Distances to emergency departments and non-urgent utilization of medical services: a systematic review.

BACKGROUND: The use of Emergency Departments (EDs) for non-urgent medical conditions is a global public health concern. OBJECTIVES: A systematic review, guided by a registered protocol (PROSPERO: CRD42023398674), was conducted to interpret the association between distance as a measure of healthcare access and the utilization of EDs for non-urgent care in high- and middle-income countries. METHODS: The search was conducted on 22 August 2023 across five databases using controlled vocabulary and natural language keywords. Eligibility criteria included studies that examined non-urgent care, and featured concepts of emergency departments, non-urgent health services and distance, reported in English. Articles and abstracts where patients were transported by ambulance/paramedic services, referred/transferred from another hospital to an ED, or those that measured distance to an ED from another health facility were excluded. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework informed the quality of evidence. RESULTS: Fifteen articles met the inclusion criteria. All studies demonstrated satisfactory quality with regard to study design, conduct, analysis and presentation of results. Eight (53.3%) of the studies (1 paediatric, 4 all ages/adult, 3 ecological) found a moderate level of evidence of an inverse association between distance and ED visit volume or utilization for non-urgent medical conditions, while the remaining studies reported very low or low evidence. CONCLUSIONS: Half of the studies reported non-urgent ED use to be associated with shortest distance traveled or transportation time. This finding bears implications for healthcare policies aiming to reduce ED use for non-urgent care.

Main findings: Using the systematic review methodology, a qualitative synthesis of the prior literature showed moderate evidence of the negative role of distance on emergency departments use across middle- and high-income countries.Added knowledge: This systematic review adds to the literature by providing evidence that clarifies prior inconsistent findings on the association between distance, a measure of healthcare access, and non-urgent emergency department utilization.Global health impact for policy and action: Based on the main finding of negative role of distance, a three-tiered policy recommendation to reduce non-urgent use of emergency departments is provided that include: 1) public health systems reforms, 2) patient education, and 3) improved access to primary care providers.

Identification of Retracted Publications and Completeness of Retraction Notices in Public Health.

OBJECTIVES: Retraction is intended to be a mechanism to correct the published body of knowledge when necessary due to fraudulent, fatally flawed or ethically unacceptable publications. However, the success of this mechanism requires that retracted publications be consistently identified as such and that retraction notices contain sufficient information to understand what is being retracted and why. Our study investigated how clearly and consistently retracted publications in public health are being presented to researchers. STUDY DESIGN AND SETTING: This is a cross-sectional study, using 441 retracted research publications in the field of public health. Records were retrieved for each of these publications from 11 resources, while retraction notices were retrieved from publisher websites and full-text aggregators. The identification of the retracted status of the publication was assessed using criteria from the Council on Publication Ethics (COPE) and the National Library of Medicine (NLM). The completeness of the associated retraction notices was assessed using criteria from COPE and Retraction Watch. RESULTS: 2841 records for retracted publications were retrieved, of which less than half indicated that the article had been retracted. Less than 5% of publications were identified as retracted through all resources through which they were available. Within single resources, if and how retracted publications were identified varied. Retraction notices were frequently incomplete, with no notices meeting all criteria. CONCLUSIONS: The observed inconsistencies and incomplete notices pose a threat to the integrity of scientific publishing and highlight the need to better align with existing best practices to ensure more effective and transparent dissemination of information on retractions.

Current and future state of pharmacological management of pediatric obesity.

Pediatric obesity is a highly prevalent chronic disease, which has traditionally been treated with lifestyle therapy alone. Yet for many youth, lifestyle intervention as a monotherapy is often insufficient for achieving clinically significant and durable BMI reduction. While metabolic/bariatric surgery achieves robust and long-lasting outcomes, it is neither widely accessible nor wanted by most pediatric patients and families. In the past 3 years, this treatment gap between lifestyle therapy and metabolic/bariatric surgery has been filled with a number of landmark clinical trials examining the safety and efficacy of anti-obesity medication (AOM) for use in children and adolescents. These trials include studies of liraglutide, phentermine/topiramate ER, semaglutide, and setmelanotide, all of which have led to FDA and/or EMA approval. Concurrent with this developing evidence base, in 2023, the American Academy of Pediatrics published their first Clinical Practice Guideline on the assessment and management of childhood obesity. The Guideline includes the recommendation that pediatric health care providers should offer AOM to youth ages ≥12 years with obesity. Recognizing that AOM use in the pediatric population will likely become the standard of care and to provide perspective on the recently generated data regarding new AOM, this narrative review summarizes the published randomized controlled trials (RCTs) from the past 10 years that examine AOM for the pediatric population. This report additionally includes RCTs examining AOM for special populations of pediatric obesity including monogenic obesity, Bardet Biedl syndrome, Prader Willi syndrome, and hypothalamic obesity. Finally, the clinical application of AOM for children and adolescents, as well as future directions and challenges are discussed.

