Time Since Last Dental Clinic Visit and Self-Reported Health among the Elderly

Background. This study determined the association between time since last dental clinic visit and self-reported health among the elderly (age ≥ 65 years). Methods. Data were from the 2010 Behavioral Risk Factor Surveillance System. A logistic regression analysis was conducted to identify factors that affect the self-reported general health of the elderly. Additionally, a negative binomial regression analysis was conducted to explore the association of time since last dental clinic visit and the self-reported number of physically unhealthy, mentally unhealthy, and sad days during the past 30 days. Results. Six predictors were identified affecting the self-reported general health of the elderly. Respondents were more likely to self-report “good, very good, or excellent” general health if they: visited the dental clinic within the past year, were non-Hispanic, had healthcare coverage, had fewer permanent teeth removed, received better education and were younger. A larger lapse of time since respondents’ last dental clinic visits was associated with increased number of mentally and physically unhealthy days and an increased number of sad days during the past 30 days. Conclusions. The positive association between better general health, fewer mentally and physically unhealthy days, and fewer sad days during the past 30 days and shorter periods of time between dental visits warrants further investigation to determine a possible causal relationship between overall health and dental visits

Contribution of the BioFire® FilmArray® Meningitis/Encephalitis Panel:: Assessing Antimicrobial Duration and Length of Stay

Introduction. Traditional evaluation of meningitis includes cerebrospinalfluid (CSF) culture and gram stain to pinpoint specific causalorganisms. The BioFire® FilmArray® Meningitis/Encephalitis (ME)Panel has been implemented as a more timely evaluation method.This study sought to assess if the BioFire® ME Panel was associatedwith a decreased length of stay or decreased antimicrobial durationwhen used in the diagnosis of meningitis or encephalitis.Methods.xA case, historical-control, chart review was performed onpatients admitted to a regional medical center with CSF pleocytosisduring Cohort 1 (the year prior to BioFire® ME Panel implementation)and Cohort 2 (the year after BioFire® ME Panel implementation).Length of hospital stay, duration of antimicrobials, and BioFire® MEPanel result were gathered and analyzed.Results. Average length of stay for both cohorts was about fourhospital days. Approximately three-fourths of all patients receivedantibiotic/antiviral treatment with an average of three days duration.No significant differences were observed between groups. The mean(median) duration of antimicrobials in the year prior to and afterthe BioFire® ME Panel implementation was 3.6 (3) and 3.1 (2) days,respectively (p = 0.835). The mean (median) length of stay in the yearprior to and after the BioFire® ME Panel implementation was 5.8 (4)and 5.4 (4) days, respectively (p = 0.941). Among the patients admittedafter the implementation of the BioFire® ME Panel, 4.3 % (n =2) had a positive bacterial result, 38.3% (n = 18) had a positive viralresult, and 57.4% (n = 27) had a negative result. Of the 27 negativeresults, 77.8% (n = 21) were treated with antimicrobial medication.Conclusions. This study suggested there is no difference betweenlength of stay or antimicrobial duration in presumed meningitis casesassessed with traditional methods as compared to the BioFire® MEPanel. Kans J Med 2019;12(1):1-3

Direct Primary Care in 2015: A Survey with Selected Comparisons to 2005 Survey Data

Introduction. Direct primary care (DPC), a fee for membershiptype of practice, is an evolving innovative primary caredelivery model. Little is known about current membershipfees, insurance billing status, physician training, and patientpanel size in DPC practices. This study aimed to obtain currentdata for these variables, as well as additional demographicand financial indicators, and relate the findings to the HealthyPeople 2020 goals. It was predicted that DPC practices would(1) submit fewer claims to insurance, (2) have decreased membershipfees, (3) be primarily family medicine trained, and(4) have increased the projected patient panel size since 2005. Methods. An electronic survey was sent to DPC practices(n = 65) requesting location, membership fees, projectedpatient panel size, insurance billing status, training,and other demographic and financial indicators. Datawere aggregated, reported anonymously, and compared totwo prior characterizations of DPC practices done in 2005. Results. Thirty-eight of 65 (59%) practices responded to the2015 survey. The majority of respondents (84%) reported usingan EMR, offering physician email access (82%), 24-hour access(76%), same day appointments (92%), and wholesale labs (74%).Few respondents offered inpatient care (16%), obstetrics (3%),or financial/insurance consultant services. Eighty-eight percent(88%) of practices reported annual individual adult membershiprates between $500 and$1,499, decreased from 2005 where81% reported greater than a $1,500 annual fee. The proportion ofpractices who submit bills to insurance decreased from 75% in2005 to 11% in 2015. Fifty-six percent (56%) of practices reportedprojected patient panel size to be greater than 600, increasedfrom 40% in 2005. Family medicine physicians represented 87%of respondents, markedly different from 2005 when 62 - 77% ofDPC respondents were general internal medicine physicians. Conclusions. Most DPC practices no longer submit to insuranceand are family medicine trained. Comparedwith the previous sampling, DPC practices report decreasedmembership fees and increased projected panelsize. These trends may signify the DPC movement’sgrowth in application and scope. KS J Med 2017;10(1):3-6

The Need for Visits to Social and Vocational Programs for the Mentally Ill as Part of General Psychiatry Residency Training

