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Biomedical subjects

D J Kenny

Publications and source records attributed to D J Kenny.

At least 19 recordsLinked to original sources
PubMed1992

Ventilation and swallowing interactions of normal children and children with cerebral palsy.

The respiratory inductance plethysmograph was used to analyse the ventilatory cycle during drinking, chewing and swallowing of normal and cerebral-palsied children aged between five and 12 years. 33 children were divided equally into three groups: normal, spastic CP and athetoid CP. A few of the children with spastic CP and over half of those with athetoid CP were unable to perform the 'big breath' task. In the remaining trials, the children with CP held their breath for a shorter time than normal children. Many children with CP required multiple swallows to consume 5mL of liquid. In the majority of trials, normal children swallowed liquids at or near the peak of inspiration, whereas the children with CP did not. Supplementary swallows and solid-bolus swallows occurred at any point in the ventilatory cycle in all groups. The children with CP had a greater need to inspire at the end of liquid tasks, especially during the 75mL task.

Cerebral Palsy↗
PubMed1991

Risk management: the clinician's defense against liability.

As Stock and LeFroy conclude, a RM program lends structure and direction to management. Consistent delivery of high-quality service requires that hundreds of individuals perform numerous roles with a value-added service orientation. Jan Carlzon, the Director of Scandinavian Airlines and the person responsible for its remarkable turnaround, has the proper perspective: "We don't seek to be one thousand percent better at any one thing. We seek to be one percent better at one thousand things." Risk management is one factor in the development of a service-oriented health care culture that leads to sustained profitability through a stable patient base. The development of a RM program for a private dental office will lay the groundwork for a higher goal; a demonstrable, verifiable quality of care throughout the practice.

Canada↗
PubMed1991

Quality assurance: a process for continuous improvement.

As E.S. Woodlard Jr., Chairman of Du Pont states, "Continuous improvement is vitally important in today's environment. The world is full of savvy, agile competitors who know quality makes a difference." Dentists are part of the health care industry and compete for their patients' discretionary dollars. Careful attention to the development of an integrated RM/QA program for their dental offices is one means of ethical marketing for patient satisfaction. Lessons from the competitive hospitals in the United States and current practices of successful service industries should form part of the framework of the QA component of a practice. A marketing plan is good sense in today's turbulent economic environment and ethical marketing will make the risky "selling" of dental treatment unnecessary.

Dental Care↗
PubMed1990

Composite resin short-post technique for primary anterior teeth.

A technique using a "mushroom shaped" composite resin short post constructed inside the pulp-treated root canal provides sufficient retention to build a composite resin crown on the reinforced superstructure of the remaining crown dentin. This technique was tested for 1 year in 92 teeth; they showed no failures of retention of the short post. Recurrent caries and severe bruxism--factors beyond operator control--posed some problems that were readily resolved.

Child, Preschool↗
PubMed1989

Correlation of ultrasound imaging of oral swallow with ventilatory alterations in cerebral palsied and normal children: preliminary observations.

Preliminary results of an investigation that synchronizes the videotaped output of ultrasound camera and the analog data from physiological measurements of swallowing and ventilation in normal and cerebral palsied (CP) children are presented. Four cerebral palsied children and three control children undertook a single sip-swallow of 5 ml of liquid and a solid mastication-swallow sequence on three occasions according to a defined protocol. The CP children exhibited much more variability and less control of the liquid bolus than did the controls. The ultrasound image clearly demonstrates the lack of control of the posterior of the tongue in many CP children. Some parts of the sequence of oral swallow and the time to achieve maximum anterior displacement of the hyoid bone appear to be slowed. The sequential events of swallowing show less variability as the sip-swallow proceeds from the oral voluntary to pharyngeal and lower involuntary phases. This study also identified a short-latency apnea that appears to accompany a saliva (protective) swallow and a long-latency apnea that accompanies semi-solid or liquid bolus (alimentary) swallows. Further investigations of normal and CP children utilizing a combined diagnostic imaging-physiological measurement approach will follow this initial study.

Apnea↗
PubMed1989

Development of a multidisciplinary feeding profile for children who are dependent feeders.

The multidisciplinary feeding profile (MFP) is the first statistically based protocol for the quantitative assessment of feeding disorders in severely disabled children. This assessment can be completed in 30-45 min with foods and facilities that are available in homes, hospitals, and chronic care units. This paper describes the state of current testing methods, the parameters of successful feeding activity, the development of the test protocol, and the results of statistical analyses.

Adolescent↗
PubMed1989

The multidisciplinary feeding profile: a statistically based protocol for assessment of dependent feeders.

The development of the multidisciplinary feeding profile entailed a level of statistical analyses not commonly utilized in test development. This paper describes the statistical analyses and offers an explanation of why specific statistical tests were chosen. It also serves to identify where clinical knowledge and experience overrode specific statistical tests.

