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Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series
No full textAbstract
Osteoradionecrosis of the jaw is a morbid complication of radiotherapy in patients with oral and oropharyngeal cancers that may be precipitated by dental extractions. Pentoxifylline and tocopherol (PENTO) has been utilized in the management of osteoradionecrosis and as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. This observational study aims to report the outcome of the prophylactic use of PENTO in the prevention of osteoradionecrosis of the jaw after dental extractions in post-radiated oral and oropharyngeal cancer patients and to review the current literature on this topic. Four post-radiated oral and oropharyngeal oncology patients were referred to the dental oncology clinic of the University Dental Practice, University of Tennessee Health Sciences Center for dental extractions. All four patients were prescribed pentoxifylline 400 mg BID (twice a day) and tocopherol 400 IU BID (oral tablets) for 2 weeks before extraction(s) and for 6 weeks after extraction(s). All patients were followed up every week after the second week post-extraction if feasible until the extraction site(s) healed (covered by mucosa). The assessment endpoint was defined as 6 weeks post-extraction with the outcomes assessed as using four categories determined by the area of exposed bone: complete healing (complete mucosal coverage of extraction site); partial healing (reduction in size of extraction site); no change; and progression (increase in size of the extraction site). At the assessment endpoint, all patients had complete healing of all extraction sites. The ORN rate at the patient level (0/4) and individual tooth level (0/8) was 0%. All patients tolerated the PENTO medications and no adverse effects from the use of these medications were reported. This limited study in addition to the other reviewed studies estimates the rate of ORN at the patient level as 3.2% (14/436) for post-radiated head and neck oncology patients after dental extractions/invasive oral procedures. In conclusion, this PENTO regimen can reduce/prevent the incidence of ORN in post-radiated head and neck oncology patients. This safe and cost-effective protocol (PENTO regimen) should be further evaluated as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. We recommend large prospective studies to be carried out to further validate these findings
Overcoming barriers to recognizing and reporting child abuse
No full textAbstract
Infants and children under age 3 years have the highest risk of dying from child abuse and neglect. Clinicians treating children must recognize and report child abuse. Barriers to consistent recognition and reporting leave children in harm\u27s way. Often, the signs of abuse in very young children are subtle, and clinicians may fail to recognize and report these signs. Clinicians also must understand the role of bias in the reporting of child abuse and ways to address abuse individually and as part of a larger system
Athletic Trainers\u27 Observations of Social Determinants of Health in the Collegiate Setting: A Card Study
No full textContext: Addressing social determinants of health (SDOH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDOH, little is known about the ability of athletic trainers (ATs) to observe SDOH in practice. Objective: To explore ATs\u27 observations of SDOH and describe actions taken at the point of care in collegiate and university settings. Design: Descriptive via an observational card study. Setting: Athletic training facilities. Patients or Other Participants: Collegiate and university ATs (23 participants across 20 institutions). Data Collection and Analysis: The ATs used a modified observation card to document observations of SDOH during patient encounters in the collegiate or university setting. The cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDOH, (2) a checkbox for observed SDOH, (3) a checkbox for the perceived negative influence of observed SDOH on patient health, and (4) an open box to write in what actions, if any, were taken to address the observed SDOH. Results: Overall, 424 cards were collected. Of 725 observed SDOH, access to social media (153/725, 21.1%), academic stressors (131/725, 18.1%), and behavioral health issues (71/725, 9.8%) were the most commonly observed. Nearly 39% (281/725) had a perceived negative influence. Of those, academic stressors (49/281, 17.4%), behavioral health issues (46/281, 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDOH acted upon, ATs used counseling and education (73/166), provided additional resources (60/166), referred to others (29/166), or communicated with others (4/166). Conclusions: Because ATs are positioned to accurately assess SDOH, they can promote better patient-centered care and improve patient outcomes. Our results suggest that many SDOH observed by ATs in the collegiate or university setting have a negative influence on patient health. Better support for patients with academic stressors and behavioral health issues is important because of these SDOH
Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients With an Ankle Sprain
