ABSTRACT
INTRODUCTION: Hospital-acquired infections (HAIs) pose a significant risk to patients, and are a major focus of infection prevention and control policies (IPC). One under-recognized reason for the generally poor compliance with IPC is that it is burdensome for healthcare workers (HCWs). AIM: To identify the burdens of IPC for HCWs. METHODS: PubMed and CINAHL were searched for studies published in English since 2000 regarding compliance with IPC and the burdens associated with compliance. After screening 1018 initial results, 25 articles were included in the final review. RESULTS: Evidence was found for burdens including dermatological complications, headaches, sensory symptoms and time pressure. Tools designed to measure compliance with IPC have limitations, and rarely assess the burdens of compliance. A strong safety culture predicted positive compliance, while knowledge of the underlying rationale for IPC had a non-linear relationship with compliance. CONCLUSION: Future research should clarify IPC-related burdens and how these may be minimized to achieve better compliance.
Subject(s)
Cross Infection , Infection Control , Humans , Infection Control/methods , Health Personnel , Cross Infection/prevention & control , Safety ManagementABSTRACT
While the genetics of MS risk susceptibility are well-described, and recent progress has been made on the genetics of disease severity, the genetics of disease progression remain elusive. We therefore investigated the genetic determinants of MS progression on longitudinal brain MRI: change in brain volume (BV) and change in T2 lesion volume (T2LV), reflecting progressive tissue loss and increasing disease burden, respectively. We performed genome-wide association studies of change in BV (N = 3401) and change in T2LV (N = 3513) across six randomized clinical trials from Biogen and Roche/Genentech: ADVANCE, ASCEND, DECIDE, OPERA I & II, and ORATORIO. Analyses were adjusted for randomized treatment arm, age, sex, and ancestry. Results were pooled in a meta-analysis, and were evaluated for enrichment of MS risk variants. Variant colocalization and cell-specific expression analyses were performed using published cohorts. The strongest peaks were in PTPRD (rs77321193-C/A, p = 3.9 × 10-7) for BV change, and NEDD4L (rs11398377-GC/G, p = 9.3 × 10-8) for T2LV change. Evidence of colocalization was observed for NEDD4L, and both genes showed increased expression in neuronal and/or glial populations. No association between MS risk variants and MRI outcomes was observed. In this unique, precompetitive industry partnership, we report putative regions of interest in the neurodevelopmental gene PTPRD, and the ubiquitin ligase gene NEDD4L. These findings are distinct from known MS risk genetics, indicating an added role for genetic progression analyses and informing drug discovery.
Subject(s)
Brain , Genome-Wide Association Study , Multiple Sclerosis , Humans , Brain/diagnostic imaging , Cost of Illness , Multiple Sclerosis/diagnostic imaging , Multiple Sclerosis/genetics , Neuroimaging , Randomized Controlled Trials as Topic , Disease ProgressionABSTRACT
BACKGROUND: Patient stratification and individualized treatment decisions based on multiple sclerosis (MS) clinical phenotypes are arbitrary. Subtype and Staging Inference (SuStaIn), a published machine learning algorithm, was developed to identify data-driven disease subtypes with distinct temporal progression patterns using brain magnetic resonance imaging; its clinical utility has not been assessed. The objective of this study was to explore the prognostic capability of SuStaIn subtyping and whether it is a useful personalized predictor of treatment effects of natalizumab and dimethyl fumarate. METHODS: Subtypes were available from the trained SuStaIn model for 3 phase 3 clinical trials in relapsing-remitting and secondary progressive MS. Regression models were used to determine whether baseline SuStaIn subtypes could predict on-study clinical and radiological disease activity and progression. Differences in treatment responses relative to placebo between subtypes were determined using interaction terms between treatment and subtype. RESULTS: Natalizumab and dimethyl fumarate reduced inflammatory disease activity in all SuStaIn subtypes (all p < 0.001). SuStaIn MS subtyping alone did not discriminate responder heterogeneity based on new lesion formation and disease progression (p > 0.05 across subtypes). CONCLUSION: SuStaIn subtypes correlated with disease severity and functional impairment at baseline but were not predictive of disability progression and could not discriminate treatment response heterogeneity.