The oral health impact of dental hygiene and dental therapy populations: a systematic review.

OBJECTIVES: Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals. METHODS: The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review. RESULTS: After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60. CONCLUSIONS: This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

The Impact of Sleep Disturbances on Endogenous Pain Modulation: A Systematic Review and Meta-Analysis.

The bidirectional relationship between sleep and pain problems has been extensively demonstrated but despite all the accumulating evidence, their shared mechanisms are currently not fully understood. This review examined the association between sleep disturbances, defined as a broad array of sleep-related outcomes (eg, poor quality, short duration, insomnia), and endogenous pain modulation (EPM) in healthy and clinical populations. Our search yielded 6,151 references, and 37 studies met the eligibility criteria. Qualitative results showed mixed findings regarding the association between sleep disturbances and temporal summation of pain (TSP) and conditioned pain modulation (CPM), with poor sleep more commonly associated with decreased pain inhibition in both populations. Quantitative results indicated that such associations were not statistically significant, neither in healthy populations when EPM outcomes were assessed for changes pre-/post-sleep intervention (TSP: .31 [95%CI: -.30 to .92]; P = .321; CPM: .40 [95%CI: -.06 to .85] P = .088) nor in clinical populations when such association was assessed via correlation (TSP: -.00 [95%CI: -.22 to .21] P = .970; CPM: .12 [95%CI: -.05 to .29]; P = .181). For studies that reported results by sex, meta-analysis showed that experimental sleep disturbances impaired pain inhibition in females (1.43 [95%CI: .98-1.88]; P < .001) but not in males (-.30 [95%CI: -2.69 to 1.60]; P = .760). Only one study investigating the association between sleep disturbances and offset analgesia was identified, while no studies assessing spatial summation of pain were found. Overall, this review provides a comprehensive overview of the association between sleep disturbances and EPM function, emphasizing the need for further investigation to clarify specific mechanisms and phenotypic subtypes. PERSPECTIVE: This review shines a light on the association between sleep disturbances and endogenous pain modulation function. Qualitatively, we found a frequent association between reduced sleep quality and impaired pain inhibition. However, quantitatively such an association was not corroborated. Sex-specific effects were observed, with females presenting sleep-related impaired pain inhibition but not males.

The relationship between methodological quality and the use of retracted publications in evidence syntheses.

BACKGROUND: Evidence syntheses cite retracted publications. However, citation is not necessarily endorsement, as authors may be criticizing or refuting its findings. We investigated the sentiment of these citations-whether they were critical or supportive-and associations with the methodological quality of the evidence synthesis, reason for the retraction, and time between publication and retraction. METHODS: Using a sample of 286 evidence syntheses containing 324 citations to retracted publications in the field of pharmacy, we used AMSTAR-2 to assess methodological quality. We used scite.ai and a human screener to determine citation sentiment. We conducted a Pearson's chi-square test to assess associations between citation sentiment, methodological quality, and reason for retraction, and one-way ANOVAs to investigate association between time, methodological quality, and citation sentiment. RESULTS: Almost 70% of the evidence syntheses in our sample were of critically low quality. We found that these critically low-quality evidence syntheses were more associated with positive statements while high-quality evidence syntheses were more associated with negative citation of retracted publications. In our sample of 324 citations, 20.4% of citations to retracted publications noted that the publication had been retracted. CONCLUSION: The association between high-quality evidence syntheses and recognition of a publication's retracted status may indicate that best practices are sufficient. However, the volume of critically low-quality evidence syntheses ultimately perpetuates the citation of retracted publications with no indication of their retracted status. Strengthening journal requirements around the quality of evidence syntheses may lessen the inappropriate citation of retracted publications.