No full textContext: Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown. Objectives: To identify ATs’ methods for determining patients’ return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods. Setting: Online survey. Design: Cross-sectional study. Patients or Other Participants: We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria. Main Outcome Measure(s): We distributed an online survey to ATs that asked about their assessment of pain, swelling, range of motion, arthrokinematics, strength, balance, gait, functional capacity, physical activity level, and patient-reported outcomes in deciding return to activity. Descriptive statistics were used to characterize participant demographics and frequencies of the assessment measures used by ATs. Chi-square analysis was conducted to identify relationships between the demographics and assessment selection. Results: Pain, swelling, range of motion, strength, balance, gait, and functional capacity were assessed by 76.2% to 96.7% of ATs. Arthrokinematics, physical activity level, and patient-reported outcomes were assessed by 25.3% to 35.1% of participants. When selecting specific assessment methods, ATs often did not use recommended ROASTs. Athletic trainers with higher degrees, completion of more advanced educational programs, employment in nontraditional settings, more clinical experience, and familiarity with expert consensus recommendations were more likely to use ROASTs. Conclusions: Before approving return to activity for patients with ankle sprains, ATs did not use some recommended outcomes and assessment methods. Practice in nontraditional settings, more advanced degrees, more clinical experience, and familiarity with expert consensus guidelines appeared to facilitate the use of ROASTs
Current trends in retraction of plastic surgery and reconstruction research
No full textBackground: Various studies regarding retractions of publications have determined the rate of retraction has increased in recent years. Although this trend may apply to any field, there is a paucity of literature exploring the publication of erroneous studies within plastic and reconstructive surgery. The present study aims to identify trends in frequency and reasons for retraction of plastic and reconstructive surgery studies, with analysis of subspecialty and journals. Methods: A database search was conducted for retracted papers within plastic and reconstructive surgery. The initial search yielded 2347 results, which were analyzed by two independent reviewers. 77 studies were jointly identified for data collection. Results: The most common reasons for retractions were duplication (n = 20, 25.9 %), request of author (n = 15, 19.5 %), plagiarism (n = 9, 11.6 %), error (n = 9, 11.6 %), fraud (n = 2, 2.6 %), and conflict of interest (n = 1, 1.3 %). 15 were basic science studies (19.4 %), 58 were clinical science studies (75.3 %), and 4 were not categorized (5.2 %). Subspecialties of retracted papers were maxillofacial (n = 29, 37.7 %), reconstructive (n = 17, 22.0 %), wound healing (n = 8, 10.4 %), burn (n = 6, 7.8 %), esthetics (n = 5, 6.5 %), breast (n = 3, 3.9 %), and trauma (n = 1, 1.3 %). Mean impact factor was 2.9 and average time from publication to retraction was 32 months. Conclusion: Analysis of retracted plastic surgery studies revealed a recent rise in frequency of retractions, spanning a wide spectrum of journals and subspecialties
Emotional Pre-Occupation And Variations in Stress Scores During Chronic Hemodialysis Management
No full textINTRODUCTION: Hemodialysis (HD) patients experience significant psychological stress related to HD. Different types of coping strategies are utilized by these patients to cope with this stress. METHODS: Variations in different types of coping strategies with the variations in HD-related stress scores and disparities by sex were assessed. HD patients aged 18 years and above who were seeking regular treatment in a specific HD-unit of a hospital in the upper Midwest, were surveyed between March 2020 and July 2020. RESULTS: Descriptive statistics, correlational analyses, and regression analyses were performed. Females could be expected to have emotional coping scores 8 units greater than males, as B = 8.017 for sex in the model, p =.000. Females could be expected to have coping scores 6.4 points higher than males when adjusted for stress levels, as: B= 6.351, p =0.001 for sex in the model. For each 1 point increase in Stress Score, the Coping Score could be expected to: increase 6.8 points when adjusted for sex, where B = 6.751 and p =0.000. CONCLUSION: Increased prevalence of emotional pre-occupation was only observed among female patients which increased with the increase in stress. Psychological interventions in female HD patients should be strongly considered in addressing emotional pre-occupation coping
Documentation
No full textWhen I was working in school-based practice, I often would see up to eight children for individual sessions in a day or I would work with children in small groups. I would try to write my notes at the end of each session. But sometimes the days were so busy, and teachers, parents, or classroom aides would have questions, making it hard to write my notes right away. If I waited until the end of the day to write my notes, it could be a challenge to remember what happened early in the day. So I came up with a system to help me remember what each child did so I could document with accuracy. I carried a clipboard with blank paper that was divided into eight sections. At the beginning of the day, I would write the initials of the children I would be working with in the boxes on the paper. At the end of the session, I would quickly jot some abbreviated notes and phrases. I developed my own cryptic messages! At lunchtime or at the end of the day when I had more time, those brief notes were enough to help me remember the session so I could document in detail. This idea could also work if you prefer using an electronic tablet and a stylus!