Subject(s)
Multiple Sclerosis, Chronic Progressive , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Humans , Dimethyl Fumarate/pharmacology , Immunosuppressive Agents/pharmacology , Magnetic Resonance Imaging/methods , Multiple Sclerosis/drug therapy , Multiple Sclerosis, Chronic Progressive/diagnostic imaging , Multiple Sclerosis, Chronic Progressive/drug therapy , Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Multiple Sclerosis, Relapsing-Remitting/pathology , Natalizumab/pharmacology , Precision MedicineABSTRACT
BACKGROUND: The clinical relevance of serum glial fibrillary acidic protein (sGFAP) concentration as a biomarker of MS disability progression independent of acute inflammation has yet to be quantified. OBJECTIVE: To test whether baseline values and longitudinal changes in sGFAP concentration are associated with disability progression without detectable relapse of magnetic resonance imaging (MRI) inflammatory activity in participants with secondary-progressive multiple sclerosis (SPMS). METHODS: We retrospectively analyzed longitudinal sGFAP concentration and clinical outcome data from the Phase 3 ASCEND trial of participants with SPMS, with no detectable relapse or MRI signs of inflammatory activity at baseline nor during the study (n = 264). Serum neurofilament (sNfL), sGFAP, T2 lesion volume, Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT), and composite confirmed disability progression (CDP) were measured. Linear and logistic regressions and generalized estimating equations were used in the prognostic and dynamic analyses. RESULTS: We found a significant cross-sectional association between baseline sGFAP and sNfL concentrations and T2 lesion volume. No or weak correlations between sGFAP concentration and changes in EDSS, T25FW, and 9HPT, or CDP were observed. CONCLUSION: Without inflammatory activity, changes in sGFAP concentration in participants with SPMS were neither associated with current nor predictive of future disability progression.
Subject(s)
Multiple Sclerosis, Chronic Progressive , Multiple Sclerosis , Humans , Multiple Sclerosis/diagnosis , Glial Fibrillary Acidic Protein , Intermediate Filaments/metabolism , Cross-Sectional Studies , Retrospective Studies , Multiple Sclerosis, Chronic Progressive/diagnostic imaging , Multiple Sclerosis, Chronic Progressive/metabolism , Biomarkers , Inflammation/metabolismABSTRACT
AIMS: With increasing age, the proportion of older individuals visiting a dental clinic decreases. The aim was to gain insight into a) whether frailty or dental status were associated with visiting a dental clinic and b) their perceived barriers to accessing oral health care. METHODS: Individuals eligible for the yearly influenza vaccination in Winschoten, The Netherlands, were invited to participate in a questionnaire survey about dental visits and perceived barriers to such visits. RESULTS: A total of 1027 individuals aged 60+ completed the questionnaire - 80% of the non-frail, 71% of the mildly frail and 60% of the moderately to severe frail individuals visited a dental clinic in the previous year. Dental status was the crucial determinant for not visiting a dental clinic. Edentate individuals were more likely to drop out of the dental care system than dentate individuals or individuals with partial prostheses. A higher proportion of moderately and severe frail people were edentate than non-frail or mildly frail people. Barriers to visiting a dentist were making an appointment, costs, and services available. Conclusions: Dental clinicians should pay attention to the barriers that they can influence. The influenza vaccination seems to be an interesting momentum for identifying people who have dropped out of the oral healthcare system.
