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Orthopaedic Trauma-Induced Pyoderma Gangrenosum: A Case Report.

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Orthopaedic Trauma-Induced Pyoderma Gangrenosum: A Case Report.

JBJS Case Connect. 2020 Apr-Jun;10(2):e0562

Authors: Hoelscher S, Hunter A, Barcak E, Wheeler M, Mapula S

Abstract
CASE: We present a case of a 60-year-old polytraumatized man who developed postoperative pyoderma gangrenosum (PG) after his initial stabilization procedures, mimicking a postoperative infection. This caused a delay in diagnosis, leading to progression of his wounds and a delay in initiation of the appropriate treatment. Once his PG was appropriately treated, his clinical status and wounds improved. He underwent successful wound coverage by plastic surgery and has been recovering from his injuries.
CONCLUSION: Prompt identification and initiation of treatment for postoperative PG is critical to avoid exacerbation of wounds and subsequent morbidity to the patient.

PMID: 32649133 [PubMed - as supplied by publisher]

Improving quality in a complex primary care system-An example of refugee care and literature review.

Richard Young, MD - Tue, 07/07/2020 - 00:18
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Improving quality in a complex primary care system-An example of refugee care and literature review.

J Eval Clin Pract. 2020 Jun 29;:e13430

Authors: Young RA, Nelson MJ, Castellon RE, Martin CM

Abstract
RATIONALE, AIMS AND OBJECTIVES: Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach.
METHODS: We report on changes in health system utilization by new refugee patients of the FHC from 2016 to 2017. We review the literature and summarize relevant theoretical understandings of quality management in complex adaptive systems as it applies to this case example.
RESULTS: Applying CAS principles in the FHC, utilization of the Emergency Department and Urgent Care Center by newly arrived refugee patients before their first clinic visit was reduced by more than half (total visits decreased from 31%-14% of the refugee patients). Our review of the literature demonstrates that traditional algorithmic top-down QI processes are most often unsuccessful in improving even a few single-disease metrics, and increases clinician burnout and penalizes clinicians who care for vulnerable patients. Improvement in a CAS occurs when front-line clinicians identify care gaps and are given the flexibility to learn and self-organize to enable new care processes to emerge, which are created from bottom-up leadership that utilize existing interdependencies and interact with the top levels of the organization through intelligent top-down causation. We give examples of early adapters who are better applying the principles of CAS change to their QI efforts.
CONCLUSIONS: Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up.

PMID: 32596835 [PubMed - as supplied by publisher]

Improving quality in a complex primary care system-An example of refugee care and literature review.

Related Articles

Improving quality in a complex primary care system-An example of refugee care and literature review.

J Eval Clin Pract. 2020 Jun 29;:e13430

Authors: Young RA, Nelson MJ, Castellon RE, Martin CM

Abstract
RATIONALE, AIMS AND OBJECTIVES: Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach.
METHODS: We report on changes in health system utilization by new refugee patients of the FHC from 2016 to 2017. We review the literature and summarize relevant theoretical understandings of quality management in complex adaptive systems as it applies to this case example.
RESULTS: Applying CAS principles in the FHC, utilization of the Emergency Department and Urgent Care Center by newly arrived refugee patients before their first clinic visit was reduced by more than half (total visits decreased from 31%-14% of the refugee patients). Our review of the literature demonstrates that traditional algorithmic top-down QI processes are most often unsuccessful in improving even a few single-disease metrics, and increases clinician burnout and penalizes clinicians who care for vulnerable patients. Improvement in a CAS occurs when front-line clinicians identify care gaps and are given the flexibility to learn and self-organize to enable new care processes to emerge, which are created from bottom-up leadership that utilize existing interdependencies and interact with the top levels of the organization through intelligent top-down causation. We give examples of early adapters who are better applying the principles of CAS change to their QI efforts.
CONCLUSIONS: Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up.

