Hospital initiatives in promoting smoking cessation: A 12-year follow-up.

In the present study, the availability of smoking cessation programs (SCP) was surveyed in the same randomly selected USA hospitals in 2000 and 2012. A total of 102 USA hospitals were randomly selected for this survey. Each hospital website was searched for the topic of smoking cessation. In the second phase of the survey, the main switchboard number of each hospital was anonymously telephoned and the 'stop smoking clinic' was requested. The phone survey results showed that the percentage of hospital switchboard calls that were connected to a SCP remained identical at 47% in 2000 and 2012. The results for the internet availability of SCP on hospital websites improved from 30% in 2000 to 47% in 2012. There were more hospitals that added additional SCP information (27%) compared with those that removed SCP information (15%) by 2012. Among the 57% of hospitals that showed no change in internet SCP information, 22% remained positive for such information while 35% remained negative. The phone survey of hospitals showed that 47% of USA hospitals were able to connect a caller to a SCP in the years 2000 and 2012. While there was no reduction over the 12 years, there was no increase in the percentage of hospital switchboards that connected to a SCP. Availability of SCP information on hospital web sites improved to a limited extent; increasing from 30% of sites in 2000 to 47% in 2012. Providing SCP on a hospital website is easy and free, for example adding a link to QuitNet or QuitLink. The present study adds to information gathered 12 years earlier, and is unusual in being able to provide follow-up data on the same set of hospitals studied previously.

Preventing "a bridge too far": promoting earlier identification of dislodged dental appliances during the perioperative period.

The presence of fixed partial dentures presents a unique threat to the perioperative safety of patients that require orotracheal intubation or placement of instruments into the gastrointestinal (GI) tract. There are many chances for the displacement of a fixed partial denture: instrumentation of the airway for intubation, or introduction of temporary devices, such as gastroscopes or transesophageal echo probes. If dislodged, the fixed partial dentures can enter the hypopharynx, esophagus or lungs and cause perforations with their sharp tines. Oral or esophageal perforation can lead to potentially fatal mediastinitis. We describe a case of a patient with a fixed partial denture who underwent cardiac surgery with intubation and transesophageal echocardiography (TEE). His partial denture was intact after the procedure. After extubation, he reported that his teeth were missing. Multiple procedures were required to remove his dislodged partial dentures. In sign-out reports, verbal descriptions of the patient's partial dentures were not adequate in this case. A picture of the patient's denture and oral pharynx pre-operatively would have provided a more accurate template for the post-operative team to refer to when caring for the patient. This may have avoided the multiple potentially risky procedures the patient had to undergo. We describe a suggested protocol utilizing a pre-operative photo to reduce the incidence of unrecognized partial denture dislodgement in the perioperative period. Because the population is aging, this will become a more frequent issue confronting practitioners. This protocol could mitigate this complication.

Mesenchymal stem cells accelerate bone allograft incorporation in the presence of diabetes mellitus.

Allograft (Allo) incorporation in the presence of a systemic disease like diabetes mellitus (DM) is becoming a major issue in the orthopedic community. Mesenchymal stem cells (MSC) are multipotent stem cells that may be derived from adult, whole bone marrow and have been shown to induce bone formation in segmental defects when combined with the appropriate carrier/scaffold. The objectives of this study were to analyze the effect of DM upon Allo incorporation in a segmental rat femoral defect and to also investigate MSC augmentation of Allo incorporation. Segmental (5 mm) femoral defects were created in non-DM and DM rats and treated with Allo containing demineralized bone matrix (DBM) or DBM with MSC augmentation. Histological scoring at 4 weeks demonstrated less mature bone in the DM/DBM group compared to its non-DM counterpart (p < 0.001). However, there was significantly more mature bone in the DM/MSC group when compared to the DM/DBM group at both 4 and 8 weeks (p < 0.001 and p = 0.004). Furthermore, significantly more bone formation was observed in the DM/MSC group compared to the DM/DBM group at the 4-week time point (p < 0.001). The results of this study suggest that MSC are a potential adjunct for bone regeneration when implanted in an orthotopic site in the presence of DM.

rhBMP-2 enhances the bone healing response in a diabetic rat segmental defect model.

OBJECTIVE: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to enhance new bone formation in fracture and bone defect models in both normal and diabetic rats. Effects of rhBMP-2 in a segmental femoral defect model in diabetes mellitus (DM) BB Wistar rats have not been reported. METHODS: Collagen sponge soaked with either buffer or rhBMP-2 was inserted in a mid-diaphyseal 3.0-mm defect fixed with polyimide plate and stainless steel screws, in 62 DM BB Wistar rats. Progress of new bone formation in the defect was monitored with serial radiographs every 2 weeks. Histomorphometric analysis of the new bone formation was done on undecalcified sections of the extracted femurs at 3 and 6 weeks post surgery. Further analysis of the new bone was done by assessment of neoangiogenesis using immunohistochemical staining for Platelet endothelial cell adhesion molecule-1. Mechanical testing was performed at 9 weeks to assess the new bone with respect to 4 different parameters of mechanical and structural properties of bone. RESULTS: Radiographs assessed over a 6-point grading system showed statistically significant improvement in scores in rhBMP-2-treated rats at 6 weeks (P < 0.001). Histomorphometric analysis showed statistically significant increase in area of new bone formation between rats treated with rhBMP-2 compared with buffer at both 3 and 6 weeks (P < 0.001). On Platelet endothelial cell adhesion molecule-1 staining at 3 weeks, the mean number of vessels in rhBMP-2-treated DM rats was 12.76 +/- 5.43/mm(2) compared with 4.49 +/- 1.89/mm(2) in buffer treated DM rats (P = 0.034). On mechanical testing, all 4 DM/buffer rats had nonunion. In DM/rhBMP-2 rats, the torque to failure and torsional rigidity values were 393.57 +/- 233.3 (P < 0.03) and 29,711 +/- 6224 (P < 0.002), respectively. CONCLUSIONS: Clearly, although DM has a known impact on osseous healing, its negative effects are ameliorated with the application of the rhBMP-2-collagen carrier and demonstrates the potential clinical role of this adjunct in the clinical arena.