Subject(s)
Dental Clinics , Influenza, Human , Humans , Health Services Accessibility , Surveys and Questionnaires , Netherlands , Oral HealthABSTRACT
INTRODUCTION: Whether the reduction in brain amyloid beta (Aß) plaque alone may substantially slow cognitive and functional decline in patients with dementia or mild cognitive impairment due to Alzheimer's disease (AD) remains debated. METHODS: An instrumental variable meta-analysis was performed to infer the effect of change in positron emission tomography (PET)-measured Aß standardized uptake value ratio (SUVR) on cognitive and functional decline. RESULTS: Pooling data from 16 randomized trials demonstrates that each 0.1-unit decrease in PET Aß SUVR is associated with a reduction (95% confidence interval) by 0.09 (0.034-0.15), 0.33 (0.12-0.55), and 0.13 (0.017-0.24) point in the average change of the Clinical Dementia Rating-Sum of Boxes, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, and the Mini-Mental State Examination, respectively. DISCUSSION: This meta-analysis provides statistically significant evidence of a likely causal relationship between a reduction in Aß plaque and a reduction in cognitive and functional decline in patients with AD. HIGHLIGHTS: A widely cited meta-analysis article concluded amyloid beta reduction does not substantially improve cognition. We identified data inconsistencies in the initial publication and found new trial data. We repeated the meta-analysis after correcting data inconsistencies and adding new trial data. Updated results suggested statistically significant clinical benefit of amyloid beta reduction. Amyloid beta is a viable biological target for the treatment and prevention of AD.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Humans , Alzheimer Disease/diagnostic imaging , Alzheimer Disease/psychology , Amyloid beta-Peptides/metabolism , Brain/diagnostic imaging , Brain/metabolism , Cognitive Dysfunction/diagnostic imaging , Positron-Emission Tomography/methods , Amyloid , CognitionABSTRACT
BACKGROUND: Prolonged-release fampridine (PR-FAM) 10-mg tablet twice daily is the only approved pharmacological treatment for improvement of walking ability in adults with multiple sclerosis (MS). LIBERATE assessed the safety/effectiveness of PR-FAM in the real-world. OBJECTIVES: The aim of this study was to collect additional safety data, including the incidence rate of seizures and other adverse events (AEs) of interest, from patients with MS taking PR-FAM in routine clinical practice (including patients aged ≥ 65 years and those with pre-existing cardiovascular risk factors). Other objectives included change over time in patient-reported evaluation of physical and psychological impact of MS while taking PR-FAM, and change over time in physician-reported assessment of walking ability in MS patients taking PR-FAM. METHODS: Patients with MS newly prescribed PR-FAM were recruited (201 sites, 13 countries). Demographic/safety data were collected at enrolment through 12 months. Physician-rated Clinical Global Impression of Improvement (CGI-I) scores for walking ability, and Multiple Sclerosis Impact Scale-29 (MSIS-29) were assessed. RESULTS: Safety analysis included 4646 patients with 3534.8 patient-years of exposure; median (range) age, 52.6 (21-85) years, 87.3% < 65 years, and 65.7% women. Treatment-emergent AEs (TEAEs) were reported in 2448 (52.7%) patients, and serious TEAEs were reported in 279 (6.0%) patients, of whom 37 (< 1%) experienced treatment-emergent serious AEs (TESAEs) considered related to PR-FAM. AEs of special interest (AESI) occurred in 1799 (38.7%) patients, and serious AESI in 128 (2.8%) patients. Seventeen (< 1%) patients experienced actual events of seizure. Overall, 1158 (24.9%) patients discontinued treatment due to lack of efficacy. At 12 months, a greater proportion of patients on-treatment had improvement from baseline in CGI-I for walking ability versus those who discontinued (61% vs. 11%; p < 0.001). MSIS-29 physical impact score improved significantly for patients on-treatment for 12 months versus those who discontinued (mean change, baseline to 12 months: - 9.99 vs. - 0.34 points; p < 0.001). Results were similar for MSIS-29 psychological impact. CONCLUSION: No new safety concerns were identified in this real-world study, suggesting that routine risk-minimization measures are effective. CGI-I and MSIS-29 scores after 12 months treatment with PR-FAM treatment show clinical benefits consistent with those previously reported. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01480063.
