerou economia para o hospital.
Title in English
Dental attendance in bone marrow transplants: clinical and economic impact
Keywords in English
Bone Marrow Transplant
Cost- Effectiveness
Cost-Benefit
Cost-Minimization
Cost-Utility
Dental Attendance
Oral Mucositis
Abstract in English
Oral mucositis is one of the main and most debilitating complications of Bone Marrow Transplants. In this therapy its incidence ranges between 75-100%. The extent and severity of Oral Mucositis are significantly correlated with the days of receiving injectable narcotics, parenteral feeding, fever, and risk of important infection, number of days of hospitalization, hospital costs and mortality. This study is a retrospective clinical and economic evaluation of patients submitted to bone marrow transplant at the "Hospital Israelita Albert Einstein", between the years 2000 and 2008. A total of 167 patients were evaluated, and were divided into two groups: Group I, composed of 91 patients who received dental treatment and Laser therapy during the BMT and Group II, composed of 76 patients who did not receive dental attendance or laser therapy. Data such as age, sex, diagnosis of the underlying disease, chemotherapy protocol, type of transplant, use of pain relief medication, days of fever, use of parenteral feeding, days of hospitalization, presence of infection and degree of oral mucositis, with and without dental attendance were collected and analyzed. A descriptive analysis, based on Frequency tables and Chi-square tests (or Fishers exact test, when this was shown to be more appropriate), was performed with the aim of verifying the statistical association among the variables of interest. Estimates of relative risks, with confidence intervals of 95% were calculated to evaluate the association between the outcome (maximum degree) and the explicative variables of interest and the mean time of hospitalization (in days) in the different groups and types of transplants was compared by means of an analysis of variance model. p- Values lower than 0.05 were considered statistically significant. By means of this study, it could be concluded that the extent and severity of Oral Mucositis were greater in the group without Dental attendance, as the risk of the patient in this group presenting Grade III or IV was 13 times higher than it was in the group attended by a Dentist. Moreover, it was observed that dental attendance during BMT, when performed in the manner described in this study, is cost-effective, as it is capable of reducing the clinical morbidities of BMT. Furthermore the benefits of dental attendance outweighed the costs, and therefore, must be adopted. It was also found that patients that were followed-up by the Dentist presented a better quality of life during BMT and that dental attendance during BMT resulted in savings for the hospital.
 
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Publishing Date
2010-08-24
 
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