You go to hospital for treatment and to get better. But sometimes, you get something much less welcome: an infection.

Pneumonia, an infection of the lungs, is one of the most common and deadly infections people develop in hospital. Around 50,000 patients contract pneumonia in Australian hospitals every year. Around 1,900 of them die from it.

It’s rarely monitored and rarely reported. And to date, few studies have looked at how it can be prevented.

But our new trial, published today in The Lancet Infectious Diseases, shows a surprisingly simple action can make a major difference: brushing patients’ teeth.

We found this can reduce the chance of getting this type of pneumonia, called non-ventilator hospital-acquired pneumonia, by 60%.

What is this type of pneumonia?

Non-ventilator hospital-acquired pneumonia occurs in patients who aren’t on a ventilator, usually outside of intensive care settings.

Patients are infected when bacteria from the mouth or throat are breathed into the lungs.

Patients who develop this type of pneumonia stay in hospital between ten and 48 days longer, and are around eight times more likely to die during their admission.

A simple intervention made a big difference

We studied 8,870 patients across three Australian hospitals to see whether improving oral care – which included tooth-brushing – could reduce this type of pneumonia.

Usually, when patients go to hospital, they don’t pack a toothbrush – especially in emergencies.

In busy hospital wards, oral care isn’t always given the attention it needs, nor are oral care products always readily available. Patients don’t always get reminders to brush their teeth and many patients need help with their oral care.

The intervention in our study was deliberately simple. We:

• gave patients in hospital a toothbrush and toothpaste in a bag when they were admitted

• educated patients and hospital staff about the importance of tooth-brushing. The toothbrush also had a written prompt on it – “Brush away pneumonia”

• assisted patients who needed help with tooth-brushing

• audited how oral care was being delivered and gave feedback to hospital wards.

We introduced the intervention into one ward at a time over 12 months at each hospital. This gradual roll-out is known as a stepped-wedge cluster randomised trial. It can test new health interventions when it’s too difficult to randomise individuals without revealing who is receiving the intervention and who isn’t.

We found that this relatively simple intervention increased the proportion of people who cleaned their teeth from 16% to 62%.

This increasing oral care led to a 60% reduction in the risk of acquiring pneumonia, from the equivalent of eight infections per month on a typical ward of 30 patients, to less than four infections per month.

This is the largest trial of its kind and the first completed across multiple hospitals.

Why does brushing teeth help?

The mouth is home to billions of bacteria. Oral hygiene often deteriorates when people are unwell, sedated, immobile, or taking certain medications.

When this happens, bacteria build up on the teeth, gums and tongue. If these bacteria are breathed in – even in tiny amounts – they can cause pneumonia.

Daily tooth-brushing reduces this bacteria. It’s a simple mechanical action with a powerful protective effect.

Yet in busy hospitals, oral care is often overlooked. Patients may not know just how important oral care is. Staff are often busy with competing priorities and oral care can be de-prioritised. There is also a general lack of understanding about the importance of oral care.

Patients can help protect themselves

One of the most important messages from our research is patients aren’t powerless. While health-care staff such as nurses play a crucial role, patients who are able to brush their own teeth can meaningfully reduce their own risk.

If you or a loved one is admitted to hospital, you can:

• bring your own toothbrush and toothpaste
• brush your teeth twice a day if you’re able
• ask staff for help if you can’t
• remind staff if oral care has been missed.

These small actions can reduce the risk of a serious, life-threatening infection.

What happens next?

Pneumonia is costly – in lives, hospital days and the financial cost of care. But because non-ventilator hospital-acquired pneumonia isn’t routinely reported, it’s often invisible.

Our research challenges the assumption that hospital-acquired pneumonia is an unavoidable complication when you go to hospital.

It also highlights the need for hospitals to monitor non-ventilator hospital-acquired infections, in the same way they monitor falls, pressure injuries and other preventable harms.

Finally, our study strengthens the case for including oral care in national infection-prevention guidelines and nursing practice.

Oral care isn’t glamorous, expensive or technologically advanced – but it works. Sometimes, the simplest interventions are the most powerful.

Brett Mitchell, Professor of Nursing and Health Services Research, University of Newcastle; Allen Cheng, Professor of Infectious Diseases, Monash University; Nicole White, Associate Professor of Statistics, Queensland University of Technology; Peta Ellen Tehan, Senior Lecturer, Monas University, Monash University, and Philip Russo, Professor, Director of Research, Nursing and Midwifery, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Magic mushrooms are better known for producing hallucinations and altering people’s sense of reality than for treating brain diseases. Most people associate them with tripping, rather than Alzheimer’s disease.

But a report on an individual patient has prompted scientists to ask whether psilocybin, the psychedelic compound in magic mushrooms, could have unexpected effects on the ageing brain.