PMID: 32596835 [PubMed - as supplied by publisher]

Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

Roderick Y. Kim DDS, MD - Mon, 06/29/2020 - 23:08
Related Articles

Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

J Oral Maxillofac Surg. 2019 Apr;77(4):852-858

Authors: Kim RY, Helman JI, Braun TM, Ward BB

Abstract
PURPOSE: Despite data showing worse outcomes and aggressive disease behavior, perineural invasion (PNI) has not been well characterized in terms of tumor location, histopathologic features, or cervical lymph node status. The specific aims of this study were to measure correlations between PNI, tumor location, and other known histopathologic characteristics used to define aggressive disease.
MATERIALS AND METHODS: This was a retrospective cohort study of adult patients with primary squamous cell carcinoma of the oral cavity who underwent neck dissection. We excluded patients whose neck was previously treated with surgery or radiation therapy. Demographic and histopathologic variables of interest were obtained from patient charts. The primary outcome of interest was PNI, and the predictors of interest included tumor location, histopathologic tumor characteristics, and cervical lymph node status. For continuous variables, mean differences were compared by t tests. For categorical variables, the differences in the distribution of the proportions were analyzed with the χ2 test. All variables were entered simultaneously into a multivariate logistic regression model to control for possible confounding. Statistical significance for the study was set at P < .05.
RESULTS: Three hundred sixty-eight patients met the study criteria. PNI showed statistically significant correlations with lymph node status, tumor depth, and specific primary tumor location. PNI was more likely to be seen in tumors located in the tongue or floor of the mouth. Tumors with PNI had a deeper depth of invasion: 15.9 ± 10.9 mm versus 10.2 ± 10.0 mm (P < .001). PNI tumors had a higher mean total number of positive nodes: 2.85 ± 5.23 versus 0.83 ± 1.80 (P < .001).
CONCLUSIONS: PNI is statistically correlated with tongue and floor-of-the-mouth subsites within the oral cavity, as well as larger tumors, deeper tumors, and disease that has progressed to the lymph nodes. Whether this correlation represents causation in either direction remains unknown.

PMID: 30142323 [PubMed - indexed for MEDLINE]

Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

Related Articles

Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

J Oral Maxillofac Surg. 2019 Apr;77(4):852-858

Authors: Kim RY, Helman JI, Braun TM, Ward BB

Abstract
PURPOSE: Despite data showing worse outcomes and aggressive disease behavior, perineural invasion (PNI) has not been well characterized in terms of tumor location, histopathologic features, or cervical lymph node status. The specific aims of this study were to measure correlations between PNI, tumor location, and other known histopathologic characteristics used to define aggressive disease.
MATERIALS AND METHODS: This was a retrospective cohort study of adult patients with primary squamous cell carcinoma of the oral cavity who underwent neck dissection. We excluded patients whose neck was previously treated with surgery or radiation therapy. Demographic and histopathologic variables of interest were obtained from patient charts. The primary outcome of interest was PNI, and the predictors of interest included tumor location, histopathologic tumor characteristics, and cervical lymph node status. For continuous variables, mean differences were compared by t tests. For categorical variables, the differences in the distribution of the proportions were analyzed with the χ2 test. All variables were entered simultaneously into a multivariate logistic regression model to control for possible confounding. Statistical significance for the study was set at P < .05.
RESULTS: Three hundred sixty-eight patients met the study criteria. PNI showed statistically significant correlations with lymph node status, tumor depth, and specific primary tumor location. PNI was more likely to be seen in tumors located in the tongue or floor of the mouth. Tumors with PNI had a deeper depth of invasion: 15.9 ± 10.9 mm versus 10.2 ± 10.0 mm (P < .001). PNI tumors had a higher mean total number of positive nodes: 2.85 ± 5.23 versus 0.83 ± 1.80 (P < .001).
CONCLUSIONS: PNI is statistically correlated with tongue and floor-of-the-mouth subsites within the oral cavity, as well as larger tumors, deeper tumors, and disease that has progressed to the lymph nodes. Whether this correlation represents causation in either direction remains unknown.

PMID: 30142323 [PubMed - indexed for MEDLINE]

The effect of insurance status on overall survival among children and adolescents with cancer.

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The effect of insurance status on overall survival among children and adolescents with cancer.

