Longevity of dental restorations in Sjogren's disease patients using electronic dental and health record data.

BACKGROUND: Decreased salivary secretion is not only a risk factor for carious lesions in Sjögren's disease (SD) but also an indicator of deterioration of teeth with every restorative replacement. This study determined the longevity of direct dental restorations placed in patients with SD using matched electronic dental record (EDR) and electronic health record (EHR) data. METHODS: We conducted a retrospective cohort study using EDR and EHR data of Indiana University School of Dentistry patients who have a SD diagnosis in their EHR. Treatment history of patients during 15 years with SD (cases) and their matched controls with at least one direct dental restoration were retrieved from the EDR. Descriptive statistics summarized the study population characteristics. Cox regression models with random effects analyzed differences between cases and controls for time to direct restoration failure. Further the model explored the effect of covariates such as age, sex, race, dental insurance, medical insurance, medical diagnosis, medication use, preventive dental visits per year, and the number of tooth surfaces on time to restoration failure. RESULTS: At least one completed direct restoration was present for 102 cases and 42 controls resulting in a cohort of 144 patients' EDR and EHR data. The cases were distributed as 21 positives, 57 negatives, and 24 uncertain cases based on clinical findings. The average age was 56, about 93% were females, 54% were White, 74% had no dental insurance, 61% had public medical insurance, < 1 preventive dental visit per year, 94% used medications and 93% had a medical diagnosis that potentially causes dry mouth within the overall study cohort. About 529 direct dental restorations were present in cases with SD and 140 restorations in corresponding controls. Hazard ratios of 2.99 (1.48-6.03; p = 0.002) and 3.30 (1.49-7.31, p-value: 0.003) showed significantly decreased time to restoration failure among cases and positive for SD cases compared to controls, respectively. Except for the number of tooth surfaces, no other covariates had a significant influence on the survival time. CONCLUSION: Considering the rapid failure of dental restorations, appropriate post-treatment assessment, management, and evaluation should be implemented while planning restorative dental procedures among cases with SD. Since survival time is decreased with an increase in the number of surfaces, guidelines for restorative procedures should be formulated specifically for patients with SD.

Survival analysis of posterior composite restorations in National Dental PBRN general dentistry practices.

OBJECTIVE: Quantify the survival of posterior composite restorations (PCR) placed during the study period in permanent teeth in United States (US) general dental community practices and factors predictive of that survival. METHODS: A retrospective cohort study was conducted utilizing de-identified electronic dental record (EDR) data of patients who received a PCR in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The final analyzed data set included 700,885 PCRs from 200,988 patients. Descriptive statistics and Kaplan Meier (product limit) estimator were performed to estimate the survival rate (defined as the PCR not receiving any subsequent treatment) after the first PCR was observed in the EDR during the study time. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. RESULTS: The overall median survival time was 13.3 years. The annual failure rates were 4.5-5.8 % for years 1-5; 5.3-5.7 %, 4.9-5.5 %, and 3.3-5.2 % for years 6-10, 11-15, and 16-20, respectively. The failure descriptions recorded for < 7 % failures were mostly caries (54 %) and broken or fractured tooth/restorations (23 %). The following variables significantly predicted PCR survival: number of surfaces that comprised the PCR; having at least one interproximal surface; tooth type; type of prior treatment received on the tooth; Network region; patient age and sex. Based on the magnitude of the multivariable estimates, no single factor predominated. CONCLUSIONS: This study of Network practices geographically distributed across the US observed PCR survival rates and predictive factors comparable to studies done in academic settings and outside the US. CLINICAL SIGNIFICANCE: Specific baseline factors significantly predict the survival of PCRs done in US community dental practices.

Illness representations of vaping associated lung injury (VALI) and E-cigarette use: common sense model of self-regulation driven mixed-method approach.

OBJECTIVE: The study explored differences in illness representations of VALI guided by the Common-Sense Model of Self-Regulation (CSM-SR) among non-patient adults. DESIGN: We employed a cross-sectional concurrent mixed-methods design. In the quantitative analysis, we used multivariate analysis of covariance (MANCOVA). Immersion/crystallization was used to analyze qualitative data. MAIN OUTCOME MEASURES: We measured differences in illness representations of VALI by e-cigarette use status, gender, and urban/rural residence. RESULTS: E-cigarette use was associated with illness representations of VALI. Current e-cigarette users discounted the detrimental nature of VALI, compared to former and never e-cigarette users. Gender and urban/rural residence moderated the association between e-cigarette use and illness representation of VALI. In the qualitative analysis, 49.3% respondents reported components of the timeline (e.g. permanent), identity (e.g. shortness of breath), causes (e.g. THC products), consequences (e.g. life-threatening), cure/control (e.g. stop vaping), and worry (e.g. fearful). CONCLUSION: Perceptions about VALI, such as cure and timeline, were associated with e-cigarettes use. Understanding the context in which adults perceive VALI, such as gender and rurality, may contribute to developing interventions that influence e-cigarette cessation. Future research employing CSM-SR to target strategies for promoting vaping abstinence is warranted.

