Same day access: a viable alternative for outpatient clinical care.

OBJECTIVE: To present our experience with a novel, same-day access (SDA) scheduling model for outpatient clinical care in oral and maxillofacial surgery (OMS). STUDY DESIGN: The primary outcome variable was OMS patient scheduling in a hospital-based outpatient clinic. Patients were given a specific appointment time to be seen the same day they contacted the clinic. This SDA clinic was compared to previous patient scheduling models for patient satisfaction, appointment wait times, annual clinic volume, no-show rates, and access to care. RESULTS: Patient satisfaction increased to 80% with SDA scheduling compared with 20% to 40% with prior models. The average wait time for patients improved to 19 minutes compared with 330 minutes with the walk-in model. Forty patients were scheduled on the same day, and 96% of all patients who called the clinic were seen within 14 days with the SDA approach. Same-day access was the only model that met its volume and budgetary goals. CONCLUSIONS: The incorporation of SDA scheduling improves patient satisfaction and is a viable alternative to more traditional scheduling protocols for clinics suffering from volume, revenue, and access to care issues.

Lactate-Loaded Nanoparticles Induce Glioma Cytotoxicity and Increase the Survival of Rats Bearing Malignant Glioma Brain Tumor.

A glioblastoma is an aggressive form of a malignant glial-derived tumor with a poor prognosis despite multimodal therapy approaches. Lactate has a preponderant role in the tumor microenvironment, playing an immunoregulatory role as well as being a carbon source for tumor growth. Lactate homeostasis depends on the proper functioning of intracellular lactate regulation systems, such as transporters and enzymes involved in its synthesis and degradation, with evidence that an intracellular lactate overload generates metabolic stress on tumor cells and tumor cell death. We propose that the delivery of a lactate overload carried in nanoparticles, allowing the intracellular release of lactate, would compromise the survival of tumor cells. We synthesized and characterized silica and titania nanoparticles loaded with lactate to evaluate the cellular uptake, metabolic activity, pH modification, and cytotoxicity on C6 cells under normoxia and chemical hypoxia, and, finally, determined the survival of an orthotopic malignant glioma model after in situ administration. A dose-dependent reduction in metabolic activity of treated cells under normoxia was found, but not under hypoxia, independent of glucose concentration. Lactated-loaded silica nanoparticles were highly cytotoxic (58.1% of dead cells) and generated significant supernatant acidification. In vivo, lactate-loaded silica nanoparticles significantly increased the median survival time of malignant glioma-bearing rats (p = 0.005) when administered in situ. These findings indicate that lactate-loaded silica nanoparticles are cytotoxic on glioma cells in vitro and in vivo.

Herpesvirus encephalitis diagnosed by polymerase chain reaction at the National Institute of Neurology of Mexico.

The frequency of central nervous system infections due to herpesvirus have been studied in various populations; however, studies in Mexican mestizo patients are scant. This paper documents the frequency of herpesvirus encephalitis in Mexican mestizo patients from the National Institute of Neurology and Neurosurgery (NINN) of Mexico. To study the frequency of herpetic viral encephalitis at the NINN in the period from 2004 to 2009. We reviewed clinical records from patients with clinically suspected encephalitis; polymerase chain reaction assays were done for detection of herpesviruses in cerebrospinal fluid (CSF) samples. The total number of patients studied was 502; in 59 (12%), the diagnosis of herpetic encephalitis was confirmed by PCR-based testing of CSF. Of them, 21 (36%) were positive for herpes simplex virus type 1, 15 (25%) for Epstein-Barr virus, 10 (17%) for varicella zoster virus, 8 (14%) for cytomegalovirus, 3 (5%) for human herpesvirus 6, and 2 (3%) for herpes simplex virus 2. Our results show a varied frequency of viral encephalitis in mestizo patients due to herpesviruses in a tertiary neurological center and point out the importance of modern molecular technology to reach the etiological diagnosis in cases of encephalitis.

Opioid prescribing patterns of oral and maxillofacial surgery residents.

OBJECTIVE: The aim of this study was to report on the opioid prescribing patterns of oral and maxillofacial surgery residents for routine office-based procedures. STUDY DESIGN: A survey was sent to current resident members of the American Association of Oral and Maxillofacial Surgeons (AAOMS). The survey asked questions related to the quantity and duration of opioids prescribed and if such factors as type of procedure, education, and prior opioid abuse by patients influenced prescription behavior. RESULTS: There was a positive relationship between the prescribing culture of residency and prescribing pattern (P value < .001). Concerns about factors that promote addiction were negatively associated with prescribing patterns (P value < .02). Prescribing culture and concerns about factors promoting addiction together explained 10% of the total variation. Residents receiving instruction on the risks of narcotic were less likely to prescribe opioids. CONCLUSIONS: Creating a culture in residency programs aimed at reducing factors that promote addiction may be the best method to reduce overprescription of opioids during training.