Int J Epidemiol. 2020 Jun 23;:

Authors: Wang X, Ojha RP, Partap S, Johnson KJ

Abstract
BACKGROUND: Differences in access, delivery and utilisation of health care may impact childhood and adolescent cancer survival. We evaluated whether insurance coverage impacts survival among US children and adolescents with cancer diagnoses, overall and by age group, and explored potential mechanisms.
METHODS: Data from 58 421 children (aged ≤14 years) and adolescents (15-19 years), diagnosed with cancer from 2004 to 2010, were obtained from the National Cancer Database. We examined associations between insurance status at initial diagnosis or treatment and diagnosis stage; any treatment received; and mortality using logistic regression, Cox proportional hazards (PH) regression, restricted mean survival time (RMST) and mediation analyses.
RESULTS: Relative to privately insured individuals, the hazard of death (all-cause) was increased and survival months were decreased in those with Medicaid [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.22 to 1.33; and -1.73 months, 95% CI: -2.07 to -1.38] and no insurance (HR = 1.32, 95% CI: 1.20 to 1.46; and -2.13 months, 95% CI: -2.91 to -1.34). The HR for Medicaid vs. private insurance was larger (pinteraction <0.001) in adolescents (HR = 1.52, 95% CI: 1.41 to 1.64) than children (HR = 1.16, 95% CI: 1.10 to 1.23). Despite statistical evidence violation of the PH assumption, RMST results supported all interpretations. Earlier diagnosis for staged cancers in the Medicaid and uninsured populations accounted for an estimated 13% and 19% of the survival deficit, respectively, vs. the privately insured population. Any treatment received did not account for insurance-associated survival differences in children and adolescents with cancer.
CONCLUSIONS: Children and adolescents without private insurance had a higher risk of death and shorter survival within 5 years following cancer diagnosis. Additional research is needed to understand underlying mechanisms.

PMID: 32572489 [PubMed - as supplied by publisher]

Erectile dysfunction: How to help patients and partners.

Katherine Buck, PhD - Mon, 06/22/2020 - 20:27
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Erectile dysfunction: How to help patients and partners.

J Fam Pract. 2020 Jun;69(5):251-254

Authors: Buck K, Stratton J, Hodgson J

Abstract
This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED.

PMID: 32555756 [PubMed - in process]

Erectile dysfunction: How to help patients and partners.

Related Articles

Erectile dysfunction: How to help patients and partners.

J Fam Pract. 2020 Jun;69(5):251-254

Authors: Buck K, Stratton J, Hodgson J

Abstract
This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED.

PMID: 32555756 [PubMed - in process]

Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study.

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Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study.

J Formos Med Assoc. 2020 Jun 11;:

Authors: Pei-Chuan Huang E, Fu CM, Chang WT, Huang CH, Tsai MS, Chou E, Wolfshohl J, Wang CH, Wu YW, Chen WJ

Abstract
BACKGROUND: To analyse the association of thoracic cage size and configuration with outcomes following in-hospital cardiac arrest (IHCA).
METHODS: A single-centred retrospective study was conducted. Adult patients experiencing IHCA during 2006-2015 were screened. By analysing computed tomography images, we measured thoracic anterior-posterior and transverse diameters, circumference, and both anterior and posterior subcutaneous adipose tissue (SAT) depths at the level of the internipple line (INL). We also recorded the anatomical structure located immediately posterior to the sternum at the INL.
RESULTS: A total of 649 patients were included. The median thoracic circumference was 88.6 cm. The median anterior and posterior thoracic SAT depths were 0.9 and 1.5 cm, respectively. The ascending aorta was found to be the most common retrosternal structure (57.6%) at the INL. Multivariate logistic regression analyses indicated that anterior thoracic SAT depth of 0.8-1.6 cm (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.40-6.35; p-value = 0.005) and thoracic circumference of 83.9-95.0 cm (OR: 2.48, 95% CI: 1.16-5.29; p-value = 0.02) were positively associated with a favourable neurological outcome while left ventricular outflow track or aortic root beneath sternum at the level of INL was inversely associated with a favourable neurological outcome (OR: 0.37, 95% CI: 0.15-0.91; p-value = 0.03).
CONCLUSION: Thoracic circumference and anatomic configuration might be associated with IHCA outcomes. This proof-of-concept study suggested that a one-size-fits-all resuscitation technique might not be suitable. Further investigation is needed to investigate the method of providing personalized resuscitation tailored to patient needs.

PMID: 32536380 [PubMed - as supplied by publisher]

Diversity and Inclusion: The Foundation for All Milestones.

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Diversity and Inclusion: The Foundation for All Milestones.

Fam Med. 2020 Jun;52(6):459-460

Authors: Elliott TC, Ko S

PMID: 32520384 [PubMed - as supplied by publisher]

Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages.