Automatic Identification of Self-Reported COVID-19 Vaccine Information from Vaccine Adverse Events Reporting System.

BACKGROUND: The short time frame between the coronavirus disease 2019 (COVID-19) pandemic declaration and the vaccines authorization led to concerns among public regarding the safety and efficacy of the vaccines. The Food and Drug Administration uses the Vaccine Adverse Events Reporting System (VAERS) where general population can report their vaccine side effects in the text box. This information could be utilized to determine self-reported vaccine side effects. OBJECTIVE: To develop a supervised and unsupervised natural language processing (NLP) pipeline to extract self-reported COVID-19 vaccination side effects, location of the side effects, medications, and possibly false/misinformation seeking further investigation in a structured format for analysis and reporting. METHODS: We utilized the VAERS dataset of COVID-19 vaccine reports from November 2020 to August 2022 of 725,246 individuals. We first developed a gold-standard (GS) dataset of randomly selected 1,500 records. Second, the GS was split into training, testing, and validation sets. The training dataset was used to develop the NLP applications (supervised and unsupervised) and testing and validation datasets were used to test the performances of the NLP application. RESULTS: The NLP application automatically extracted vaccine side effects, body locations of the side effects, medication, and possibly misinformation with moderate to high accuracy (84% sensitivity, 82% specificity, and 83% F-1 measure). We found that 23% people (386,270) faced arm soreness, 31% body swelling (226,208), 23% fatigue/body weakness (168,160), and 22% (159,873) cold/flue-like symptoms. Most of the complications occurred in the body locations such as the arm, back, chest, neck, face, and head. Over-the-counter pain medications such as Tylenol and Ibuprofen and allergy medication like Benadryl were most reported self-reported medications. Death due to COVID-19, changes in the DNA, and infertility were possible false/misinformation reported by people. CONCLUSION: Some self-reported side effects such as syncope, arthralgia, and blood clotting need further clinical investigations. Our NLP application may help in extracting information from big free-text electronic datasets to help policy makers and other researchers with decision making.

Systematic review and meta-analysis of randomized controlled trials of interventions addressing caregiver distress and burden among cancer caregivers.

Objective: Informal caregivers (ICs) are vital to supportive cancer care and assisting cancer patients, but this caregiving burden is associated with significant distress. While addressing caregiving, it is important to explore if the caregivers are receiving care they need. Evaluating interventions that address burden and distress is integral to targeting ICs needs. This study evaluated interventions addressing IC burden and distress. Methods: Randomized control trials (RCT) assessing interventions for IC burden and distress and exploring supportive care as an adjunct to the intervention were included. Six electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through October 2021. Effect sizes were estimated, and risk of bias was assessed. Results: Of 678 studies, 11 were included. Most ICs were spouses, females, and white. Interventions included educational programs, cognitive behavioral treatment, and a telephone support program. Five studies utilized behavioral theories and seven included supportive care. Pooled results showed no significant effect on reducing caregiver distress (ES, -0.26, p<0.001). Conclusions: Caring for the caregiver with interventions for reducing burden and distress are not efficacious. Innovative, well-designed, more pragmatic RCTs are needed. Innovation: This study exclusively focused on interventions and supportive care needs for reducing distress and burden among cancer ICs.

Factors associated with COVID-19-related mental health among Asian Indians in the United States.

Background: In the United States, the COVID-19 pandemic has caused increased mental health symptoms and mental illness. Specific subgroups such as Asian Indians in the US have also been subject to additional stressors due to unprecedented loss of lives in their home country and increased Asian hate due to the misperception that Asians are to be blamed for the spread of the SARS-CoV-2. Objective: We examined the various factors including discrimination associated with COVID-19-related mental health symptoms among Asian Indians. Methods: We administered an online survey between May 2021 and July 2021 using convenient and snowball sampling methods to recruit Asian Indian adults (age > 18 years, N = 289). The survey included questions on mental health and the experience with unfair treatment in day-to-day life. Descriptive analysis and logistic regressions were performed. Results: Overall, 46.0% reported feeling down, depressed, or lonely and feeling nervous, tense, or worried due to the COVID-19 pandemic; 90.0% had received at least one dose of vaccination and 74.7% reported some form of discrimination. In the fully-adjusted logistic regression, age (AOR = 0.95; 95%CI- 0.92, 0.97;p < 0.01) and general health (AOR=0.84; 95%CI- 0.73, 0.97; p < 0.015) were negatively associated with mental health symptoms. Participants who experienced discrimination were more likely (AOR=1.26; 95%CI- 1.08, 1.46; p < 0.01) to report mental health symptoms. Conclusion: In this highly vaccinated group of Asian Indians discriminatory behaviors were associated with mental health symptoms suggesting the need for novel institutional level policy responses to reduce anti-Asian racism.

