Search PubMed⌕ Search

Biomedical subjects

S Wilson

Publications and source records attributed to S Wilson.

At least 649 records · Page 36Linked to original sources
PubMedDate not supplied

Opinions of practitioners and program directors concerning accreditation standards for postdoctoral pediatric dentistry training programs.

PURPOSE: This study was performed to assess opinions of program directors and practitioners about the importance and necessary numbers of experiences required by current accreditation standards for training of pediatric dentists. METHODS: A 32-item questionnaire was sent to all program directors of ADA-accredited postdoctoral pediatric dentistry training programs and to a random sample of 10% of the fellow/active membership of the American Academy of Pediatric Dentistry. RESULTS: An overall response rate of 56% was obtained from the single mailing. Practitioners and program directors differed significantly (P < or = 0.05) only in their opinions about the number of submucosal and intravenous sedation cases required for proficiency of eight experiences surveyed. The two groups differed significantly in 3 of 12 areas in terms of importance attributed for practice of contemporary pediatric dentistry: initiating and completing a research paper, biostatistics/epidemiology, and practice management. Program directors had little difficulty obtaining required experiences, and program dependence on Medicaid did not negatively affect quality of education. CONCLUSION: Practitioners and program directors agreed on the importance of most experiences and activities required by current accreditation standards.

Accreditation↗
PubMedDate not supplied

The use of unlicensed assistive personnel and selected outcome indications.

This pilot study examine the satisfaction levels of patients, RNs, and UAPs after implementing a patient care delivery system using UAPs as nurse extenders on a 41-bed short-stay medical-surgical observation unit. It also compared patient fall statistics prior to and after implementing the new care model. The convenience study sample included 40 patients, 15 RNs, and 9 UAPs and covered 2 months of unit experience in mid 1997. Risk management statistics from a comparable period 2 years prior showed no significant difference in the number of patient falls. Patient satisfaction scores on five of the seven regularly collected questions was higher in 1997 than the comparable earlier period. RN satisfaction with the care model using UAPs was above a neutral score of 3 on a 5-point Likert scale on two out of three items, but additional attention to the RN's role in effective delegation to UAPs was needed.

Accidental Falls↗
PubMedDate not supplied

A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care.

PURPOSE: The purpose of this retrospective study was twofold: a) to examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on patient age, dental needs, and pre-operative clinical impression; and b) to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children. METHOD: Records of more than 600 patients sedated at Columbus Children's Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens: a) chloral hydrate and hydroxyzine (CH-H), b) chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or c) midazolam (M). A minimum of 300 patients (100/drug regimen) were randomly selected. The standard sedation sheet used in all sedations at the clinic included, among other factors, pre-operative assessments of patient behavior, interaction, and cooperation. Physiological and behavioral variables during the intraoperative sedation periods were also available. These periods included initial baseline vitals, vitals following drug administration, topical and local drug administration, rubber, dam placement, and a minimum of the first 15 minutes of restorative procedures. The three drug regimens were compared for these variables. Data were entered into SPSS for data analysis using one-way ANOVA, Chi-square, regression analysis, and descriptive statistics. RESULTS: The results indicated significant mean differences in patient age, weight, and duration by drug regimen (F = 20.3, P < 0.001; 16.2, P < 0.001; and 48.7, P < 0.001, respectively). ANOVA indicated a significant difference among drug regimens for percent of quiet, sleeping, and struggling behaviors. Quiet behavior accounted for 26%, 41%, and 67% of all behaviors for CH-H, CH-D-H, and M, respectively. Sleep accounted for 50%, 43%, 0.4% and struggling 11%, 8%, and 19% for CH-H, CH-D-H, and M, respectively. Pre-operative behaviors were also significantly different and patient cooperation was the only variable found minimally predictable of intra-operative behaviors (R = 0.32, P < 0.001). Significant differences among drug regimens were found for heart rate (HR) and mean arterial blood pressure (MAP) during certain procedures (e.g., CH-H produced lower MAP compared to the other drug regimens); however, all physiological variables were within normal limits for the children. CONCLUSION: Significant differences were found for behavioral and physiological variables among the drug regimens (e.g., CH-D-H produced significantly more quiet and sleeping behaviors than M). Prospective studies are needed to confirm these findings.

Analysis of Variance↗
PubMedDate not supplied

Phacoemulsification and opaque intraocular lens implantation for the treatment of intractable diplopia.

