Post-exchange neutrophil count, but not post-hematocrit, predicts endogenous erythropoiesis in patients with sickle cell disease undergoing chronic red cell exchange.

BACKGROUND: With chronic transfusion in sickle cell disease (SCD), equipoise exists regarding whether increasing the post-procedure hematocrit (Hct) suppresses endogenous erythropoiesis. Reticulocytosis predicts SCD morbidity and mortality, so this study's objective was to clarify the role of the post-procedure Hct in suppressing reticulocytosis and to identify other potential red cell exchange (RCE) parameters predictive of reticulocytosis. STUDY DESIGN AND METHODS: This retrospective analysis of 17 patients who underwent chronic RCE at a single institution between 2014 and 2022 examined both standard red cell exchanges (SRCE) and exchanges preceded by isovolemic hemodilution (IVH-RCE). Post-procedure parameters with biologic plausibility to influence the subsequent procedure's absolute reticulocyte count (sPre-ARC) were examined using regression modeling. RESULTS: Neither post-hematocrit, nor post-hemoglobin (Hb), nor ΔHb/day was associated with sPre-ARC or the change in HbS% per day (ΔHbS%/day). Concurrent Hb was predictive for SRCE but not IVH-RCE, where ARC trended lower than with SRCE. Male gender and post-procedure neutrophil and white cell counts were predictors of sPre-ARC, consistent with their associations with SCD morbidity and mortality. IVH-RCE had a stronger correlation than standard RCE between pre-Hct and neutrophil or white cell depletion. DISCUSSION: Although targeting a post-procedure Hct maintains a higher subsequent pre-procedure Hb and a lower sPre-HbS%, it does not lead to sustained suppression of reticulocytosis as measured by the sPre-ARC or the ΔHbS%/day. IVH-RCE or the addition of hydroxyurea could be considered in those patients with high reticulocyte, white blood cell, or neutrophil counts.

Comparison of computerized provider order entry specific transfusion indications versus the use of "Other".

BACKGROUND: Computerized physician order entry (CPOE) systems are one way to reinforce evidence-based transfusion indications for blood products. The new CPOE system that was implemented at our institution allowed healthcare providers to select "Other" as an indication and provide reasons for transfusion outside of accepted guidelines. STUDY DESIGN AND METHODS: Transfusion order records for packed red blood cells (RBCs), platelets, and fresh frozen plasma (FFP) from high product-ordering areas of Long Island Jewish Medical Center and Cohen's Children's Medical Center from April 2021, when the new CPOE system was implemented, to November 2021 were reviewed. The percentage of "Other" orders was determined and the reason for each "Other" order was reviewed to identify possible areas for education or valid indications not included in the institutionally recognized indications. RESULTS: 9.7% of RBC orders, 1.9% of platelet orders, and 18.2% of FFP orders were placed with "Other" as the indication for transfusion (χ2 2  = 88.5; p < .001). Reasons for "Other" orders were varied, but notable reasons included indications already institutionally accepted such as, bleeding (15.7% of pediatric "Other" RBC orders), hold for OR (14.3% of pediatric and 15.8% of adult "Other" RBC orders), and novel reasons such as FFP for ACE-inhibitor associated angioedema (84.6% of adult "Other" FFP orders). DISCUSSION: The findings from our study provide examples of potential difficulties hospitals may encounter when they implement a new computerized physician order entry system. Provider education may play an important role to reduce the number of "Other" orders placed for already recognized indications.

Tooth loss and dementia amongst older adults residing in long-term care facilities in Vancouver: A case-control study.

