Tag: pubmed

J Surg Oncol. 2022 Apr 27. doi: 10.1002/jso.26907. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Low anterior rectosigmoid resection for a gynecologic disease is usually performed in concert with other procedures and can result in significant morbidity should anastomotic complication occur. This study examined surgical outcomes of side-to-end reanastomosis after low anterior resection (STELAR) performed by gynecologic oncology service.

METHODS: This is a case series examining consecutive patients who underwent STELAR for gynecologic indications by a single gynecologic oncology group from 2009 to 2018. Prospectively collected institutional surgical database was searched for STELAR, and standard descriptive statistics were used to describe intraoperative and postoperative complications specific to reanastomosis.

RESULTS: A total of 69 women underwent STELAR, with median age and body mass index of 54 years and 24 kg/m² , respectively. 63.8% of patients had ovarian cancer and 84.4% had stage III-IV disease. The median estimated blood loss was 875 ml. Four (5.8%) women underwent protective loop colostomy at the time of STELAR. Postoperatively, there was 1 (1.4%) case of abscess formation within 30 days and 1 (1.4%) case of anastomotic leak 5 weeks after STELAR that required reoperation and diversion. No cases of fistula were clinically identified.

CONCLUSION: Side-to-end reanastomosis may be a safe and feasible procedure to accomplish low rectosigmoid anastomosis in women with gynecologic disease.

PMID:35476891 | DOI:10.1002/jso.26907

J Opioid Manag. 2022 Mar-Apr;18(2):151-159. doi: 10.5055/jom.2022.0705.

ABSTRACT

OBJECTIVE: This article overviews the current statistics and factors related to increased rates of opioid use disorder (OUD) in rural areas, uncovering factors that may contribute to increased vulnerability to opioid overdose. We qualitatively review opinions, feelings, and thoughts surrounding this issue in rural areas of Utah, analyzing participant stories in reference to three themes through qualitative interviews, including the solitude of addiction, the beguiling strength of addiction, and one way out of addiction.

DESIGN: In 2018, three focus groups were convened with 25 individuals from the rural area. Participants either currently or formerly (selfreported substance free for 6 months or more) experienced OUD with prescription opioids and heroin, or were family members of individuals who currently and formerly experienced OUD. These focus groups addressed current issues in OUDs in a rural Utah community related to person, place, and time. Following the focus groups, six individuals were invited to participate in semi-structured interviews. In-depth, semi-structured interviews queried individual experiences through a phenomenological approach, using a moderator guide with queries focused on identified themes related to the solitude, the intensity, and the difficulty escaping substance use disorder (SUD). Methodology included training community scholars with lived experience and member-checking to ensure phenomenological emphasis.

RESULTS: Our qualitative reviews of the experience of OUD and SUD in rural Utah discussed the relevance and the nuance of the three identified themes. The interviewee statements further underscore the solitude, intensity, and difficulty of an individual’s journey through SUD, the all-consuming nature of OUD, and the trouble that these factors cause in rural recovery.

CONCLUSIONS: We conclude that even during difficult situations in the rural experience with the opioid crisis, hope persists. OUD support in rurality may differ from the expected urban experience and include more coordination with criminal justice workers. Rural Americans have insights to share that could help turn the tide of this crisis.

PMID:35476884 | DOI:10.5055/jom.2022.0705

J Opioid Manag. 2022 Mar-Apr;18(2):133-141. doi: 10.5055/jom.2022.0703.

ABSTRACT

OBJECTIVE: The primary objective of this paper is to understand pharmacists’ naloxone offering and dispensing practices and factors affecting those practices. The secondary objective of this paper is to refine an existing survey instrument and use it to understand pharmacists’ naloxone offering and dispensing behaviors and factors affecting it.

DESIGN, SETTINGS, AND PARTICIPANTS: A statewide mail survey of pharmacists was conducted in Wisconsin using stratified random sampling. Survey data were analyzed using descriptive statistics to understand pharmacists’ naloxone offering and dispensing practices and multiple regression analysis to understand factors affecting these practices.

MAIN OUTCOMES: (1) Pharmacists’ practices about naloxone offering and dispensing; (2) factors affecting these practices.

