Eagle’s syndrome associated with temporomandibular disorder: A clinical report

In this clinical report, Eagle’s syndrome symptoms were resolved for a period of 1 year after oral rehabilitation and physiotherapy. Long-term follow-up care will provide more information on the success of the conservative treatment for patients with Eagle’s syndrome associated with TMD.     

Developmental Health of Infants and Children Subsequent to Foster Care

BACKGROUND: Every day, the United States child welfare system is entrusted with the care of over 400,000 children through foster care. The majority of children entering this social setting are infants, the most developmentally vulnerable. METHODS: Bronfenbrenner's human health ecology model and Bowlby's attachment theory are used to delineate the social setting of foster care and its impact on developmental health, and elucidates the relationship between childhood experiences and the overall continuum of health. Additionally, the notion of inherited genes and environmental influences or epigenetics toward gene expression will be explored. RESULTS: Research points out that what happens in childhood matters; the consequences of not addressing childhood adversity and the associated risk factors of foster care increase a child's risk for poor developmental health and other major illnesses noted later in life such as cardiac disease, depression, and even premature death. Healthcare providers and others charged with caring for this vulnerable population who understand the social setting of foster care and its impact on developmental health may help identify and treat developmental problems earlier, thus potentially reducing long-term effects of abuse and neglect. CONCLUSION: Improvement plans that promote best practice for child welfare must include those that directly address the unique developmental needs of all infants and children in foster care itself. Such plans will ensure that foster care as an intervention to protect vulnerable children at risk does not create more harm by reducing the associated risks and maximizing benefits while in foster care, and ensures that those born genetically vulnerable and disproportionately susceptible to poor outcomes in adversity are also protected and provided opportunities that promote optimal developmental health.     

Evaluation of a multischool collaborative COVID-19 vaccination project

To describe experiences of student nurses and faculty who participated in COVID-19 vaccine delivery through a multischool collaboration. Cross-sectional survey. Student nurses and faculty members from five university schools and colleges of nursing who participated in one or more COVID-19 vaccination or education events in 2021. Surveys were designed for students and faculty to document process and outcome experiences associated with project participation. Surveys were administered through an online survey platform. Overall, 648 students and 68 faculty members participated in the project. The evaluation survey was completed by 115 students (18%) and 58 faculty members (85%). Students valued increasing their clinical skills and reported the experience influenced their perspectives on nursing, fueling their passion and informing future career choices. Students reported that it was personally important to contribute to the vaccination effort. Few students reported challenges in participating in the project. Faculty reported positive experiences including gaining knowledge about public health and their communities, fueling their passion for nursing education, feeling a deeper connection with students, and experiencing personal satisfaction from contributing to the pandemic response. This project resulted in meaningful student learning opportunities, enhanced capacity for the public health emergency response, and strengthened partnerships among nursing programs and between academia and public health community partners.     

A prospective evaluation of anterior transposition of the inferior oblique muscle, with and without resection, in the treatment of dissociated vertical deviation

BACKGROUND: Anterior transposition of the inferior oblique muscle (ATIO) has become a popular surgical treatment for dissociated vertical deviation (DVD), particularly in patients with coexisting inferior oblique muscle overaction (IOOA). We wanted to assess whether adding a resection improves the outcome compared with standard anteriorization. METHODS: We undertook a prospective, randomized evaluation of ATIO, with and without a 7-mm resection, in patients with DVD of at least 5 PD in one eye. We included 51 eyes of 30 patients, 26 eyes treated with the standard ATIO and 25 treated with a 7-mm resection added. We recorded the size of the preoperative and final DVD, grade of the preoperative and final IOOA, rates of reoperation, and complications. Mean follow-up was 15.4 months in the standard group and 25.0 months in the resection group, with a minimum of 4 months for all cases. RESULTS: The median preoperative and postoperative DVD was 12 PD and 4 PD in the standard group, respectively. This compared with 14 PD and 4 PD, respectively, in the resection group, representing no statistically significant difference in outcome. The presence or absence of IOOA did not influence the result of ATIO for either group. No significant complications of surgery occurred in either group. CONCLUSIONS: ATIO is an effective treatment for DVD and can be used to treat DVD in patients with or without IOOA, with few adverse effects. Our study revealed no advantage to adding a 7-mm resection to the standard procedure.     

Distal aortic diameter and peripheral arterial occlusive disease

OBJECTIVE: Several studies have reported an association between abdominal aortic dilatation and peripheral arterial occlusive disease. Narrowing of aortic diameter, also called abdominal aortic hypoplasia, and peripheral arterial occlusive disease have received insufficient attention. Precise estimates of the relationship between aortic hypoplasia and peripheral arterial occlusive disease are lacking. In this study, we assessed the relationship between abdominal aortic diameter and peripheral arterial occlusive disease. METHODS: In this cross-sectional study, we analyzed 1572 patients 18 to 79 years of age, newly referred to the vascular center of our hospital with clinically manifest atherosclerotic arterial disease or for treatment of cardiovascular risk factors. Diameter measurements were used to subdivide patients according to tertiles of abdominal aortic diameter. Peripheral arterial occlusive disease was assessed by adjusted Rose questionnaire, ankle-brachial pressure index, and the presence of gangrene or leg ulcers. RESULTS: Compared with patients with normal aortic diameter, peripheral arterial occlusive disease was twice as prevalent in patients at both ends of the aortic diameter spectrum. When the lowest tertile was compared with the middle tertile in male patients, the adjusted odds ratio was 1.7 (95% CI, 1.0-3.1). When the highest tertile was compared with the middle tertile, the adjusted odds ratio was 2.1 (95% CI, 1.2-3.4). Similar results were found in female patients. The adjusted odds ratio of lowest versus middle tertile was 2.4 (95% CI, 1.1-5.0) and 1.8 (95% CI, 0.8-4.0) when the highest tertile was compared with the middle tertile. CONCLUSION: The risk of peripheral arterial occlusive disease was increased in the lower and upper distribution of aortic diameter. Apparently, both patients with an aortic diameter too large and patients with an aortic diameter too small are prone to peripheral arterial occlusive disease. This is the first large study that shows that small aortic diameter is associated with peripheral arterial occlusive disease.     

Ethical persuasion: the rhetoric of communication in critical care

This article reviews the ethics of rhetoric in critical care. Rational appeals in critical care fail to move patients or surrogates to a better course of action. Appeals to their emotions are considered illegitimate because they may preclude autonomous choice. This article discusses whether it is always unethical to change someone's beliefs, whether persuasive communication is inherently harmful and whether it leaves no space for voluntariness. To answer these questions, the article engages with Aristotle's work, Rhetoric. In considering whether there is a place for emotionally charged messages in a patient–provider relationship, the article intends to delineate the nature of this relationship and describe the duties this relationship implies. The article presents examples of persuasive communication used in critical care and discusses whether providers may have a duty to persuade patients. This duty is supported by the fact that doctors often influence patients' and families' choices by framing presented options. Doctors should assume responsibility in recognizing these personal and contextual influences that may influence the medical choices of their patients. They should attempt to modify these contextual factors and biases in a way that would assist patients and families in reaching the desired outcomes. The opening sections surveyed a number of definitions found in relevant literature and outlined some of the concepts included in the proposed definition. This definition helps to distinguish instances of persuasion from cases of manipulation, coercion and deception. Considering the fact that patients and families often make irrational decisions and the fact that doctors inadvertently influence their choices, the article suggested that persuasion can be a positive tool in medical communication. When patients or families clearly do not understand the risks or make decisions that contradict their long‐term goals, persuasion can be used as a positive influence.