Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children.

Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.

Contrast-enhanced ultrasound of benign and malignant liver lesions in children.

Contrast-enhanced ultrasound (CEUS) is increasingly being used in children. One of the most common referrals for CEUS performance is characterization of indeterminate focal liver lesions and follow-up of known liver lesions. In this setting, CEUS is performed with intravenous administration of ultrasound contrast agents (UCAs). When injected into a vein, UCA microbubbles remain confined within the vascular network until they dissipate. Therefore, visualization of UCA within the tissues and lesions corresponds to true blood flow. CEUS enables continuous, real-time observation of the enhancement pattern of a focal liver lesion, allowing in most cases for a definite diagnosis and obviating the need for further cross-sectional imaging or other interventional procedures. The recent approval of Lumason (Bracco Diagnostics, Monroe Township, NJ) for pediatric liver CEUS applications has spurred the widespread use of CEUS. In this review article we describe the role of CEUS in pediatric liver applications, focusing on the examination technique and interpretation of main imaging findings of the most commonly encountered benign and malignant focal liver lesions. We also compare the diagnostic performance of CEUS with other imaging modalities for accurate characterization of focal liver lesions.

The virtual child: evaluation of an internet-based pediatric behavior management simulation.

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

Influence of community-based dental education on dental students' preparation and intent to treat underserved populations.

This study examined the influence of community-based dental education (CBDE) on dental students' perceived ability to treat underserved patients and their selection of community dental clinics as a first career path. In a 2009 survey, fourth-year dental students at the University of Michigan recorded their attitudes, skill level, and confidence in treating underserved patients before and after CBDE rotations and estimated what percentage of their practice they planned to devote to Medicaid-eligible patients. The first career choices of graduates from 2005 to 2010 were also correlated with the number of weeks the students spent in CBDE rotations. The results showed an improvement in student skill and confidence in treating low-income patients after the rotations. The examination of first career choices showed that, after three to five weeks of CBDE rotations, 5.6 percent of the students planned to practice in a community-based dental clinic. However, in 2009 when rotations were increased to eight weeks and included multiple clinic types, 11.8 percent of the students in 2009 and 16.5 percent in 2010 selected a community-based dental clinic as their preferred practice location. These findings suggest that CBDE improves dental students' skill and confidence level in treating underserved patients and that more time spent in CBDE rotations, specifically more than five weeks in multiple clinic types, may increase the number of graduates who select practice in community-based clinics as a first career choice.

Mentoring of dental and dental hygiene faculty: a case study.

Given the predicted shortages of dental faculty in the United States, it is important to retain faculty members. Mentoring could play a crucial role in this context. The objectives of this case study were to explore how a six-year mentoring program in the Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry changed faculty members' perceptions of support from colleagues and their mentoring expectations. In addition, we sought to determine how junior versus senior faculty members and mentors versus mentees differed in their perceptions of faculty roles, their self-perceived competence, and their awareness of departmental expectations at the end of the program. Data were collected with self-administered surveys from twenty-five of the thirty-six faculty members in this department in 2002 (response rate: 69 percent) and from thirty-seven of the fifty-four faculty members in 2008 (response rate: 69 percent). The results showed that the perceptions of support from colleagues improved significantly over the six-year period. During the same time period, mentoring expectations increased. In 2008, junior faculty members as compared to senior faculty members remained less positive about their role as faculty members, felt less well prepared for their professional life, and were less aware of departmental expectations. In conclusion, a departmental mentoring program resulted in improved support from colleagues and increased expectations concerning mentoring experiences. However, future targeted interventions are needed to address the identified differences between junior and senior faculty members. Recommendations for faculty mentoring efforts are discussed.

Creation of a scholars program in dental leadership (SPDL) for dental and dental hygiene students.

There is a great need for leaders in the dental profession. As technological advances make our world smaller and our lives faster and more complex, we as a profession face challenges and opportunities that are evolving. Many of the changes in the scope and mode of practice will require new and different approaches. Meeting these challenges will require changes in how we as dental professionals do business; interact with our patients, other stakeholders, and health care providers; and educate our future colleagues. The purposeful incorporation of leadership education into dental and dental hygiene curricula represents an important departure from existing paradigms-but will help prepare our students to address these challenges. This article provides an overview of the development of a Scholars Program in Dental Leadership (SPDL) at the University of Michigan School of Dentistry. Our aim for the program is to create a learning environment that fosters leadership development, so that students are prepared and motivated to assume leadership positions in the profession and their communities.