The report describes changes observed in a Japanese-American woman in her 80s with advanced Alzheimer’s disease after she received psilocybin-containing mushrooms. Dementia is a broad term for symptoms that affect memory, thinking and everyday independence. Alzheimer’s disease is its most common cause.

The woman had experienced progressive decline for a decade. For the previous five years, she had largely communicated using single words and relied heavily on others for everyday care. She also had difficulty walking and dressing herself and experienced chronic urinary incontinence.

She received 5g of psilocybin-containing mushrooms. The exact amount of psilocybin is unclear because mushroom potency varies. During the experience, she sweated heavily and entered a prolonged sleep-like state. Around 19 hours later, she began speaking spontaneously and recalling memories from her own life.

Over the following days and weeks, caregivers reported that she seemed more alert, recognised family members, walked more independently, began dressing herself and regained urinary continence. One month later, she received a second supervised session involving 3g of mushrooms and again appeared more expressive and agile.

The case has drawn comparisons with neurologist Oliver Sacks’s 1973 book Awakenings, which described patients who unexpectedly regained lost abilities after treatment with the Parkinson’s drug L-dopa, also known as levodopa. The diseases and drugs are entirely different. Both raise questions about how much function may remain hidden within a damaged brain.

However, the report does not show that psychedelics reverse Alzheimer’s disease.

It involved one person, rather than a controlled clinical trial. Her diagnosis was based on her clinical history, rather than confirmed using biomarkers: biological signs of Alzheimer’s disease that can be detected using tests such as brain scans or analysis of spinal fluid. There was no comparison group and no standardised testing of memory and thinking before and after treatment. Observations were largely based on reports from caregivers and family members.

Alzheimer’s disease involves abnormal proteins, inflammation, damage to connections between brain cells and, ultimately, the death of neurons, or nerve cells. There is no evidence that psilocybin reversed these underlying disease processes.

The authors suggest that psilocybin may temporarily have altered communication between surviving brain networks: groups of brain regions that work together. This could have made some abilities more accessible for a limited period. Because the report did not include brain scans, this remains an untested hypothesis.

Scientists are interested in this possibility partly because of the brain’s ability to adapt.

For much of the 20th century, scientists believed that the adult brain was relatively fixed. It is now known that the brain can reorganise itself throughout life. New connections can form and networks can change in response to experience.

This process, known as neuroplasticity, supports learning, memory and recovery from injury. It generally becomes less efficient with ageing and dementia.

Psilocybin acts mainly through a serotonin receptor called 5-HT2A. Serotonin is a chemical messenger involved in mood, perception and other functions. Receptors are proteins that allow cells to respond to chemical signals.

Studies in animals suggest that psilocybin can encourage the formation of dendritic spines: tiny protrusions on nerve cells that help them communicate. Psychedelics may also affect signalling pathways involving brain-derived neurotrophic factor, or BDNF, a protein involved in maintaining nerve-cell connections.

Brain-imaging studies suggest that psilocybin temporarily changes communication between large-scale brain networks. Some networks become less rigidly separated, while familiar patterns of activity are disrupted.

Over the past decade, clinical trials have produced promising results in depression. Smaller studies have also examined psilocybin-assisted therapy for anxiety and some forms of addiction.

Other research has explored possible anti-inflammatory effects. This is relevant because chronic inflammation is thought to contribute to Alzheimer’s disease and other neurodegenerative disorders: conditions in which nerve cells gradually become damaged or die.

Laboratory and animal research therefore suggests that psychedelics may influence nerve-cell growth, inflammation and brain-network activity. Whether these effects occur in people with Alzheimer’s disease remains unknown.

Separate research at the University of California, Berkeley, is examining how psilocybin affects cognitively healthy adults aged 60 to 85. The study is not testing a dementia treatment. Participants will receive synthetic psilocybin and undergo brain scans and tests of memory and thinking.

There are important reasons for caution.

Psilocybin is not risk-free. Psychedelic experiences can be frightening and disorienting, particularly for vulnerable people. Older adults may face increased risks of falls, heart and circulation problems and interactions with medications.

The woman experienced heavy sweating, suspected high body temperature and a prolonged sleep-like state. The absence of lasting complications does not establish that the approach is safe.

It would be dangerous to interpret the report as a reason to experiment with psychedelic mushrooms outside a closely supervised research or clinical setting.

The case raises a possibility: even after years of severe cognitive decline, some abilities may remain temporarily accessible. Whether psilocybin played a direct role, how it might have done so and whether similar effects could be reproduced in other people remain unknown. Answering those questions will require controlled research.

Rahul Sidhu, PhD Candidate, Neuroscience, University of Sheffield

This article is republished from The Conversation under a Creative Commons license. Read the original article.