Oral Care and the Connection to Adverse Events in Dentistry

As the healthcare industry continues to change, dental providers are concerned about the different types of adverse events that can occur if systemic diseases are not well understood when treating patients. The purpose of this study was to explore the level of understanding among dental care providers of the relationship between oral care and systemic diseases and how these are linked to adverse events. The theoretical foundation that was used for this study was the Swiss cheese model. The research questions were designed to address the level of understanding among dental care providers of the link between oral care and systemic diseases as well as their perceptions of adverse events in dentistry and why they occur. Using a qualitative phenomenological approach, interviews were conducted with 10 dental care providers who practice in the New Jersey area. As I reviewed the field notes and listened to the audio recording, themes were developed to gain a deeper understanding of the research. The research findings revealed that dental providers have moderate knowledge of systemic disease and that some dentists had encountered an adverse event when providing oral care to patients; this experience led participants to look at patients\u27 overall health instead of only oral care. Positive social change could result from improved training and education for dental providers to gain a better understanding of systemic diseases and systems such as the Swiss cheese model for preventing adverse events in patients with systemic diseases. Dental providers should be more involved with community services by providing health fairs to educate the public about why taking care of their oral health is as important as their physical health

Lymphocyte Proliferation In Vitro Alteration by Benzo[a]pyrene, Diesel Exhaust Extract and Sodium Arsenite

Biological actions in humans typically result in a range of measurable responses. Some of the difference or variation in biological responses (inter-individual variation) is due to factors such as diet, age, genetics, smoking, exercise, lifestyle and health status. Previous or ongoing chemical exposures can also contribute to variation. The current study focuses on evaluating inter-individual differences in the background proliferative capacity of human T-lymphocytes and in the ability of T-lymphocytes to respond to three environmentally relevant toxicants; benzo[a]pyrene (B(a)P), diesel exhaust extract (DEE) and sodium arsenite (SA). Any alteration in an individual's lymphocyte proliferative response resulting from xenobiotic exposure could change immunocompetance. The goals of this study were 1) to evaluate in vitro proliferation of T-lymphocytes in response to three toxicants. We observed a greater inhibition of cellular proliferation in T-lymphocytes treated with As than with B(a)P or DEE. For all three toxicants statistically significant differences from untreated controls were seen at the highest dose only. 2) To characterize inter-individual differences of baseline proliferative capacity based on age or gender. Pediatric subjects were not statistically different from adults. Men had a higher proliferative response than women. 3) To determine if baseline proliferative capacity was predictive of individual responses. Differences in baseline levels of proliferative capacity were predictive of the extent to which the individual responded to the toxicants. 4) To determine the utility of this experimental design for use in field epidemiological studies. This study design and the lymphocyte proliferation assay can provide useful biomarker data; baseline data need to be established for the study subjects, and several repeat samples should be analyzed.Master of Science in Public Healt

Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review

Background Clinical considerations for drug treatment of acute seizures involve variables such as safety, tolerability, drug-drug interactions, dosage, route of administration, and alterations in pharmacokinetics because of critical illness. Therapy options that are easily and quickly administered without dilution, well tolerated, and effective are needed for the treatment of acute seizures. The objective of this review is to focus on the clinical considerations relating to the use of intravenous brivaracetam (IV BRV) for the treatment of acute seizures in the hospital, focusing on critically ill patients. Methods This was a scoping literature review of PubMed from inception to April 13, 2021, and search of the American Academy of Neurology (AAN) 2021 Annual Meeting website for English language publications/conference abstracts reporting the results of IV BRV use in hospitalized patients, particularly in the critical care setting. Outcomes of interest relating to the clinical pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma concentrations of IV BRV 15 min after the first dose were similar between patients receiving IV BRV as bolus or infusion. IV BRV was generally well tolerated in patients with acute seizures in the hospital setting, with a low incidence of individual TEAEs classified as behavioral disorders. IV BRV demonstrated efficacy and effectiveness and had a rapid onset, with clinical and electrophysiological improvement in seizures observed within minutes. Although outside of the approved label, findings from several studies suggest that IV BRV reduces seizures and is generally well tolerated in patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management of acute seizures in hospitalized patients where rapid administration is needed, representing a clinically relevant antiseizure medication for potential use in the critical care setting

