'We are preventing pneumonia and saving lives, one clean mouth at a time.' : A content analysis of the use of research evidence in support of oral health claims made in clinical educational materials produced by industry
CCCF ePoster library. Millington A. 11/12/19; 285178; EP78
Anna Millington
Anna Millington
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Anna Millington, BSc, Cliodna Cussen, MFA, Sasha Mazzarello, MSc, Quinn Grundy, PhD, RN, Craig M. Dale, RN, PhD, CNCC(C)
Affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto

Oral health care comprises a unique nursing accountability and an essential intervention to oral health deterioration and pneumonia in critically ill patients. Due to insufficient pre- and post-licensure education in oral health care, industry has become a principle source of information about oral health products. Nurses may look to pharmaceutical and device manufacturers for education to inform oral care delivery supported by scientific evidence. To date, there has been little research into the evidence-based claims within industry-provided educational resources accessible to nurses.
To investigate the amount, type and accuracy of citation use in support of oral health product-related claims from industry-authored educational materials targeted at critical care nurses.
Two researchers independently sampled educational offerings from the websites of four major international device manufacturing companies (Avanos, Intersurgical, Medline, and Sage Products). Documents (web pages, downloadable documents, videos, etc.) were included if they were produced and/or authored by the company, focused on oral health conditions and/or practices, targeted at clinicians, and identified as related to education. Based on previous analyses of drug and device claims in advertising, we created a data extraction tool in Redcap with three sections: products, product-related claims, and citations supporting the claims. Each instrument went through pilot phases until we reached an acceptable level of agreement. Two independent coders extracted data and assessed whether the evidence in the citation supported the product-related claims. Coding discrepancies were discussed and resolved with a third author. A descriptive analysis of the findings was carried out using Excel.
69 documents met inclusion criteria (9 Avanos, 10 Intersurgical, 7 Medline, 43 Sage/Stryker). Products were divided into three categories: pharmaceutical products (oral rinses, moisturizers, etc.), devices (bite blocks, toothbrushes, suction catheters, etc.) and combination products (e.g., oral care kits designed for up to 24 hours use). Document formats included web pages providing information about a particular health outcome (such as ventilator-associated pneumonia), continuing education courses, instructional videos, posters and hospital protocol templates.
Preliminary analysis based on a random sample of documents (n=19, 28%) found that 100% of these documents made efficacy claims. Of 110 claims extracted so far, 51% (56) were not cited. We found 284 total citations representing 90 unique sources, 40% of which were published more than 10 years ago (range 1975-2008). Preliminary analysis of claims with citations demonstrates limited supports for efficacy claims due to inappropriate study design (e.g., non-randomized study), contained statistically non-significant findings, or related to a non-critical care study population (e.g. long term care).
The findings of this study indicate that claims made by device manufacturing companies are not always supported by evidence, and when they do reference evidence, it is not always current or valid. Critical care nurses should critically appraise claims provided by manufacturers. Device manufacturing companies need to be held to a higher level of accountability through the development of policies that draw a clearer line between marketing and education.

Quinn, B., 'Basic Care is Essential Care: Implementing Oral Hygiene to Prevent Hospital-Acquired Pneumonia,' SAGE Products, https://sageproducts.com/sage-university/non-ce-courses/

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