Outcomes Assessment of a Predoctoral Pediatric Dentistry Clinical Rotation Using Alumni Surveys.

Objectives The electrocardiogram (ECG) of patients with hypertrophic cardiomyopathy (HCM) ranges from normal to exhibiting evidence of ventricular hypertrophy, including pathologic Q waves and ST-T wave changes. Deep Q waves in the inferior and lateral leads are one of the classic ECG findings associated with HCM. The prevalence or frequency of this finding in pediatric HCM patients, however, is not well-established. Furthermore, other pediatric health conditions have also been associated with pathologic and non-pathologic Q waves and an awareness of those conditions is important to consider when Q waves are observed. The primary goal of this systematic review of the literature is to describe the prevalence of pathologic Q waves in the ECGs of pediatric patients with echocardiogram proven HCM. A secondary goal is to review other pediatric conditions that can present with pathologic and non-pathologic Q waves. Methods The databases PubMed, Web of Science, Scopus and cumulative index to nursing and allied health literature (CINAHL) were searched utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format. The Rayyan systemic review software was used to screen articles for final review. The initial search (Search 1) consisted of the following terms: “dagger Q wave”, “dagger-like Q waves”, “dagger shape Q waves”. Subsequently, a broader search (Search 2) was conducted to determine if viable articles were omitted in the first search. This broader search strategy eliminated the term “HCM”. The authors then performed detailed review of the articles these two searches yielded, as well as a review of the references of these articles to find other relevant articles as well as produce a list of other pediatric conditions that may be associated with pathologic or nonpathologic Q waves. Results Of the articles found via the three searches, a total of nine English language articles that specifically addressed the prevalence of pathological Q waves in pediatric HCM patients were ultimately included in our systematic review. These nine articles described a total of 845 pediatric patients with HCM. Of these, 258 (30.5%) demonstrated pathological Q waves on their electrocardiograms. The range of percentages reported for pathological Q waves was 12.5 to 66.7%. Additionally, our review found fifteen different pediatric conditions reported to be associated with pathologic or non-pathologic Q waves. Conclusion Our systematic review confirmed that pathologic Q waves are a common and early electrocardiographic finding in children with HCM and may, in fact, be the only ECG finding. In addition, our review provided an extensive list of other pediatric diseases and conditions associated with pathologic or non-pathologic Q waves on the electrocardiogram.

Rationale Asthma is one of the most common pediatric chronic health conditions. Regular follow-up care as recommended by national guidelines can significantly improve asthma outcomes, and our prior pilot research suggests that telemedicine for follow-up pediatric asthma care is feasible. The goal of the current study is to examine the impact of telemedicine (TM) versus in-person (IP) asthma follow-up care on pediatric asthma outcomes. Methods We conducted a 2-year retrospective cohort chart review of pediatric asthma patients to examine outcomes of patients receiving follow asthma care via IP or TM …

BackgroundOral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.MethodsDentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed.FindingsData from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories.ConclusionsThe study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

To conduct a comparative analysis of eight pediatric self-report scales for ages 8-17 years from the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS®) in six pediatric chronic health conditions, using indicators of disease severity.

ObjectivesThe WHO estimate that one in seven 10–19-year-olds experiences a mental health disorder while ‘My World Survey 2’/The National Study of Youth Mental Health in Ireland conducted in 2019 involved...

Pregnancy is a unique time in a woman's life when many physiological, physical, emotional and hormonal changes occur. It can also be quite an anxious time for women, particularly in the first trimester, when the risk of miscarriage is at its highest. Uncertainty still exists around the topic of dental treatment and care during pregnancy, which may create challenges for both the patient and the dental team. CPD/Clinical Relevance: The common health and oral health conditions that occur in pregnancy are relevant to all clinicians.

Mindfulness interventions are commonly used to manage psychological and physiological distress associated with pediatric health conditions. Mindfulness approaches are particularly well-suited to pediatric illnesses because many of these conditions are chronic and mindfulness encourages both acceptance of what one cannot change and engagement in behaviors that improve functioning. Rather than seeking to ameliorate illness, mindfulness encourages nonjudgmental present awareness and moving in the direction of one’s values. This chapter provides an introduction to mindfulness practices for pediatric health conditions along with illustrations of how clinicians can apply mindfulness principles in their practice with pediatric patients. We provide descriptions of how to adapt mindfulness principles for use with children and adolescents, considering cognitive developmental differences that influence the type of intervention content appropriate across different ages. Finally, we provide examples of mindfulness intervention application for common chronic conditions (i.e., pain, gastrointestinal distress, obesity) to assist the practitioner in tailoring mindfulness interventions to these populations.

Effects of the Ketogenic Diet for Epilepsy on Pediatric Patients' Oral Health Condition

BackgroundHigh incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions.MethodsAn integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included.ResultsXerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients.ConclusionsThis review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.