Retracted publications in pharmacy systematic reviews.

OBJECTIVE: Systematic reviews and other evidence syntheses, the pinnacle of the evidence pyramid, embody comprehensiveness and rigor; however, retracted data are being incorporated into these publications. This study examines the use of retracted publications in the field of pharmacy, describes characteristics of retracted publications cited by systematic reviews, and discusses factors associated with citation likelihood. METHODS: Using data from Retraction Watch, we identified retracted publications in the pharmacy field. We identified all articles citing these retracted publications in Web of Science and Scopus and limited results to systematic reviews. We classified the retraction reason, determined whether the citation occurred before or after retraction, and analyzed factors associated with the likelihood of systematic reviews citing a retracted publication. RESULTS: Of 1,396 retracted publications, 283 were cited 1,096 times in systematic reviews. Most (65.0%) (712/1096) citations occurred before retraction. Citations were most often to items retracted due to data falsification or manipulation (39.2%), followed by items retracted due to ethical misconduct including plagiarism (30.4%), or concerns about or errors in data or methods (26.2%). Compared to those not cited in systematic reviews, cited items were significantly more likely to be retracted due to data falsification and manipulation, were published in high impact factor journals, and had longer delays between publication and retraction. CONCLUSIONS: Further analysis of systematic reviews citing retracted publications is needed to determine the impact of flawed data. Librarians understand the nuances involved and can advocate for greater transparency around the retraction process and increase awareness of challenges posed by retractions.

ROLE OF LIBRARIANS AND INFORMATION PROFESSIONALS IN IDENTIFYING dPROS IN THE EVIDENCE.

While dental patient-reported outcomes provide important insight to why patients seek oral health care, finding research literature on these outcomes as well as measures for dental patient-reported outcomes is quite difficult due to a lack of standardization in both indexing terms as well as reporting practices. This results in these outcomes and measures often being underutilized. Librarians and information professionals are experts in navigating and managing research literature. Additionally, librarians are powerful collaborators for evidence-based practice, and can provide support for research methodology design and reporting. This article explores how partnering with librarians and information professionals can benefit clinicians and researchers to further the utilization of dental patient-reported outcomes in patient care.

Nonmalignant Oral Disease--Specific Dental Patient-Reported Outcome Measures for Adult Patients: A Systematic Review.

OBJECTIVES: Dental patient-reported outcome measures (dPROMs) can be differentiated into outcome measures for all oral diseases, so-called disease-generic dPROMs, and measures for specific oral diseases, so-called disease-specific dPROMs. The aim of this systematic review was to identify the psychometrically validated nonmalignant disease-specific dPROMs for adult patients and the dental patient-reported outcomes (dPROs) they measure. METHODS: This systematic review searched Ovid MEDLINE, Embase, PsycINFO, and the Cochrane databases along with hand searching, through July 28, 2020, to identify original articles of English language, multi-item dPROMs for adult dental patients with a specific oral disease, condition, or oral manifestations of systemic diseases. We analyzed the questionnaires for content commonalities, the reference or recall period, and the dimensionality. RESULTS: We retrieved 4228 unique references and identified 34 questionnaires; of which, 31 questionnaires captured impacts from oral diseases or conditions and three from oral manifestations of systemic diseases. All questionnaires together contained 102 dPROMs, measuring 75 dPROs. Oral health-related quality of life was a broader dPRO, which was measured by 24 dPROMs. The 74 narrower dPROs were measured by 78 dPROMs. The dPRO names suggested that essentially four dPROs were measured: Oral Function (N = 19), Orofacial Pain (N = 7), Orofacial Appearance (N = 11), and Psychosocial Impact (N = 37). CONCLUSIONS: Many psychometrically validated tools (N = 102) are available to measure the impact of specific nonmalignant oral disease on patients. While these tools intend to measure the particular patient-perceived impact profile of the oral disease, all tools measure in essence only four, more general concepts - the dimensions of oral health-related quality of life.

Dental patients' functional, pain-related, aesthetic, and psychosocial impact of oral conditions on quality of life-Project overview, data collection, quality assessment, and publication bias.

