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JACC. Advances Oct 2023Cardiac rehabilitation (CR) is strongly recommended for a spectrum of cardiovascular conditions and procedures including aortic valve replacement.
BACKGROUND
Cardiac rehabilitation (CR) is strongly recommended for a spectrum of cardiovascular conditions and procedures including aortic valve replacement.
OBJECTIVES
The purpose of this study was to characterize patient and hospital factors associated with CR participation after transcatheter aortic valve replacement (TAVR) and determine which factors explain hospital-level variation in CR participation.
METHODS
We linked clinical and administrative claims data from patients who underwent TAVR at 24 Michigan hospitals between January 1, 2016 and June 30, 2020 and obtained rates of CR enrollment within 90 days of discharge. Sequential mixed models were fit to evaluate hospital variation in 90-day post-TAVR CR participation.
RESULTS
Among 3,372 patients, 30.6% participated in CR within 90-days after discharge. Several patient factors were negatively associated with CR participation after TAVR including older age, Medicaid insurance, atrial fibrillation/flutter, dialysis use, and slower baseline 5-m walk times. There was substantial hospital variation in CR participation after TAVR ranging from 5% to 60% across 24 hospitals. Patient case mix did not explain hospital variation in CR across hospitals with median OR numerically increasing from 2.11 (95% CI: 1.62-2.67) to 2.13 (95% CI: 1.61-2.68) after accounting for patient-level factors.
CONCLUSIONS
Less than 1 in 3 patients who underwent TAVR in Michigan participated in CR within 90-days of discharge. Although several patient factors are associated with CR participation, hospital-level variation in CR participation after TAVR is not explained by patient case mix. Identifying hospital processes of care that promote CR participation after TAVR will be critical to improving CR participation after TAVR.
PubMed: 38938330
DOI: 10.1016/j.jacadv.2023.100581 -
Telemedicine Journal and E-health : the... Jun 2024Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting...
Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting disadvantaged communities disproportionately. This study examined patient- and provider-level factors associated with portal usage among Medicaid recipients in a large federally qualified health center (FQHC) network in Texas. Deidentified electronic medical records of patients 18 years or older from a large Texas FQHC network were analyzed. The dependent variable was a binary flag indicating portal usage during the study period. Independent variables included patient- and provider-level factors. Patient-level factors included sociodemographic, geographic, and clinical characteristics. Provider characteristics included primary service line, provider type, provider language, and years in practice. Because the analysis was at the individual level, a multivariable logistic regression model focused on adjusted associations between independent variables and portal usage. The analytic sample consisted of 9,271 individuals. Compared with individuals 18-39 years, patients 50 years and older had lower odds (50-64 OR: 0.60, < 0.001; 65+ OR: 0.51, < 0.001) of portal usage. Males were less likely to use portals (OR: 0.44, = 0.03), and compared to Non-Hispanic Whites, Non-Hispanic Black (OR: 0.86, = 0.02) and Hispanics (OR: 0.83, < 0.001) were significantly less likely to use portals. Individuals with 1 or more telemedicine consults had a two-times greater odds of portal usage (OR: 1.97, < 0.001). Compared to individuals who had clinic visits in December 2018, portal usage was significantly higher in the pandemic months (March 2020-November 2020, all 's < 0.01). Importantly, the behavioral health service line had the greatest odds (OR: 1.52, < 0.001), whereas the dental service line had the lowest odds (OR: 0.69, = 0.01) compared to family practice. No other provider characteristics were significant. Our finding of significant patient-level factors is important and can contribute to developing appropriate patient-focused health information technology approaches to ensure equitable access and maximize the potential benefits of patient portals in health care delivery.
PubMed: 38938215
DOI: 10.1089/tmj.2024.0194 -
Oral Diseases Jun 2024Oral leukoplakia (OL) is one of the most common and investigated oral potentially malignant disorders (OPMD). Preventing OSCC occurrence should be the primary outcome in...
Surgical treatment compared with "wait and see" in patients affected by oral leukoplakia to prevent oral cancer: Preliminary data from a multicenter randomized controlled trial.
OBJECTIVE
Oral leukoplakia (OL) is one of the most common and investigated oral potentially malignant disorders (OPMD). Preventing OSCC occurrence should be the primary outcome in the clinical management of OL. Surgical removal of OL is performed by most clinicians, although its effectiveness in reducing OSCC onset has still not been established by randomized controlled trials (RCT). Wait and see approach is characterized by frequent clinical examinations and periodical biopsies of OL, avoiding unnecessary surgical procedures. This is the first multicenter RCT in literature aiming at comparing the effectiveness of surgical removal and the "wait and see" approach in preventing OSCC onset in patients affected by dysplastic and non-dysplastic OL.
METHODS
Two Italian referral care centres for oral diseases were involved in this multicenter two-arm RCT comparing the surgical removal of OL (group A) and the "wait and see" approach (group B), with the aim of reducing oral cancer onset.
