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PubMedDate not supplied

Risk management from a collaborative perspective.

Medication error studies, which reveal mistakes that occur, are different from claims analyses, which show the medication errors that cause harm. Warfarin and other high-risk and narrow therapeutic index agents are more frequently involved in claims because errors, whether frequent or not, are more likely to result in harm. Pharmacists in collaborative relationships with physicians can reduce medication errors by identifying potential risks, selecting and implementing techniques for addressing possible errors, monitoring the system, and making changes as necessary using continuous quality improvement principles. Five recommended approaches for preventing medication errors include listening, learning, and thinking; monitoring, checking, and reevaluating; documenting, charting, and reading; talking, smiling, and communicating; and implementing a system of quality management.

Cooperative Behavior↗
PubMed2002

Sharing humour and laughter in autism and Down's syndrome.

Everyday humour and laughter can tell us about children's ability to engage with and understand others. A group of 19 pre-school children with autism and 16 pre-school children with Down's syndrome, matched on non-verbal mental age, participated in a cross-sectional study. Parental reports revealed no group differences in overall frequencies of laughter or laughter at tickling, peekaboo or slapstick. However, in the autism group, reported laughter was rare in response to events such as funny faces or socially inappropriate acts, but was common in strange or inexplicable situations. Reported responses to others' laughter also differed: children with autism rarely attempted to join in others' laughter and rarely attempted to re-elicit it through acts of clowning or teasing. Analysis of videotaped interactions also showed no group differences in frequencies of child or adult laughter. However, the children with autism showed higher frequencies of unshared laughter in interactive situations and lower frequencies of attention or smiles in response to others' laughter. Humour is an affective and cultural phenomenon involving the sharing of affect, attention and convention; children with autism show problems in some simple affective and mutual as well as joint attentional and cultural aspects of humorous engagement.

Adult↗
PubMed1977

The use of behavior modification techniques to successfully manage the child dental patient.

Techniques of desensitization, modeling, and contingency management that can be used in the dental office for reducing anxiety and encouraging appropriate behavior in children are discussed. The "tell, show and do" approach is one desensitization technique easily applied in the private practice. Language should be at the child's level of understanding. An older sibling will frequently serve as an excellent model for a fearful child. Social reinforcers-a handshake, a smile, or praise-should be dispensed throughout dental treatment. Rewards should only follow desired behavior.

Behavior Therapy↗
PubMed1990

What about whiteners? Safety concerns explored.

The quest for a brighter, more attractive smile has fueled rapid growth in the marketplace for tooth whiteners. With names like BriteSmile, Denta-Lite, Ultra Lite and Whiter Teeth, these products are grabbing the attention of looks-conscious consumers. More than a dozen whiteners have flooded the market recently, most of them available by dentist prescription, a few being sold directly to consumers over the counter. There's no doubt these products work as whiteners, at least on mild to moderate stains. The looming questions is this: are they safe? This article explores that safety question and seeks to provide practicing dentists with some perspective on the issue. We don't pretend to have the definitive answer. As always, it's up to you, doctor, to decide what's best for your patients. It's up to us to provide information that helps you make those crucial decisions. That's our goal.

Carbamide Peroxide↗
PubMed1993

Correcting generalized gingival recession.

Recession associated with the maxillary anterior gingiva can be particularly displeasing to the patient with a high smile line. The coronally positioned flap technique was used in this case to create a more esthetic appearance.

Adult↗
PubMed1997

In-office bleaching: where we came from, where we are today.

Discolored teeth are the primary aesthetic concern among dental patients. While many seek professional advice and treatment, an alarming number opt for non-professional quick-fix solutions. The in-office bleaching modality often is overlooked in favor of at-home vital bleaching. But this option has been proven to be effective, quick and safe-either alone or in combination with other aesthetic treatments-as a method of brightening and enhancing a patient's smile.

Anti-Bacterial Agents↗
PubMed2003

Orthodontic treatment with a series of removable appliances.

