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Awake endotracheal intubation using a hyperangulated video laryngoscope with a Total Control Introducer in a patient with a history of difficult intubation
No full textWe report the first use of a fully articulating introducer called the Total Control Introducer (TCI) in combination with a hyperangulated video laryngoscope (VL) to perform an awake intubation in a patient with a history of difficult intubation. After appropriate airway topicalisation, a VL with a hyperangulated blade was inserted to visualise the glottis. A TCI articulating introducer was then used to dynamically navigate through the oropharynx into the trachea. Under indirect visualisation, an endotracheal tube was then passed over the TCI. The TCI was removed and the endotracheal tube was secured. General anaesthesia was induced after confirmation of intubation with capnography and auscultation. The patient was successfully intubated on the first attempt without complications
Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: Systematic review and meta-analysis
No full textContext: Osteopathic manipulative treatment (OMT) has been utilized by osteopathic clinicians as primary or adjunctive management for dizziness caused by neuro-otologic disorders. To our knowledge, no current systematic reviews provide pooled estimates that evaluate the impact of OMT on dizziness. Objectives: We aimed to systematically evaluate the effectiveness and safety of OMT and analogous techniques in the treatment of dizziness. Methods: We performed a literature search in CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database (AMED), EMCare, Physiotherapy Evidence Database (PEDro), PubMed, PsycINFO, Osteopathic Medicine Digital Library (OSTMED.DR), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2021 for randomized controlled trials (RCTs) and prospective or retrospective observational studies of adult patients experiencing dizziness from neuro-otological disorders. Eligible studies compared the effectiveness of OMT or OMT analogous techniques with a comparator intervention, such as a sham manipulation, a different manual technique, standard of care, or a nonpharmacological intervention like exercise or behavioral therapy. Assessed outcomes included disability associated with dizziness, dizziness severity, dizziness frequency, risk of fall, improvement in quality of life (QOL), and return to work (RTW). Assessed harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse events. The meta-analysis was based on the similarities between the OMT or OMT analogous technique and the comparator interventions. The risk of bias (ROB) was assessed utilizing a modified version of the Cochrane Risk of Bias Tool for RCTs and the Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) for observational studies. The quality of evidence was determined utilizing the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results: There were 3,375 studies identified and screened, and the full text of 47 of them were reviewed. Among those, 12 (11 RCTs, 1 observational study, n=367 participants) met the inclusion criteria for data extraction. Moderate-quality evidence showed that articular OMT techniques were associated with decreases (all p\u3c0.01) in disability associated with dizziness (n=141, mean difference [MD]=-11, 95% confidence interval [CI]=-16.2 to -5.9), dizziness severity (n=158, MD=-1.6, 95% CI=-2.4 to -0.7), and dizziness frequency (n=136, MD=-0.6, 95% CI=-1.1 to -0.2). Low-quality evidence showed that articular OMT was not associated with ACD rates (odds ratio [OR]=2.2, 95% CI=0.5 to 10.2, p=0.31). When data were pooled for any type of OMT technique, findings were similar; however, disability associated with dizziness and ACD rates had high heterogeneity (I2=59 and 46%). No studies met all of the criteria for ROB. Conclusions: The current review found moderate-quality evidence that treatment with articular OMT techniques was significantly associated with decreased disability associated with dizziness, dizziness severity, and dizziness frequency. However, our findings should be interpreted cautiously because of the high ROB and small sample sizes in the eligible studies
Celiac Disease Dietary Adherence on the Rural–Urban Continuum
No full textPoor adherence to a gluten-free diet for those with celiac disease is a well-established risk factor, leading to gastrointestinal symptoms, malabsorption of nutrients, and psychiatric complications. Previous studies have shown that those outside urban areas encounter unique barriers to dietary adherence and are less likely to engage in health management behaviors than those in urban regions. This study aimed to examine the relationship between gluten-free dietary adherence and individual, relationship, and community factors, including the geographic location of residence on the rural–urban continuum, for 253 adults with celiac disease living in the United States. Those with celiac disease residing in urban regions had significantly better dietary adherence than those residing in nonurban areas (p \u3c 0.05). Those living in nonurban communities had, on average, poor enough adherence scores to suggest ongoing intestinal damage from gluten consumption. Geographic location, age, years since diagnosis, and annual income significantly predicted compliance with a gluten-free diet for those with celiac disease, accounting for nearly 20% of the variance. Those living outside urban areas with a lower income, younger age, and more recent diagnosis of celiac disease had the worst dietary adherence, placing them at the most risk for ongoing disease progression and complications
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Training Dental Hygiene Students to Care for Patients with Disabilities