RESULTS
This report shows preliminary data on the first 161 patients, with a mean follow-up of 19.14 ± 11.25 months. Eight cases of OSCC occurred (6 out 8 involving the tongue): one case in group A and seven cases in group B. Moreover, OL recurred in 13 (20%) cases after surgical excision.
CONCLUSIONS
Within the limitations of this preliminary report, these initial data underline the increased risk of OSCC onset in the case of OL of the tongue in the presence of epithelial dysplasia in group B ("wait and see") compared to group A (surgery). This RCT is currently ongoing at the same clinical departments, with the aim of enrolling 310 patients and collecting data at 5-year follow-up, in order to achieve conclusive results, in an evidence-based medicine approach.
PubMed: 38938085
DOI: 10.1111/odi.15058 -
Journal of Dentistry Jun 2024This study aimed to assess the association between posterior occlusal support (POS) and the risk of tooth loss in older adults aged ≥75 years.
OBJECTIVES
This study aimed to assess the association between posterior occlusal support (POS) and the risk of tooth loss in older adults aged ≥75 years.
METHODS
This longitudinal study analyzed 94,422 participants who participated in multiple dental check-ups provided as part of the public healthcare services in Osaka, Japan, from 2018 to 2022. The participants were categorized into nine groups (A1-3, B1-4, and C1 and C2) according to their POS status using the Eichner index at baseline. The dental charts were compared between the initial and final assessments to assess tooth loss. Logistic regression analysis was used to examine the association between POS status and tooth loss, adjusted for several covariates, including age, sex, body mass index, periodontal status, oral hygiene, history of diabetes, history of hypertension, attendance at the annual dental check-up, and observational period. Furthermore, stratified logistic regression analyses were conducted using anterior or posterior tooth loss.
RESULTS
After controlling for confounders, POS status was associated with tooth loss. The odds ratios (ORs) with A1 as the reference were 1.74 in A2, 2.55 in A3, 3.40 in B1, 4.74 in B2, 5.79 in B3, 6.00 in B4, 4.44 in C1, and 3.00 in C2, respectively. The ORs for anterior tooth loss were higher than those for posterior tooth loss, with the highest OR observed in B4 (21.4).
CONCLUSIONS
This large population-based cohort study showed that a decreased POS was a risk indicator for tooth loss; furthermore, the risk increased even further in the anterior teeth region.
PubMed: 38936455
DOI: 10.1016/j.jdent.2024.105144 -
Journal of Dentistry Jun 2024The objective of this review is to examine the relationship between oral diseases and respiratory health, investigating how oral microbiome disruptions contribute to... (Review)
Review
OBJECTIVE
The objective of this review is to examine the relationship between oral diseases and respiratory health, investigating how oral microbiome disruptions contribute to respiratory tract infections. Additionally, it aims to explore the impact of respiratory disease symptoms and treatments on the oral microbiome.
DATA SOURCES
The literature utilized in this review was sourced from studies focusing on the correlation between oral health and respiratory infections, spanning a period of 40 years. Various databases and scholarly sources were likely consulted to gather relevant research articles, reviews, and clinical studies.
STUDY SELECTION
This review summarizes four decades-long research, providing insights into the intricate relationship between oral and respiratory health. It delves into how oral diseases influence respiratory tract conditions and vice versa. The selection process likely involved identifying studies that addressed the interaction between oral microbiome disruptions and respiratory complications.
CONCLUSION
Oral diseases or poor oral habits have been known to increase the risk of getting respiratory infections. Modern techniques have demonstrated the relationship between oral disease and respiratory tract infections like influenza, chronic obstructive pulmonary diseases, asthma, and Pneumonia. Apart from that, the medications used to treat respiratory diseases affect oral physiological factors like the pH of saliva, and saliva flow rate, which can cause significant changes in the oral microbiome. This review provides regular oral hygiene and care that can prevent respiratory health and respiratory infections.
CLINICAL SIGNIFICANCE
Understanding the intricate relationship between oral health and respiratory infections is crucial for healthcare providers. Implementing preventive measures and promoting good oral hygiene habits can reduce respiratory tract infections and improve overall respiratory health outcomes.
PubMed: 38936454
DOI: 10.1016/j.jdent.2024.105213 -
Forensic Science International Jun 2024While clinical dentistry has seamlessly integrated the digital revolution, there is a gap in the technological capabilities of forensic dentistry.The study aimed to...