BACKGROUND: In the United States, the demand for straight white teeth has never been more important to patients. Crowded, poorly aligned teeth are not esthetically pleasing and are difficult to keep clean. However, until recently, the process of straightening the teeth typically has involved appliances involving bands, brackets and wires that also can be difficult to clean. The desire for a cosmetic solution to misaligned teeth has led to an increase in the number of patients seeking veneers, crowns and other laboratory-fabricated cosmetic restorations. Some clinicians are not aware that there are other ways to align teeth without either significant enamel reduction or conspicuous fixed orthodontic appliances. DESCRIPTION OF TECHNIQUE: An alternative method of treatment, involving a series of clear removable appliances, circumvents this shortcoming and enables tooth alignment while avoiding deterioration in the cosmetics of the smile during treatment. This article describes a method of treatment, Invisalign (Align Technology, Santa Clara, Calif.), that clinicians can use in conjunction with 3-D computer models to accomplish the esthetic and oral hygiene objectives during and after treatment. CASE DESCRIPTIONS: The authors present three case reports, all involving a chief concern of crowding. The first case involved treatment of both arches by interproximal reduction, alignment of teeth and leveling the curve of Spee. The second case involved treatment of both arches by proclination, expansion and minor interproximal reduction. The final case shows relief of lower-arch crowding via lower-incisor extraction. CLINICAL IMPLICATIONS: In addition to satisfying the patient's chief concern of desiring straight teeth, this method of treatment satisfies additional objectives of esthetic treatment and esthetic results with significant oral hygiene benefits. Clinicians can address a patient's chief concern effectively without requiring an inventory of appliances (such as bands, brackets, wires and instruments). Furthermore, the use of 3-D computer models can give clinicians additional information to make more complete decisions regarding treatment.

Adult↗
PubMed2005

Are snow-white teeth really so desirable?

Properly accomplished, bleaching or whitening teeth is a highly positive behavior-changing procedure that is not going to go away. It has been one of the major encouragements for patients to accept upgrades in their smiles. However, bleaching has some negative challenges. Dental practitioners who are aware of these can help ensure that the patient's bleaching experience is a satisfying one.

Attitude to Health↗
PubMed2004

A review of the angiotensin-converting enzyme inhibitor, zofenopril, in the treatment of cardiovascular diseases.

Based on preclinical and clinical findings, zofenopril appears to be an angiotensin-converting enzyme (ACE) inhibitor with high potency, significant tissue selectivity and a long duration of action. Its ancillary properties, such as antioxidant activity and cardiovascular (CV) protection, make this drug potentially suitable for the treatment, and possibly prevention, of several CV diseases. There is a large body of evidence that support a complex interaction between ACE inhibitors and CV disease. A review of the preclinical profile of zofenopril clearly suggest that such interaction can be even more complex and could involve some drug-specific properties directly involved in the definition of the overall clinical profile of zofenopril as emerged from randomised clinical trials. In particular, zofenopril combines the feature of an effective ACE inhibitor, with plasma and tissue activity, along with that of an antioxidant compound, and both these characteristics can contribute to its capacity of controlling hypertension and improving the prognosis of patients with coronary artery disease. The results of The Survival of Myocardial Infarction Long term Evaluation (SMILE) trials have demonstrated that the early administration of zofenopril to patients with acute myocardial infarction is associated with a significant reduction in the 6-week occurrence of major CV events (death and congestive heart failure) in high-risk patients with anterior non-thrombolysed myocardial infarction, and this effect is enhanced in some higher-risk subgroups of patients, such as those with a history of diabetes or arterial hypertension.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Global, behavioral and self ratings of interpersonal skills among adult children of alcoholic, divorced and control parents.

