Coronavirus (COVID-19) Information and Resources

Information and resources on coronavirus (COVID-19)

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A selection of Penn Dental Medicine faculty publications related to the work within the Center for Integrative Global Oral Health.

Baker D, Giuliano KK, Thakkar-Samtani M, Scannapieco FA, Glick M, Restrepo MI, Heaton LJ, Frantsve-Hawley J. The association between accessing dental services and nonventilator hospital-acquired pneumonia among 2019 Medicaid beneficiaries. Infect Control Hosp Epidemiol. 2022 Jul 11:1-3.

In this 2019 cross-sectional study, we analyzed hospital records for Medicaid beneficiaries who acquired nonventilator hospital-acquired pneumonia (NVHAP). The results suggest that Medicaid beneficiary receiving preventive dental treatment in the 12 months prior to a hospitalization or periodontal therapy in the 6 months prior to a hospitalization is associated with a reduced risk of NVHAP. Oral health care interventions may be an additional strategy for NVHAP prevention during inpatient hospitalization.
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Carrasco-Labra A, Devji T, Qasim A, Phillips M, Johnston BC, Devasenapathy N, Zeraatkar D, Bhatt M, Jin X, Brignardello-Petersen R, Urquhart O, Foroutan F, Schandelmaier S, Pardo-Hernandez H, Vernooij RW, Huang H, Rizwan Y, Siemieniuk R, Lytvyn L, Patrick DL, Ebrahim S, Furukawa TA, Nesrallah G, Schunemann HJ, Bhandari M, Thabane L, Guyatt GH. Serious reporting deficiencies exist in minimal important difference studies: Current state and suggestions for improvement. J Clin Epidemiol. 2022 Jun 24:S0895-4356(22)00161-5.

Anchor-based minimal important difference (MID) estimates can inform the interpretation of patient-reported outcomes (PRO) results by defining the extent to which participants exposed to an intervention have experienced an important change in health status. We identified 585 studies, providing 5,324 anchor-based MID estimates in the medical literature linked to 526 distinct PROMs. Between 15% and 25% of studies failed to specify the country in which the study was conducted, the upper and lower values of the PROM, whether higher or lower scores represent desirable health status, the number of participants included in the MID calculation and the threshold in the anchor used to define the MID. The most serious issues impacting the credibility assessments included infrequent reporting of the correlation between the anchor and PROM, inadequate details to judge the precision of the MID point estimate, and insufficient information about the threshold used to ascertain the MID.
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Tampi M, Carrasco-Labra A, O’Brien KK, Velandia-González M, Brignardello-Petersen R. Systematic review on reducing missed opportunities for vaccinations in Latin America. Rev Panam Salud Publica. 2022 Jun 21;46:e65.

The purpose of this study was to estimate the prevalence of missed opportunities for vaccination (MOV) in Latin America and the effect of interventions targeting health systems, health workers, patients, and communities to reduce MOVs. The Evidence suggests the rate of MOV in Latin America ranged from 5% to 37%, with a pooled estimate of 17% (95% CI [9 to 32]) (low certainty) and that monetary incentives to healthcare teams, training for healthcare teams on how to communicate with patients, and educational interventions for caregivers probably reduce MOV (moderate to very low certainty).
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Giuliano KK, Baker D, Thakkar-Samtani M, Glick M, Restrepo MI, Scannapieco FA, Heaton LJ, Frantsve-Hawley J. Incidence, mortality, and cost trends in nonventilator hospital-acquired pneumonia in medicaid beneficiaries, 2015-2019. Am J Infect Control. 2022 Jun 19:S0196-6553(22)00499-0.

Nonventilator hospital-acquired pneumonia (NVHAP) is associated with substantial morbidity, mortality, and costs during an episode of acute care. We examined NVHAP incidence, mortality, and costs of Medicaid beneficiaries over a 5-year period (2015-2019). Overall NVHAP incidence was 2.63 per 1,000 patient days, and mortality was 7.76%, with an excess cost per NVHAP case of $20,189. This study supports the inclusions of NVHAP as a Hospital-Acquired Condition Reduction Program (HACRP) hospital-acquired infections (HAI) initiative.
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Zhang YQ, Jiao RM, Witt CM, Lao L, Liu JP, Thabane L, Sherman KJ, Cummings M, Richards DP, Kim EA, Kim TH, Lee MS, Wechsler ME, Brinkhaus B, Mao JJ, Smith CA, Gang WJ, Liu BY, Liu ZS, Liu Y, Zheng H, Wu JN, Carrasco-Labra A, Bhandari M, Devereaux PJ, Jing XH, Guyatt G. How to design high quality acupuncture trials-a consensus informed by evidence. BMJ. 2022 Mar 30;376:e067476.

