Racial disparities with PRN medication usage in inpatient psychiatric treatment

Racial disparities in psychiatric diagnoses and treatment have significant public health implications, contributing to inequities in healthcare outcomes. We specifically examined racial disparities regarding pro re nata (PRN), or as needed, medications. Data from 14,616 encounters across 2019-2020 within Community Health Network's inpatient psychiatric setting in Indianapolis, Indiana were included in this study. Due to the demographic sample size, analyses were narrowed to Black and White patients. Primary outcomes included comparisons across race for all PRN administrations and PRN administrations of antipsychotics vs. non-antipsychotics. Logistic regression was used to examine associations between race and PRN administrations by medication category, including all antipsychotics vs. non-antipsychotics overall, hydroxyzine, and lorazepam, independently. Significant differences in the percentage of administrations between Black and White patients were observed. Black patients received more PRN medications overall (71.0%) compared to White patients (67.7%) (p < 0.01). Further, while 17.7% of Black patients were administered PRN antipsychotics, this was true for only 8.2% of White patients (p < 0.001). When comparing antipsychotic PRNs with non-antipsychotic, hydroxyzine, and lorazepam PRNs, independently, Black patients were 58% (OR 1.58, p < 0.001), 109% (OR 2.09, p < 0.001), and 32% (OR 1.32, p < 0.001), more likely to receive antipsychotic PRNs, respectively, than White patients, controlling for sex, age, length of stay, and psychotic disorder diagnosis. Our study identifies yet another area of medical care with significant racial disparities. In this analysis of PRN medications during psychiatric admission, we identified significant differences in medication utilization by race. This information provides a basis for further investigation of disparities in patient-centered data.

Cultural Considerations in Working with Arab American Youth

There is limited literature on Arab American mental health, particularly among youth. This chapter will provide an overview of the Arab American/MENA population, their migration to the United States, traditional Arab culture and values, Arab American youth identity, acculturation and acculturation stress, the impact of discrimination on Arab American youth, mental illness in Arab American youth, and cultural variables to consider in seeking help. This chapter will provide recommendations and cultural considerations when working with Arab American youth.

Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients

Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical template and to demonstrate that immediate function can be easily performed with immediate implants in postextraction sites supporting full-arch rehabilitation. Material and Methods. 14 subjects were consecutively rehabilitated (13 maxillae and 1 mandible) with 99 implants supporting full-arch fixed prostheses followed between 6 and 24 months (mean of 16 months). Outcome measures were prosthesis and implant success, biologic and prosthetic complications, pain, oedema evaluation, and radiographic marginal bone levels at surgery and then at 6, 12, 18, and 24 months. Data were analyzed with descriptive statistics. Results. The overall cumulative implant survival rate at mean follow-up time of 16 months was 97.97%. The average marginal bone loss was 0,9 mm. Conclusions. Within the limitations of this study, the results validate this treatment modality for full-arch rehabilitations with predictable outcomes and high survival rate after 2 years.

[Computer-assisted implantology]

We had for aim to present the three applications of computer-assisted implantology: preoperative exploration of the surgery site, guided surgery, and preparation of the temporization prosthesis before surgery. Cases are presented for each indication and their clinical relevance is discussed.

A complete finite element model of a mandibular implant-retained overdenture with two implants: Comparison between rigid and resilient attachment configurations

PURPOSE

The aim of this study was to evaluate the influence of the retention mechanism on the behavior of a mandibular implant-retained overdenture (IRO) during the simulation of mastication. Therefore, a complete three-dimensional finite element model of a mandible with its IRO was developed.

MATERIALS AND METHODS

The geometry of the edentulous mandible and overdenture was generated from computed tomography. Two MKIII implants (Nobel Biocare) with ball abutments and Dalbo Plus (Cendres et Métaux) attachments were placed in the canine areas. Three foodstuff positions were analyzed for two retention mechanisms, "resilient" or "rigid". Special attention was given to the modeling of the mandibular environment and of the existing contact between the different components. A probable muscular action was determined following the minimal work principle.

RESULTS

The food-crushing force was provided by masseters with a two-third/one-third ratio between working and non-working sides. The "resilient" configuration provided a wider contact area between the mucosa of the denture bearing area and the prosthesis. An increase of the mastication force transiting through the mucosa was also noted and lower stresses were observed in the bone surrounding implants.

