Mandatory reporting of oral injuries indicating possible child abuse

BackgroundThe dental professional may see pediatric patients who have signs of intraoral trauma, perioral trauma or both. Evaluation should include the possibility of nonaccidental, deliberately inflicted abuse. Reporting such injuries is mandated.MethodsThe authors reviewed the criminal and civil statutes in all 50 states to determine what role dental professionals are required to play in instances of abuse or neglect.ResultsMandates in all 50 states require that dental professionals be aware of and report instances of child abuse and neglect to the proper state authority. State laws also protect the reporting dental professional from civil retribution.ConclusionsState laws and dental ethical duties require all dental professionals to be aware of and to report instances of child abuse or neglect. These same laws protect clinicians in this duty. It is the clinician's responsibility to help prevent ongoing injury to people who are incapable of self-protection.Clinical ImplicationsClinicians should learn to recognize signs of abuse and neglect, which often involve injury to the mouth and dentition. Dental professionals are mandated to report such abuse to state child protection authorities.     

Patients' attitudes toward screening for medical conditions in a dental setting

Objectives: Previous studies demonstrated the efficacy of chairside medical screening by dentists to identify patients who are at increased risk for developing cardiovascular‐associated events and the favorable attitude of dentists toward chairside medical screening. This study assessed patient attitudes toward chairside medical screening in a dental setting. Methods: A self‐administered questionnaire of eight five‐point response scale questions was given to a convenience sample of adult patients attending an inner‐city dental school clinic and two private practice settings. Wilcoxon–Mann–Whitney tests and t‐tests were used to compare responses between study groups. Friedman nonparametric analysis of variance was used to compare response items within each question. Results: Regardless of setting, the majority of respondents was willing to have a dentist conduct screening for heart disease, high blood pressure, diabetes, human immunodeficiency virus infection, and hepatitis infection (55‐90 percent); discuss results immediately (79 percent and 89 percent); provide oral fluids, finger‐stick blood, blood pressure measurements, and height and weight (60‐94 percent); and pay up to $20 (50‐67 percent). Respondents reported that their opinion of the dentist would improve regarding the dentist's professionalism, knowledge, competence, and compassion (48‐77 percent). The fact that the test was not done by a physician was ranked as the least important potential barrier. While all respondents expressed a favorable attitude toward chairside screening, the mean score was significantly lower among clinic patients across most questions/items. The priority rankings within an item were similar for both groups. Conclusions: Acceptance by patients of chairside medical screening in a dental setting is a critical element for successful implementation of this strategy.     

Dream as Transaction: An Exercise in Interpersonal Theory

The author explores the multiple meanings for her of analyst disclosures and the application of a fixed analytic frame. She challenges the idea that most analytic rules, outside of the context of a particular and ever-changing clinical situation, can universally hold true. She believes that questions pertaining to “right” and “wrong” are, perhaps, an inapt line of inquiry in this regard. Drawing material from reflections on her own developmental history in relation to disclosure and risk, as these factors play out in the dyadic interactions of a particular, out-of-the-ordinary, highly charged clinical case, she highlights a distinction between a potentially inappropriate application of generic analytic “rules” and a necessary steadying personal connection with a hierarchy of ethical principles.     

Surgical versus medical treatment of spontaneous posterior fossa haematomas: A cooperative study on 205 cases

22 Italian centres have joined together in a cooperative study aiming to define the ideal management of spontaneous posterior fossa haematomas. 205 cases have been evaluated: 155 cerebellar haematomas and 50 brainstem haematomas. Out of these, 190 cases, all studied by CT scan, are the subject of the present study.

Cerebellar haematomas have been divided, according to a tomographic classification, into 3 groups: group 1 (4th ventricle not shifted), group 2 (4th ventricle shifted or obliterated) and group 3 (intraventricular blood). Each group has been subdivided into: A (no hydrocephalus),. and B (hydrocephalus). Regardless of therapeutical modalities, mortality rate was 38% for cerebellar haematomas; level of consciousness a few hours after haemorrhage and size of the lesion appeared to be significant prognostic factors. As a whole, medical treatment gave better results than surgical treatment. Considering each tomographical group in detail, surgery should be limited to patients in group 2B and 3B, especially when exhibiting neurological deterioration.

For brainstem haematomas, overall mortality was 57%. The possibility of survival was linked to the presence or absence of initial loss of consciousness and to the size of the lesion; while hydrocephalus did not influence the final outcome, ventricular blood was a risk factor. Surgical evacuation showed some value in chronic cases. However, medical treatment appears to be the best policy for brainstem haematomas of limited size; for larger lesions, the outcome appears to be uniformly fatal, regardless of the treatment employed.     