OBJECTIVE: The goal of this study is to evaluate interpersonal skills and the relationships among interpersonal skills in a nonclinical sample of adult children of alcoholic, divorced and control parents using a multimethod assessment strategy. METHOD: Subjects were prescreened to rule out parental psychopathology and maternal alcoholism. Subjects (N = 238, 50% male, 86% white) interacted with a same- or opposite-sex confederate in a series of videotaped roleplays, which were either unstructured or structured via discussion topics and acquaintance instructions. The videotapes were coded for (1) global or general impression ratings of subject and (2) four behavioral components of interpersonal skill: talk, gaze, smile and self-manipulation. Subjects also rated their own skills and anxiety during the roleplays. RESULTS: Male and female children of alcoholics were judged to be more anxious when interacting with an opposite-sex partner than with a same-sex partner. Children of divorce and controls were not influenced by the gender of their interaction partner. Children of alcoholics were also judged to be less socially skilled then children of divorce. There was some suggestion that children of alcoholics and divorce may not accurately perceive their own level of skill. CONCLUSIONS: The findings provide some support for interpersonal skills deficits among adult children of alcoholics, although the deficits were not pervasive or consistent across methods. Limitations of the findings and the overall study were discussed.

Adult↗
PubMed2000

The discovery of phenylketonuria: the story of a young couple, two retarded children, and a scientist.

In the 1920s, a little girl 3 years of age was brought from China to the United States by her American mother. Although the child was beautiful, her mind was not developing. The grief-stricken mother had consulted doctors in China, but they could neither diagnose the problem nor provide treatment. Morning and night the same questions occupied her mind: "What is the matter with my little girl? What is causing it? Is there any doctor, anywhere, who can cure her?" In the United States, she also went from doctors to psychologists to clinics looking for someone who could help. Finally, she went to the Mayo Clinic in Rochester, Minnesota. When she had answered all of the doctor's questions, and all the tests were finished, they still could not tell her what was wrong. There was nothing they could do. The disease from which the little girl suffered was unknown at that time. The mother was Pearl Buck. In her book, The Child Who Never Grew,(1) she described her first infant: "I remember when she was only 3 months old she lay in her basket on the sun deck of a ship. I had taken her there for the morning air. The people who promenaded on deck often stopped to look at her, and my pride grew as they spoke of her unusual beauty and of the intelligent look of her deep, blue eyes. I do not know at what moment the growth of her intelligence stopped, nor to this day why it did." This is a classical description of the disease, phenylketonuria (PKU). A perfect infant seems to develop normally for several months, then the development slows and at some point seems to stop. "Look at Mommy-look at Daddy!" the parents say as they try to coax the treasured smiles. Instead, the child drifts into a dream world and into irreversible mental retardation. All Pearl Buck's devotion and determination was of no avail in finding the cause of her child's retardation. It was to be another mother with the same commitment to her beautiful but retarded children, who approximately 10 years later followed the same path until she found a special doctor who unlocked the secret of the fate of these children. When 1 of the authors (W.R.C.) visited Miss Buck at her Pennsylvania home in 1960, she talked about how her daughter, Carol, then a grown person, had recently been diagnosed as having PKU, as a result of screening tests at the New Jersey Vineland Training School for the Mentally Retarded. During my visit and without disclosing the reason, Pearl Buck was invited to sniff a vial of phenylacetate crystals (the odor of stale urine samples from PKU patients). Immediately she recalled that Carol, as a child, had the same unusual odor. She was relieved that the prophesy of the last words in her book had come true: "What has been, need not forever continue to be so. It is too late for some of our children, but if their plight can make people realize how unnecessary much of the tragedy is, their lives, thwarted as they are, will not have been meaningless." These could be the words of Borgny Egeland, the mother of the children through whom the mystery of PKU was brought to light. Or they could express the conviction of the physician and biochemist, Asbjörn Fölling, who believed that "what was not known could be known." Through the discovery of PKU in these children, hope has been given to thousands of other children and to their grateful parents ().

Female↗
PubMed2003

Naturopathic treatment for ear pain in children.