CONCLUSION

Resilient attachments allowed for an increase of the mastication load transiting through denture bearing surface. Furthermore, this study proposed an accurate model of the mandibular IRO, including its environment and faithful behavior reproduction.

Biomechanical study of a prosthetic solution based on an angled abutment: case of upper lateral incisor

OBJECTIVES

To study the complex behaviour of an upper lateral incisor restoration using an angled abutment, a mechanical analysis of the abutment bearing capacity was firstly carried out. The evolution of bone properties around implant was then simulated as a function of time to estimate the maximal load that could be supported by the prosthetic solution without bone damage.

MATERIALS AND METHODS

According to the Food and Drug Administration procedure, experimental tests were firstly carried out on five samples. A 25 degrees -angled abutment screwed to an implant embedded into a massive steel bloc was submitted to a static loading. Two finite element models were also built: the first one (I) to interpret and complete the results obtained in the experimental part and the second one (II) to simulate bone remodelling around implant considering a strain energy stimulus.

RESULTS

According to experiments, the abutment straightening was observed for an average force of 869N. Numerical model (I) confirmed this result and indicated that the initial irreversible deformation (yielding) of abutment was obtained for a 283N compressive force. It could thus be deduced that this abutment can safely be used for an incisor restoration. Model (II) showed that, after 26 months, some of the cancellous bone initially present in an approximately one millimetre thick shell surrounding the implant had reached the density of cortical bone. A safe load notion corresponding to the force leading to the maximal admissible strain value for trabecular bone was introduced. It evolved from 44N after surgery to approximately 160N after 26 months.

Acute liver failure: results of a 5-year clinical protocol

This investigation summarizes and evaluates the results of a clinical protocol that we designed to care for patients with acute liver failure (ALF). Adult patients with ALF were enrolled in the protocol. Grade II portal-systemic encephalopathy prompted admission to the intensive care unit (ICU). Patients who met the clinical criterion were activated for liver transplantation. Intracranial pressure (ICP) was monitored in patients with grade III encephalopathy. An increase in ICP was treated with hyperventilation, diuretics, barbiturates, or a combination thereof. Survival was considered to have occurred if the patient left the hospital alive. Our series included 25 patients. Orthotopic liver transplantation (OLT) was performed on 19 patients, 12 of whom survived. Only 2 of 6 patients who did not undergo transplantation survived. Ten of 11 patients who underwent transplantation before reaching grade IV encephalopathy survived. Only 2 of 8 patients who underwent transplantation after reaching grade IV survived (P = .006). The causes of death included cerebral edema (3 patients), disseminated aspergillosis (3 patients), and other (5 patients). ICP was monitored in 11 patients. Increased pressure was documented by seven of the monitors placed. There was one focal hemorrhage secondary to a subdural monitor. Outcome is improved if transplantation occurs before grade IV encephalopathy. ICP monitoring can be accomplished without significant risk of hemorrhage. In our series, infection with aspergillus occurred frequently and with fatal outcome.

Study of central neurotransmitters in stress-induced gastric ulceration in albino rats

1 Restraint when combined with cold (4 degrees C) consistently induces gastric ulceration in rats at 2 h. The cold-restraint ulcer (CRU) technique provides a suitable model for acute studies. 2 The peripheral mechanisms in CRU seem to be increased sympathetic and parasympathetic outflow since CRU was significantly reduced by prior spinal transection or vagotomy or by appropriate blocking agents. Since metiamide significantly reduced CRU, H2-histamine receptors are also involved. 3 Central catecholaminergic as well as cholinergic mechanisms seem to be responsible for the activation of peripheral sympathetic and parasympathetic outflow in CRU, since central administration of dibenamine, propranolol, 6-hydroxydopamine and atropine prevented the CRU. 4 Exogenous administration of putative neurotransmitters (adrenaline, noradrenaline and acetylcholine) into the cerebroventricular system produced gastric ulceration similar to CRU. However, dopamine, histamine and 5-hydroxytryptamine failed to induce gastric ulceration. 5 The results with intracerebroventricular adrenaline and acetylcholine indicate a central cholinergic link distal to adrenergic activation in the ulcerogenesis. 6 Intracerebroventricular adrenaline-induced gastric ulceration appears to be most akin to CRU. However, other central neurotransmitter mechanisms may also be involved.