Optimal Dosage and Administration Practices for Vitamin K Antagonist Reversal With 4-Factor Prothrombin Complex Concentrate

Expert consensus and international guidelines recommend urgent co-administration of vitamin K and 4-factor prothrombin complex concentrates (4F-PCCs) to rapidly reverse VKA-related bleeding. This narrative review examined real-world evidence and strategies to optimize international normalized ratio (INR) reversal, hemostasis, and outcomes in patients receiving 4F-PCC in this setting. Key determinants for success include the appropriate use of alternative dosing and administration strategies, such as fixed dosing and increased infusion speed, adherence to institutional guidelines, and removing significant institutional barriers to reduce time to treatment. In the opinion of authors, minimizing the time to treatment with 4F-PCCs is of paramount importance when treating patients with VKA-related bleeding. Practices that safely and feasibly shorten the time to administration should be included in guidelines for institutions responsible for anticoagulant care, and adhered to in centers that perform invasive procedures on patients receiving VKA therapy. Further studies are required to optimize use of 4F-PCC, particularly in relation to the ideal dosing strategy and the role of INR

Dialogues of being-in-living relations : re-imagining office education

From a feminist perspective this paper represents a rediscovery and reconstruction of meaning for education through a reaffirmation of our human wholeness and in celebration of our ambiguous human condition. This is a powerful and interpenetrating vagueness which leaves room for multifarious interpretations and becomes implied within the author's title. The concern reflects the rise of fundamentalism and the unwillingness to live in ambiguity, a life that requires constant learning and seeking toward authentic existence. Exploring the historical backdrop of scientific management in relation to descriptions of a gendered hierarchy of management and the language which propelled it into existence, the author performs a thinking completion by revealing how the connecting threads of a dual structure, patriarchal social relations and political-economic forces, influenced the ambiguity of women's lives who entered the American office between 1900-1930. From this legacy, the author discusses the ethos of the modern office, rooted as it is in a hierarchy of class, gender and race distinctions, and a paradoxical mythology that says hard work and merit determines rank; conclusively pointing toward our ambiguous human condition as persons simultaneously distinct and yet intimately related to others

The Effects Of Cranberry Supplementation On Inflammation And Macrophage Function In Older, Overweight, Or Obese Individuals

Cranberries show potential as an anti-inflammatory therapeutic due to their high levels of polyphenol compounds. However, evidence on the anti-inflammatory effects of cranberry is from studies of polyphenol fractions at doses higher than those circulating in human serum post-supplementation. THP-1 macrophages were pre-incubated with serum from cranberry or placebo supplemented individuals, followed by LPS stimulation to determine potential anti-inflammatory effects of serum metabolites. We first aimed to determine baseline levels of inflammation and functional ability of macrophages in an older-overweight population compared to younger-athletic individuals. Results showed that serum from older individuals was less effective at overcoming cytotoxic effects of LPS on macrophages, compared to younger subjects. Macrophages exposed to serum from older subjects also exhibited lower levels of phagocytosis and expression of molecules associated with activation of adaptive immunity than younger-athletic subjects. We also aimed to determine whether cranberry supplementation could alleviate LPS-induced inflammation or alter macrophage functioning in older subjects. When older subjects were given an eight-week cranberry supplement, their serum did not lower levels of inflammation or alter macrophage functioning in our model of inflammation, compared to serum from placebo supplemented controls. We conclude that the ingestion of cranberry polyphenols was not anti-inflammatory in our model

Predictors of Gastrointestinal Bleeding Among Patients with Atrial Fibrillation After Initiating Dabigatran Therapy

To identify demographic and clinical risk factors associated with gastrointestinal (GI) bleeding among a large cohort of patients with atrial fibrillation (AF) who initiated dabigatran therapy for stroke prevention, and to describe patterns of subsequent anticoagulant use after occurrence of the GI bleeding event

