Evidence-based Recommendations on Periodontal Practice and the Management of Periodontal Patients During and After the COVID-19 Era: Challenging Infectious Diseases Spread by Airborne Transmission

Background: Periodontal care, which was completely suspended during the peak of the SARS-Cov-2 pandemic and was delayed and recurrently discontinued during the succeeding waves, must be safely provided in the COVID-19 era. Objectives: The study aimed to provide recommendations on periodontal practice, optimizing safety, ergonomics, and economic resources, and the management of periodontal patients, ensuring continuity, timing, and effectiveness of periodontal care in the COVID-19 era. Methods: Reported protocols for the dental practice in the context of the COVID-19 and current evidence on periodontitis treatment and prevention were reviewed. Results: Evidence-based recommendations on contamination control and ergonomic improvements for periodontal practice and the management of periodontal patients challenging COVID-19 and airborne infectious diseases have been provided. Conclusion: Due to the economic, ergonomic, and ethical concerns raised by limited periodontal care due to the SARS-Cov-2 pandemic, and awareness of other emerging airborne transmitted infections, the periodontal practice should integrate measures minimizing airborne cross-infections and optimizing time-space and economic resources. The management of periodontal patients in the COVID-19 era should comprise less complex treatments and more comprehensive and definitive approaches, reducing emergencies, session length and number, and, concurrently, extending the recall and maintenance intervals. Moreover, it should implement prevention strategies through teledentistry tools and apps, improving periodontal awareness and self-care, and also through the self-reporting of periodontitis and periodontal risk assessment tools, performing both “population-based” and “high-risk” surveillance of periodontitis. Finally, it should enhance inter-professional collaboration, through telehealth networks, especially targeting subjects at high-risk of both periodontitis and systemic disorders, each of the two variously linked to COVID-19 onset and worsening.

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Differentiation of endemic areas by incidence rates of tick-borne infectious diseases as the basis for choosing prevention strategy and tactics

ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT ◽

10.35627/2219-5238/2019-321-12-56-61 ◽

2019 ◽

pp. 56-61

Author(s):

N.V. Rudakov ◽

N.A. Penyevskaya ◽

D.A. Saveliev ◽

S.A. Rudakova ◽

C.V. Shtrek ◽

...

Keyword(s):

High Risk ◽

Infectious Diseases ◽

Population Based ◽

Preventive Therapy ◽

Incidence Rates ◽

Prevention Strategy ◽

Individual Risk ◽

The Individual ◽

Integral Assessment ◽

Very High

Research objective. Differentiation of natural focal areas of Western Siberia by integral incidence rates of tick-borne infectious diseases for determination of the strategy and tactics of their comprehensive prevention. Materials and methods. A retrospective analysis of official statistics for the period 2002-2018 for eight sub-federal units in the context of administrative territories was carried out. The criteria of differentiation were determined by means of three evaluation scales, including long-term mean rates of tick-borne encephalitis, tick-borne borreliosis, and Siberian tick-borne typhus. As a scale gradation tool, we used the number of sample elements between the confidence boundaries of the median. The integral assessment was carried out by the sum of points corresponding to the incidence rates for each of the analyzed infections. Results. The areas of low, medium, above average, high and very high risk of tick-borne infectious diseases were determined. Recommendations on the choice of prevention strategy and tactics were given. In areas of very high and high incidence rates, a combination of population-based and individual prevention strategies is preferable while in other areas a combination of high-risk and individual strategies is recommended. Discussion. Epidemiologic zoning should be the basis of a risk-based approach to determining optimal volumes and directions of preventive measures against natural focal infections. It is necessary to improve the means and methods of determining the individual risk of getting infected and developing tick-borne infectious diseases in case of bites, in view of mixed infection of vectors, as well as methods of post-exposure disease prevention (preventive therapy).

