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Obesity is a well-recognized global epidemic that can lead to longer operative times as well as a greater technical demand. Despite this, the available literature evaluating the impact of obesity on hip hemiarthroplasty (HA) and total hip arthroplasty (THA) when treating fractures about the femoral neck is scarce. Between 2015 and 2018, we retrospectively reviewed all patients that had a HA or THA performed as treatment for an isolated fracture of the femoral neck. Patients were classified as obese and nonobese depending on current body mass index (BMI) when the index procedure was performed. Preoperative and postoperative variable were obtained from the electronic medical record. A total of 157 patients underwent hip HA or THA for an isolated fracture of the femoral neck. In those patients undergoing HA, obesity was associated with an increase in operative times (P = 0.021) and was associated with a nonsignificant increase in total operating room time (P = 0.088) and duration of anesthesia (P = 0.14). In those patients undergoing THA, obesity was associated with longer operative times (P = 0.043), total operating room time (P = 0.032), and duration of anesthesia (P = 0.045). There were no significant differences in complication rates postoperatively between obese and non-obese patients undergoing either procedure. The treatment of isolated fractures of the femoral neck with HA or THA leads to an increase in operative time without an increase in postoperative complications in obese patients.

Diabetes is a serious disease, which is often accompanied by complications, such as blindness, kidney failure, heart attacks, strokes and amputations. High blood pressure and abnormal cholesterol levels are frequent comorbidities. Diabetes has an immense impact on public health and medical care. In South Carolina (SC), medical costs rise with increased duration of the disease, and lifespan is shortened by 5 to 10 years in most patients. To describe the burden of diabetes in SC, we examined the public health surveillance systems available to estimate the prevalence, mortality and hospitalization rates and some disability statistics and hospital charges. Diabetes is the 7 leading cause of death in SC, directly or indirectly claiming more than 3,000 lives annually, and the 5 leading cause of death in blacks, claiming about 1,200 black lives each year. Minorities, predominantly blacks, experienced a substantially higher death rate and more years of potential life lost than whites. The racial disparity in mortality has widened over the past 10 years. People with diabetes are at increased risk for blindness, lower extremity amputation, kidney failure, nerve disease, hypertension, ischemic heart disease and stroke. Approximately 450,000 South Carolinians are affected by diabetes, many of whom were still undiagnosed in 2010. One of every 5 patients in a SC hospital has diabetes, and 1 in every 10 visits to a SC emergency room is diabetes related. The total charges for diabetes and diabetes-related hospitalizations and emergency room visits were more than $4.2 billion in 2010.

Aim: To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining., Methodology: A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05)., Results: A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92)., Conclusions: Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams.

The quality and quantity of in-service education programs offered to staff members of long-term care facilities have long lagged behind that offered in hospitals, medica centers, and other sectors of the health care industry. The authors review the need for, and the problems and benefits of, in-service education in long-term care facilities, and suggest a model program.