OBJECTIVE: Otitis media is 1 of the most frequent diseases of early infancy and childhood and 1 of the most common reasons for children to visit a physician. In the past 2 decades, there has been a substantial increase in the diagnosis of otitis media worldwide. In the United States, 93% of all children have had at least 1 episode of acute otitis media (AOM) by 7 years of age. Otalgia is the hallmark of AOM. Most affected children either complain of earache or manifest behavior that the parents interpret as indicating ear pain. Treatment of the ear pain early in the course of AOM decreases both parental anxiety and the child's discomfort and accelerates the healing process. The objective of this study was to determine the efficacy and tolerability of naturopathic versus traditional treatment for the management of otalgia commonly associated with AOM in children. METHODS: The study was designed as a double-blind trial in an outpatient community clinic. A total of 171 children who were aged 5 to 18 years and had otalgia and clinical findings associated with middle-ear infection were studied. The children were randomly assigned to receive treatment with Naturopathic Herbal Extract Ear Drops (NHED) or anesthetic ear drops, with or without amoxicillin. On enrollment, the children were assigned by computer-numbered randomization to receive NHED (contents: allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil) 5 drops 3 times daily, alone (group A) or together with a topical anesthetic (amethocaine and phenazone in glycerin) 5 drops 3 times daily (group B), or oral amoxicillin 80 mg/kg/d (maximum 500 mg/dose) divided into 3 doses with either NHED 5 drops 3 times daily (group C) or topical anesthetic 5 drops 3 times daily (group D). A double-blind design was used, and all ear drops were placed in identical bottles. Treatment was initiated by the nurse in all cases. A single physician (M.S.) evaluated and treated all of the patients included in the study and recorded all of the data. The presence or absence of ear pain was assessed over 3 days with a visual analog scale. Ear pain was assessed by a specially devised observational instrument based on previous reports. One side of the instrument consisted of a linear numbered scale, from 1 (no pain) to 10 (worst possible pain), and a corresponding color scale, ranging from blue to dark red. The reverse side contained a scale of 5 facial expressions, ranging from broad smile (no pain) to a sad and crying face (worst possible pain), and a corresponding color scale, ranging from blue to dark red. RESULTS: There were no significant between-group differences in patient age or gender, degree of fever, main symptoms, associated symptoms, and severity or laterality of acute otitis media. Each group had a statistically significant improvement in ear pain over the course of the 3 days. Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin. Results were better in the NHED group than in the controls. Nevertheless, the findings indicated that the pain was mostly (80%) self-limited and could be explained simply by the time elapsed. The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend topical medications as the first line of treatment for ear pain in the absence of systemic infection or serious underlying disease. Because no evidence was found that systemic antibiotics alone improved treatment outcome, if antibiotics do not change the natural course of otitis media, then the main goal of treatment, as in the present study, should be to alleviate the ear pain. The alternative, naturopathic herbal extract medications, may offer many new possibilities in the management of ear pain associated with AOM. Primary care physicians should be aware that at least 10% of their patients may have tried 1 or more forms of alternative/complementary medicine before presenting for consultation. As it was widely reported in the medical literature, these herb, these herbal extracts have the potential to meet all of the requirements of appropriate medication that could be routinely used in the pediatric patient, namely in vitro bacteriostatic and bacteriocidal activity against common pathogens, immunostimulation ability, antioxidant activity, and anti-inflammatory effects. They are also well-absorbed with good penetration into the tissue surrounding the tympanic membrane. They have been found to enhance local immunologic activity. Finally, herbal extracts are well-tolerated (owing to their long elimination time), easy to administer, and less expensive than the new antibiotics. There are no documented side effects. On the basis of our findings that the group with the most significant treatment effects (NHED with topical anesthetic) explained only 7.3% of the total pain reduction, we propose that sometimes the general practitioner or pediatrician needs to give the human body a chance to repair itself. Nevertheless, if the physician believes that there is an indication for some treatment, especially if the parents are anxious, then a local treatment such as one used in our study might be adequate. CONCLUSIONS: This study suggests that in cases of ear pain caused by AOM in children in which active treatment, besides a simple 2- to 3-day waiting period, is needed, an herbal extract solution may be beneficial. Concomitant antibiotic treatment is apparently not contributory.