BACKGROUND: Knowledge about the magnitude of Oral Health-Related Quality of Life (OHRQoL) impairment across dental patient populations is essential for clinical practice, public health and research. Within the project Mapping Oral Disease Impact with a Common Metric, this systematic review aimed to describe functional, pain-related, aesthetic and broader psychosocial impact of oral conditions with a single metric using OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact. METHODS: A search using PubMed, EMBASE, Cochrane, CINAHL and PsycINFO was performed on 8 June 2017, and updated on 14 January 2019. Only publications in the English language were considered. To characterise the extent of available standardised and clinically relevant OHRQoL information, we determined the number of publications, dental patient populations, which are clinically similar, and patient samples within each population with four-dimensional OHRQoL information using the Oral Health Impact Profile (OHIP) questionnaire. A quality assessment and a publication bias assessment were performed. RESULTS: We identified 171 publications that characterised 199 dental populations and 329 patient samples with four-dimensional OHRQoL information. The vast majority of populations were only characterised by one patient sample. Study quality was not related to OHRQoL magnitude, and substantial publication bias could be excluded. CONCLUSIONS: Standardised and clinically relevant information using the four OHRQoL dimensions Oral Function, Oro facial Pain, Oro facial Appearance and Psychosocial Impact was available for a significant number of dental patient populations. Findings can provide a framework to interpret OHRQoL impairment of individual patients, or groups of patients, for clinical practice, public health and research.

Addressing Disparities in Physician Access to Information in Support of Evidence-based Practice.

The purpose of this study is to determine if Minnesota physicians have access to information resources needed to support evidence-based practice (EBP), which supports a culture of safety and patient-centered care. A survey was used to determine Minnesota physicians' need for, and access to, evidence-based clinical information. A total of 877 responses (6.4% response rate) were included in the data analysis. Participants spent 24 min daily seeking answers to clinical questions and averaged 4.41 questions per day that could not be immediately answered. Physicians reported high levels of information needs met (85.8%), though they reported limited access to drug resources, citation databases, systematic reviews, and full-text books and articles. Results also showed use of unreliable sources to support decision-making. A key finding was the extent to which workplace affiliation broadens disparities in information access. National and regional approaches can work to support EBP by reducing the information gap caused by workplace affiliation and other barriers. Further research should be done to identify partnerships, funding, infrastructure, and support to address these gaps.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

The continued citation of retracted publications in dentistry.

OBJECTIVE: Publications are retracted for many reasons, but the continued use and citation of retracted publications presents a problem for future research. This study investigated retractions in the dental literature to understand the characteristics of retracted publications, the reasons for their retractions, and the nature and context of their citations after retraction. METHODS: In September 2018, the authors identified retracted dentistry publications using the Retraction Watch database. Citations to those publications were retrieved from Scopus and Web of Science. Characteristics of retracted publications and their citations were collected, including study design, reasons for retraction, and nature of citation (positive, negative, or neutral). We used chi-square tests to determine if there were notable differences between retracted publications that were cited following retraction and those that were not, and if there were relationships between the nature of the citation, the study design of the original publication, and its reason for retraction. RESULTS: Of the 136 retracted publications, 84 were cited after retraction. When restricted to English language, 81 retracted publications received citations from 685 publications. Only 5.4% of the citations noted the retracted status of the original publication, while 25.3% of citations were neutral and 69.3% were positive. Animal studies were more likely to be uncited after retraction, while in vitro studies and randomized controlled trials were more likely to be cited. Retracted publications that were cited negatively were more likely to have been retracted due to scientific distortion than those that were cited positively or neutrally. Retracted publications that were cited negatively were also more likely to be observational studies than those cited positively or neutrally. CONCLUSION: Retracted publications in dentistry are continually cited positively following their retraction, regardless of their study designs or reasons for retraction. This indicates that the continued citation of retracted publications in this field cannot be isolated to certain research methods or misconduct but is, instead, a more widespread issue.

A systematic scoping review of oral health models.

