Short peripheral intravenous catheter securement with cyanoacrylate glue compared to conventional dressing: A randomized controlled trial.

BACKGROUND: Short peripheral intravenous catheters (PIVCs) fail prior to completion of therapy in up to 63% of hospitalizations. This unacceptably high rate of failure has become the norm for the most common invasive procedure in all of medicine. Securement strategies may improve PIVC survival. METHODS: We conducted a prospective, single-site, parallel, two-arm randomized controlled investigation with a primary outcome of catheter failure comparing securement with standard semi-permeable dressing and clear tape (SPD) to standard semipermeable dressing and clear tape with cyanoacrylate glue (SPD + CG). Adult emergency department patients with a short PIVC and anticipated hospital duration ⩾ 48 h were enrolled and followed until IV failure or completion of therapy for up to 7 days. Secondary outcomes included complications and cost comparisons between groups. Primary outcome was assessed by intention to treat and per protocol analyses. FINDINGS: 350 patients were enrolled between November 2019 and October 2020. PIVC survival for SPD + CG was similar to SPD group with the absolute risk difference of IV failure in the intention-to-treat (-5.8%, p = 0.065) population and improved in the per protocol (-8.1%, p = 0.04) population, respectively. Kaplan-Meier survival analysis indicated there was a significant benefit of the SPD + CG at greater than 2 days of hospitalization (p = 0.04). Prior to 48 h, there was no survival enhancement to either group (p = 0.98) in the intention to treat population. In a multivariable analysis with piecewise Cox regression, when the IV was functional greater than 48 h, the risk of IV failure in the SPD + CG was 43% less than the SPD group (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.34 to 0.97; p = 0.04). Cumulative cost related to IV during hospitalization was similar between groups with a lower incremental rescue cost in the SPD + CG group. INTERPRETATION: SPD combined with cyanoacrylate glue provides similar benefit to patients compared to SPD alone and potentially improves short PIVC survival when the IV was inserted >48 h. As this strategy is cost neutral, it could be considered in admitted patients, particularly those with longer anticipated hospital durations.

Comparison of 2 Midline Catheter Devices With Differing Antithrombogenic Mechanisms for Catheter-Related Thrombosis: A Randomized Clinical Trial.

Importance: Data regarding upper extremity midline catheter (MC)-related thrombosis (CRT) are sparse, with some evidence indicating that MCs have a high rate of CRT. Objective: To compare 2 MCs with differing antithrombogenic mechanisms for this outcome. Design, Setting, and Participants: In this parallel, 2-arm randomized clinical trial, 496 adult patients hospitalized at a tertiary care suburban academic medical center who received an MC were assessed for eligibility between January 1, 2019, and October 31, 2020, and 212 were randomized. Interventions: Inpatients were randomized to receive a 4F antithrombotic MC (MC-AT) or a 4.5F antithrombotic and antimicrobial MC (MC-AT-AM). Main Outcomes and Measures: The primary outcome was symptomatic midline CRT inclusive of deep vein thrombosis or superficial venous thrombophlebitis within 30 days after insertion. Secondary outcomes included catheter-associated bloodstream infection and catheter failure. Results: A total of 191 patients (mean [SD] age, 60.2 [16.7] years; 114 [59.7%] female) were included in the final analysis: 94 patients in the MC-AT group and 97 in the MC-AT-AM group. Symptomatic midline CRT occurred in 7 patients (7.5%) in the MC-AT group and 11 (11.3%) in the MC-AT-AM group (P = .46). Deep vein thrombosis occurred in 5 patients (5.3%) in the MC-AT group and 5 patients (5.2%) in the MC-AT-AM group (P > .99). Pulmonary embolism occurred in 1 patient in the MC-AT group. No catheter-associated bloodstream infection occurred in either group. Premature catheter failure occurred in 22 patients (23.4%) in the MC-AT group and 20 (20.6%) in the MC-AT-AM group (P = .64). In Cox proportional hazards regression analysis, no statistically significant difference was found between groups for the risk of catheter failure (hazard ratio, 1.27; 95% CI, 0.67-2.43; P = .46). Conclusions and Relevance: No difference was found in thrombosis in MCs with 2 distinct antithrombogenic mechanisms; however, the risk of CRT in both groups was high. Practitioners should strongly consider the safety risks associated with MCs when determining the appropriate vascular access device. Trial Registration: ClinicalTrials.gov Identifier: NCT03725293.

Some current legal issues that may affect oral and maxillofacial radiology. Part 2: digital monitors and cone-beam computed tomography.

In this second of 2 papers about technological developments in dental radiology, we discuss the legal impact of using digital monitors and cone-beam computed tomography (CBCT) on dental practice. Although some technical developments such as charge-coupled devices and photostimulatable phosphors are commonly used in the dental profession, some, such as greyscale monitors, are better known in medicine as standards of care for primary diagnosis. This complex subject has been overviewed. The recent emergence of CBCT, which is changing current approaches to imaging for preimplant planning, has provoked a number of legal dilemmas, such as an accompanying responsibility for reading and interpreting large fields of view that include extragnathic areas that are ordinarily outside the dentist"s purview.

Some current legal issues that may affect oral and maxillofacial radiology: part 1. Basic principles in digital dental radiology.