Subject(s)
4-Aminopyridine/administration & dosage , Multiple Sclerosis/drug therapy , Patient Reported Outcome Measures , Physicians , Potassium Channel Blockers/administration & dosage , Walking/physiology , Adult , Aged , Aged, 80 and over , Delayed-Action Preparations/administration & dosage , Female , Humans , Male , Middle Aged , Multiple Sclerosis/diagnosis , Multiple Sclerosis/physiopathology , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: REFINE was an exploratory, dose- and frequency-blinded, prospective, randomized, dose-ranging study in relapsing-remitting multiple sclerosis (RRMS) patients. OBJECTIVE: To examine the efficacy, safety, and tolerability of natalizumab administered via various regimens in RRMS patients. METHODS: Clinically stable RRMS patients previously treated with 300 mg natalizumab intravenously for ⩾12 months were randomized to one of six natalizumab regimens over 60 weeks: 300 mg administered intravenously or subcutaneously every 4 weeks (Q4W), 300 mg intravenously or subcutaneously every 12 weeks (Q12W), or 150 mg intravenously or subcutaneously Q12W. The primary endpoint was the mean cumulative number of combined unique active magnetic resonance imaging (MRI) lesions at week 60. RESULTS: In total, 290 patients were enrolled. All Q12W dosing arms were associated with increased clinical and MRI disease activity and closed early; ⩾39.5% of patients in each Q12W arm met rescue criteria. In the 300 mg intravenous and subcutaneous Q4 W arms, the mean cumulative number of combined unique active MRI lesions was 0.23 and 0.02, respectively; annualized relapse rates were 0.07 and 0.08, respectively; and trough natalizumab serum levels and α4-integrin saturation were comparable. CONCLUSION: Natalizumab 300 mg subcutaneous Q4W was comparable to 300 mg intravenous Q4W dosing with respect to efficacy, pharmacokinetics/pharmacodynamics, and safety.
Subject(s)
Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Humans , Magnetic Resonance Imaging , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Natalizumab/adverse effects , Prospective StudiesABSTRACT
Interest in neurofilaments has risen sharply in recent years with recognition of their potential as biomarkers of brain injury or neurodegeneration in CSF and blood. This is in the context of a growing appreciation for the complexity of the neurobiology of neurofilaments, new recognition of specialized roles for neurofilaments in synapses and a developing understanding of mechanisms responsible for their turnover. Here we will review the neurobiology of neurofilament proteins, describing current understanding of their structure and function, including recently discovered evidence for their roles in synapses. We will explore emerging understanding of the mechanisms of neurofilament degradation and clearance and review new methods for future elucidation of the kinetics of their turnover in humans. Primary roles of neurofilaments in the pathogenesis of human diseases will be described. With this background, we then will review critically evidence supporting use of neurofilament concentration measures as biomarkers of neuronal injury or degeneration. Finally, we will reflect on major challenges for studies of the neurobiology of intermediate filaments with specific attention to identifying what needs to be learned for more precise use and confident interpretation of neurofilament measures as biomarkers of neurodegeneration.