Intractable diplopia secondary to paralytic strabismus may be treated with the occlusion of the affected eye. Established treatments include occlusion with a patch, opaque spectacles or contact lenses, and performing upper lid lowering procedures or tarsorrhaphies. Two cases are presented in which intractable diplopia was resolved by performing clear lens phacoemulsification and the insertion of an opaque intraocular lens. Both patients reported a resolution of their diplopia having been dissatisfied with other forms of treatment. Although opaque intraocular lens insertion is not recommended as the initial treatment of choice in such cases, it offers a valuable treatment option for those patients in whom other forms of therapy have failed.

Diplopia↗
PubMedDate not supplied

The relationship between child temperament and early childhood caries.

PURPOSE: Among the potential risk factors associated with nursing caries/baby bottle tooth decay--a subset of Early Childhood Caries (ECC)--is a "strong-tempered" behavioral style in the child. However, the few empirical studies that have investigated this description remain controversial. The research goal of this study was to operationalize the "strong-tempered" profile and investigate its association to parental feeding practices and ECC levels. METHODS: In an observational-correlational study design, 58 children (ASA I), ages 18 to 70 months (M = 43 months, SD = 17), were reliably assessed for ECC levels by a clinical evaluator. A second evaluator, blind to ECC status, interviewed parents using a demographic survey, a feeding practices measure, and the EAS Temperament Survey for Children. RESULTS: Multiple regression analyses indicated that none of the four temperament factors (Emotionality, Activity, Sociability, and Shyness) significantly predicted duration of feeding habit defined as the length of time in months that the child breast or bottle fed, whichever lasted the longest. However, the combination of greater duration of feeding habit and higher levels of Shyness predicted all three measures of ECC: the presence or absence of caries (r2 = .19, P < .001), the number of carious teeth (r2 = .23, P < .001) and the number of carious surfaces (r2 = .21, P < .001). Furthermore, the addition of Native status significantly increased the predictive value of all of three models (r2 = .37, r2 = .43, r2 = .29, respectively, Ps < .0001). CONCLUSION: Temperament did not predict the duration of feeding habit but together, shyness and duration of feeding habit was associated with ECC.

Bottle Feeding↗
PubMedDate not supplied

Social factors associated with pediatric emergency department visits for caries-related dental pain.

PURPOSE: This study was performed to describe and relate sociodemographic factors and management of visits to a pediatric hospital emergency department for caries-related dental pain. METHODS: Retrospective chart review of cases with a verifiable chief complaint of caries-related dental pain in 1998, was conducted using established protocol and trained reviewers. RESULTS: Three hundred of 984 hospital ED dental emergencies met the study's selection criteria and 109 children were six years old or younger. Almost two-thirds (66%) came from single parent families. Fifty-eight percent were self-pay or covered by government programs and the rest had some insurance. African-American children were 45% of cases. Over 80% were from within Franklin County, OH. Only 4 children (1%) had been seen for the same tooth previously. Lower primary molars were most often affected. Race, insurance, parental marital status were not significantly related to follow-up attendance at the facility (P > 0.05). Those living outside Franklin County and under 5 years of age were more likely to attend follow-up appointments (P < 0.05). When compared to the catchment population of Franklin County, this ED sample had six times as many uninsured children, two and a half times more African-Americans, and came from single parent families four and a half times more often. CONCLUSIONS: Children seen in the ED were predominantly poor, from single-parent families, and disproportionately minority, and were different from the catchment area population. These social risk factors were not related to attendance at follow-up.

Adolescent↗
PubMedDate not supplied

Conscious sedation experiences in graduate pediatric dentistry programs.

PURPOSE: Conscious sedation is a behavior modification adjunct taught in all postgraduate pediatric dental residency programs. It has been a decade since the last survey was done specifically related to didactic and clinical aspects of conscious sedation in postgraduate pediatric dental programs. The aim of the study was to determine the clinical and didactic experiences associated with conscious sedation in these programs and to compare some of the findings to those collected a decade ago. METHODS: A 31-item survey similar to that of a decade ago was constructed and sent to all pediatric dentistry program directors of accredited postgraduate and residency programs in the United States. The items covered several didactics including didactic topics, sedative agents, monitoring, and emergency policy among others. A follow-up mailing was done involving those who had not responded 6 weeks following the initial mailing. RESULTS: Fifty-four of 58 (93%) program directors returned the 31-item survey. The following are highlighted findings. Conscious sedation among residency programs was achieved most commonly with a combination of sedative agents used with N2O. Midazolam was more popular than chloral hydrate. The oral route was the predominant route of administration. More lecture hours were spent on conscious sedation than 10 years ago. The pre-cordial stethoscope, pulse oximeter, and blood pressure cuff were the most commonly used monitors. Sedative agent and anticipated depth of sedation were the factors most often considered in choosing monitors used during the sedation of a patient. The capnograph was being used more frequently than it was 10 years ago. Programs did not report an increase in sedation emergencies but practiced emergency drills more often and had increased numbers of individuals certified in Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS). The percent of the total patient population which required sedation is about 1-20%, with most directors reporting an increase in the numbers of sedations done in the past few years. CONCLUSIONS: While many factors remained unchanged or slightly modified when compared to the survey done a decade ago, the results of this study suggest that there has been significant changes in several key factors including the most frequently used sedative (i.e., midazolam) and increased preparation in the area of emergency preparedness.