Outpatient Anesthesia Morbidity and Mortality Experience Among Massachusetts Oral and Maxillofacial Surgeons.

PURPOSE: The purpose of this retrospective study was to document the prevalence of different complications and the mortality rate for outpatient procedures performed under anesthesia by oral and maxillofacial surgeons in the Commonwealth of Massachusetts. MATERIALS AND METHODS: A mailed questionnaire was filled out by active members of the Massachusetts Society of Oral & Maxillofacial Surgeons who practiced using the single-operator-anesthetist model. Morbidity and mortality information was acquired for calendar years 2015 and 2016. RESULTS: The findings of this study were consistent with those of previous publications on the same topic. No office deaths occurred, and the mortality rate was 0 of 431,680 patient visits. The prevalence of other anesthesia-related complications was low. CONCLUSIONS: On the basis of the results of our study, we can conclude that the office-based team model used by oral and maxillofacial surgeons in Massachusetts for the delivery of outpatient anesthesia is safe with a low complication rate.

Treatment of odontogenic infections: An analysis of two antibiotic regimens.

PURPOSE: Retrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. PATIENTS AND METHODS: Evaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. RESULTS: 78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. CONCLUSION: Clindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.

Effects of Maintenance on Quality of Performance of Cryotherapy Devices for Treatment of Precancerous Cervical Lesions.

OBJECTIVE: The aim of the study was to evaluate the impact of maintenance on performance of cryosurgical equipment used in El Salvador primary health clinics. MATERIALS AND METHODS: Nine gynecological cryotherapy devices used in El Salvador were bench tested against a new machine of the same make and model. The devices were run for five successive double-freeze cycles. The El Salvador machines then received maintenance by a specialized engineer and another double-freeze cycle was performed. Temperature at the device probe tip was recorded throughout each cycle and ballistic gelatin was used as the tissue analogue to measure freeze ball dimensions achieved by the devices. Outcome measures were mean lowest-sustained temperatures and freeze ball mean weight, depth, and diameter. Paired and unpaired t tests were used to compare results premaintenance versus postmaintenance and postmaintenance versus the reference, respectively. RESULTS: Premaintenance versus postmaintenance freeze ball dimensions were significantly different (mean differences in weight = 2.31 g, p = .01; depth = 2.29 mm, p = .03; diameter = 3.51 mm, p = .02). However, postmaintenance dimensions were not significantly different than those of the reference (weight = 7.44 g vs. 8.39 g, p = .07; depth = 10.71 vs. 11.24 mm, p = .1; diameter = 31.38 mm vs. 32.05 mm, p = .3). Postmaintenance, minimum, and lowest-sustained temperatures were within the recommended clinical range. CONCLUSIONS: Specialized maintenance was necessary for heavily used cryotherapy devices to perform adequately, highlighting the challenges of gas-based cryotherapy in low- and middle-income countries.

A pilot study of community-based self-sampling for HPV testing among non-attenders of cervical cancer screening programs in El Salvador.

OBJECTIVE: To establish the feasibility and acceptability of home-based HPV self-sampling among women who did not attend screening appointments in rural El Salvador. METHODS: In a cross-sectional study, data were collected from May 2015 to January 2016 among 60 women aged 30-59 years who were not pregnant, provided informed consent, had not been screened in 2 years, had no history of pre-cancer treatment, and did not attend a scheduled HPV screening. Participants completed questionnaires and received educational information before being given an opportunity to self-sample with the Hybrid Capture 2 High Risk HPV DNA Test. RESULTS: Self-sampling was accepted by 41 (68%) participants. Almost all women chose to self-sample because the process was easy (40/41, 98%), could be performed at home (40/41, 98%), and saved time (38/41, 93%), and because they felt less embarrassed (33/41, 80%). The most common reason for declining the test was not wanting to be screened (8/19, 42%). The prevalence of high-risk HPV types among women who accepted self-sampling was 17% (7/41). CONCLUSION: For most women, community-based self-sampling was an acceptable way to participate in a cervical cancer screening program. In low-resource countries, incorporating community-based self-sampling into screening programs might improve coverage of high-risk women.

