Metformin Use Is Associated With Lower Mortality in Veterans With Diabetes Hospitalized With Pneumonia.

BACKGROUND: Recent studies suggest that metformin use may be associated with improved infectious disease-related outcomes, whereas other papers suggest potentially worse outcomes in serious bacterial infections. Our purpose was to examine the association of prior outpatient prescription of metformin on 30- and 90-day mortality for older veterans with pre-existing diabetes hospitalized with pneumonia. METHODS: We conducted a retrospective cohort study using national Department of Veterans Affairs data of patients ≥65 years with a prior history of diabetes who were hospitalized with pneumonia over a 10-year period (fiscal years 2002-2012.) For our primary analysis, we created a propensity score and matched metformin users to nonusers 1:1. RESULTS: We identified 34 759 patients who met the inclusion criteria, 20.3% of whom were prescribed metformin. Unadjusted 30-day mortality was 9.6% for those who received metformin versus 13.9% in nonusers (P < .003), and 90-day mortality was 15.8% for those who received metformin versus 23.0% for nonusers (P < .0001). For the propensity score model, we matched 6899 metformin users to 6899 nonusers. After propensity matching, both 30-day (relative risk [RR]: .86; 95% confidence interval [CI]: .78-.95) and 90-day (RR: .85; 95% CI: .79-.92) mortality was significantly lower for metformin users. CONCLUSIONS: Prior receipt of metformin was associated with significantly lower mortality after adjusting for potential confounders. Additional research is needed to examine the safety and potential benefits of metformin use in patients with respiratory infections.

Improved dental student clinical skills performance through an integrated dental and medical student curriculum.

PURPOSE/OBJECTIVES: In light of a movement to eliminate the historical separation of dentistry and medicine to produce more collaborative and knowledgeable clinicians and to improve care, integrated education models are vital. This study aimed to demonstrate the effectiveness of an integrated medical and dental student curriculum at the University of Connecticut. It was hypothesized that a medical and dental student doctoring course within an already combined biomedical curriculum would result in statistically significantly increases in dental student clinical skills performance. METHODS: Analysis of variance (ANOVA) was utilized for an overall test of scores from 2016 to 2019. When ANOVA indicated significant differences, post hoc pairwise comparisons using Tukey's adjustment classified pairs that differed significantly. Lastly, a contrast was constructed to test the difference before and after the course's introduction. A two-sided α of 0.05 was used. RESULTS: Dental students were assessed on three cases for history taking and master interview rating scale (MIRS) criteria. The mean averages in history taking and MIRS criteria after the implementation of this course increased by 7.81 (SE = 1.83, p < 0.0001) and 11.95 (SE = 1.34, p < 0.0001) for a toothache case, 11.37 (SE = 1.98, p < 0.0001) and 9.84 (SE = 1.35, p < 0.0001) for a loose bridge case, and 12.47 (SE = 1.75, p < 0.0001) and 10.07 (SE = 1.28, p < 0.0001) for a sensitive tooth case. CONCLUSION: An integrated doctoring course within a combined curriculum at the University of Connecticut Schools of Medicine and Dental Medicine resulted in a statistically significant increase in dental student clinical skills assessment scores, demonstrating this model's utility.