Subject(s)
Biomarkers , Intermediate Filaments , Nerve Degeneration , Synapses , Animals , HumansABSTRACT
Objective: To infer molecular effectors of therapeutic effects and adverse events for dimethyl fumarate (DMF) in patients with relapsing-remitting MS (RRMS) using untargeted plasma metabolomics. Methods: Plasma from 27 patients with RRMS was collected at baseline and 6 weeks after initiating DMF. Patients were separated into discovery (n = 15) and validation cohorts (n = 12). Ten healthy controls were also recruited. Metabolomic profiling using ultra-high-performance liquid chromatography mass spectrometry (UPLC-MS) was performed on the discovery cohort and healthy controls at Metabolon Inc (Durham, NC). UPLC-MS was performed on the validation cohort at the National Phenome Centre (London, UK). Plasma neurofilament concentration (pNfL) was assayed using the Simoa platform (Quanterix, Lexington, MA). Time course and cross-sectional analyses were performed to identify pharmacodynamic changes in the metabolome secondary to DMF and relate these to adverse events. Results: In the discovery cohort, tricarboxylic acid (TCA) cycle intermediates fumarate and succinate, and TCA cycle metabolites succinyl-carnitine and methyl succinyl-carnitine increased 6 weeks following treatment (q < 0.05). Methyl succinyl-carnitine increased in the validation cohort (q < 0.05). These changes were not observed in the control population. Increased succinyl-carnitine and methyl succinyl-carnitine were associated with adverse events from DMF (flushing and abdominal symptoms). pNfL concentration was higher in patients with RRMS than in controls and reduced over 15 months of treatment. Conclusion: TCA cycle intermediates and metabolites are increased in patients with RRMS treated with DMF. The results suggest reversal of flux through the succinate dehydrogenase complex. The contribution of succinyl-carnitine ester agonism at hydroxycarboxylic acid receptor 2 to both therapeutic effects and adverse events requires investigation.
Subject(s)
Citric Acid Cycle/drug effects , Dimethyl Fumarate/pharmacology , Immunologic Factors/pharmacology , Metabolome , Multiple Sclerosis, Relapsing-Remitting/blood , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Adult , Cohort Studies , Dimethyl Fumarate/adverse effects , Female , Humans , Immunologic Factors/adverse effects , Male , Middle AgedABSTRACT
OBJECTIVE: To identify short-term changes in gene expression in peripheral blood mononuclear cells (PBMCs) associated with treatment response to dimethyl fumarate (DMF, Tecfidera) in patients with relapsing-remitting MS (RRMS). METHODS: Blood samples were collected from 24 patients with RRMS (median Expanded Disability Status Scale score, 2.0; range 1-7) at baseline, 6 weeks, and 15 months after the initiation of treatment with DMF (BG-12; Tecfidera). Seven healthy controls were also recruited, and blood samples were collected over the same time intervals. PBMCs were extracted from blood samples and sequenced using next-generation RNA sequencing. Treatment responders were defined using the composite outcome measure "no evidence of disease activity" (NEDA-4). Time-course and cross-sectional differential expression analyses were performed to identify transcriptomic markers of treatment response. RESULTS: Treatment responders (NEDA-4 positive, 8/24) over the 15-month period had 478 differentially expressed genes (DEGs) 6 weeks after the start of treatment. These were enriched for nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and inhibition of nuclear factor κB (NFκB) pathway transcripts. For patients who showed signs of disease activity, there were no DEGs at 6 weeks relative to their (untreated) baseline. Contrasting transcriptomes expressed at 6 weeks with those at 15 months of treatment, 0 and 1,264 DEGs were found in the responder and nonresponder groups, respectively. Transcripts in the nonresponder group (NEDA-4 negative, 18/24) were enriched for T-cell signaling genes. CONCLUSION: Short-term PBMC transcriptome changes reflecting activation of the Nrf2 and inhibition of NFκB pathways distinguish patients who subsequently show a medium-term treatment response with DMF. Relative stabilization of gene expression patterns may accompany treatment-associated suppression of disease activity.