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Rates of violence in patients classified as high risk by structured risk assessment instruments

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.131938 ◽

2014 ◽

Vol 204 (3) ◽

pp. 180-187 ◽

Cited By ~ 34

Author(s):

Jay P. Singh ◽

Seena Fazel ◽

Ralitza Gueorguieva ◽

Alec Buchanan

Keyword(s):

Risk Assessment ◽

High Risk ◽

Risk Groups ◽

Evidence Base ◽

Assessment Tools ◽

Current Evidence ◽

Assessment Instruments ◽

Individual Liberty ◽

Current Evidence Base ◽

Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

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Silver Diamine Fluoride: a critical review and treatment recommendations

Dental Update ◽

10.12968/denu.2019.46.7.626 ◽

2019 ◽

Vol 46 (7) ◽

pp. 626-632

Author(s):

Jilen Patel ◽

Robert P Anthonappa ◽

Nigel M King

Keyword(s):

High Risk ◽

Current Evidence ◽

Evidence Based ◽

Dental Practice ◽

Silver Diamine Fluoride ◽

Disadvantaged Populations ◽

Carious Lesions ◽

Caries Management ◽

High Risk Populations ◽

High Risk Children

Over the last decade there has been a renewed interest in the use of Silver Diamine Fluoride (SDF) as an adjunctive modality in the management of caries among high-risk populations. This review presents the current evidence behind the use of SDF and recommendations for its use in caries management dental practice. CPD/Clinical Relevance: Silver diamine fluoride is an effective, evidence-based modality that can contribute towards arresting carious lesions among high-risk children and disadvantaged populations.

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Evidence-based treatment of carotid artery stenosis

Neurosurgical FOCUS ◽

10.3171/2011.3.focus1143 ◽

2011 ◽

Vol 30 (6) ◽

pp. E2 ◽

Cited By ~ 9

Author(s):

Kate C. Young ◽

Anunaya Jain ◽

Minal Jain ◽

Robert E. Replogle ◽

Curtis G. Benesch ◽

...

Keyword(s):

Medical Management ◽

Stroke Risk ◽

Population Based ◽

Current Evidence ◽

Stent Insertion ◽

Evidence Based ◽

Evidence Based Treatment ◽

Design Considerations ◽

Symptom Status ◽

Symptomatic Stenosis

Carotid atheromatous disease is an important cause of stroke. Carotid endarterectomy (CEA) is a well-established option for reducing the risk of subsequent stroke due to symptomatic stenosis (> 50%). With adequately low perioperative risk (< 3%) and sufficient life expectancy, CEA may be used for asymptomatic stenosis (> 60%). Recently, carotid angioplasty and stent placement (CAS) has emerged as an alternative revascularization technique. Trial design considerations are discussed in relation to trial results to provide an understanding of why some trials were considered positive whereas others were not. This review then addresses both the original randomized studies showing that CEA is superior to best medical management and the newer studies comparing the procedure to stent insertion in both symptomatic and asymptomatic populations. Additionally, recent population-based studies show that improvements in best medical management may be lowering the stroke risk for asymptomatic stenosis. Finally, the choice of revascularization technique is discussed with respect to symptom status. Based on current evidence, CAS should remain limited to specific indications.

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Development and performance of a population-based risk stratification model for COVID-19

10.1101/2021.05.25.21257783 ◽

2021 ◽

Author(s):

Emili Vela ◽

Gerard Carot-Sans ◽

Montse Clèries ◽

David Monterde ◽

Xènia Acebes ◽

...

Keyword(s):

Risk Stratification ◽

Hospital Admissions ◽

Population Based ◽

Current Evidence ◽

Individual Risk ◽

Severe Illness ◽

Evidence Based ◽

Operating Characteristics ◽

Healthcare Resources ◽

North East

The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease 2019 (COVID-19). Current evidence indicates that age is far from accurate in identifying the risk of severe illness; furthermore, the count of individual risk factors has limited applicability to population-based "stratify-and-shield" strategies. We developed a COVID-19 risk stratification system that allows allocating people into four mutually-exclusive risk categories based on multivariate models for hospital admissions, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from the entire population of Catalonia (North-East Spain; 7.5 million people) and validated using an independent dataset of 218,329 individuals with PCR-confirmed COVID-19, who were infected after developing the model. This showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85 - 0.85) for hospital admissions, 0.86 (0.86 - 0.97) for ICU transfers, and 0.96 (0.96 - 0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.

