Background: The use of saliva to identify individuals with disease and to follow the progress of the affected individual has attracted the attention of numerous investigators. Its noninvasive method of collection, simplicity, and cost effectiveness make it a useful tool not only to the general practitioner but also to the pediatric dentist. Aim: The aim of this paper is to provide the clinician with a comprehensive review of the diagnostic uses of saliva in dentistry.

Avulsion and luxation account for up to 16% of all traumatic injuries in the permanent dentition and 7.2% of injuries in the primary dentition. A range of treatment options are available that can help conserve the tooth after a traumatic episode. There are, however, occasions where loss of the traumatized tooth is inevitable with special regard to avulsion injuries. replantation of teeth having doubtful long-term prognosis. Following the traumatic loss of an anterior tooth it is important that an immediate replacement is provided in order to avoid esthetic, masticatory and phonetic difficulties and to maintain the edentulous space to avoid arch length discrepancy. The loss of an anterior tooth in a child or young adolescent may present a difficult prosthetic problem.3 This problem can be managed in several ways. This article reports utilization of the avulsed tooth as part of fixed semi-permanent bridge.

BackgroundUnplanned 30-day hospital readmissions following a stroke is a serious quality and safety issue in the United States. The transition period between the hospital discharge and ambulatory follow-up is viewed as a vulnerable period in which medication errors and loss of follow-up plans can potentially occur. We sought to determine whether unplanned 30-day readmission in stroke patients treated with thrombolysis can be reduced with the utilization of a stroke nurse navigator team during the transition period.MethodsWe included 447 consecutive stroke patients treated with thrombolysis from an institutional stroke registry between January 2018 and December 2021. The control group consisted of 287 patients before the stroke nurse navigator team implementation between January 2018 and August 2020. The intervention group consisted of 160 patients after the implementation between September 2020 and December 2021. The stroke nurse navigator interventions included medication reviews, hospitalization course review, stroke education, and review of outpatient follow-ups within 3 days following the hospital discharge.ResultsOverall, baseline patient characteristics (age, gender, index admission NIHSS, and pre-admission mRS), stroke risk factors, medication usage, and length of hospital stay were similar in control vs. intervention groups (P > 0.05). Differences included higher mechanical thrombectomy utilization (35.6 vs. 24.7%, P = 0.016), lower pre-admission oral anticoagulant use (1.3 vs. 5.6%, P = 0.025), and less frequent history of stroke/TIA (14.4 vs. 27.5%, P = 0.001) in the implementation group. Based on an unadjusted Kaplan–Meier analysis, 30-day unplanned readmission rates were lower during the implementation period (log-rank P = 0.029). After adjustment for pertinent confounders including age, gender, pre-admission mRS, oral anticoagulant use, and COVID-19 diagnosis, the nurse navigator implementation remained independently associated with lower hazards of unplanned 30-day readmission (adjusted HR 0.48, 95% CI 0.23–0.99, P = 0.046).ConclusionThe utilization of a stroke nurse navigator team reduced unplanned 30-day readmissions in stroke patients treated with thrombolysis. Further studies are warranted to determine the extent of the results of stroke patients not treated with thrombolysis and to better understand the relationship between resource utilization during the transition period from discharge and quality outcomes in stroke.

Background: Unplanned 30-day hospital readmissions following a stroke is recognized as a serious quality and safety issue in the United States. The transition period from the hospital discharge is recognized as a vulnerable period in which medication errors and loss of ambulatory follow-ups can potentially occur. There, we sought to determine if 30-day stroke readmission can be prevented with utilization of a stroke nurse navigator team. Our secondary outcome of interest was 90-day outcome events. Methods: We first retrospectively analyzed 1657 consecutive patients presenting with ischemic or hemorrhagic strokes, included in an institutional stroke registry between January 2018 and August 2020, the time before the utilization of stroke nurse navigator teams. The stroke nurse navigator interventions included medication reviews, hospitalization course review, stroke education, and establishment of outpatient follow-ups within 3 days following the discharge. Following the stroke nurse navigator team phone checks ins in September 2020, we then retrospectively analyzed 851 consecutive patients presenting with stroke, included in the registry between September 2020 and December 2021. Results: Baseline 30-day stroke readmission rate was 11.7% (194/1657) before nurse navigator team. The Readmission rate reduced to 8.2% (71/870), which was statistically significant (p<0.05) following the period that utilized stroke nurse navigator team. Baseline 90-day death and cardiovascular events before the stroke nurse intervention was 5.4% (89/1657) and 8.1% (134/1657), respectively. Following the intervention, there was also no statistical difference in the 90-day outcome events of death and cardiovascular event 6.2% (27/433) and 7.3% (32/433), p>0.05. Conclusion: Utilization of the Stroke nurse navigator team can reduce unplanned 30-day stroke readmissions, but it did not have an impact on 90-day clinical outcome. Further studies are warranted to study the relationship between resource utilization during transition period from discharge and quality outcome in stroke.