RESULTS: Most pharmacies stocked naloxone (92.9 percent) and were under the Wisconsin standing order (80.1 percent). The majority of pharmacists reported that they occasionally (36.6 percent), rarely (29.3 percent), or never (21.5 percent) offer naloxone to patients. The majority reported that they occasionally (29.3 percent), rarely (52.4 percent), or never (15.2 percent) dispense naloxone. While most pharmacists were confident in their ability to initiate conversations about nalox-one, they were not confident on how to screen patients at risk for opioid overdose. Pharmacists offered naloxone more when they felt more confident initiating a conversation regarding the need for naloxone with patients (β = 0.50, p < 0.05). Pharmacists dispensed naloxone more when they have had more previous training about dispensing naloxone (β = 0.43, p < 0.05).

CONCLUSION: Many pharmacists hardly offer or dispense naloxone under the standing order. Pharmacists may benefit from standardized training and resources about screening patients for risk of overdose and overdose risk communication.

PMID:35476882 | DOI:10.5055/jom.2022.0703

J Opioid Manag. 2022 Mar-Apr;18(2):123-132. doi: 10.5055/jom.2022.0702.

ABSTRACT

AIM: To investigate adherence to discharge advice in a prescription opioid prescribing guideline (GL) post-orthopedic surgery.

METHODS: The guideline in draft form was introduced in February 2018. To assess longer-term adherence to discharge advice and to understand which components of that advice were adhered to, regular audits of discharge prescribing were performed after formal GL launch in February 2019, a year after the draft of the GL had been available. The post-GL audit was conducted for three months (March to May 2019) and results reviewed. When these audit results showed a need for improvement in prescribing practice, a 1-month education “booster” named prescription opioid practice improvement safe opioid supply (POPI SOS) took place. Audits for a further 3 months (July to Sept 2019) were then carried out to ascertain whether the additional effort improved adherence to the guideline.

RESULTS: On average, adherence to all elements of the guideline was low at only 23.1 percent at 12 months post-draft GL and 1 month after its formal launch. After POPI SOS, a statistically significant improvement was achieved with an average increase in adherence to 52.5 percent (ρ < 0.001). Greatest improvement was seen in the percentage of patients discharged with an opioid plan included in the discharge summary, increasing from 35.8 to 77.7 percent (ρ < 0.001). The second significant improvement observed was in the supply of opioids being limited to four days or less, an increase from 38.1 to 61.9 percent (ρ < 0.001).

CONCLUSION: Introduction of the guideline was not sufficient to promote sustained change in practice. Ongoing monitoring and education were required for its implementation. These findings highlight that comprehensive, locally adapted, evidence-based opioid stewardship is needed to increase the safety of patients and the community in relation to opioid therapy.

PMID:35476881 | DOI:10.5055/jom.2022.0702

Int J Oral Maxillofac Implants. 2022 Mar-Apr;37(2):381-390. doi: 10.11607/jomi.9271.

ABSTRACT

PURPOSE: The exact etiopathogenesis of peri-implant diseases remains unclear. While significant information on molecular markers is available, studies on biomarkers related to possible biocorrosion are sparse. This study aimed to evaluate periimplant crevicular fluid (PICF) for possible titanium (Ti) contamination and explore associations between clinical findings, inflammatory mediators, and Ti levels.

MATERIALS AND METHODS: Patients with implant-supported restoration (≥ 1 year in function) were recruited for this cross-sectional study. Demographics, systemic, and periodontal health history were recorded. Clinical evaluations were conducted to reach peri-implant/periodontal diagnoses and grade severity of peri-implant soft tissue inflammation. Crevicular fluid (CF) was collected from both implants and adjacent teeth (PICF, gingival crevicular fluid [GCF]) and analyzed for Ti (inductively coupled plasma mass spectrometry) and inflammatory mediators (V-plex assays). Multiple regression analysis with a linear mixed effect model was used to analyze possible associations between clinical diagnosis, PICF/GCF cytokine, and Ti concentrations.

RESULTS: Seventy-seven patients (aged 62 ± 2 years; 39 male) with 117 implants (9 ± 1 years in function) were recruited. Diabetes, positive periodontitis history, and current/former smoking were reported by 8%, 39%, and 39% of subjects, respectively. Seventy-nine implant sites (63 patients) were included in CF cytokine analysis, and 45 of these sites (42 patients) were paired with Ti analysis. Statistically significant increases from health to disease were noted in log-transformed PICF concentrations of IL-1β, IL-6, IL-10, and INF-γ (P ≤ .05). Also, statistically significant increases from health to severe clinical inflammation were detected in log-transformed PICF concentrations of IL-8, IL-13, and TNF-α (P ≤ .05). Ti was detected in the majority (82%) of PICF and GCF samples. There was no statistically significant difference in log-transformed Ti concentration based on disease status. However, log-transformed Ti concentration was positively correlated to IL-1β, IL-2, IL-4, IL-8, IL-13, and INF-γ concentrations when data were adjusted for site-specific health (P ≤ .05).