No full textPurpose The purpose of this study was to evaluate the impact of a novel training program on dental hygiene students’ knowledge, attitudes and beliefs about caring for individuals with disabilities. Methods A mixed methods approach was used. Students from five dental hygiene programs based at community colleges completed a two-hour didactic training session to supplement their existing special care dentistry coursework. Students completed an original 14-item pretest and posttest before and after the training that assessed attitudes and beliefs, and two validated posttests that assessed knowledge. Afterwards, students completed a clinical rotation in an advanced care dental clinic at a local academic institution gaining hands-on experience with equipment and patient treatment. Descriptive statistics were used to report training scores, types of services rendered and modifications to treatment. Student comments about their experiences were assessed using thematic analysis. Results Two hundred and ninety-four students completed didactic training and 261 completed clinical rotations. Posttest scores indicated positive improvements in knowledge, attitudes and beliefs. All students provided direct patient care. Sixty-nine percent treated patients with intellectual and developmental disabilities; 75% placed silver diamine fluoride or fluoride varnish. Altered patient positioning was used by 70.5%. Most students (95.4%) reported that their experience positively changed their attitudes towards caring for patients with disabilities in the future. Eight themes emerged, notably increased comfort and confidence, a willingness and desire to treat patients, the acquisition of new skills, and clinician behaviors of empathy and compassion towards others. Conclusion Training can help prepare dental hygiene students with the confidence and skills to address the oral health needs of individuals with disabilities
Soft Tissue Grafting Procedures before Restorations in the Esthetic Zone: A Minimally Invasive Interdisciplinary Case Report
No full textAn esthetically pleasing smile is a valuable aspect of physical appearance and plays a significant role in social interaction. Achieving the perfect balance between extraoral and intraoral tissues is essential for a harmonious and attractive smile. However, certain intraoral deficiencies, such as non-carious cervical lesions and gingival recession, can severely compromise the overall aesthetics, particularly in the anterior zone. Addressing such conditions requires careful planning and meticulous execution of both surgical and restorative procedures. This interdisciplinary clinical report presents a complex case of a patient with esthetic complaints related to asymmetric anterior gingival architecture and severely discolored and eroded maxillary anterior teeth. The patient was treated using a combination of minimally invasive ceramic veneers and plastic mucogingival surgery, resulting in a successful outcome. The report emphasizes the potential of this approach in achieving optimal esthetic results in challenging cases, highlighting the importance of an interdisciplinary team approach in achieving a harmonious balance between dental and soft tissue aesthetics
Managing ascites in patients with cirrhosis
No full textAbstract
Patients with cirrhosis have a 50% to 60% chance of developing ascites within 10 years of diagnosis. Once ascites has developed, patients have a predicted 50% mortality within 3 years. This article discusses the pathophysiology of ascites caused by cirrhosis, standards in diagnosing ascites, and the recommendations and guidelines for treating ascites. Properly managing patients with decompensated cirrhosis can improve their quality of life and longevity and minimize additional complications
COVID-19 Infection with Severe Hypothermia in a Fully Vaccinated Patient
Get PDFHypothermia is an uncommon presentation of COVID-19 infection, typically observed in patients with severe disease prior to the availability of vaccines. However, the occurrence of hypothermia in vaccinated patients with COVID-19 disease has not yet been documented. This case reports a rare presentation of severe hypothermia in a 41-year-old female with COVID-19 disease, who suffered from several comorbidities, including heart failure with preserved ejection fraction, chronic pericardial effusion, nephrotic syndrome, CKD 4, hypertension, type 2 diabetes, thyroid cancer status post-thyroidectomy with resultant postsurgical hypothyroidism, glaucoma, and anemia of chronic disease. Upon presentation, the patient was encephalopathic with hypothermia of 27.2 °C (81 °F) per rectal thermometer and bradycardia of 35 beats per minute. The patient underwent active rewarming, which included warm fluids, heated high flow nasal cannula 5L/min FiO2 28%, and Bair hugger with the goal of rewarming the patient at no greater than 2°C per hour. The patient recovered her temperature overnight, but remained encephalopathic. Despite adherence to the established therapeutic measures for severe hypothermia, the patient clinically declined and expired. This case underscores the potential for hypothermia to manifest in patients with COVID-19 who have received two vaccine doses. The implications of this finding will be discussed, highlighting the need for further research and awareness regarding hypothermia as a possible presentation of COVID-19 in vaccinated individuals
Preparing for Pandemics: Lesson Plan Design for Children in Elementary School
Get PDFContext: The COVID-19 pandemic necessitated distance learning to attenuate the spread of the virus, and school-aged children were particularly affected by this change. Because of their age and education level, children generally lacked understanding about the pandemic and the preventive measures necessary to prevent the spread of this and other infectious diseases. It is unknown how many schools nationwide incorporated disease-prevention education in their curriculums during the pandemic. Therefore, developing distance learning interventions that convey these topics at their level of understanding is important to improve health literacy and raise their awareness of factors that positively influence health.