Persons with Disabilities↗
PubMed1989

'Locked-in' syndrome. Occurrence after coronary artery bypass graft surgery.

The 'locked-in' syndrome has not previously been described in the immediate period after open-heart surgery. We describe the case of a patient who remained tetraplegic and mute, but alert, after graft surgery. A brief review of the aetiological factors in the development of this type of stroke after coronary artery bypass is presented.

Coronary Artery Bypass↗
PubMed1989

Ear lobe crease and coronary artery disease in patients undergoing coronary arteriography.

An association between the ear lobe crease and coronary heart disease has been documented. A prospective study of 125 consecutive patients undergoing coronary arteriography was carried out to evaluate the ear lobe crease with the presence and extent of coronary artery disease. An ear lobe crease was observed in 65 patients, but this trait was not related to age, sex, smoking history, previous myocardial infarction, history of hypertension, family history of heart disease, body mass index or angiographically defined coronary artery disease. We conclude the ear lobe crease is not related to coronary heart disease.

Adult↗
PubMed1989

Growth, development, and aging of orofacial tissues: neural aspects.

Neural factors influence post-natal growth, development, and aging throughout the body. This influence may be mediated through sensory or motor effects interacting with endocrine and immunological factors. Growth effects may be expressed directly by sensory or motor nerves on the tissue or indirectly by motor function. Direct neutrotrophic effects have been well-documented in the development of striated muscle, the taste bud, and the amphibian limb. Evidence for a trigeminal neurotrophic effect on tooth development and facial development is lacking. Growth disturbances of the jaws consequent to lesioning of the trigeminal nerve are due most likely to functional disturbances rather than neutrotrophism. Examples of function impact on orofacial growth are abundant. Oral and facial target tissues, like those elsewhere in the body, determine the nature of the target tissue innervation and its central organization. Central effects consequent to tooth loss or dental pulp entirpation are well-documented. Inflammation and pain may exert growth effects through release of "wound hormones" or secondarily to somatic and autonomic effects. There is evidence that vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) elaborated from sympathetic and parasympathetic neurons may have a modulatory role in growth. While the effects of longstanding motor pathologies on skeletal growth are well-known, concomitant sensory deficits and soft tissue disturbances have not been examined. However, the pathological models beg the question of normal regulation. While muscle develops in the absence of innervation, neurotrophic effects are clearly identified. Little is known about the interaction of simple and complex motor behavior on growth. Regulation of growth is frequently visualized within a form-function paradigm. For example, anterior open bites have been seen as the consequence of tongue thrusting or tongue thrusting as a consequence of open bites. Low tonic forces in posture are thought to be more important in the development of both the face and the dental alveolar complex than the higher intermittent forces in mastication and swallowing. The need for an active (reflex) contribution to growth at the TMJ is in dispute.(ABSTRACT TRUNCATED AT 400 WORDS)

Face↗
PubMed1989

Sugar load of oral liquid medications on chronically ill children.

Children with congenital disorders or chronic illnesses receive additional sugar from oral liquid medications. The purpose of this study was to determine the history of oral liquid medication usage and the incidence of dental caries from birth until about 36 months of age in a population of 20 such children. A pattern appeared in the frequency and dispensing characteristics of the 44 different drugs used for these children. Parents gave daily doses of syrupy medications and elixirs 3-4 times a day and at least two of these doses were given just before or during a designated nap or bedtime. Parental concerns for the more serious medical condition naturally overrode the consideration of sound dental hygiene practices. In this study, diseased, extracted and filled primary teeth def(t) were recorded and the medicinal sugar load at the time of examination was calculated as well as the cumulative medicinal sugar load from birth. Average age on examination was 31 months and the median number of def(t) was eight. The mean total amount of additional sugar from oral liquid medications was 8,696 g and the maximum sugar consumed by one child was over 20 kg. Physicians currently have no choice but to prescribe certain medications that contain 30 to 70 per cent sugar for patients who are already at higher than usual risk for dental caries due to chronic illness.

Child, Preschool↗
PubMed1987

Biofeedback techniques and behaviour modification in the conservative remediation of drooling by children with cerebral palsy.

In an attempt to decrease the rates of drooling of 12 children with cerebral palsy, the authors investigated the effectiveness of EMG auditory feedback training of the orbicularis oris, of making the act of swallowing a conscious one, and of providing an auditory signal to cue swallowing by means of an Accularm interval timer. After biofeedback training there was a significant decrease in drooling rates and a small increase in swallowing rates. After the Accularm was used the children maintained the decreased drooling rates and there was a further small improvement in swallowing rates. One month after treatment stopped there was a non-significant regression in the rates of both drooling and swallowing. The marked decrease in drooling after biofeedback training must be attributed to more effective swallowing as a result of improved oral motor control, rather than to increased rates of swallowing.

Adolescent↗
PubMed1987

MacDentist.

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Computer Communication Networks↗