Background. Comprehensive treatment planning for psychiatric illnesses should be based on a biopsychosocial model of treatment to address the acuity and chronicity of these disorders. To achieve this goal, knowledge about pharmacological, psychological, and social aspects of the treatment plan should be presented as an integral part of general psychiatry residency training. This survey study was conducted to examine how many programs provide training where residents have scheduled visits to social and vocational mental health service organizations in the community and to identify potential obstacles to including this rotation in general psychiatry residency training. Methods. A voluntary, anonymous survey was sent via SurveyMonkey® to the program directors of all general psychiatry residency programs in the United States. The survey consisted of five questions designed to assess if their programs had a rotation where residents visit social and vocational programs in the community designed for mentally ill patients to provide knowledge of the community mental health resources to their residents. Results. Of the 168 survey invitations issued, 73 (44%) responded. Fifty-six responders acknowledged that their residents were required to visit a community mental health organization, but their programs did not offer visits to community social and vocational programs. Seventeen program directors reported that their program did not provide this experience to their residents and indicated a desire to include such a rotation. Conclusions. Community mental health service organization visits should enhance knowledge of psychiatry residents about community mental health resources and indirectly promote better patient care. Information obtained from this survey should create discussion to work toward better psychiatric resident training

The Influence of Loan Repayment and Scholarship Programs on Healthcare Provider Retention in Underserved Kansas

Background. In an effort to redistribute healthcare providersto underserved areas, many states have turned to financialincentive programs. Despite substantial research on theseprograms on a national scale, little is known about the successof such programs in Kansas. The purpose of this studywas to provide insight into the relationship between financial incentive programs and provider retention in Kansas. Methods. A cross-sectional telephone survey was conducted inApril and May of 2011 with participants who had completedtheir obligations to the Kansas State Loan Repayment Program(SLRP), the National Health Service Corps (NHSC) Loan Repaymentprogram, or the National Health Service Corps Scholar shipprogram in Kansas between January 2006 and January 2011. Results. Of the 112 providers included in the study, 54.4% (n = 61)had left their program sites sometime after finishing their commitment,with the mean length of stay after the obligation periodended being 7.3 (median = 3) months. Of the 54 participants whohad left their program sites and whose current locations wereknown, 33.3% (n = 18) were located in new Health ProfessionalShortage Areas (HPSA), 25.9% (n = 14) were in a new non-HPSA,and 40.7% (n = 22) had left the state. Family satisfaction with thecommunity and attending a professional school in Kansas wereassociated statistically with retention of physicians in Kansas. Conclusions. Nearly half of all participants had remained attheir sites even after their obligation period ended, with familysatisfaction with the community appearing to be the strongestpredictor for retention among those who had stayed.Efforts to match a provider’s family with the community successfullyand to support the family through networking mayimprove future provider retention. KS J Med 2016;9(1):6-11

Treatment of Intractable Diabetic Macular Edema with Pegaptanib Versus Bevacizumab, Both in Combination with Dexamethasone

BACKGROUND: Diabetic macular edema is a significant cause of vision loss, and some patients do not respond optimally to existing treatments. This study compared the response of intractable diabetic macular edema to intravitreal injection of two anti-VEGF drugs, bevacizumab and pegaptanib, both in combination with dexamethasone. METHODS: A retrospective chart review was conducted to examine patients from an ophthalmology practice in one year with diabetic macular edema (DME), recurrent or persistent, after focal laser or intravitreal bevacizumab. Patients received bevacizumab/dexamethasone or pegaptanib/dexamethasone. Outcome measures were improvement in best corrected visual activity (converted to LogMAR) and central macular thickness (CRT). Data on adverse effects also were collected. RESULTS: The bevacizumab/dexamethasone group included 25 eyes which had pre-treatment LogMAR = 0.69 ± 0.49 (mean ± SD) and CRT = 419 ± 131. Post-treatment LogMAR was 0.70 ± 0.48 and CRT = 377 ± 107. The pegaptanib/dexamethasone group included 14 eyes; pretreatment LogMAR = 0.80 ± 0.55 and CRT = 520 ± 108. Post-treatment LogMAR was 0.77 ± 0.49 and CRT = 46 4 ± 106. Neither treatment had a significant effect on visual acuity. Both groups experienced a significant decrease in CRT over time (p = 0.006). The pegaptanib/ dexamethasone group had higher CRT at all times (p = 0.020), but the trend in CRT decrease was not different between the two groups. Intraocular pressure increased in both groups (p = 0.038). No other adverse effects were reported. CONCLUSIONS: Neither bevacizumab/dexamethasone or pegaptanib/dexamethasone significantly improved visual acuity in intractable DME, but both decreased central macular thickness. Differences in outcome measures between the two treatment groups were not significant. The only adverse effect seen was a small increase in intraocular pressure

Prevalence and Predictors of Social Support Utilization among Cancer Patients Undergoing Treatment

Background. The purpose of this study was to quantify the prevalence of cancer patients utilizing social support services while undergoing treatment and to identify patient and clinical factors associated with utilization of such services. Methods. This was a cross-sectional study. Surveys were distributed to three cancer clinics at 11 locations in the greater Kansas City metropolitan area in 2010. Study inclusion criteria included being at least 18 years old and undergoing treatment for cancer at the time of survey completion. Results. A total of 465 oncology patients completed surveys. Two-thirds (67.5%, n = 314) were undergoing treatment for cancer and were included in the final analysis. More than half (63.7%, n = 198) were female, and the average age was 58.9 ± 13.3 years. More than one-third (37.4%, n = 117) reported using cancer-related social support services. Additionally, 22% (n = 69) reported not using support services but were interested in learning more about those services. Patients had increased odds of having used support services if they were female (OR = 2.67; 95% CI = 1.47, 4.82), were younger adults, or had stage I-III (OR = 2.67; 95% CI 1.32, 5.26) or stage IV cancer (OR = 2.3; 95% CI 1.14, 4.75) compared to those who did not know their cancer stage. Conclusions. More than one-third of patients reported using social support services. A substantial portion of participants reported not using support services but were interested in learning more about those services. Increasing social support service utilization might be especially important to explore for men, those who do not know their cancer stage, and older adults