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Use Characteristics and Triage Acuity of a Digital Symptom Checker in a Large Integrated Health System: Population-Based Descriptive Study (Preprint)

10.2196/preprints.20549 ◽

2020 ◽

Author(s):

Keith E Morse ◽

Nicolai P Ostberg ◽

Veena G Jones ◽

Albert S Chan

Keyword(s):

Health Care ◽

General Population ◽

Health System ◽

Descriptive Study ◽

The United States ◽

Population Based ◽

Assessment Tools ◽

Urgent Care ◽

Evidence Based ◽

Integrated Health

BACKGROUND Pressure on the US health care system has been increasing due to a combination of aging populations, rising health care expenditures, and most recently, the COVID-19 pandemic. Responses to this pressure are hindered in part by reliance on a limited supply of highly trained health care professionals, creating a need for scalable technological solutions. Digital symptom checkers are artificial intelligence–supported software tools that use a conversational “chatbot” format to support rapid diagnosis and consistent triage. The COVID-19 pandemic has brought new attention to these tools due to the need to avoid face-to-face contact and preserve urgent care capacity. However, evidence-based deployment of these chatbots requires an understanding of user demographics and associated triage recommendations generated by a large general population. OBJECTIVE In this study, we evaluate the user demographics and levels of triage acuity provided by a symptom checker chatbot deployed in partnership with a large integrated health system in the United States. METHODS This population-based descriptive study included all web-based symptom assessments completed on the website and patient portal of the Sutter Health system (24 hospitals in Northern California) from April 24, 2019, to February 1, 2020. User demographics were compared to relevant US Census population data. RESULTS A total of 26,646 symptom assessments were completed during the study period. Most assessments (17,816/26,646, 66.9%) were completed by female users. The mean user age was 34.3 years (SD 14.4 years), compared to a median age of 37.3 years of the general population. The most common initial symptom was abdominal pain (2060/26,646, 7.7%). A substantial number of assessments (12,357/26,646, 46.4%) were completed outside of typical physician office hours. Most users were advised to seek medical care on the same day (7299/26,646, 27.4%) or within 2-3 days (6301/26,646, 23.6%). Over a quarter of the assessments indicated a high degree of urgency (7723/26,646, 29.0%). CONCLUSIONS Users of the symptom checker chatbot were broadly representative of our patient population, although they skewed toward younger and female users. The triage recommendations were comparable to those of nurse-staffed telephone triage lines. Although the emergence of COVID-19 has increased the interest in remote medical assessment tools, it is important to take an evidence-based approach to their deployment.

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Development and performance of a population-based risk stratification model for COVID-19

10.21203/rs.3.rs-503359/v1 ◽

2021 ◽

Author(s):

Emili Vela ◽

Gerard Carot-Sans ◽

Montse Clèries ◽

David Monterde ◽

Xènia Acebes ◽

...

Keyword(s):

Risk Stratification ◽

Hospital Admissions ◽

Population Based ◽

Current Evidence ◽

Individual Risk ◽

Severe Illness ◽

Evidence Based ◽

Operating Characteristics ◽

Healthcare Resources ◽

North East

Abstract The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease 2019 (COVID-19). Current evidence indicates that age is far from accurate in identifying the risk of severe illness; furthermore, the count of individual risk factors has limited applicability to population-based “stratify-and-shield” strategies. We developed a COVID-19 risk stratification system that allows allocating people into four mutually-exclusive risk categories based on multivariate models for hospital admissions, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from the entire population of Catalonia (North-East Spain; 7.5 million people) and validated using an independent dataset of 218,329 individuals with PCR-confirmed COVID-19, who were infected after developing the model. This showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85–0.85) for hospital admissions, 0.86 (0.86–0.97) for ICU transfers, and 0.96 (0.96–0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.

