Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice.

Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice.

The role of angioplasty for non-Q wave myocardial infarction: the impact of diabetes on outcomes.

Understanding of the mechanisms, outcomes and treatment of non-Q wave myocardial infarction (NQMI) has evolved. Coexisting diabetes poses additional challenges. We studied baseline characteristics, in-hospital and one-year outcomes for NQMI patients having percutaneous transluminal angioplasty.

Coronary angioplasty in black and white patients: demographic characteristics and outcomes.

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) is an effective means of revascularization, but differences may exist in application and outcomes for patient subgroups. Few data compare PTCA in black and white patients. METHODS: We compared patient characteristics and outcomes of PTCA in 3,447 white patients and 52 black patients. RESULTS: Comparing baseline characteristics, more black patients were hypertensive (87% vs 57%) or diabetic (38% vs 22%). Procedural success was similar, and in-hospital complications were infrequent in both groups. Over a mean follow-up of 115 weeks, no significant difference occurred between the two groups in nonfatal MI, repeat PTCA, coronary artery bypass grafting, or death. Event-free survival was lower in blacks than in whites. CONCLUSIONS: At our center, black patients have success rates, in-hospital outcomes, and long-term survival after PTCA similar to those of white patients, though event-free survival was lower in blacks.

Gender-related risk factors and outcomes for non-Q wave myocardial infarction patients receiving in-hospital PTCA.

BACKGROUND: We analyzed the risk factors and outcomes associated with non-Q wave myocardial infarction (MI) in females and males. We studied 376 consecutive patients N 275 males (73%) and 101 females (27%) N who presented with non-Q wave MI and had percutaneous transluminal coronary angioplasty (PTCA) prior to discharge during the period between January 1992 and February 1996. RESULTS: Females were significantly older (68 +/- 10 years vs. 61 +/- 11 years; p < 0.001) and had more hypertension (67% vs. 51%; p < 0.01). Males had a slightly lower ejection fraction (47 +/- 11%) compared to females (50 +/- 10%; p < 0.001). Angioplasty was equally successful for women and men (96% vs. 97%; p = NS) with a statistically significant smaller number of lesions dilated per patient in females (1.38 vs. 1.51; p < 0.04). There were no significant differences in unstable angina, prior coronary artery bypass graft (CABG) surgery, saphenous vein graft PTCA, single vessel versus multiple vessel disease or history of prior MI. In-hospital complications (i.e., the need for CABG or repeat PTCA, recurrent MI, and stroke) were not statistically significant for either females or males. There was a trend for a higher in-hospital death rate in females after a non-Q wave MI, but it was not statistically significant (4% vs. 1%; p = 0.058). However, at one-year follow-up females had a significantly worse survival rate than men (89% vs. 95%; p < 0.04), although event-free survival rate was similar (61% female, 66% male; p = NS). CABG was performed less commonly in women by the end of one year (p < 0.02) than in men, while the performance of PTCA was similar. CONCLUSIONS: Although women with non-Q wave MI presented with more risk factors than men, in-hospital revascularization was equally successful with few complications and morbid events and similar event-free outcome at one year. However, one year mortality was worse for women, suggesting a need for more aggressive follow-up evaluation and treatment. For both women and men, this aggressive percutaneous revascularization strategy resulted in much better outcome than previously reported for medical treatment of non-Q wave MI.

One-year outcomes of diabetic versus nondiabetic patients with non-Q-wave acute myocardial infarction treated with percutaneous transluminal coronary angioplasty.

Risk factors and outcomes associated with non-Q-wave myocardial infarction (MI) in diabetics and nondiabetics were analyzed for 376 consecutive patients, 77 with diabetes (20%) and 299 nondiabetics (80%), who had non-Q-wave MI and had percutaneous transluminal coronary angioplasty (PTCA) performed before discharge from hospital during the period from January 1992 to February 1996. Diabetics were slightly older (64 +/- 10 years vs 61 +/- 12 years, p <0.053), had more prior coronary artery bypass grafting (CABG) surgery (27% vs 12%, p <0.001), and hypertension (77% vs 49%, p <0.001). There was no significant difference in unstable angina, saphenous vein graft PTCA, single versus multiple vessel disease, or history of MI. PTCA success rates for diabetics versus nondiabetics were similar (96% vs 97%, p = NS). In-hospital complications such CABG, recurrent MI, repeat PTCA, stroke, and death were not statistically significant between the 2 groups. At 1-year follow-up, survival in diabetics (92%) was similar to nondiabetics (94%, p = NS), although event-free survival (PTCA, CABG, MI, death) was worse in diabetics (55% vs 67% for nondiabetics, p <0.05). Although diabetic patients with non-Q-wave MI represent a cohort with more risk factors for poor outcome, aggressive in-hospital revascularization with PTCA results in an excellent short-term outcome as well as 1-year survival similar to the nondiabetic patients. However, total events at 1-year follow-up are more common in the diabetic patients, suggesting that more aggressive screening and therapy in follow-up may be warranted, and that a diabetic with non-Q-wave MI will require increased utilization of cardiovascular resources in the first year after the event.