Administration, Oral↗
PubMedDate not supplied

Advanced practice nursing: opportunities and challenges.

Planning for the future may not be easy but it is always worthwhile. Resources that can help in making choices include professional organizations such as the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, KNA, American Academy of Nurse Practitioners, American College of Nurse Practitioners, the Internet, and the college and university Schools of Nursing. Taking control of one's destiny is the best gift that can be given to one's self. Increasing options for career development is just one of the benefits of pursuing educational goals. The first step is commitment to goal. Selecting the right specialty, planning how financial obligations will be met and choosing the program that best meets identified needs are steps that will follow. Health care changes are occurring at such a rapid pace the individual nurse may feel caught in a whirlwind without control. Making the choice to seek change will present its own challenges but without change, growth is impossible. For those considering an Advanced Practice role, making the commitment, outlining a plan with each step clearly identified, reliance on a strong support system, and maintaining a vision of the completed goal will lead to success.

Career Choice↗
PubMedDate not supplied

The influence of social status and prior explanation on parental attitudes toward behavior management techniques.

The purpose of this study was to determine whether parental social status influences preference toward behavior management techniques used during dental treatment of children. One hundred and twenty-two parents from two private practices and one institutional site completed a questionnaire and rated eight commonly used behavior management techniques. These techniques were tell-show-do, nitrous oxide/oxygen, Papoose Board (Olympic Medical Group, Seattle, WA), voice control, hand-over-mouth (HOM), oral premedication, active restraint, and general anesthesia (GA). Half the parents viewed these eight techniques on a videotape which contained prior explanation for each technique (experimental group). The other half (control group) viewed the same techniques on videotape, but without prior explanations. Parents indicated their degree of acceptability by marking a line on a visual analogue scale (VAS, scored from 1 to 99). A score below 50 was considered acceptable. The parents were divided into "high" and "low" social status groups. Significant differences for HOM and GA were noted between mean scores of the experimental and control groups for both "high" and "low" social status groups; the control groups were less accepting except for GA in the "low" group where the reverse was true (P < 0.05). Techniques judged least acceptable were HOM, GA, Papoose Board and oral premedication. Parental acceptance of individual techniques varied greatly, suggesting the importance of informed consent irrespective of social status.

Adult↗
PubMedDate not supplied

Chloral hydrate and its effects on multiple physiological parameters in young children: a dose-response study.

This study evaluated the dose-response effect of chloral hydrate (CH) used alone on several physiological parameters in 26 healthy children 21 to 42 months old. Selection criteria for the children in this institutionally approved study included: a) uncooperative behavior during an initial examination; b) a minimum of four sextants with caries involvement; c) healthy, ASA I; d) parental informed consent; e) a noncompromised airway (e.g., minimal tonsillar enlargement) and f) no known allergies. A repeated measures, Latin-square design was used in evaluating either a placebo and three dosages of CH (25, 50, 70 mg/kg) over four visits for each of eight patients or the same three dosages over three visits for each of the remaining patients. The physiological parameters included: heart and respiratory rate, systolic and diastolic blood pressure, peripheral oxygen saturation, and expired carbon dioxide. For statistical purposes, physiological parameters were analyzed during specific phases which included: baseline, topical and local anesthesia administration, at initiation of cavity preparation; and at the end of the appointment. A repeated measures ANOVA and descriptive statistics were used to analyze the data. The results indicated that the diastolic blood pressure and expired carbon dioxide were affected significantly by CH dosage (P less than 0.02 and 0.005, respectively). The findings should be tempered in light of patient behavior during the visits. Dental procedures also had an influence on cardiovascular parameters. The significance of these findings related to patient safety and behavior in these very young children is discussed.