Impacto en el acceso a medicamentos en la población colombiana después de la actualización del plan de beneficios en el 2012 / Impact on the Access to Medication in Colombian Population after the Benefit Plan Update in 2012 / Impacto no acesso a remédios na populagáo colombiana após a atualizagáo do plano de beneficios no 2012

Objetivo: evaluar los cambios en la demanda de servicios en salud, luego de la actualización del plan de beneficios de Colombia, entre los años 2010 y 2012. Métodos: estudio tipo descriptivo y explicativo, donde se evalúa el uso de tecnologías sanitarias antes y después de la actualización del Plan Obligatorio de Salud. Se tomaron las dispensaciones de medicamentos entre el 2010 y el 2012 del Sistema de Información de Precios de Medicamentos. Para valorar los cambios se construyó una escala de valoración de cambios porcentuales. Resultados: se evidenciaron cambios en el comportamiento de la demanda de servicios. Como se esperaba, la actualización del Plan de Beneficios representa para los pacientes mayor acceso a las nuevas tecnologías, medido a través del mayor uso de tecnologías nuevas. Conclusión: la actualización del plan de beneficios mejoró el acceso de los pacientes a una gran parte de los servicios de salud.

Objective: Assessing the changes in the demand of health services after the update of the benefit plan in Colombia, during 2010 and 2012. Methods: Descriptive and Explanatory type study, where the use of healthcare technologies before and after the update of the Compulsory Health Plan is assessed. We took the drug dispensations between 2010 and 2012 from the Drug Price Information System. To assess the changes, we made an evaluation scale of percentage changes. Results: We found evidence of changes in the behavior of the demand of services. As expected, the update of the Benefits Plan represents greater access to new technologies, measured through a greater use of new technologies. Conclusion: The update of the Benefits Plan improved access for patients to a large part of the health services.

Objetivo: avaliar as mudancas na demanda de servicos em saúde, após atualizacao do plano de beneficios da Colombia, entre os anos 2010 e 2012. Métodos: estudo tipo descritivo e explicativo, onde avalia-se o uso de tecnologias sanitarias antes e depois da atualizacao do Plano Obrigatório de Saúde. Tomaram-se as dispensares de medicamentos entre o 2010 e 2012 do Sistema de Informacao de Precos de Medicamentos. Para avaliar as mudancas foi construída uma escala de valoracao de mudancas porcentuais. Resultados: evidenciaram-se mudancas no comportamento da demanda de servicos. Como esperado, a atualizacao do Plano de Beneficios representa para os pacientes maior acesso as novas tecnologias, medido a través do maior uso de tecnologia nova. Conclusao: a atualizacao do plano de beneficios melhorou o acesso dos pacientes a uma grande parte dos servicos de saúde.

Vector control in alveolar distraction osteogenesis.

Distraction osteogenesis is a surgical technique which utilizes the body's own reparative mechanisms for hard and soft tissue reconstruction. It has numerous applications in the maxillofacial complex, and has been successfully used for vertical and horizontal augmentation of alveolar ridges future prior to implant placement. In our opinion, this method is a useful and acceptable alternative to conventional bone grafting techniques in a selected group of patients. Although the concept of alveolar distraction is exciting, and has certain specific advantages (eg, soft tissue regeneration, predictable augmentation of height in the posterior mandible), optimal vector control of the distraction regenerate remains an issue of critical importance. The purpose of this article is to present our experience with some simple techniques that we have successfully used at our center for proper vector control during internal alveolar distraction osteogenesis.

Diagnóstico de laboratorio de las enfermerdades transmitidas por vectores / Laboratory Diagnosis to Diseases Transmitted by Vectories / Prevención y control del paludismo y otras metaxénicas

Técnicas de laboratorio en el diagnóstico de las ETV [Enfermedades transmitidas por vectores].- Toma, preparación y embalaje de las muestras.- Morfología de los parásitos, causantes de las ETV.- Red de control de calidad registro y notificación

Diagnóstico clínico y tratamiento de las enfermerdades transmitidas por vectores / Prevención y control del paludismo y otras metaxénicas / Clinical Diagnosis and Treatment to Diseases Transmitted by Vectories

Diagnóstico clínico de las ETV [Enfermedades transmitidas por vectores].- Principales métodos de diagnóstico.- Esquema de tratamiento y manejo de pacientes.- Sistemas de información

Participación comunitaria en la prevención y control de las enfermedades transmitidas por vectores / Prevención y control del paludismo y otras metaxénicas / Communitarian Participation in Prevention and Control of Diseases Transmitted by Vectories

Diagnóstico de las enfermedades transmitidas por vectores.- Los vectores de las ETV [Enfermedades transmitidas por vectores].- Tratamiento de las ETV.- Métodos de control de las ETV

Estrategias de control de las enfermedades transmitidas por vectores con participación comunitaria / Prevención y control del paludismo y otras metaxenicas / Strategies of Control of the Diseases Transmitted by Vectories with Communitarian Participation

Comportamiento epidemiológico, clínica y control de las ETV [Enfermedades transmitidas por vectores].- Participación comunitaria en el control de las ETV.- Aspectos gerenciales en el control de las ETV.- Planificación estratégica