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Predictors of conversion to psychosis

Psychotic Disorders ◽

10.1093/med/9780190653279.003.0014 ◽

2020 ◽

pp. 113-121

Author(s):

Rachael G. Grazioplene ◽

Tyrone D. Cannon

Keyword(s):

High Risk ◽

General Population ◽

Population Based ◽

Clinical High Risk ◽

Neuronal Connectivity ◽

Prodromal Phase ◽

Population Sampling ◽

Treatment And Prevention ◽

Progressive Loss ◽

Ascertainment Scheme

The prodromal phase of psychosis represents an opportunity to understand how psychosis develops, and research in this area has the potential to generate strategies for treatment and prevention. This chapter reviews findings from clinical high risk (CHR) and general population sampling research related to prediction of psychosis, discussing what has been learned from these two approaches as well as theoretical and practical pitfalls of each. Work conducted in the CHR paradigm has yielded practical tools for psychosis prediction as well as evidence that progressive loss of neuronal connectivity may underlie onset of full psychosis, but cases meeting criteria for a CHR syndrome represent a small fraction of new onsets of psychosis in the population. Population-based studies benefit from a broader ascertainment scheme but are limited in feasibility of in-depth or frequent assessments and follow-ups. The chapter concludes with a discussion of how to reconcile different approaches under a transdiagnostic framework.

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Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study

BJPsych Open ◽

10.1192/bjo.2020.169 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Natasa Basrak ◽

Naoise Mulcrone ◽

Sue Sharifuddin ◽

Zeshan Ghumman ◽

Nirvana Bechan ◽

...

Keyword(s):

Mental Health ◽

High Risk ◽

Adverse Outcome ◽

Population Based ◽

High Risk Group ◽

Adverse Outcomes ◽

Psychiatric Services ◽

Assessment Tools ◽

Chronological Age ◽

Forensic Mental Health

Background Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions. Structured assessment tools exist to ascertain the risk of adverse outcome in the event of SARS-CoV-2 infection. Aims To assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools. Method All patients of a national forensic mental health service (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-Age tool and the COVID-Risk tool. Results We found high rates of relevant physical comorbidities. Mean chronological age was 45.5 years (s.d. = 11.4, median 44.1), mean score on the COVID-Age tool was 59.1 years (s.d. = 19.4, median 58.0), mean difference was 13.6 years (s.d. = 15.6), paired t = 10.9, d.f. = 140, P < 0.001. Three patients (2.1%) were chronologically over 70 years of age, compared with 43 (30.5%) with a COVID-Age over 70 (χ2 = 6.99, d.f. = 1, P = 0.008, Fisher's exact test P = 0.027). Conclusions Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

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Intra-aortic balloon counterpulsation: current evidence-based and unresolved issues

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2020-3s-18-32 ◽

2020 ◽

Vol 24 (3S) ◽

pp. 18

Author(s):

Yu. N. Neverova ◽

T. S. Golovina ◽

R. S. Tarasov

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Conflict Of Interest ◽

Current Evidence ◽

Evidence Based ◽

Coronary Syndrome ◽

Myocardial Revascularisation ◽

Percutaneous Coronary ◽

Intra Aortic Balloon Counterpulsation ◽

Balloon Counterpulsation

This literature review provides the current evidence-based research regarding the role of intra-aortic balloon counterpulsation in the treatment of patients in various clinical situations. These include patients with acute coronary syndrome, complicated or uncomplicated by cardiogenic shock, accompanied by high-risk percutaneous coronary interventions, accompanying patients in need of coronary artery bypass surgery in various conditions as a ‘bridge’ to decision-making or treatment. Because the introduction of intra-aortic balloon counterpulsation into clinical practice, it has been the most common method of hemodynamic support in high-risk patients. The classical strategy for the treatment of acute myocardial infarction has evolved over the last decade from a thrombolysis scenario to a primary coronary revascularisation scenario, which resulted in a larger patient cohort. The currently available data, however, do not support the routine use of intra-aortic balloon counterpulsation by most of this population. Current studies have shown that the use of intra-aortic balloon counterpulsation did not lead to a decrease in 30-day mortality in patients with acute coronary syndrome and cardiogenic shock who received therapy with the strategy of early myocardial revascularisation as the planned primary goal. The expediency of using high-risk percutaneous coronary intervention as an accompanying method is ambiguous, whereas the use of the method as a ‘bridge’ to surgical myocardial revascularisation may be justified and requires additional research. The article provides the current recommendations for the treatment of patients. Research results and unresolved issues are being discussed.Received 3 June 2020. Revised 4 August 2020. Accepted 24 August 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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