This study estimates the frequency and duration of boarding for pediatric mental health conditions at US acute care hospitals and describes hospital resources available to support youths during boarding.

Background/Objectives: Pharmacogenetic (PGx) testing can predict drug efficacy, toxicity, and risk of adverse drug reactions (ADRs). However, PGx-guided prescribing for pediatric chronic pain is underutilized. Methods: We evaluated the rate of deviance from standard drug dosing regimens in children and adolescents with chronic pain based on PGx testing of drug-metabolizing genes. We also assessed the acceptability and feasibility of PGx testing and implementation of PGx-guided recommendations from patient, caregiver, and prescriber perspectives. Finally, we explored whether PGx results could predict self-reported therapeutic responses and/or ADRs to medications. Results: Forty-eight participants aged 8–17 years with chronic pain provided DNA via buccal swab. Genetic variant data for CYP2D6, CYP2C9, and CYP2C19 metabolism genes and associated metabolizer status were analyzed with respect to clinical PGx guidelines for dosing recommendations of analgesics and psychotropic medications. Participants, their caregivers, and their prescribers also completed quantitative questionnaires evaluating their experience with PGx testing. Twenty-three (50%) participants were predicted to benefit from non-standard dosing for medications with clinical PGx guidelines. Participants expressed satisfaction with the PGx testing process and felt it was safe and worthwhile. Prescribers also reported that PGx results were relevant for medication choices in 42 (91%) participants. Seven (15%) participants had genotyping results which may have predicted their self-reported therapeutic responses and/or ADRs to specific medications. Conclusions: Though further research on pharmacodynamic associations is required to sufficiently address the complexity of interpatient responses to medications for the treatment of pediatric pain and mental health conditions, PGx testing may be used to inform individualized medication choices based on genetic make-up.

Data from the Adult Dental Survey conducted in 2009/10 have recorded some major changes in the pattern of oral conditions in British adults. The change in the number of sound and untreated teeth in recent decades has been particularly marked in younger adults. Across all ages there were 17.9 sound and untreated teeth per dentate adult, but among the youngest (16-24-year-olds) it was 26.9 teeth indicating rapidly improving prospects for young adults compared with their predecessors. Between 1998 and 2009 the overall prevalence of caries of all types in England has fallen dramatically from 54% to 31% overall, but the number of teeth affected by caries among those people affected by decay is almost unchanged at around 2.7 affected teeth per person. Caries, and the reduction in caries, affected people of all ages. The rate of new restorations is correspondingly low and young adults in particular had fewer restorations than their predecessors. Much activity is now likely to be around repairing or extending existing restorations. By contrast 37% of dentate adults had crowns, up from 34% in 1998, averaging around three crowns per person among those who have crowns. A minority of British adults had a very healthy periodontal status (17%) and moderate periodontal disease (pockets of 4 mm to less than 6 mm) has also reduced markedly in the last decade, in line with measurably less plaque and more frequent brushing. However, more severe disease has increased slightly (from 6% to 9% of adults). The frequency of impact of poor oral health on people's lives has also reduced in the last decade. However, while clinical conditions are improving, there is a proportion of dentate adults that experience negative effects on their daily life frequently (16%) and/or severely (17%) due to their oral health; who are more likely to be those in a lower socioeconomic position and those with worse clinical status in terms of caries and periodontal disease.

Pediatric Fertility Counseling

Objectives: To compare the effectiveness of general anesthesia versus local anesthesia with or without conscious sedation for minor oral surgery procedures in pediatric patients. Methods: We performed a retrospective chart review of 192 pediatric patients who underwent 227 minor oral surgery procedures between 2017 and 2019 at the Oral and Maxillofacial Surgery Department at Hospital Clínico Universitario in Valencia, Spain. Results: Of the 192 patients studied, 57.27% were male and 42.73% female (mean age, 9.83 years). General anesthesia was used in 51.54% of procedures, and LA with or without conscious sedation in 48.46%. Pain, occurring in 2.56% of general anesthesia procedures and 2.73% of local anesthesia procedures, was the most common complication, followed by infection (1.71% of general anesthesia procedures). Procedural success was 94.87% in the general anesthesia group and 91.82% in the local anesthesia group. No significant differences were observed in success or complication rates between the groups. Conclusions: Compared with local anesthesia with or without conscious sedation, general anesthesia does not result in lower procedural success rates or a higher risk of complications other than mild pain in pediatric dental patients.

Managing the anxiety of pediatric dental patient has long been the purview of dentists over many years. Various techniques have been used with moderate and variant success rates over the last few years. The main aim of this study was to ascertain if music distraction is an effective means of managing anxiety in pediatric dental patients. Forty children aged between 4 and 8 years were selected for the study. The assessment of anxiety was done using Venham's picture test, Venham's anxiety rating scale, pulse rate, and oxygen saturation during different treatment visits. The values were statistically analyzed and it was concluded that audio distraction did decrease the anxiety level in pediatric dental patients, but not to a very significant level.