Acute Disease↗
PubMed1997

Studies of the candidate genes TGFB2, MSX1, TGFA, and TGFB3 in the etiology of cleft lip and palate in the Philippines.

Population-based candidate-gene studies can be an effective strategy for identifying genes involved in the etiology of disorders where family-based linkage studies are compromised by lack of access to affected members, low penetrance, and/or genetic heterogeneity. We evaluated association data for four candidate genes using a population from the Philippines that is genetically separate from previously studied Caucasian populations. Case ascertainment was made possible by collaboration with Operation Smile, a volunteer medical organization, which facilitated identification of a large number of cases for study. A new allelic variant of transforming growth factor-beta 3 was identified to use in these studies. After exclusion of syndromic cases of cleft lip and palate, no evidence for association with previously reported allelic variants of transforming growth factor-beta 2 (TGFB2), homeobox 7 (MSX1), or transforming growth factor-alpha (TGFA), or with the new TGFB3 variant was detected. Previous association studies using Caucasian populations of nonsyndromic cleft lip and/or palate (CL/P) and cleft palate only (CPO) have strongly suggested a role for TGFA in the susceptibility of clefting in humans. Exclusion of significant association in a non-Caucasian population for TGFA suggests that TGFA plays less of a role than it does in Caucasians. This may be due to multiple or different genetic and/or environmental factors contributing to the etiology of this most common cranio-facial anomaly in the Philippine population.

Alleles↗
PubMed1997

Clinical and epidemiologic studies of cleft lip and palate in the Philippines.

Clinical and epidemiologic studies of defined geographic populations can serve as a means of establishing data important for genetic counseling and as a first step in identifying strategies best suited for identification of causes. Under the sponsorship of Operation Smile International, clinical, genetic, and epidemiologic studies were carried out at six sites within the Philippines between 1989 and 1996. Patients who were being evaluated for surgical repair of craniofacial anomalies (primarily clefts of the lip and palate) were briefly examined for the presence of associated anomalies, and a family history was obtained to look for the frequency of cleft lip and palate in siblings. Birth records of 47,969 newborns over an 8-year period at one hospital in Bacolod City in the province of Negros Occidental were reviewed. Medical records of infants born with clefts of the lip and/or palate and other major anomalies were reviewed and birth prevalence rates calculated. Findings include a birth prevalence of 1.94 per 1000 live births for cleft lip with/without palate in the Philippines. Recurrence rates in siblings for nonsyndromic clefts of the lip and palate were 23 per 1000 for cleft lip with or without cleft palate, and 14 per 1000 for cleft palate only. The percentage of clefts associated with multiple anomalies was 21% at birth and 6% for individuals examined during the screening process, providing evidence for a high postnatal death rate. These data provide groundwork for additional etiologic studies including segregation analysis and molecular genetic studies involving linkage or association, as well as for studies of environmental contributions to clefting such as vitamin deficiencies. Preliminary molecular analysis using an association approach is reported in a companion paper. The findings suggest a high incidence of cleft lip and palate in native-born Filipinos.

Abnormalities, Multiple↗
PubMed2005

You are my teachers.