CONCLUSION: Ti was detectable in PICF and adjacent GCF, even in health. Specific inflammatory mediator concentrations were increased in peri-implant disease and significantly associated with Ti concentrations, even when data were adjusted for peri-implant health status. Increased GCF inflammatory mediator concentrations were also associated with increased Ti concentrations. Ti effects on peri-implant as well as periodontal tissues require additional longitudinal investigations.

PMID:35476868 | DOI:10.11607/jomi.9271

Int J Oral Maxillofac Implants. 2022 Mar-Apr;37(2):400-406. doi: 10.11607/jomi.9332.

ABSTRACT

PURPOSE: To describe the benefits of covering the extrasinusal length of extramaxillary zygomatic implants with a pedicled buccal fat pad flap through a tunnel approach.

MATERIALS AND METHODS: Four extramaxillary zygomatic implants were placed in 10 patients and loaded immediately with an acrylic provisional fixed prosthesis. The extrasinusal length of every implant was covered with a pedicled buccal fat pad flap. Study variables were implant survival rate, peri-implant soft tissue recession (PISTR), peri-implant soft tissue condition (PISTC), modified Bleeding Index (mBI), and suppuration. The statistical analysis comprised the Brunner-Langer model of longitudinal data for each variable and the analysis of variance to assess main effects and interactions.

RESULTS: All the zygomatic implants showed osseointegration, resulting in a survival rate of 100%. The PISTR was evaluated after surgery (T0) and after 12 months (T1), statistically significant differences being observed (P = .014). Recession also depended on specific implant positioning; zygomatic implants in the anterior were found to have a higher risk of recession vs implants in the posterior (P = .065). The PISTC was assessed at T0 and T1, and no statistically significant changes were observed (P = .718). Bleeding on probing was present in 10% of the implants at T0 and in 15% at T1, the difference being nonsignificant (P = .317).

CONCLUSION: The use of a pedicled buccal fat pad flap to cover the extrasinusal length of extramaxillary zygomatic implants appears to reduce the risk of soft tissue recession and exposure of the implant surface to the oral cavity.

PMID:35476870 | DOI:10.11607/jomi.9332

Int J Oral Maxillofac Implants. 2022 Nov-Dec;37(2):356-364. doi: 10.11607/jomi.9022.

ABSTRACT

PURPOSE: To determine clinical parameters, histologic features, and radiographic linear bone width changes of regenerated bone using different biomaterials for ridge preservation following tooth extraction.

MATERIALS AND METHODS: For this pilot study, five patients were grafted with anorganic bovine bone and collagen plus recombinant human platelet-derived growth factor-BB (rhPDGF-BB), five patients were grafted with anorganic bovine bone and collagen alone, and five patients did not receive any biomaterial (control) after tooth extraction. Clinical, histologic, and radiographic evaluations were carried out 4 months postextraction.

RESULTS: Differences in terms of buccolingual width were found when comparing the control group to the group grafted with anorganic bovine bone and collagen plus rhPDGF-BB (P = .012). No statistical differences were observed between the groups in terms of mineralized or nonmineralized tissue formation or in terms of the number of osteoblasts or osteocytes per mm2 after 4 months of healing. Interestingly, the number of vessels in the grafted area was found to be significantly different among the three groups (P = .005). The number of Musashi-1 positive cells was also different among groups, both in the mineralized and the nonmineralized areas of the grafted bone (P = .024 and .005, respectively).

CONCLUSION: Anorganic bovine bone with bovine collagen is an efficient biomaterial to avoid postextraction resorption of the alveolar ridge. The addition of rhPDGF-BB appears to improve the biologic features of the newly formed bone and decrease bone resorption; further studies are needed for confirmation.

PMID:35476865 | DOI:10.11607/jomi.9022

Int J Oral Maxillofac Implants. 2022 Mar-Apr;37(2):339-345. doi: 10.11607/jomi.9329.

ABSTRACT

PURPOSE: To evaluate the use of a new resin metal opaquer on the surface of titanium abutments, in combination with two luting agents, and its effect on the retentive strength of implant-supported zirconia copings.