Despite over 14,000 published randomized controlled trials in acupuncture, shortcomings persist, including research corresponding poorly to clinical practice, poor reporting, and serious limitations on study design. An international panel including patients, clinicians, researchers, trialists in acupuncture and surgery, and experts in statistics, patient engagement, clinical epidemiology, and methodology developed guidance for acupuncture trials’ design. This guidance covers methodological issues, including the selection of controls, blinding, and the challenges specific to acupuncture trials, including four essential design elements for acupuncture based on whether trials are primarily explanatory/mechanistic or pragmatic/practical.
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Screening testing in health care: Getting it right.
The Journal of the American Dental Association, Volume 153, Issue 4, April 2022, Pages 365-370.
Glick M, Carrasco-Labra, A.
Involving oral health care professionals in screening for diseases traditionally not within the scope of practice of dentistry will emphasize further the link between oral health and general health and well-being. An understanding by oral health care professionals of how to interpret screening test results will benefit their patients substantially and, in the case of contagious diseases, the public at large.
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Increasing the usefulness of acupuncture guideline recommendations. BMJ. 2022 Feb 25;376:e070533
Zhang YQ, Lu L, Xu N, Tang X, Shi X, Carrasco-Labra A, Schünemann H, Chen Y, Xia J, Chen G, Liu J, Liu B, Wang J, Qaseem A, Jing X, Guyatt G, Zhao H.
The minimal important difference (MID) refers to the smallest difference in an outcome measure that patients perceive as beneficial. Using a MID allows the interpretation of the magnitude of health status change in patient-reported outcome measures (PROM). Previous studies proposed the utilization of a universal value for what represents a MID in standard deviation (SD) units (e.g., 0.5 SD). Our study results failed to find evidence of the existence of this constant MID value across PROMs.
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Minimal important changes in standard deviation units are highly variable and no universally applicable value can be determined. J Clin Epidemiol. 2022 Jan 25;145:92-100.
Y, Fujii T, Tsutsumi Y, Kataoka Y, Tajika A, Okada Y, Carrasco-Labra A, Devji T, Wang Y, Guyatt GH, Furukawa TA
“More than 1,300 consensus and evidence-based clinical practice guidelines were published between 1991 and 2007, and these included 2,189 recommendations on the use of acupuncture. Two-thirds of these recommendations focused on pain-related conditions.” This article summarizes the progress made when addressing deficiencies limiting the clinical usefulness of evidence-informed clinical practice guidelines (CPG) in acupuncture, examines the barriers to inclusion of acupuncture interventions in CPG, and suggests strategies to remediate these shortcomings. Critical recommendations for guideline developers in acupuncture include 1) joint efforts for guideline development, 2) change toward a more patient-centric guideline approach, 3) increase use of existing extensive acupuncture evidence to inform recommendations, and 4) Improve CPG reporting quality.
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COVID-19 Vaccination: To Lead by Example or an Opportunity Lost. J Dent Res. 2021;100(13):1421-2.
Glick M, Wolff M
Vaccine hesitancy and tremendous misinformation about the actual science are leaving the public with significant confusion. However, sound epidemiologic science is guiding us to a clear path toward mitigating this modern-day scourge. It is remarkable how putting an end to current COVID-19 outbreaks has such a simple solution—convincing the public to accept getting vaccinated. The dental research, dental education, and dental practice communities have a unique opportunity to act as trusted public exemplars as well as trusted interpreters of the science for the public.
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COVID-19 and Scientific Illiteracy, a Syndemic. J Am Dent Assoc. 2021;152(12):967-8.
Glick M, Wolff M, Carrasco-Labra A
As scientists, we may be reluctant to comment on information found on social media; however, we must develop strategies for communicating clearly and concisely to refute misinformation and disinformation. If we leave this information in the echosphere unrebutted, it takes on the ethos of fact in the minds of those who are less informed. Being scientific resources and communicators should be an integral part of our social contract as health care professionals.
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Long COVID and Oral Health Care Considerations. J Am Dent Assoc. 2022;153(2):167-74.
France K, Glick M
An increasing number of patients recovering from COVID-19 are developing a new syndrome known as long COVID. This condition can affect multiple organ systems and may lead to fatigue, respiratory difficulties, renal and hepatic impairments, the need for antiplatelet and anticoagulant medications, psychiatric complications, and various other symptoms. Many of these medical concerns will require modification to routine oral health care interventions. Recommendations for the treatment of affected people in an oral health care setting are presented, including a thorough evaluation of the patient history and current status, understanding of how related symptoms may affect oral health care interventions, and which modifications to treatment are needed to provide safe and appropriate care.
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