scholarly journals Oral Health Care Delivery for Children During COVID-19 Pandemic—A Retrospective Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Avia Fux-Noy ◽  
Luna Mattar ◽  
Aviv Shmueli ◽  
Elinor Halperson ◽  
Diana Ram ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Behavior Management ◽  
Deep Sedation ◽  
Care Delivery ◽  
Medical Center ◽  
Pediatric Dentistry ◽  
Control Measures ◽  
Healthy Children ◽  
Efficient Treatment ◽  
Dental Staff

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

scholarly journals Demand in Pediatric Dentistry for Sedation and General Anesthesia by Dentist Anesthesiologists: A Survey of Directors of Dentist Anesthesiologist and Pediatric Dentistry Residencies

2012 ◽  
Vol 59 (1) ◽  
pp. 3-11 ◽  
Author(s):  
C. Gray Hicks ◽  
James E. Jones ◽  
Mark A. Saxen ◽  
Gerardo Maupome ◽  
Brian J. Sanders ◽  
...  
Keyword(s):  
North America ◽  
General Anesthesia ◽  
Training Program ◽  
Online Survey ◽  
Response Rate ◽  
Training Programs ◽  
Deep Sedation ◽  
Program Directors ◽  
Pediatric Dentistry ◽  
Pediatric Dentists

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

2015 ◽  
Vol 123 (1) ◽  
pp. 198-205 ◽  
Author(s):  
Nancy McLaughlin ◽  
Peng Jin ◽  
Neil A. Martin
Keyword(s):  
Quality Improvement ◽  
Quality Indicator ◽  
Outpatient Surgery ◽  
Care Delivery ◽  
Average Length ◽  
Medical Center ◽  
Postoperative Bleeding ◽  
Time Interval ◽  
Neurosurgical Procedures ◽  
Neurosurgical Department

OBJECT Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery. METHODS All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated. RESULTS The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days. CONCLUSIONS This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.

scholarly journals Estimation of the Number of General Anesthesia Cases Based on a Series of Nationwide Surveys on Twitter during COVID-19 Pandemic in Japan: A Statistical Analysis

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 153
Author(s):  
Yosuke Fujii ◽  
Hiroki Daijo ◽  
Kiichi Hirota
Keyword(s):  
General Anesthesia ◽  
Japanese Society ◽  
Care Delivery ◽  
Japanese Government ◽  
State Of Emergency ◽  
Social Network Service ◽  
The Social ◽  
Public Data ◽  
The Status ◽  
Minimum Number

Background and objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to more than 200 countries. In light of this situation, the Japanese Government declared a state of emergency in seven regions of Japan on 7 April 2020 under the provisions of the law. The medical care delivery system has been under pressure. Although various surgical societies have published guidelines on which to base their surgical decisions, it is not clear how general anesthesia has been performed and will be performed in Japan. Materials and Methods: One of the services provided by the social network service Twitter is a voting function—Twitter Polls—through which anonymous surveys were conducted. We analyzed the results of a series of surveys 17 times over 22 weeks on Twitter on the status of operating restrictions using quadratic programming to solve the mathematical optimizing problem, and public data provided by the Japanese Government were used to estimate the current changes in the number of general anesthesia performed in Japan. Results: The minimum number of general anesthesia cases per week was estimated at 67.1% compared to 2015 on 27 April 2020. The timeseries trend was compatible with the results reported by the Japanese Society of Anesthesiologists (correlation coefficient r = 0.69, p < 0.001). Conclusions: The number of general anesthesia was reduced up to two-thirds during the pandemic of COVID-19 in Japan and was successfully quantitatively estimated using a quick questionnaire on Twitter.

Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia

2018 ◽  
Vol 42 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Maxwell N Rudie ◽  
Michael M Milano ◽  
Michael W Roberts ◽  
Kimon Divaris
Keyword(s):  
General Anesthesia ◽  
Pediatric Dentistry ◽  
Continuing Care ◽  
Administrative Claims ◽  
Care Needs ◽  
Special Health Care ◽  
Chapel Hill ◽  
Dental Rehabilitation ◽  
Tests Of Association ◽  
System Information

Purpose: The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. Study design: Administrative claims data were used to identify children and adolescents (age &lt;18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. Results: There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p&lt;0.0005) to have multiple DRGAs compared to non-craniofacial ones. Conclusion: DRGAs are on the increase—with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

scholarly journals An FQHC Research Network in Oral Health: Enhancing the Workforce and Reducing Disparities