PURPOSE: The purpose of this systematic scoping review was to identify, analyze, and compare existing generic oral health models in English scientific dental literature. METHODS: We conducted a literature search in five databases, Ovid Medline, Embase, PsycINFO, Cochrane, and Web of Science, using pre-determined inclusion and exclusion criteria and calculated the interrater agreement coefficient "prevalence-adjusted bias-adjusted kappa" (PABAK). We identified, reviewed, and displayed the generic oral health models in review tables. RESULTS: Of the 3498 references identified, 13 oral health models from seven countries met the inclusion criteria. The interrater agreement coefficient resulted in a ''substantial agreement'' (PABAK = 0.80). Ten of the 13 (77%) generic oral health models were developed in English-speaking countries. All models were multidimensional and contained from two to 12 dimensions. Four models presented linear conception, and we observed non-linear conception in six models. Authors presented the unidirectional or reciprocal relations between dimensions in six models, and five models, respectively. Two models did not show models' relation or conception. Researchers used only experts (N = 1), literature (N = 2), dental patients (N = 2), or general population subjects (N = 3), or a combination of these sources (N = 5) for development of their generic oral health models. Statistical analyses supported the majority of the models (N = 8). CONCLUSIONS: The identified 13 oral health models vary substantially in their characteristics. This systematic scoping review of generic oral health models provides a toolbox, from which dental researchers can choose the theoretical model they consider fit best their oral health concept they want to investigate. Ideally, the international dental community will come soon to an agreement of accepting one oral health model, and this will provide an opportunity for comparison of outcomes across studies and populations and thus elevate dentistry to a higher evidence-based level.

Patient-Reported Outcome Measures for Adult Dental Patients: A Systematic Review.

OBJECTIVES: Patient-reported outcomes (PROs) are used beside disease-oriented outcomes (eg, number of teeth, clinical attachment level) to better capture the impact of diseases or interventions. To assess PROs for dental patients (dPROs), dental PRO measures (dPROMs) are applied. The aim of this systematic review was to identify generic dPROMs for adult patients and the dPROs. METHODS: This systematic review searched the MEDLINE, Embase, and PsycINFO databases along with hand searching, through December 2017, to identify English-language, multi-item dPROMs that are oral health generic, that is, they are applicable to a broad range of adult patients. RESULTS: We identified 20 questionnaires that contained 36 unique dPROs. They were measured by 53 dPROMs. dPRO names (N = 36) suggested they could be grouped into four dPRO categories: (1) Oral Function (N = 11), Orofacial Pain (N = 7), Orofacial Appearance (N = 3), and Psychosocial Impact (N = 14), as well as an additional dPRO that represented perceived oral health in general. Only eight questionnaires had a specific recall or reference period. dPROM's score dimensionality was only investigated in 13 of the 20 questionnaires. CONCLUSIONS: The identified 36 dPROs represent the major aspects of an adult dental patient's oral health experience; however, four major dPRO categories, that is, Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact, summarize how patients are impacted. If multi-item, oral health-generic dPROMs are to be used to measure patients' suffering, the 53 dPROMs represent current available tools. Limitations of the majority of these dPROMs include incomplete knowledge about their dimensionality, which affects their validity, and an unspecified recall period, which reduces their clinical applicability.

Universal dental adhesives: Current status, laboratory testing, and clinical performance.

Increasing demand for simplified and user-friendly adhesive systems has led to the development of a new class of adhesives termed as Universal Adhesives (UAs). The term "Universal" reflects manufacturers' claims that these adhesives can be applied with any adhesion strategy and offer the versatility of use with a variety of direct and indirect restorative materials. The aim of this review was to synthesize the literature regarding the current status of UAs, their adhesion potential to various substrates and their performance in different restorative situations. In vitro studies, clinical trials and systematic reviews were identified utilizing controlled vocabulary and keyword searches in Medline and EMBASE databases. About 282 studies (272 in vitro studies; 11 clinical studies) were included. Available laboratory and clinical evidence does not support the claim that UAs can be used with any adhesive strategy. Although, they can chemically bond to various tooth and direct/indirect restorative substrates, the stability of this bond is material-dependent and subject to hydrolytic degradation. Hence, additional measures are still needed to ensure long-term durability. which undermines the versatility of UAs. The lack of long-term data regarding the clinical performance of UAs further complicates clinical decision-making. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2121-2131, 2019.

Endogenous pain modulation in chronic orofacial pain: a systematic review and meta-analysis.

