Point of care tobacco treatment sustains during COVID-19, a global pandemic.

BACKGROUND: Tobacco cessation treatment for cancer patients is essential to providing comprehensive oncologic care. We have implemented a point of care tobacco treatment care model enabled by electronic health record (EHR) modifications in a comprehensive cancer center. Data are needed on the sustainability of both reach of treatment and effectiveness over time, including the COVID-19 pandemic. METHODS: Using EHR data from the pre-implementation (P: 5 months) and post-implementation periods (6 month-blocks, T1-T5 for a total of 30 months), we compared two primary outcomes: 1) reach of treatment among those smoking and 2) effectiveness assessed by smoking cessation among those smoking in the subsequent 6 month period. We analyzed the data using generalized estimation equation regression models. RESULTS: With the point of care tobacco treatment care model, reach of treatment increased from pre to post T5 (3.2 % vs. 48.4 %, RR 15.50, 95 % CI 10.56-22.74, p < 0.0001). Reach of treatment in all post periods (T1-T5 including the COVID-19 pandemic time) remained significantly higher than the pre period. Effectiveness, defined by smoking cessation among those smoking, increased from pre to post T2 before the pandemic (12.4 % vs. 21.4 %, RR 1.57, 95 % CI 1.31-1.87, p < 0.0001). However, effectiveness, while higher in later post periods (T3, T4), was no longer significantly increased compared with the pre period. CONCLUSION: A point of care EHR-enabled tobacco treatment care model demonstrates sustained reach up to 30 months following implementation, even during the COVID-19 pandemic and changes in healthcare prioritization. Effectiveness was sustained for 12 months, but did not sustain through the subsequent 12 months.

The Effect of Laser-Etched Surface Design on Soft Tissue Healing of Two Different Implant Abutment Systems: An Experimental Study in Dogs.

This study describes the early soft tissue morphology around two different implant systems that received either smooth or laser-etched abutments in a beagle dog model. Implants were placed in the healed mandibular molar region of eight beagle dogs and allowed to heal for 7 weeks. When the most apical aspect of the junctional epithelium (JE) was above or within the upper half of the laser-etched region, fibers were oriented perpendicular to the abutment surface. In contrast, JE positioned within the lower half of the laser-etched region or within or below the implant-abutment gap level presented fibers oriented parallel to the abutment surface.

Guidelines for Clinical Management of Laser-Etched (Laser-Lok) Abutments in Two Different Clinical Scenarios: A Preclinical Laboratory Soft Tissue Assessment Study.

One-stage implants were placed in the mandibles of eight beagle dogs with laser-etched (LL) and machined abutments. After 4 weeks, half of the LL abutments were disconnected and reconnected after 10 minutes of saline storage, and the other half were replaced with a new LL abutment (impression simulation) with or without sulcus de-epithelialization. After abutment change, systems remained in vivo for 3 weeks. Results showed that LL abutments can be reconnected and that sulcus scoring prior to LL placement of one-stage implants receiving machined abutments may be beneficial.

Overweight predicts poorer exercise capacity in congenital heart disease patients.

BACKGROUND: Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults. METHODS: Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85-95 or > 95 percentile respectively for age and gender or by adult criteria. Severity of CHD was assigned based on criteria published in standard guidelines. RESULTS: 63 patients had mild, 198 moderate, and 157 severe heart disease. Each ACHD group was 32 to 34% OW or OB. Measured exercise time (ET) of CHD patients with moderate or severe heart disease was less than that of controls in each weight categories. However, OB or OW people have shorter ET than their normal weight peers with CHD. Multiple regression using ET as the dependent variable finds that female sex, relative BMI, and VE/VCO2 at peak exercise are all associated with lesser ET with high significance. Peak heart rate is associated with greater ET, with borderline significance. Severity of heart disease is not independently associated with ET. CONCLUSIONS: OW and OB are strongly associated with reduced ET in persons with congenital heart disease. Losing weight may improve exercise capacity in ACHD.