Diferencias en la tasa de atrofia global y regional y del volumen lesional entre género en esclerosis múltiple

Introduction

Previous studies showed gender-associated clinical and MRI differences in multiple sclerosis (MS) evolution. However, only few studies were done with non conventional MRI techniques and no one was done in a South American MS population. The aim of this study was to investigate gender differences according to nonconventional MRI measures in patients with MS from Buenos Aires, Argentina.

Methods

Relapsing-remitting MS patients (RRMS) with at least 6 years of follow up and an MRI at onset and at 6 years were included. Patients were assessed using nonconventional MRI measures: total brain volume (TBV), neocortical grey brain volume (GBV), white brain volume (WBV), lesion load (LL), % of brain volume change between onset and year 6 (% BVC) and regional brain volume change. Gender-related MRI differences were investigated using general linear model analysis.

Results

The 45 patients were included (25 female). Mean follow up time was 7.3±0.2 years. No differences in age, EDSS at onset, DMD treatment, TBV, GBV, WBV neither LL were found between gender at baseline. Six years later, males showed a decrease in TBV (P=.002) and GBV (P≤0.001) and an increase in LL (P=.02) and % BVC (P<.001) vs. females. Female patients showed a decrease in the volume of frontal subcortical region.

Discussion

This is the first study showing differences in brain volume changes between gender in MS patients from South America. Future studies will confirm our initial findings.     

The place of surveillance technology in residential care for people with intellectual disabilities: is there an ideal model of application

Background The demand for (care) services for people with intellectual disabilities (ID) is on the rise, because of an expanding population of people with ID as resources are concurrently diminishing. As a result, service providers are increasingly turning to technology as a potential answer to this problem. However, the use and application of surveillance technology (ST) in the care for people with ID provokes conflicting reactions among ethicists and healthcare professionals, and no ethical consensus has been reached as of yet. The aim of this study was thus to provide an overview of how ST is viewed by (care) professionals and ethicists working in the field by investigating what the ideal application of ST in the residential care for people with ID might entail. Methods Use was made of the concept mapping method as developed by Trochim; a computer‐assisted procedure consisting of five subsequent steps: brainstorming, prioritising, clustering, processing by the computer and finally analysis. Various participants (ranging from ethicists, physicians to support workers) were invited on the basis of their intended (professional) background. Prior to this study, the views of care professionals on the (ideal) application of ST in the residential care of people with dementia have been consulted and analysed using concept mapping. A comparison between the two studies has been made. Results Results show that the generated views represent six categories, varying from it being beneficial to the client; reducing restraints and it being based on a clear vision to (the need for) staff to be equipped; user friendliness and attending to the client. The results are presented in the form of a graphic chart. Both studies have produced very similar results, but there are some differences, as there appears to be more fear for ST among care professionals in the care for people with ID and views are expressed from a more developmental perspective rather than a person‐centred perspective with regard to people with dementia. Conclusions When it comes to views on using technology both in dementia care and the care for people with ID, there appears to be an inherent duality, often rooted in the moral conflict between safety versus freedom or autonomy. What is more, elaboration on abstract concepts often presumed to be self‐evident, whether ethical or not, has proven to be difficult. How ST is viewed and apprehended is not so much dependent of the care setting and care needs, but rather whether it is clear to everyone affected by ST, what one wants to achieve with ST.     

The National Institutes of Health Chemical Countermeasures Research Program (NIH CCRP): A collaborative opportunity to develop effective and accessible chemical medical countermeasures for the American people

The United States Department of Health and Human Services (HHS) leads the nation in preventing, preparing for, and responding to the adverse health effects of public health emergencies and disasters. In addition to biological, radiological and nuclear agents, the risk of a high consequence public health emergency due to the intentional and/or accidental release of chemical agents is a major growing concern of the US government. As such, the federal government is fully committed to address public health security threats posed by chemicals. To enhance chemical emergency preparedness and response, HHS oversees the interdepartmental research, advanced development, regulatory review and approval, procurement, and stockpiling of medical countermeasures (MCMs). Within the National Institute of Health (NIH/HHS), the National Institute of Allergy and Infectious Diseases (NIAID) is responsible for the fundamental research and early development of MCMs to prevent deaths and/or treat injuries during and after emergencies due to large scale chemical exposure. This commentary provides an overview of the NIAID/NIH Chemical Countermeasures Research Program (CCRP) and resources to facilitate the research, discovery, and early development of chemical MCMs. Available product development resources include research funding opportunities, expert advice from the NIH, and preclinical and efficacy service support cores to reduce opportunity costs and entry barriers for prospective developers interested in entering or accelerating the development of chemical MCMs.