Cynthia Claassen, PhD - Mon, 06/08/2020 - 16:43
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Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages.

Psychosomatics. 2020 Apr 28;:

Authors: Horowitz LM, Snyder DJ, Boudreaux ED, He JP, Harrington CJ, Cai J, Claassen CA, Salhany JE, Dao T, Chaves JF, Jobes DA, Merikangas KR, Bridge JA, Pao M

Abstract
BACKGROUND: Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk-screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults.
METHODS: Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard.
RESULTS: A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%-100%), a specificity of 89% (95% confidence interval = 86%-91%), and a negative predictive value of 100% (95% confidence interval = 99%-100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire.
CONCLUSIONS: The ASQ is a valid and brief suicide risk-screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener.

PMID: 32487323 [PubMed - as supplied by publisher]

Occurrence of Glioma in Pregnant Patients: An Institutional Case Series and Review of the Literature.

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Occurrence of Glioma in Pregnant Patients: An Institutional Case Series and Review of the Literature.

Anticancer Res. 2020 Jun;40(6):3453-3457

Authors: Singh P, Mantilla E, Sewell J, Hatanpaa KJ, Pan E

Abstract
BACKGROUND/AIM: Gliomas present a uniquely challenging clinical situation in the context of pregnancy, with no standard recommendations. This case series aimed to describe the treatment regimen and outcomes of five pregnant patients with gliomas.
PATIENTS AND METHODS: This is a retrospective study. A patient database from electronic medical records was evaluated to identify pregnant patients with gliomas treated at our institution between 2008-2018.
RESULTS: Five study patients who were pregnant with gliomas were identified. Of these, 4 were diagnosed during pregnancy, while 1 was diagnosed prior to her pregnancy. One patient had grade 2 astrocytoma, 1 had grade 3 anaplastic astrocytoma, and 3 had grade 4 glioblastomas (GBM). All patients received surgery, and one patient received radiation therapy without concurrent chemotherapy during her pregnancy. All delivered healthy babies. Three of the 5 patients remain alive, and 2 of the 5 were progression-free at the last follow-up.
CONCLUSION: Treatment plans must be specifically tailored to the individual patient based on the glioma grade, the mother's desire to continue the pregnancy, and the risks of delaying treatment until after pregnancy. Additional studies need to be performed to definitively establish uniform guidelines for the treatment of pregnant patients with glioma.

PMID: 32487644 [PubMed - in process]

Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages.

Related Articles

Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages.

Psychosomatics. 2020 Apr 28;:

Authors: Horowitz LM, Snyder DJ, Boudreaux ED, He JP, Harrington CJ, Cai J, Claassen CA, Salhany JE, Dao T, Chaves JF, Jobes DA, Merikangas KR, Bridge JA, Pao M

Abstract
BACKGROUND: Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk-screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults.
METHODS: Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard.
RESULTS: A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%-100%), a specificity of 89% (95% confidence interval = 86%-91%), and a negative predictive value of 100% (95% confidence interval = 99%-100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire.
CONCLUSIONS: The ASQ is a valid and brief suicide risk-screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener.

PMID: 32487323 [PubMed - as supplied by publisher]

An Epigenetics-Based, Lifestyle Medicine-Driven Approach to Stress Management for Primary Patient Care: Implications for Medical Education.

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An Epigenetics-Based, Lifestyle Medicine-Driven Approach to Stress Management for Primary Patient Care: Implications for Medical Education.