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Background: The timed 25-foot walk (T25FW) is widely used as a clinic performance measure, but has yet to be directly validated against gait speed in the home environment. Objectives: To develop an accurate method for remote assessment of walking speed and to test how predictive the clinic T25FW is for real-life walking. Methods: An AX3-Axivity tri-axial accelerometer was positioned on 32 MS patients (Expanded Disability Status Scale [EDSS] 0-6) in the clinic, who subsequently wore it at home for up to 7 days. Gait speed was calculated from these data using both a model developed with healthy volunteers and individually personalized models generated from a machine learning algorithm. Results: The healthy volunteer model predicted gait speed poorly for more disabled people with MS. However, the accuracy of individually personalized models was high regardless of disability (R-value = 0.98, p-value = 1.85 × 10-22). With the latter, we confirmed that the clinic T25FW is strongly predictive of the maximum sustained gait speed in the home environment (R-value = 0.89, p-value = 4.34 × 10-8). Conclusion: Remote gait monitoring with individually personalized models is accurate for patients with MS. Using these models, we have directly validated the clinical meaningfulness (i.e., predictiveness) of the clinic T25FW for the first time.
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BACKGROUND: In people with multiple sclerosis treated with interferon-beta or glatiramer acetate, new MRI lesions and relapses during the first year of treatment predict a poor prognosis. OBJECTIVE: To study this association in those receiving natalizumab. METHODS: Data were collected on relapses, new MRI activity, and Modified Rio Score after initiation of natalizumab in an observational cohort of 161 patients with high baseline disability. These were correlated with Expanded Disability Status Scale (EDSS) progression at years 1, 2, 3, and 3-7 after treatment initiation, versus pre-treatment baseline. RESULTS: 46/161 patients had a relapse in the first year and 44/161 had EDSS progression by year 2. Relapses and Modified Rio Score in the first year of treatment predicted EDSS progression at year 1 and 2 after treatment initiation. However, this effect disappeared with longer follow-up. Paradoxically, there was a trend towards inflammatory activity on treatment (first year Modified Rio Score, relapses, and MRI activity) predicting a lower risk of EDSS progression by years 3-7, although this did not reach statistical significance. Those with and without EDSS progression did not differ in baseline age, EDSS, or pre-treatment relapse rate. Relapses in year 0-1 predicted further relapses in years 1-3. CONCLUSIONS: Breakthrough inflammatory activity after natalizumab treatment is predictive of short-term outcome measures of relapses or EDSS progression, but does not predict longer term EDSS progression, in this cohort with high baseline disability.
Subject(s)
Magnetic Resonance Imaging , Multiple Sclerosis , Natalizumab/administration & dosage , Adult , Female , Follow-Up Studies , Humans , Inflammation/diagnostic imaging , Inflammation/drug therapy , Inflammation/physiopathology , Male , Middle Aged , Multiple Sclerosis/diagnostic imaging , Multiple Sclerosis/drug therapy , Multiple Sclerosis/physiopathology , Natalizumab/adverse effectsABSTRACT
OBJECTIVES: The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. MATERIALS AND METHODS: Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in all new long-stay patients (n = 725) admitted to a nursing home between January 2009 and December 2013. All patients were followed from admission until death or until they left the nursing home. RESULTS: At admission, dementia patients were significantly older than somatic patients; median [IQR] ages were, respectively, 85 [79-89] and 81 [76-87] (p = 0.001). In addition, edentulous patients were significantly older than patients with remaining teeth, 83 [79-89] versus 80 [74-86] (p = 0.001) years. Thirty percent of the admitted patients died within 12 months after admission. A small minority (20%) of the patients had their own teeth. In this group, poor oral hygiene (72%), caries (70%), and broken teeth (62%) were frequently observed. Edentulous patients were significantly more cooperative with treatment than patients with remaining teeth (64 versus 27%). Finally, significantly less professional dental care was given to edentulous patients when compared to patients with remaining teeth (median 90 [IQR 60-180] versus 165 [75-375] min). CONCLUSION: When compared to edentulous elderly patients, patients with remaining teeth were younger at admittance, were more often non-cooperative, and had a poorer oral health and higher need for dental care. CLINICAL RELEVANCE: It is important that health care workers ensure adequate oral health and dental care to frail elderly, especially for elderly with remaining teeth.