While clinical dentistry has seamlessly integrated the digital revolution, there is a gap in the technological capabilities of forensic dentistry.The study aimed to compare the superimposition accuracy of two different three-dimensional record formats, namely the intraoral scanner and cone beam computer tomography, in the context of forensic identification.The sample consisted of randomly selected adults (n=10) of both sexes aged between 20 and 50 years. Following the acquisition of data using the Medit i700 wireless scanner and the iCAT Tomograph with InVivo software, the records were analysed and compared through superimposition using Medit Scan Clinic software to assess the technical precision of anatomical identification details.The results obtained through the superimposition of dental and bone records following intra- and inter-observer analysis enabled an accurate comparison and identification of an individual. This method can differentiate between positive and negative matches, achieving exclusion results and offering a potential solution to overcoming the absence of a standardisation procedure in human identification.
PubMed: 38936201
DOI: 10.1016/j.forsciint.2024.112104 -
Osteoporosis International : a Journal... Jun 2024
PubMed: 38935084
DOI: 10.1007/s00198-024-07173-7 -
American Journal of Orthodontics and... Jun 2024White spot lesions (WSLs) represent a prominent pathology encountered during orthodontic treatment, originating from enamel demineralization induced by the accumulation...
INTRODUCTION
White spot lesions (WSLs) represent a prominent pathology encountered during orthodontic treatment, originating from enamel demineralization induced by the accumulation of bacterial biofilms. The previously developed bioinspired enamel coating form of self-assembling antimicrobial peptide D-GL13K exhibited antimicrobial activity and enhanced acid impermeability, offering a potential solution to prevent demineralization. The primary aim of this investigation is to assess the in vivo anti-demineralization properties and biocompatibility of the D-GL13K coating.
METHODS
A rat model was developed to assess the antimicrobial enamel coating during fixed orthodontic treatment. The anti-demineralization efficacy attributed to the D-GL13K coating was evaluated by employing optical coherence tomography, Vickers microhardness testing, and scanning electron microscopy. The biocompatibility of the D-GL13K coating was investigated through histologic observations of vital organs and tissues using hematoxylin and eosin.
RESULTS
The D-GL13K coating demonstrated significant anti-demineralization effects, evidenced by reduced demineralization depth analyzed through optical coherence tomography and enhanced Vickers hardness than in the noncoated control group, showcasing the coating's potential to protect teeth from WSLs. Scanning electron microscopy analysis further elucidated the diminished enamel damage observed in the group treated with D-GL13K. Importantly, histologic examination of vital organs and tissues using hematoxylin and eosin staining revealed no overt disparities between the D-GL13K coated group and the noncoated control group.
CONCLUSIONS
The D-GL13K enamel coating demonstrated promising anti-demineralization and biocompatibility properties in a rat model, thereby suggesting its potential for averting WSLs after orthodontic interventions. Further research in human clinical settings is needed to evaluate the coating's long-term efficacy.
PubMed: 38935006
DOI: 10.1016/j.ajodo.2024.05.016 -
Journal of the American Dental... Jun 2024People with special health care needs in long-term care settings have difficulty accessing a traditional dental office. The goal of the authors was to assess initial...
BACKGROUND
People with special health care needs in long-term care settings have difficulty accessing a traditional dental office. The goal of the authors was to assess initial treatment decision concordance between dentists conducting traditional in-person examinations using mobile equipment and additional dentists conducting examinations using asynchronous teledentistry technology.
METHODS
Six dentists from Access Dental Care, a North Carolina mobile dentistry nonprofit, saw new patients on-site at 12 participating facilities or asynchronously off-site with electronic dental records, radiographs, and intraoral images, all captured by an on-site dental hygienist. Off-site dentists were masked to other dentists' treatment need decisions; 3 through 5 off-site examinations were conducted for each on-site examination. Demographic and binary treatment need category data were collected. For the 3 most prevalent treatment types needed (surgery, restorative, and new removable denture), the authors calculated the percentage agreement and κ statistics with bootstrapped CIs (1,000 replicates).
RESULTS
The 100 enrolled patients included 47 from nursing homes, 45 from Programs of All-Inclusive Care for the Elderly, and 8 from group homes for those with intellectual and developmental disabilities. Mean (SD) age was 73.9 (16.5) years. Among dentate participants, the percentage agreement and bootstrapped κ (95% CI) were 87% and 0.74 (0.70 to 0.78) for surgery and 78% and 0.54 (0.50 to 0.58) for restorative needs, respectively, and among dentate and edentulous participants, they were 94% and 0.78 (0.74 to 0.83), respectively, for new removable dentures.
CONCLUSIONS
The authors assessed the initial dental treatment decision concordance between on-site dentists conducting in-person examinations with a mobile oral health care delivery model and off-site dentists conducting examinations with asynchronous dentistry. Concordance was substantial for surgery and removable denture treatment decisions and moderate for restorative needs. Patient characteristics and facility type were not significant factors in the levels of examiner agreement.
PRACTICAL IMPLICATIONS
This evidence supports teledentistry use for patients with special health care needs and could help improve their access to oral health care.
PubMed: 38934969
DOI: 10.1016/j.adaj.2024.05.004