Abnormal endogenous pain modulation was suggested as a potential mechanism for chronic pain, ie, increased pain facilitation and/or impaired pain inhibition underlying symptoms manifestation. Endogenous pain modulation function can be tested using psychophysical methods such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), which assess pain facilitation and inhibition, respectively. Several studies have investigated endogenous pain modulation function in patients with nonparoxysmal orofacial pain (OFP) and reported mixed results. This study aimed to provide, through a qualitative and quantitative synthesis of the available literature, overall estimates for TSP/CPM responses in patients with OFP relative to controls. MEDLINE, Embase, and the Cochrane databases were searched, and references were screened independently by 2 raters. Twenty-six studies were included for qualitative review, and 22 studies were included for meta-analysis. Traditional meta-analysis and robust variance estimation were used to synthesize overall estimates for standardized mean difference. The overall standardized estimate for TSP was 0.30 (95% confidence interval: 0.11-0.49; P = 0.002), with moderate between-study heterogeneity (Q [df = 17] = 41.8, P = 0.001; I = 70.2%). Conditioned pain modulation's estimated overall effect size was large but above the significance threshold (estimate = 1.36; 95% confidence interval: -0.09 to 2.81; P = 0.066), with very large heterogeneity (Q [df = 8] = 108.3, P < 0.001; I = 98.0%). Sensitivity analyses did not affect the overall estimate for TSP; for CPM, the overall estimate became significant if specific random-effect models were used or if the most influential study was removed. Publication bias was not present for TSP studies, whereas it substantially influenced CPM's overall estimate. These results suggest increased pain facilitation and trend for pain inhibition impairment in patients with nonparoxysmal OFP.

Digital versus conventional impressions for full-coverage restorations: A systematic review and meta-analysis.

BACKGROUND: The primary objective of this systematic review was to investigate the survival of full-coverage restorations fabricated by using digital impressions (DIs) versus that of those fabricated by using conventional impressions. The authors also compared secondary outcomes of marginal and internal fit and occlusal and interproximal contacts. TYPES OF STUDIES REVIEWED: The authors conducted a systematic literature search in multiple databases to identify clinical trials with no restrictions by publication type, date, or language. The authors assessed study-level risk of bias and outcome-level strength of evidence. The authors performed a meta-analysis by using a random-effects model. RESULTS: Ten studies met the inclusion criteria. The authors identified no studies in which the investigators compared the impression techniques with respect to survival of full-coverage restorations. Mean differences for marginal gap and internal gap were -9.0 micrometers (95% confidence interval, -18.9 to 0.9) and -15.6 µm (95% confidence interval, -42.6 to 11.4), respectively. Studies assessing internal gap were substantially heterogeneous (I2 = 72%; P = .003). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Research is lacking to draw robust conclusions about the relative benefits of DIs in terms of restoration survival. Low-quality evidence for marginal fit and internal fit suggested similar performance for both techniques. Evidence quality for interproximal contact and occlusal contact was very low and insufficient to draw any conclusions regarding how the impression techniques compared. Given the uncertainty of the evidence, results should be interpreted with caution. With increasing popularity and adoption of digital scanners by dentists, pragmatic practice-based trials involving standardized, patient-centered outcomes may improve confidence in the comparative effectiveness of DIs.

Measuring the health literacy of the Upper Midwest.

OBJECTIVES: Health literacy-the ability to obtain, process, and understand basic health information-is a major determinant of an individual's overall health and health care utilization. In this project, the authors examined predictors of health literacy levels, including numeracy and graphic literacy, among an adult population in the Upper Midwest. METHODS: The research was conducted at the Minnesota State Fair. Three previously validated scales were used to assess health literacy: Newest Vital Sign, the General Health Numeracy Test, and questions from Galesic and Garcia-Retamero's Graph Literacy Scale. Demographic information-such as age, educational attainment, zip code, and other potential predictors and modifiers-was collected. Multivariate linear regression was conducted to examine the independent effects of educational attainment, race, ethnicity, gender, and rural or urban location on overall health literacy and scores on each of the individual instruments. RESULTS: A total of 353 Upper Midwest residents completed the survey, with the majority being white, college-educated, and from an urban area. Having a graduate or professional degree or being under the age of 21 were associated with increased health literacy scores, while having a high school diploma or some high school education, being Asian American, or being American Indian/Alaska Native were associated with lower health literacy scores. CONCLUSION: Advanced health literacy skills, including the ability to calculate and compare information, were problematic even in well-educated populations. Understanding numerical and graphical information was found to be particularly difficult, and more research is needed to understand these deficits and how best to address them.