Am J Lifestyle Med. 2020 May-Jun;14(3):294-303

Authors: Lee J, Papa F, Jaini PA, Alpini S, Kenny T

Abstract
Over 75% of patients in the primary care setting present with stress-related complaints. Curiously, patients and health care providers all too often see stress as a relatively benign sequela of many common illnesses such as heart disease, cancer, lung disease, dementia, diabetes, and mental illness. Unfortunately, various day-to-day lifestyle choices and environmental factors, unrelated to the presence of any disease, can cause stress sufficient to contribute to the development of various diseases/disorders and suboptimal health. There is evidence suggesting that counseling in stress management-oriented therapeutic interventions (as offered by lifestyle medicine-oriented practitioners) may prevent or reduce the onset, severity, duration, and/or overall burden of stress-related illnesses. Such counseling often involves considerations such as the patient's nutrition, physical activity, interest in/capacity to meditate, drug abuse/cessation, and so on. Unfortunately, lifestyle medicine-oriented approaches to stress management are rarely offered in primary care-the patient care arena wherein such counseling would likely be best received by patients. Would health care outcomes improve if primary care providers offered counseling in both stress management and positive lifestyle choices? The purpose of this article is to provide both primary care practitioners and educators in health care training programs with an introductory overview of epigenetics. An emerging field of science offering insights into how factors such as stress and lifestyle choices interact with our genes in ways that can both positively and negatively impact the various micro (eg, cellular) through macro (eg, physiologic, pathophysiologic) processes that determine our tendencies toward illness or wellness. A deeper understanding of epigenetics, as provided herein, should enable primary care providers and medical educators to more confidently advocate for the primary benefits associated with counseling in both stress reduction and the pursuit of healthy lifestyle choices.

PMID: 32477032 [PubMed]

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

Roderick Y. Kim DDS, MD - Mon, 06/01/2020 - 15:00
Related Articles

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

J Oral Maxillofac Surg. 2020 May 23;:

Authors: Moe J, Brookes C, Dyalram D, Kim R, Melville J, Quereshy F, Roser S, Salman S, Schlieve T, Steed M, Fisher E

PMID: 32473915 [PubMed - as supplied by publisher]

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

J Oral Maxillofac Surg. 2020 May 23;:

Authors: Moe J, Brookes C, Dyalram D, Kim R, Melville J, Quereshy F, Roser S, Salman S, Schlieve T, Steed M, Fisher E

PMID: 32473915 [PubMed - as supplied by publisher]

QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry.

Dustin DeMoss, DO - Mon, 05/25/2020 - 14:20
Related Articles

QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry.

J Psychosom Res. 2020 May 11;135:110138

Authors: Xiong GL, Pinkhasov A, Mangal JP, Huang H, Rado J, Gagliardi J, Demoss D, Karol D, Suo S, Lang M, Stern M, Spearman EV, Onate J, Annamalai A, Saliba Z, Heinrich T, Fiedorowicz JG

Abstract
OBJECTIVE: Several psychiatric medications have the potential to prolong the QTc interval and subsequently increase the risk for ventricular arrhythmias such as torsades de pointes (TdP). There is limited guidance for clinicians to balance the risks and benefits of treatments.
METHODS: After a review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus guidelines for ECG monitoring of the QTc interval for patients with medical and psychiatric comorbidities who are prescribed medications with the potential to prolong the QTc interval. A risk score was developed based on risk factors for QTc prolongation to guide clinical decision-making.
RESULTS: A baseline ECG may not be necessary for individuals at low risk for arrythmia. Those individuals with a risk score of two or more should have an ECG prior to the start of a potentially QTc-prolonging medication or be started on a lower risk agent. Antipsychotics are not equivalent in causing QTc prolongation. A consensus-based algorithm is presented for the management of those identified at high (QTc >500 msec), intermediate (males with QTc 450-499 msec or females with QTc > 470-499 msec), or low risk.
CONCLUSIONS: The proposed algorithm can help clinicians in determining whether ECG monitoring should be considered for a given patient. These guidelines preserve a role for clinical judgment in selection of treatments that balance the risks and benefits, which may be particularly relevant for complex patients with medical and psychiatric comorbidities. Additional studies are needed to determine whether baseline and serial ECG monitoring reduces mortality.

PMID: 32442893 [PubMed - as supplied by publisher]

Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study.

Michael Warner, DDS - Mon, 05/25/2020 - 14:20
Related Articles

Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study.

J Oral Maxillofac Surg. 2020 Apr 23;:

Authors: Granquist EJ, Bouloux G, Dattilo D, Gonzalez O, Louis PJ, McCain J, Sinn D, Szymela V, Warner M, Quinn PD