MATERIALS AND METHODS: Sixty customized titanium abutments were designed and fabricated with virtual design software and a milling machine. Thirty abutment specimens were coated with metal opaquers, and the others were not coated. Then, the titanium abutments were fitted into the implant analogs, and the abutment-implant analog complexes were embedded in acrylic resin blocks. Sixty CAD/CAM-fabricated zirconia copings were seated on the abutments and secured with glassionomer cement or self-adhesive resin cement. The specimens were stored in 100% humidity for 1 hour and artificial saliva for 23 hours at 37°C before thermocycling for 5,000 cycles of 5°C to 55°C with a 30-second dwell time. The retentive strength was measured using a pull-out test with a universal testing machine. The dislodgment forces were statistically analyzed via two-way analysis of variance (ANOVA). The failure modes were evaluated and categorized by examining the fracture surface.

RESULTS: The metal opaquer material had a significant negative effect on retention of zirconia copings. The nonopaquer titanium abutments showed significantly (P < .05) higher retentive strength than the metal opaquer abutments. Comparing the cements, the retentive strength values of self-adhesive resin cement were significantly higher than those of glass-ionomer cement. The metal opaquer groups exhibited mostly mixed-type failures, a combination of adhesive failures and cohesive failures, whereas the nonopaquer groups showed mostly adhesive-type failures.

CONCLUSION: The titanium abutments coated with the new metal opaquer material resulted in a reduction of retentive strength. Self-adhesive resin cements exhibited significantly higher retention than glass-ionomer cements.

PMID:35476863 | DOI:10.11607/jomi.9329

Int J Oral Maxillofac Implants. 2022 Mar-Apr;37(2):329-338. doi: 10.11607/jomi.9374.

ABSTRACT

PURPOSE: The scarce standard therapeutic protocols for the management of peri-implant diseases results in the empirical application of therapeutic modalities. The objective of this study was to carry out a survey to analyze the therapeutic trends of professionals with different academic backgrounds and levels of expertise.

MATERIALS AND METHODS: An exploratory cross-sectional internet-based study survey of board-certified members of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) was conducted. To assess the therapeutic trends, four clinical vignettes representing different scenarios of peri-implant biologic complications were provided to the participants. Differences in practice patterns were determined using chi-square test and Student t test or analysis of variance (ANOVA) test for qualitative variables.

RESULTS: A total of 268 members of the AAP and EFP completed the survey. A significant difference in preferred treatment plan was found between EFP and AAP periodontists, resective therapy being the treatment of choice by the majority of the former (41.2%) and regenerative therapy by the latter (48.9%; P < .001). Overall, 48.1% of experts did not consider any intervention for the management of mucositis. Antibiotic prescriptions differed among groups, with statistical significance in each clinical case, and the explantation criteria were inconsistent and differed significantly among groups.

CONCLUSION: Substantial variations exist concerning the decision-making to manage peri-implant diseases and conditions.

PMID:35476862 | DOI:10.11607/jomi.9374

Int J Oral Maxillofac Implants. 2022 Mar-Apr;37(2):e41-e49. doi: 10.11607/jomi.9197.

ABSTRACT

PURPOSE: Titanium and zirconium wear are discussed in the literature as contributing factors for mechanical complications. The purpose of this study was to evaluate if current implant designs present visible clinical evidence of surface damage after insertion and removal in dense bone and if these changes are comparable in titanium and zirconia implants.

MATERIALS AND METHODS: For this experimental in vitro and pilot study, four implant systems were evaluated. Astra Tech Implants (Dentsply Sirona), Nobel Biocare Implants (Nobel Biocare), Straumann Implants (Institut Straumann), and Zeramex Implants (Dentalpoint). Six implants of each group with similar lengths (between 10 and 11 mm) and diameters (between 4.0 and 4.5 mm) were used. Protocols for implant bed preparations in dense bovine bone disks represented type II bone density. The implants were inserted and removed to evaluate the changes experienced by their surfaces using a magnification compatible with 5× magnification of the clinical setting. The presence or absence of damage and type of damage were evaluated at the coronal, middle, and apical regions at higher magnification. The Cochran Q test for binary dichotomous samples was used for statistical comparisons.

RESULTS: All the groups showed surface changes; titanium implants showed abrasion at the threads’ flanks, and zirconia implants showed microfractures at the tip of the threads.

CONCLUSION: Due to the insertion and removal of titanium and zirconia implants in dense bone, the flanks and tips of the implant threads will develop visible surface damage.

PMID:35476861 | DOI:10.11607/jomi.9197