Analysis of Variance↗
PubMedDate not supplied

The evaluation of child behavior during dental examination and treatment using predmedication and placebo.

The purpose of this study were to determine the association of scores on the North Carolina Behavior Rating Scale (NCBRS) to those of the Frankl scale during restorative visits; and to quantify and compare rated behavior of children during an oral examination and restorative visits involving either a placebo or a combination of chloral hydrate (CH) and hydroxyzine. Fifteen patients 21-37 months old participated in this institutionally approved study. The study was a double-blind, crossover design. Following an examination using a mirror, explorer, and prophylaxis cup, the child received either a placebo or a combination of chloral hydrate (CH) and hydroxyzine. Fifteen patients 21-37 months old participated in this institutionally approved study. The study was a double-blind, crossover design. Following an this institutionally approved study. The study was a double-blind, crossover design. Following an examination using a mirror, explorer, and prophylaxis cup, the child received either a placebo or a combination of chloral hydrate and hydroxyzine. The sequence was reversed at the next appointment. All exam and treatment visits were videotaped and analyzed using the NCBRS. In addition, all treatment visits were rated with the Frankl scale. The data were analyzed using a repeated ANOVA and correlation coefficients. The results showed a high interrater reliability (> 86% agreement) and a significant correlation between the NCBRS and Frankl scale (P < 0.001). No significant difference was found for the amount of disruptive behavior among oral examination, placebo, and medication visits (P < or = 0.097), although a consistent decrease in mean disruptive behavior for that order of visits was observed most frequently.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMedDate not supplied

Parental attitudes toward behavior management techniques used in pediatric dentistry.

Previous studies evaluating parents' attitudes toward behavior management techniques used in pediatric dentistry suggest that parental attitudes are generally negative. The purpose of this study was to reexamine this issue by comparing the effect of prior explanation on parental acceptance of eight behavior management techniques. Videotaped segments were made of children's dental appointments containing examples of eight behavior management techniques. One group of 40 parents viewed a videotape which provided no explanation for each technique before it was shown. Another group of 40 parents viewed a videotape which provided no explanation of the techniques. The parents then were asked to rate the acceptability of each technique using a visual analogue scale. Results indicated that the informed parents were significantly more accepting of behavior management techniques than the uninformed parents but both groups were generally positive about the techniques studied. Further, parents reporting greater stress were less accepting of the techniques studied.

Adult↗
PubMedDate not supplied

Group effect on parental rating of acceptability of behavioral management techniques used in pediatric dentistry.

The rating of acceptability by parents either in groups of five or alone of behavior management techniques (BMT) displayed in videotaped vignettes was studied. Ratings of acceptability of the techniques for use on "a" vs. "their" child also were evaluated. Sixty parents were divided randomly into two groups (A and B). For Group A, six groups of five parents viewed a videotape containing eight BMT. All parents in Group B viewed the same videotape individually. Following the presentation of each BMT, the parents were requested to rate the technique for acceptability using a visual analogue scale (VAS). One half of Groups A and B were told to rate the acceptability of each BMT for use on "a" child. The remaining parents in Groups A and B were told to rate the acceptability for "their" child. The results indicated that there were no significant differences between groups (groupings of five vs. alone) or "their" and "a" child ratings. However, there was a consistent trend for those in groups to rate BMT as less acceptable than those rating alone. The implications of these findings are discussed in reference to findings of previous studies.

Analysis of Variance↗
PubMedDate not supplied

Conscious sedation and pulse oximetry: false alarms?

The use of pulse oximetry in dental procedures involving sedation and children has been encouraged strongly. Reports have indicated that hemoglobin desaturations are not uncommon when a variety of drugs (including nitrous oxide) and dosages are used. The present study investigated the nature of desaturations in relation to patient activity as a function of a drug combination, single drug dose-response design, and placebo conditions. Twenty-two patients (mean age 29.45 months; range 20-37 months) participated in this two-part study. In part 1, 12 patients received a placebo and a combination of chloral hydrate and hydroxyzine in a crossover, double-blind design. In part 2, 10 patients received a placebo and three doses of chloral hydrate in a double-blind, randomized sequence of four visits involving a dose-response design. During each restorative visit, the peripheral oxygen saturation, expired carbon dioxide, heart and respiratory rates, blood pressure, and frontalis electromyogram of each child was monitored. The overall results of 63 visits indicated that 87-90% of the 235 desaturation episodes were due to patient movement. The clinical implications of the findings are discussed.

Child, Preschool↗