Dr. Owen Wangensteen reminded Dr. Edlich that the chief responsibility of a teacher is to create an atmosphere friendly to learning. Dr Wangensteen indicated that the role of professor has been defined as that of teacher, clinician, and investigator. He then indicated that two more responsibilities must be added: (1) sideline cheerleader and (2) regimental water carrier. Above all those enumerated functions, he believed that the most important concern of a professor is to create an atmosphere friendly to learning. He/she must have the willingness to recognize every type of talent and ability and to encourage men/women of promise. He must be the professor of the open door, easily accessible to students, residents, and associates. The major goal of Dr. Edlich's comments, as he receives the Distinguished Medical Alumni Award from The Minneapolis Medical Alumni Association (Minneapolis, Minnesota, USA) is to acknowledge his distinguished colleagues and friends who have served as his teachers during his academic career. They include the following individuals: Theodore J. Edlich, III, President of Total Action Against Poverty; Elizabeth C. Edlic, Cofounder/Chairman and Chief Executive Officer of OneWorldLive; Richard F. Edlich, Jr., President of Edlich Realty; Rachel C. Edlich, Executive Vice President and Cofounder of OneWorldLive; William B. Long, III, MD, President and Medical Director of Trauma Specialists LLP; William P. Magee, MD, Cofounder and Director of Operation Smile; John Barrow, President of Coolibar Incorporated; Mary M. Barrow, Cofounder of Coolibar Incorporated; Kathryne L. Winters, Website Manager and Senior Research Assistant; Lise Borel, DDS, Independent Pharmaceutical/Biotechnical Consultant; Mary Jude Cox, MD, Board Certified Glaucoma Specialist, Teaching Staff at Wills Eye Hospital Glaucoma Service; John Wish, PhD, Member of the Board of The Association of Air Medical Services, Director of the Research Committee; and Dr. Andrew J. Gear, Plastic Surgical Resident, University of Minnesota Medical School.

Autobiographies as Topic↗
PubMed2002

Mobius syndrome: a case report.

Mobius Syndrome is characterized by showing unilateral facial nerve palsy of the sixth and seventh nerves, lack of facial expression, inability to smile and to tightly close the right eyelids. In this report, a 7-year-old-boy with Mobius syndrome is presented. He had asymmetry of facial expression, anomalies of fingers and severe tooth decay. After dental treatment, the periodic re-care visits should be done according to the eruption pattern.

Child↗
PubMed1968

Production and elimination of disruptive classroom behavior by systematically varying teacher's behavior.

The effects of teacher behaviors on the classroom behaviors of children were investigated by systematically varying approving (praise, smiles, contacts, etc.) and disapproving (verbal reprimands, physical restraint, etc.) classes of teacher behavior. Measures were taken on both teacher and child behaviors. Each day a sample of 10 children was observed. The subject pool was a class of 28 well-behaved children in a middle-primary public school class. The results demonstrated that approving teacher responses served a positive reinforcing function in maintaining appropriate classroom behaviors. Disruptive behaviors increased each time approving teacher behavior was withdrawn. When the teacher's disapproving behaviors were tripled, increases appeared most markedly in the gross motor and noise-making categories of disruptive behavior. The findings emphasize again the important role of the teacher in producing, maintaining, and eliminating disruptive as well as pro-social classroom behavior.

Journal Article↗
PubMed1971

Reduction of dangerously aggressive behavior in a severely retarded resident through a combination of positive reinforcement procedures.

A severely retarded resident was released from a timeout chair only occasionally for brief periods of time. Under the timeout contingency alone, the subject made a choke response within minutes of being released. Attention, such as hugs, smiles, and candy was then increased, first by providing it non-contingently and continuously as long as there were no aggressive responses and then, by making it contingent upon incompatible responses. Under conditions of timeout plus increased attention, choking decreased aburptly. Grabbing responses, which increased when choking was reduced, were also reduced under conditions of timeout plus attention. Unrestrained time was gradually increased and all extra attention, i.e., more scheduled attention than provided other residents, was gradually withdrawn. When the resident was unrestrained all day and all extra attention was withdrawn, grabs and, to a lesser extent, chokes increased. Both were again reduced to a manageable level by scheduling several brief periods of attention each day. Hence, the program resulted in quick reductions that endured when the program was largely withdrawn. The changes in aggressive responding as a function of the presence and absence of extra attention suggest the importance of extra "positive reinforcement" in programs based upon positive reinforcement procedures and dealing with retarded residents for whom positive reinforcers may be scarce.

Journal Article↗