Subject(s)
Dental Care for Aged , Health Services Needs and Demand , Health Status , Nursing Homes , Oral Health , Aged , Aged, 80 and over , Female , Humans , Male , Netherlands , Patient ComplianceABSTRACT
PURPOSE: The aim of this prospective comparative study was to assess whether age has influence on peri-implant health in patients treated with mandibular two-implant overdentures during a 10-year evaluation period. MATERIALS AND METHODS: A prospective study was carried out with two groups of edentulous patients, viz a younger (n = 52; mean age 45 years, 35-50 years) and an older (n = 53; mean age 68 years, 60-80 years) group. In all patients, two dental implants were placed in the interforaminal region of the mandible and after a 3-month healing period overdentures were fabricated. Clinical and radiographic parameters were evaluated immediately after completion of the prosthetic treatment, and after 1, 5 and 10 years. Implant loss, plaque index, gingival index, bleeding index, and probing depth were assessed as clinical parameters. Peri-implant bone loss was assessed on dental radiographs made with a standardized long-cone technique with a direction device. RESULTS: Implant survival after 10 years was 97.1% and 93.4% in the younger and older group, respectively. Ten-year scores of plaque, gingiva, and bleeding were between 0 and 1 for both groups (possible scores 0-3), and mean probing depth was 3 mm in both groups. Mean peri-implant bone loss after 10 years was 1.2 and 1.4 mm in the younger and older patients, respectively. No significant differences were observed between the groups. CONCLUSION: Clinical performance of mandibular two-implant overdentures is equally successful in younger and older patients.
Subject(s)
Dental Prosthesis, Implant-Supported , Denture, Overlay , Adult , Age Factors , Aged , Dental Prosthesis Design , Female , Humans , Male , Mandible , Middle Aged , Prospective StudiesABSTRACT
Early in the implant era, transmandibular implant systems were used for retention of implant-retained mandibular overdentures in the severely resorbed mandible. These transmandibular systems require very thorough aftercare, especially when patients become frail and dependent on care. As a result, oral care often receives less attention in frail elderly patients or the patient cannot maintain the needed level of oral care. Care providers often are unfamiliar with the level of oral care needed to preserve transmandibular implants in good condition. This case series describes the risk for severe complications, including chronic pain and fracture of the mandible, in frail elderly patients who were unable to maintain oral care at the desired level and whose caregivers did not provide the needed level of oral care.
Subject(s)
Dental Prosthesis, Implant-Supported/adverse effects , Denture, Overlay , Frail Elderly , Mandible/surgery , Aged , Aged, 80 and over , Female , Humans , MaleABSTRACT
In 2008, Paulo Zamboni pioneered the 'liberation procedure' for treating multiple sclerosis (MS), claiming that MS is caused by an abnormality of venous drainage which he called chronic cerebrospinal venous insufficiency (CCSVI). CCSVI has been very controversial, both socio-politically and scientifically after going 'viral' via social media. In late 2012, only 56 original scientific research papers had been published on the 'CCSVI syndrome'; however, over 1,150,000 hits on Google existed when searching for the term 'chronic cerebrospinal venous insufficiency' or CCSVI. It is unclear whether the scientific community's response to CCSVI was influenced by Zamboni's original articles, a reactionary response to the 'social phenomenon' of CCSVI or indeed a complex interplay between both these factors. Furthermore, the epidemiology of this 'social phenomenon' remains un-investigated. A PubMed literature search revealed that the greatest level of public interest in CCSVI, as measured by Google Trends, occurred after only 30% of primary articles and 11% of negative studies were submitted for publication. The epicentre of social epidemic has been divided between Italy and Canada. Whilst Canadian scientists had yet to publish a primary article on CCSVI, it had a relative 76% search volume on Google Trends. It is likely that this public interest was sparked by media and political opportunism and fuelled by social media that was disconnected from the scientific community. Our findings call for a concerted effort for clinicians and scientists to engage with the public to ensure that uptake and spread of scientific discoveries via social media are viewed and interpreted in an appropriate context. Examples of how this may be achieved will also be discussed.