A client-centered life skills education program for enhancing successful integration among newly arrived refugee and asylum seeking Afghan women
Get PDFIntroduction. Refugees and asylum seekers are subsects of immigrants who are forcibly displaced from their home environments. They face unique challenges after immigrating that prohibit their ability to acclimate to their new environments, such as language barriers, role and identity changes, and a lack of social support. This capstone project explores the effects of a ten-week client-centered life skills education program on integration into their newfound communities for refugees and asylum seekers. Methods. Three participants who identified as refugees or asylum seekers seeking services at the community partner for this project, Matthew House, were included. All participants were from Afghanistan and had resided in Chandler, AZ for no more than two years. The Canadian Occupational Performance Measure, the Occupational Self Assessment, and the Life Skills Exit Survey were three outcome measures used to evaluate changes in performance and satisfaction with the life skills covered throughout the program. Results. From the COPM, participants uniquely exhibited challenges with various occupational problems, and performance and satisfaction scores generally improved after the program. From the OSA, self-expression and a satisfying routine were the most shared concerns that participants exhibited difficulties with. Increased self-confidence in and increased knowledge of skills were two themes that emerged from the life skills program exit survey. Conclusion: The findings conveyed that a life skills education program effectively supports refugees and asylum seekers’ integration into their new environments. Occupational therapy is an instrumental profession that can enhance the quality of life for this population due to its holistic, client-centered nature, and because life skills are daily occupations
Community Education to Postpartum Parent About Pelvic Health
Get PDFThere is a lack of literature about whether pregnant and postpartum parents receive enough support and education about common pelvic floor conditions and treatment options. This lack of support can delay or stop them from knowing they have pelvic floor dysfunction, as well as seeking services to treat their pelvic floor dysfunction. This project provided pelvic floor education focused on bladder health, bowel health, and sexual health to pregnant and postpartum parents. The objective of this pelvic health education program was to increase pelvic floor knowledge in pregnant and postpartum parents, which would empower them to seek pelvic floor therapy services from skilled professionals. Participants filled out a knowledge survey before and after each class to assess how the class changed their baseline knowledge level on the topics discussed. Participants demonstrated improved scores on the post-surveys, indicating that their knowledge increased about pelvic health topics related to bladder, bowel, and sexual health. This project supports the need for pregnant and postpartum parents to receive more education throughout their pregnant and postpartum journeys
Novel Occupational Therapy Treatment in the Pediatric Intensive Care Unit
Get PDFMillions of children are hospitalized in the United States each year. Hospitalization can negatively impact the child, their family, and their education. Occupational therapy can be used to target the family unit in coping and engagement in meaningful occupations in the hospital setting. The magazine photo collage has been used in the past to target coping and social interaction, but there is limited evidence of its use in occupational therapy in the hospital setting. This project aimed to explain the experience of families in creating and using the magazine photo collage in occupational therapy in the hospital setting. In this capstone project, one family completed the magazine photo collage as part of an occupational therapy intervention. The family completed the magazine photo collage in one session and the mother was able to report on her experience with creating the magazine photo collage. The bonding experience sparked dialogue between the family members and the mother reported a positive experience with creating the magazine photo collage, showing how meaningful it could be in the hospital setting. This project included the experience of one family, and future research would benefit from more feedback from the children as well as the parents. Future research would also benefit from analyzing the use of the magazine photo collage over a longer period of time