Developments in oral and maxillofacial radiology affect almost every aspect of dentistry: some change the legal framework in which Canadian dentists practise; some re-emphasize established standards of care, such as the dental radiologist's mantra, ALARA (using a dose that is as low as reasonably achievable) and viewing images in reduced ambient lighting. Developments in the legislation that regulates the use of radiology, such as Health Canada"s Safety Code 30 for radiation safety in dentistry and the Healing Arts Radiation Protection Act, also affect the practice of dental radiology. Some technical developments, such as charge-coupled devices and photostimulatable phosphors, are already well-known to the profession. Teleradiology, currently used in hospitals, but unfamiliar to most dentists (especially those working in urban communities), may soon have an impact on dentistry when it is used for Canada"s electronic health record, now under development. In this first of 2 articles about dental digital technology, we discuss the legal impact of developments in oral and maxillofacial radiology on dental practice and patient care.

Does the type of implant prosthesis affect outcomes for the completely edentulous arch?

PURPOSE: A systematic review, including meta-analysis, was conducted to answer the question "Does the type of implant prosthesis affect outcomes for the completely edentulous arch?" The current paper was to assess the impact of fixed or removable prosthesis type on implant survival and success outcomes. MATERIALS AND METHODS: Pertinent literature was identified through December 31, 2005 using a PubMed search strategy and hand-searching of relevant journals, a personal library, and reference lists from included studies. Inclusion and exclusion criteria were applied to the titles and abstracts and subsequently to the full text of included references. The 72 included studies reported oral implant survival or success, crestal bone levels or loss, and/or prosthesis success or maintenance differentiated by arch and by prosthesis type (fixed or removable, splinted or nonsplinted) established either in 1-year randomized clinical trials or 5-year observational studies. RESULTS: Statistical analysis revealed only a site-specific rather than a design-specific finding that implant survival for mandibular fixed prosthesis groups had a 6.6% greater implant survival than maxillary fixed prostheses groups (P < .001). The observation of greater implant failure for removable over fixed protheses groups in the maxilla appeared likely due to deficient preoperative bone volume in the removable prosthesis groups. DISCUSSION: There is little evidence that implant survival or success is affected directly by prosthesis type based on current designs studied for at least 5 years. Prosthesis maintenance does appear to vary with different prosthesis designs. CONCLUSION: While this study suggests implant survival and success may not be affected by variation across the established types of implant prostheses, maintenance demands can vary with implant prosthesis type, especially with overdenture attachments. Clinicians should remain diligent in basing implant prosthodontic technique on established protocols.

Patterns of tooth loss in young adult Hong Kong Chinese patients in 1983 and 1998.

OBJECTIVE: To describe and compare patterns of tooth loss in 2 groups of 21- to 25-year-old Hong Kong Chinese patients examined 15 years apart. MATERIALS AND METHODS: The panoramic radiographs of consecutive young adult patients who attended the primary care department of the Dental School of the University of Hong Kong in 1983 and 1998 were reviewed. RESULTS: The proportions of patients with full dentition were 36.0% in 1983 and 45.1% in 1998. However, when third molars were excluded, the proportions were 44.3% and 62.3%, respectively. The prevalence of missing first molars was 10.5% and 3.2% for the 1983 and 1998 groups, respectively, whereas that for missing third molars was 13.5% and 17.9% and that for missing premolars was 1.9% and 2.4%, respectively; all of the differences were statistically significant (p < 0.01). Although the first molars, especially the lower first molars, were at greatest risk of being lost in both groups, the prevalence of missing first molars fell substantially (10.5% in 1983, 3.2% in 1998); in contrast, the prevalence of missing premolars and third molars increased. CONCLUSIONS: The decline in the prevalence of missing first molars may in part reflect the efficacy of toothbrushing, whereas the increase in missing premolars and third molars reflects increases in orthodontic and oral surgical activity in the intervening period.

Multiple idiopathic cervical root resorption most frequently seen in younger females.

DATA SOURCES: Medline and references of included studies were used to source articles. STUDY SELECTION: Selected articles were case reports or reviews of patients who had multiple root resorption with no systemic or local factors that may have contributed to root resorption, the resorption originating at the cemento-enamel junction of teeth and involving more than three teeth in the dentition. DATA EXTRACTION AND SYNTHESIS: Clinical, histological and historical findings are summarised for all identified patients. RESULTS: Multiple idiopathic cervical root resorption (MICRR) was an incidental finding on routine clinical and radiographic examination. There appeared to be no correlation between this type of resorption and any medical or dental finding. Radiographically, MICRR was found to begin at the cemento-enamel junction and then either progress to involve the entire cervical region or, at some point, spontaneously arrest. Those cases that progressed to involve the entire cervical region required extraction. The number of teeth that demonstrated this condition ranged from five up to 24 per patient. More teeth became involved as the condition was followed in time. There was no detectable frequency of occurrence for any particular dental region or tooth among the involved teeth. Of a total of 18 patients, 13 were females whose ages ranged from 7 to 68 years of age. Ten of the 18 patients were Caucasian. CONCLUSIONS: Multiple idiopathic cervical root resorption was found most frequently associated with younger females. This condition appeared to be of unknown aetiology and uncertain natural history.