OBJECTIVE: The purpose of this case-control study was to determine the association between dementia and the number of missing teeth, functional occlusal units and denture use in older adults residing in Long-Term Care (LTC) facilities. BACKGROUND: Many studies have shown an association between dementia and tooth loss. However, few studies with a large sample size have been reported describing the relationship between dementia and the number of missing teeth, remaining teeth and functional occlusal units. METHODS: An oral health assessment database of 2160 older adults admitted to LTC facilities in Vancouver, Canada, between 2015-2019 was utilised. Participants with a diagnosis of dementia in their medical records (N = 1174) were compared to those without dementia (N = 986). Multiple logistic regression analysis was used to explore a potential association between the number of missing teeth, functional occlusal units and the use of dentures and dementia. RESULTS: The number of remaining teeth (OR = 1.0, 95% Confidence Interval = 1.0-1.0; P = .054) and number of functional occlusal units (OR = 1.0, 95% CI = 1.0-1.0; P = .059) were not associated with dementia after adjusting for age, sex, oral self-care and systemic conditions. Denture use (OR = 1.1, 95% CI = 0.5-2.4; P = .790) was not associated with dementia in edentulous patients. CONCLUSION: There was no association between dementia and the number of remaining teeth, functional occlusal units or wearing dentures.

Impact of the COVID-19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service.

BACKGROUND AND OBJECTIVE: In Canada, the COVID-19 pandemic was associated with significant morbidity and mortality in older adults, particularly those in long-term care (LTC). Access to oral health services was limited during the pandemic due to public health restrictions. The aim of this paper was to describe the impact of the pandemic on the clinical education and service of the University of British Columbia (UBC) Geriatric Dentistry Program (GDP), which provides care to LTC residents. METHODS: Data were collected from UBC GDP AxiUm dental software records, including number of dental appointments in 2019 and 2020. Data on revenue in 2019 and 2020 based on clinical production were collected through financial summary reports. Data on the number of educational rotations were collected from summary reports from scheduling software. RESULTS: In 2020, significant reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. The number of GDP appointments for June-December 2020 was lower by 68%. The clinical productivity reduced by 67% for the same period. Expenses were slightly reduced. The overall number of LTC clinical rotations for students were only slightly lower for undergraduate students in 2020 than in 2019, and it increased for graduate students. CONCLUSION: The COVID-19 pandemic and associated public health restrictions had a negative impact on the clinical service and productivity of the UBC GDP in 2020 relative to 2019. However, clinical educational rotations to LTC were slightly increased in 2020 relative to 2019. Dental care for LTC residents can be provided if rigorous administrative controls, engineering controls and personal protective equipment are employed.

Characteristics of Emergent and Essential Dental Services in University and Hospital-based Settings During COVID-19 Pandemic in Vancouver, Canada.

OBJECTIVES: In early 2020, COVID-19 was classified a pandemic. During phase 1 (16 March-18 May 2020) in British Columbia (BC), dental services were restricted to those that were emergent and essential. Such services were provided by several university and hospital-based dental clinics affiliated with the University of British Columbia (UBC), including the BC Cancer Agency Department of Oral Oncology (BCCA), BC Children's Hospital Department of Dentistry (BCCH) and the UBC Oral Health Centre (OHC). This study was designed to describe the types of in-person dental visits during phase 1. METHODS: Data were collected from electronic health records on all in-person dental visits between 16 March and 18 May 2020. Information included date of visit, demographics, reason for the dental visit and treatment provided. Data are presented using descriptive statistics. RESULTS: During phase 1, 396 patients were seen: 263 at the BCCA, 58 at BCCH and 75 at the OHC. At the BCCA, the most frequent reason for an in-person dental visit was essential consultation related to oncology treatment. At BCCH, the most frequent reason was pediatric oral/maxillofacial trauma. At these 2 sites, the most frequent treatment provided was consultation. At the OHC, the most frequent reason for a visit was severe odontogenic pain and infection, and the most frequent treatment was oral surgery. CONCLUSION: During phase 1, emergent and essential dental care was provided at 3 UBC-affiliated clinics. The most common reasons for an in-person visit were odontogenic infection, severe pain, trauma and essential consultations related to medical therapy. The most common treatments provided were consultations and oral surgery.

Accidental displacement of mandibular Third molars into the submandibular space - Two case reports, a suggested surgical approach and management algorithm.

Displacement of a mandibular third molar into a fascial space is a relatively rare event with potentially serious complications. The surgical procedure to remove a displaced tooth, or part thereof from these spaces may be difficult due to poor access and an abundance of vital structures within these spaces. Here, we present two cases of submandibular displacement, suggest an intra-oral approach and algorithm to help guide practitioners with management of displaced third molars in the submandibular space.