Psychological Distress Among Asian Indians and Non-Hispanic Whites in the United States.

Introduction: The prevalence of psychological distress (PD) among Asian Indians is unknown. This study estimated and compared moderate-serious PD in Asian Indians and non-Hispanic Whites (NHWs) in the United States. Methods: We used a cross-sectional design using the National Health Interview Survey (2012-2017). Adult (age >18 years) NHWs and Asian Indians (N=2,218) were included. PD was measured using the six-item Kessler (K6) scale. We used multivariable logistic regression to determine the association of Asian Indian ethnicity with PD. Results: In the analysis, 19.9% of NHWs and 11.0% of Asian Indians reported moderate-serious PD. Asian Indians were less likely to report PD in both unadjusted (unadjusted odds ratio=0.50; 95% confidence interval [CI]=0.42-0.58) and fully adjusted (adjusted odds ratio=0.7; 95% CI 0.59-0.82) models. Conclusions: Asian Indians had a lower prevalence of PD than NHWs, likely due to multiple protective factors such as high socioeconomic status and lower multimorbidity.

Cost impact of different treatment regimens of brolucizumab in neovascular age-related macular degeneration: A budget impact analysis.

BACKGROUND: Brolucizumab is a new anti-vascular endothelial growth factor (anti-VEGF) approved for treating neovascular age-related macular degeneration (nAMD). Multiple treatment regimens are available for treating nAMD. These regimens include manufacturer-recommended regimens, pro re nata (PRN) regimens, and treat-and-extend (T&E) regimens, which are based on clinical practice guidelines and data observed in the real-world clinical setting, classified as real-world evidence (RWE). Most budget impact models predict the financial consequences of adding a new drug to the formulary based on the manufacturer-recommended regimen. With different anti-VEGF treatment regimens being used in nAMD by ophthalmologists, it is OBJECTIVE: To estimate the budget impact of different treatment regimens of brolucizumab in nAMD from a US payer perspective. METHODS: A Microsoft Excel-based budget impact model was developed for different treatment regimens of brolucizumab over a 1-year time frame from a US payer perspective. A separate analysis was performed to estimate the budget impact from a US patient population perspective. Model inputs included drug costs, administration costs, physician visit costs, and disease monitoring costs. Outcomes in the budget impact model included the cost per member per month, annual health plan cost, and the US patient population-based annual cost. Based on the prevalence of nAMD in public and commercial health plans, a scenario analysis was conducted on the US population to account for the differences in the drug cost to the public and commercial payers. Further, 1-way sensitivity analyses were conducted to test model assumptions and uncertainty in model inputs. RESULTS: The addition of brolucizumab to the formulary increased the net budgetary impact under PRN and T&E regimens. The maximum increase in expenditure for a hypothetical health plan with 1 million enrollees was associated with the PRN regimen ($824,696), followed by the T&E regimen ($163,101). In contrast, using the manufacturer-recommended and RWE regimens led to an annual saving of $93,068 and $94,170 for the health plan, respectively. In the US patient population model, the introduction of brolucizumab resulted in savings in the manufacturer-recommended ($30.99 million) and RWE regimens ($31.35 million) but led to an increase in annual expenditures for the PRN ($274.58 million) and T&E ($54.30 million) regimens. CONCLUSIONS: Payers need to evaluate the cost impact of different treatment regimens of existing and new anti-VEGFs when making formulary decisions in nAMD management. DISCLOSURES: Mr Siddiqui, Ms Dhumal, Dr Patel, and Dr LeMasters have nothing to disclose. Dr Kamal has received research funding from Cerevel Therapeutics, served as a consultant to Pfizer/Cytel Inc, and received honoraria from Pharmacy Times Continuing Education. Dr Almony has served as a consultant to Cardinal Health and received honoraria from Pharmacy Times Continuing Education and Prime Education.

Differences in medication usage of dental patients by age, gender, race/ethnicity and insurance status.