2007 ◽  
Vol 122 (5) ◽  
pp. 592-601 ◽  
Author(s):  
Christine A. Riedy ◽  
Kiet A. Ly ◽  
Vickie Ybarra ◽  
Peter Milgrom
Keyword(s):  
Health Disparities ◽  
Oral Health ◽  
Care Delivery ◽  
Medical Science ◽  
Safety Net ◽  
Health Centers ◽  
Research Network ◽  
Dental Staff ◽  
Practice Based Research ◽  
Improve Health Care Delivery

Federally Qualified Health Centers (FQHCs) contribute greatly to reducing health disparities by providing care to underserved communities. Yet these safety-net clinics face chronic manpower shortages and turnover. Practice-Based Research Networks aid in translating medical science from bench to clinical practice. These networks have been used to understand and improve health-care delivery and reduce disparities. Initiatives to strengthen lagging translational research in dentistry have begun, but there is no FQHC research network that addresses oral health. This article reviews the potential for, and outlines a model of, an Oral Health FQHC Research Network. It characterizes the needs for an FQHC research network, describes a successful FQHC research-oriented program, and outlines an Oral Health FQHC Research Network conceptual model. It argues that strengthening FQHCs through involvement of their dental staff in clinical research may enhance their jobs, draw staff closer to the community, and strengthen their ability to reduce health disparities.

scholarly journals An Investigation of the Long and Short Term Behavioral Effects of General Anesthesia on Pediatric Dental Patients With Autism

2021 ◽  
Vol 2 ◽  
Author(s):  
Janine Tran ◽  
Jung-Wei Chen ◽  
Larry Trapp ◽  
Laura McCormack
Keyword(s):  
General Anesthesia ◽  
Sleep Disturbances ◽  
Activity Level ◽  
Behavioral Effects ◽  
Healthy Children ◽  
Post Discharge ◽  
Dental Surgery ◽  
Dental Patients ◽  
Post Surgery

Purpose: The purpose of this study was to compare the incidence of short and long term adverse behavioral effects of general anesthesia (GA) in healthy vs. moderate to severe autistic (ASD) children.Methods: Forty healthy and 37 ASD children, aged 3–17 years, undergoing GA for dental surgery participated in this study. Their anesthesia records were reviewed, and their parents answered telephone surveys to assess activity level, sleep disturbances, gastrointestinal disturbances, central nervous system effects, and respiratory depression. Three follow-up surveys were taken 8 h, 24 h, and 3 months post-surgery.Results: Four hundred fifty-five incidences of adverse behavioral effects occurred within 8 h post-surgery. Significantly more ASD patients had difficulty walking (P = 0.016) and nausea (P = 0.030), while more healthy children snored in the car ride home (P = 0.036) and talked about the dental surgery (P = 0.027). Three months post-discharge, sixASD patients acted in a way that concerned caregivers compared to 0 healthy patients, (P = 0.008). Incidence of adverse behavioral effects significantly decreased from 8 to 24 h overall.Conclusions: Most behavioral effects occur within 8 h post-surgery. There are potential long term adverse behavioral effects in ASD children from GA, but the chance is low and generally not long lasting.

scholarly journals Control Measures for Continuous Deep Sedation Until Death: A Framing Analysis of the Views of Physicians

2021 ◽  
pp. 104973232110376
Author(s):  
Stijn Vissers ◽  
Lenzo Robijn ◽  
Sigrid Dierickx ◽  
Freddy Mortier ◽  
Joachim Cohen ◽  
...  
Keyword(s):  
Deep Sedation ◽  
Self Regulation ◽  
Interesting Case ◽  
Control Measures ◽  
External Control ◽  
Framing Analysis ◽  
Structured Interviews ◽  
Continuous Deep Sedation ◽  
Sound Control ◽  
Professional Self

Physicians have been subject to increasing external control to improve their medical practice, and scholars have theorized extensively about their opposition to such control. However, little empirical attention has been paid to the views and reasoning that lie behind this opposition. An in-depth understanding is necessary for enhancing the effectiveness and efficiency of external controls, and continuous deep sedation until death (CDS) is an interesting case in this regard. This study aims to explore how physicians frame control measures for CDS. We conducted 47 semi-structured interviews with Belgian physicians in 2019. A qualitative framing analysis was performed to analyze their views and reasoning. This study reveals that physicians approach CDS practice and control measures with different emphases. Controlling by mechanisms of professional self-regulation and state governance are put forward as appropriate means to improve CDS practice. Policymakers should take into consideration physicians’ frames to develop sound control measures.

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