Trends in US malpractice payments in dentistry compared to other health professions - dentistry payments increase, others fall.

Background Little is known about trends in the number of malpractice payments made against dentists and other health professionals. Knowledge of these trends will inform the work of our professional organisations.Methods The National Practitioner Data Bank (NPDB) in the United States was utilised. Data about malpractice payments against dentists, hygienists, nurses, optometrists, pharmacists, physicians (DO and MD), physicians' assistants, podiatrists, psychologists, therapists and counsellors during 2004-14 were studied. Variables include type of healthcare provider, year malpractice payment was made and range of payment amount.Results In 2004 there were 17,532 malpractice payments against the studied health professions. In 2014 there were 11,650. In 2004, the number of malpractice payments against dentists represented 10.3% of all payments and in 2014 it represented 13.4%. Number of malpractice payments against dentists in 2012-2014 increased from 1,388 to 1,555.Conclusions There is an upward pressure on the number of dental malpractice payments over the last 3 years. Concurrently, there is a downward pressure on the number of combined non-dentist healthcare professional malpractice payments.

Clinical decision making - choosing between intuition, experience and scientific evidence.

Intuition usually results in poorer decisions than an evidence-based decision-making process. However, research has shown there are certain circumstances when intuition is equivalent or superior to evidence based decision-making. The first pre-requisite is domain expertise and being a dentist is insufficient - a minimum of five years additional practicing experience is needed. Intuition allows the expert to store information in subconscious frameworks and extract that data without conscious thought at a rapid rate. Decisions that have severe time constraints, problems that are complex and ambiguous in nature, and a lack of scientific evidence are some factors that are suitable for intuition-based clinical decision-making.

Do dentists make poor leaders?

Dentists work, largely, alone (apart from subordinates) with little feedback from colleagues and other health professionals. The author of this article argues that dentists do not lead, they manage. Moreover, dentists face unique challenges in becoming effective leaders because many innate skills that help dentists excel in their profession are in conflict with good leadership. The purpose of this article is to stir debate and raise the awareness that dentists do not, innately, have strong leadership skills and must pursue formal training in leadership to succeed in the modern era of collaborative healthcare.

Prevalence and predictors of complications following facial reconstruction procedures.

Facial reconstruction procedures are immensely challenging and are done for a multitude of reasons. The purpose of this report is to provide nationally representative estimates of different types of facial reconstructive procedures and to examine prevalence and predictors of a wide range of complications associated with these procedures in the USA. The Nationwide Inpatient Sample, the largest inpatient dataset for the USA, was used. Data for the years 2004-2010 related to facial reconstruction procedures were identified through ICD-9-CM procedure codes. Associated complications were identified using secondary diagnosis field codes. Multivariable logistic regression models were used to examine the association between patient/hospital-level factors and the occurrence of complications. A total 26,374 facial reconstruction procedures were performed. About 20% of all patients who had facial reconstruction procedures developed a complication. Frequently occurring complications included postoperative pneumonia (4.9% of hospitalizations), hemorrhage (3.9%), other infections (3.6%), non-healing wounds (3.5%), and iatrogenically induced complications (3.2%). Significant factors found to be consistently associated with different types of complications included age, co-morbid burden, sex, and type of admission. The reported results are generalizable within limitations and can be used by health care providers to tailor quality improvement initiatives to minimize or better treat complications in the high-risk cohorts.

Immediate Effects of Use of Recombinant Bone Morphogenetic Protein in Children Having Spinal Fusion and Refusion Procedures in United States.

STUDY DESIGN: Retrospective study of Nationwide Inpatient Sample (NIS). OBJECTIVE: The objective of this study is to estimate the prevalence of complications in children who had insertion of recombinant human bone morphogenetic protein (rhBMP) at the time of spinal fusion procedures (SFP) and to examine if the use of rhBMP is associated with an increased risk of complications. SUMMARY OF BACKGROUND DATA: Use of rhBMP for SFP has been associated with conflicting safety profile reports in adults. METHODS: NIS (years 2004-2010) was used. All patients with age  < 18 years who had a SFP during hospitalization with or without insertion of rhBMP were selected. Complications were selected based on a literature review of studies examining outcomes of SFP. Association between insertion of rhBMP and occurrence of complications was examined by multivariable logistic regression models. RESULTS: Of the 72,898 children who underwent SFP, 7.1% children had insertion of rhBMP. Overall complication rate was 14.34% (15.2% in rhBMP group and 14.3% in no-rhBMP group). There was no statistically significant difference in the overall complication rate [odds ratio (OR) = 1.08, 95% confidence intervals (CI) = 0.89-1.30] or among 14 different complications between rhBMP and no-rhBMP groups. Children who had rhBMP were associated with higher odds for "other infections" (OR = 2.09, 95% CI = 1.26-3.48, P = 0.004) when compared with their counterparts. CONCLUSION: Despite the lack of Food and Drug Administration approval, rhBMP was not infrequently used in pediatric SFP. In this large retrospective study using administrative data, the use of rhBMP in children during SFP was not associated with higher risks for majority of assessed complications with the exception of "other infections". Future studies must examine the long-term impact of use of rhBMP in children with SFP. LEVEL OF EVIDENCE: 3.

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States.

SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years 2004-2010. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included <96 h (17.1%) and ⩾96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV <96 h (odds ratio=3.42 (2.44-4.79), P<0.0001) or IMV ⩾96 h (OR=4.61 (3.17-6.70), P<0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P<0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P<0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

Dentists in the US should be integrated into the hospital team.

Few dentists play integrated roles within hospital settings and few hospital emergency rooms have dentists. Existing research shows that only 67% of ER visits for dental problems are managed appropriately. Every year Americans die in hospital after being admitted because of dental disease and a recent study found that 20 people died after such hospitalisations in the United States in 2008. Authors of the current correspondence have conducted extensive research on characteristics of emergency room visits and hospitalisations due to various dental conditions using a nationwide dataset for the United States. This opinion article is intended to provoke discussion about the restructuring of hospitals to integrate oral health professionals into the hospital team.