BACKGROUND: Limited studies have investigated the medication profile of young adult dental patients despite the high prevalence of prescription opioid abuse in this population. OBJECTIVE: This study investigated the extent and differences in medication usage of dental patients older than 18 years by age, race/ethnicity, gender, insurance status and mechanism of action in an academic dental clinic setting. METHODS: Using an automated approach, medication names in the electronic dental record were retrieved and classified according to the National Drug Code directory. Descriptive statistics, multivariable ANOVA and Post hoc tests were performed to detect differences in the number of medications by patient demographics. RESULTS: Of the 11,220 adult patients, 53 percent reported taking at least one medication with significant differences in medication usage by demographics. Hydroxymethylglutaryl-coenzyme A reductase inhibitors (21-36%), and angiotensin-converting enzyme inhibitors (19-23%) ranked the top two medication classes among patients 55 years and older. Opioid agonists (7-14%), and Selective Serotonin Reuptake Inhibitors (SSRIs) (5-12%) ranked the top two medication classes among patients aged 18-54 years. CONCLUSIONS: The results underscore the importance of dental providers to review medical and medication histories of patients regardless of their age to avoid adverse events and to determine patient's risk for opioid abuse.

Leveraging Electronic Dental Record Data for Clinical Research in the National Dental PBRN Practices.

OBJECTIVES: The aim of this study is to determine the feasibility of conducting clinical research using electronic dental record (EDR) data from U.S. solo and small-group general dental practices in the National Dental Practice-Based Research Network (network) and evaluate the data completeness and correctness before performing survival analyses of root canal treatment (RCT) and posterior composite restorations (PCR). METHODS: Ninety-nine network general dentistry practices that used Dentrix or EagleSoft EDR shared de-identified data of patients who received PCR and/or RCT on permanent teeth through October 31, 2015. We evaluated the data completeness and correctness, summarized practice, and patient characteristics and summarized the two treatments by tooth type and arch location. RESULTS: Eighty-two percent of practitioners were male, with a mean age of 49 and 22.4 years of clinical experience. The final dataset comprised 217,887 patients and 11,289,594 observations, with the observation period ranging from 0 to 37 years. Most patients (73%) were 18 to 64 years old; 56% were female. The data were nearly 100% complete. Eight percent of observations had incorrect data, such as incorrect tooth number or surface, primary teeth, supernumerary teeth, and tooth ranges, indicating multitooth procedures instead of PCR or RCT. Seventy-three percent of patients had dental insurance information; 27% lacked any insurance information. While gender was documented for all patients, race/ethnicity was missing in the dataset. CONCLUSION: This study established the feasibility of using EDR data integrated from multiple distinct solo and small-group network practices for longitudinal studies to assess treatment outcomes. The results laid the groundwork for a learning health system that enables practitioners to learn about their patients' outcomes by using data from their own practice.

Evaluation of a Dental Diagnostic Terminology Subset.

The objective of this study was to determine how well a subset of SNODENT, specifically designed for general dentistry, meets the needs of dental practitioners. Participants were asked to locate their written diagnosis for tooth conditions among the SNODENT terminology uploaded into an electronic dental record. Investigators found that 65% of providers' original written diagnoses were in "agreement" with their selected SNODENT dental diagnostic subset concept(s).

Characterizing Restorative Dental Treatments of Sjögren's Syndrome Patients Using Electronic Dental Records Data.

Scant knowledge exists on the type of restorative treatments Sjögren's syndrome patients (SSP) receive in spite of their high dental disease burden due to hyposalivation. Increased adoption of electronic dental records (EDR) could help in leveraging information from these records to assess dental treatment outcomes in SSP. In this study, we evaluated the feasibility of using EDR to characterize the dental treatments SSP received and assess the longevity of implants in these patients. We identified 180 SSP in ten years of patients' data at the Indiana University School of Dentistry clinics. A total of 104 (57.77%) patients received restorative or endodontic treatments. Eleven patients received 23 implants with a survival rate of 87% at 40 months follow-up. We conclude that EDR data could be used for characterizing the treatments received by SSP and for assessing treatment outcomes.

Identifying Patients' Smoking Status from Electronic Dental Records Data.

Smoking is a significant risk factor for initiation and progression of oral diseases. A patient's current smoking status and tobacco dependency can aid clinical decision making and treatment planning. The free-text nature of this data limits accessibility causing obstacles during the time of care and research utility. No studies exist on extracting patient's smoking status automatically from the Electronic Dental Record. This study reports the development and evaluation of an NLP system for this purpose.

Extraction and Evaluation of Medication Data from Electronic Dental Records.

With an increase in the geriatric population, dental care professionals are presented with older patients who are managing their comorbidities using multiple medications. In this study, we developed a system to extract medication information from electronic dental records (EDRs) and provided patient distribution by the number of medications.