Student Perceptions of a Flipped Pharmacotherapy Course

Objective. To evaluate student perception of the flipped classroom redesign of a required pharmacotherapy course

Mechanistic Indicators of Childhood Asthma (MICA) Study: piloting an integrative design for evaluating environmental health

BACKGROUND: Asthma is a common complex disease responsible for considerable morbidity and mortality, particularly in urban minority populations. The Mechanistic Indicators of Childhood Asthma study was designed to pilot an integrative approach in children's health research. The study incorporates exposure metrics, internal dose measures, and clinical indicators to decipher the biological complexity inherent in diseases such as asthma and cardiovascular disease with etiology related to gene-environment interactions. METHODS/DESIGN: 205 non-asthmatic and asthmatic children, (9-12 years of age) from Detroit, Michigan were recruited. The study includes environmental measures (indoor and outdoor air, vacuum dust), biomarkers of exposure (cotinine, metals, total and allergen specific Immunoglobulin E, polycyclic aromatic hydrocarbons, volatile organic carbon metabolites) and clinical indicators of health outcome (immunological, cardiovascular and respiratory). In addition, blood gene expression and candidate SNP analyses were conducted. DISCUSSION: Based on an integrative design, the MICA study provides an opportunity to evaluate complex relationships between environmental factors, physiological biomarkers, genetic susceptibility and health outcomes. PROJECT APPROVAL: IRB Number 05-EPA-2637: The human subjects' research protocol was reviewed by the Institutional Review Board (IRB) of the University of North Carolina; the IRB of Westat, Inc., the IRB of the Henry Ford Health System; and EPA's Human Subjects' Research Review Official

Epidemiology and injectable antiseizure medication treatment patterns of seizure patients treated in United States hospitals

Objective This study aimed to examine the epidemiology of seizures, clinical outcomes, and antiseizure medication treatment patterns among seizure patients treated in United States hospitals.DesignA retrospective cross-sectional study was conducted using data from a large geographically diverse hospital discharge database.Setting860 acute care hospitals in the United States.ParticipantsPatients aged ≥18 years with an outpatient emergency department or inpatient visit between 1 July 2016–31 December 2019 were included. Intervention None. Main outcomes and measures Key outcomes included prevalence of seizure, seizure type, admission point of origin, intensive care unit admission, discharge status, and injectable antiseizure medication utilization. Seizures were identified by the International Classification of Disease, Tenth Revision, Clinical Modification diagnosis codes. Results Among 36,598,627 unique emergency department outpatients (72,372,464 outpatient visits) and 16,543,592 unique inpatients (24,923,489 inpatient admissions) analyzed, seizure was present in 2.1% of outpatients (1.87% of outpatient visits) and 4.9% of inpatients (4.8% of inpatient admissions). In overall seizure patients, 49.1% were unclassified, 4.4% had generalized onset, 2.9% had focal onset, and 42.8% were categorized as other (including 38.5% with convulsion). Among seizure-associated inpatient admissions, <1% were transferred directly from skilled nursing facility or other long-term care facilities but 22.7% were discharged to such facilities. Nearly a third (31%) of all inpatients were admitted to ICU. About 88.3% of patients with injectable ASM use had monotherapy, 4.6% had polytherapy with 1 day or multiple non-consecutive days of overlap, and 7.0% had polytherapy with ≥2 consecutive days of overlap. The percentage of patients with no step down to any oral ASM ranged between 34.0–57.0%. Conclusions Seizures affect a substantial number of hospital-based emergency department outpatient and inpatient encounters and are associated with poor clinical outcomes and significant healthcare burden. Concomitant use of injectable ASMs is uncommon and a high percentage of IV ASM users with a diagnosis of seizure had no step down to oral therapy.RelevanceThe study findings may inform clinicians and hospital decision makers about current clinical practice and burden of seizures and identify areas to improve overall outcomes for patients with seizures