Abstract
PURPOSE: In February 2011, the Food and Drug Administration issued a postmarket surveillance order to all manufacturers of temporomandibular joint (TMJ) implants in the United States. The objective of the present study was to measure implant subsequent surgical intervention (SSI) among patients who had undergone TMJ reconstruction with the Biomet TMJ replacement system (Zimmer Biomet, Warsaw, IN).
MATERIALS AND METHODS: A prospective observational study was conducted by sending a questionnaire to patients who had received a Biomet TMJ replacement system from 1995 to 2010 in the United States. The questionnaire was sent annually from 2012 to 2015. The primary endpoint was the SSIs. SSIs included both device removal and reoperations. Kaplan-Meier survival analysis was used to determine the survivorship, and Cox proportional hazard regression analysis was performed to evaluate the preoperative diagnosis and SSI.
RESULTS: The mean age at implantation was 46.6 ± 12.5 years, with a gender distribution of 86.1% female. Data from 499 joints in 319 subjects were collected as a part of the survey. The mean follow-up time was 8.6 ± 3.9 years (range, 2-20 years). The first SSI frequency was 11.2% (4.2% removal rate and 7.0% reoperation rate). The survivorship rate (Kaplan-Meier) was 96% at 3 years, 94% at 5 years, and 86% at 10 years. The mean interval to failure using a survival function to determine the time to SSI (Greenwood's formula) was 13.5 ± 0.193 years. The most common causes of SSI included adhesion removal (2.6%; 13 of 498), heterotopic bone/ankylosis (2.0%; 10 of 498), and infection (1.6%; 8 of 498).
CONCLUSIONS: The results from the present study are consistent with the reported survivorship rates for other orthopedic devices (5-year survival for total hip or knee arthroplasty, 95.9 and 97.2%, respectively). The etiology of SSIs in the Biomet TMJ replacement system was primarily secondary to biologic failure (ie, adhesions, heterotopic bone, and infection).

PMID: 32439381 [PubMed - as supplied by publisher]

Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study.

Related Articles

Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study.

J Oral Maxillofac Surg. 2020 Apr 23;:

Authors: Granquist EJ, Bouloux G, Dattilo D, Gonzalez O, Louis PJ, McCain J, Sinn D, Szymela V, Warner M, Quinn PD

Abstract
PURPOSE: In February 2011, the Food and Drug Administration issued a postmarket surveillance order to all manufacturers of temporomandibular joint (TMJ) implants in the United States. The objective of the present study was to measure implant subsequent surgical intervention (SSI) among patients who had undergone TMJ reconstruction with the Biomet TMJ replacement system (Zimmer Biomet, Warsaw, IN).
MATERIALS AND METHODS: A prospective observational study was conducted by sending a questionnaire to patients who had received a Biomet TMJ replacement system from 1995 to 2010 in the United States. The questionnaire was sent annually from 2012 to 2015. The primary endpoint was the SSIs. SSIs included both device removal and reoperations. Kaplan-Meier survival analysis was used to determine the survivorship, and Cox proportional hazard regression analysis was performed to evaluate the preoperative diagnosis and SSI.
RESULTS: The mean age at implantation was 46.6 ± 12.5 years, with a gender distribution of 86.1% female. Data from 499 joints in 319 subjects were collected as a part of the survey. The mean follow-up time was 8.6 ± 3.9 years (range, 2-20 years). The first SSI frequency was 11.2% (4.2% removal rate and 7.0% reoperation rate). The survivorship rate (Kaplan-Meier) was 96% at 3 years, 94% at 5 years, and 86% at 10 years. The mean interval to failure using a survival function to determine the time to SSI (Greenwood's formula) was 13.5 ± 0.193 years. The most common causes of SSI included adhesion removal (2.6%; 13 of 498), heterotopic bone/ankylosis (2.0%; 10 of 498), and infection (1.6%; 8 of 498).
CONCLUSIONS: The results from the present study are consistent with the reported survivorship rates for other orthopedic devices (5-year survival for total hip or knee arthroplasty, 95.9 and 97.2%, respectively). The etiology of SSIs in the Biomet TMJ replacement system was primarily secondary to biologic failure (ie, adhesions, heterotopic bone, and infection).

PMID: 32439381 [PubMed - as supplied by publisher]

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

Roderick Y. Kim DDS, MD - Mon, 05/18/2020 - 12:45
Related Articles

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

J Oral Maxillofac Surg. 2020 Apr 14;:

Authors: Williams FC, Hammer DA, Wentland TR, Kim RY

Abstract
PURPOSE: Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involve outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques.
MATERIALS AND METHODS: Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles.
RESULTS: All 12 patients had received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses.
CONCLUSIONS: The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.

PMID: 32404269 [PubMed - as supplied by publisher]

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