Objective: To implement a distance learning intervention that teaches elementary-aged children about infectious diseases and pandemics and to evaluate their understanding of the material.
Methods: A four-week program with weekly lessons was developed to teach fifth grade students about infectious diseases and pandemics. Weekly lessons involved one or two instructional videos, preintervention and postintervention quiz, live online interactive session. Participants also completed a survey before (Presurvey) and after (Postsurvey) the entire 4-week program to evaluate their understanding of the material.
Results: 61 fifth graders (ages 10-11) participated in the project. Quiz scores improved from preintervention to postintervention for week 1 (74% [3.0] vs 86% [2.2], PP=.34), and week 3 (78% vs 83%, P=.20). Scores were the same in week 4 (95%,P=.86). Survey responses before and after the program also improved, particularly for questions related to understanding what it means to be in a pandemic (33% [18/54] vs 55% [24/44], P=.008) and that SARS-CoV-2 is a virus and causes COVID-19 (4% [2/54] vs 27% [12/44], P
Conclusion: Project results suggested that our distance learning intervention improved fifth grade students’ knowledge about infectious diseases and pandemics. Although it was difficult to maintain the same response rate for weekly quizzes or to fully engage participants during the virtual lessons, the live interactive sessions were well received and seemed to improve their understanding of these topics. Because our project intervention seemed to provide participants with greater health literacy, similar interventions should be considered for other grade levels at elementary schools across the country to promote awareness about infectious diseases or other global health issues
Effects of an Occupation-Based Social and Life Skills Session on the Strength of Intimate Partner Violence Victims’ Generalized Self-Efficacy Beliefs
Get PDFBackground: Prior research has identified occupational therapy as a profession poised to provide interventions to enhance the recovery of intimate partner violence victims. The present study aimed to implement a program to affect the generalized self-efficacy beliefs of intimate partner violence victims residing in Autumn House Emergency Crisis Shelter.
Methodology: The Generalized Self-Efficacy Scale was administered before and after a total of seven individual/group sessions to a sample of adults residing at the shelter over the course of the occupational therapy program. Statistical analysis was performed utilizing a one-sample Kolmogorov-Smirnov test and paired T-test Cronbach’s alpha to establish whether the distribution of data was normalized and whether the results of the Generalized Self-Efficacy Scale were significant to indicate a change in self-efficacy beliefs from pre- to post-session.
Results: A sample of 13 adults participated in the program who completed the assessment before and after a program session. Overall one-sample Kolmogorov-Smirnov test for the Generalized Self-Efficacy Scale was .200, which suggested that the data’s distribution was not significantly non-normal. The Generalized Self-Efficacy Scale had a two-sided p-value of 004, which suggested that the change in assessment scores was statistically significant.
Conclusion: Overall, evidence suggested that the occupational therapy program provided sessions that positively and significantly affected the self-efficacy beliefs of participants from pre- to post-session. Further research should investigate whether this program or similarly developed programs influence the same positive outcomes reliably among participants of varying demographics such as gender, age, race, gender identity, and sexual orientation.
Keywords: intimate partner violence, occupational therapy, self-efficacy beliefs, occupational therapy program, Generalized Self-Efficacy Scal