Engaging student analysis of the practitioner-patient relationship assessed with reflective outcomes.

The representations and beliefs of both patient and practitioner influence the relationship that develops between them. We developed an innovative, interactive teaching tool in two stages (1- interviews with the patient or healthcare practitioner and 2- a session with sharing of the patient's and practitioner's perspective) whose objectives are to recognize the basic characteristics of PPR and identify how it can be influenced by expectations, beliefs and emotions. This pedagogical device was particularly appreciated by the students, as it enabled them to identify the importance of the patient's point of view and to reflect on their future professional identity.

Development and Validation of the SCAN-Score to Indicate General Anesthesia for Dental Care in Children.

Background: General anesthesia is an approach used to address behavior issues in pediatric dentistry. This indication often relies on the practitioner's discretion rather than objective criteria. We developed SCAN-score to assist pediatric dentists in the case of doubt to indicate general anesthesia for uncooperative children. The study aims were to assess the validity of the SCAN-score, which aims to indicate general anesthesia or chairside management for dental care. Methods: A retrospective study was performed on children aged between 2 and 10 years who received dental care. The SCAN-score combined three item scales (age, need of care, behavior) and three additional factors: communication barriers, permanent teeth caries, and local anesthesia contraindications. Mean scores were estimated. An ROC curve was constructed with sensitivities and specificities obtained. Results: The study included 284 children, with 154 treated through chairside methods and 130 treated under general anesthesia. The mean score was 5.6 ± 2.8 in the chairside management group and 12.9 ± 1.9 in the general anesthesia group. The sensitivity of the score (cutoff at 10) was 0.99, and the specificity was 0.94. The estimate of the ROC is 0.994. Conclusions: The SCAN-score appears to be an excellent tool to support the practitioner's decision to refer to general anesthesia care.

Enteral tube feeding in patients receiving dietary treatment for metabolic diseases: A retrospective analysis in a large French cohort.

CONTEXT: A strictly controlled diet (often involving enteral tube feeding (ETF)) is part of the treatment of many inherited metabolic diseases (IMDs). OBJECTIVE: To describe the use of ETF in a large cohort of patients with IMDs. DESIGN: A retrospective analysis of ETF in patients with urea cycle disorders (UCDs), organic aciduria (OA), maple syrup disease (MSUD), glycogen storage diseases (GSDs) or fatty acid oxidation disorders (FAODs) diagnosed before the age of 12 months. SETTING: The reference center for IMDs at Necker Hospital (Paris, France). RESULTS: 190 patients born between January 1991 and August 2017 were being treated for OA (n = 60), UCDs (n = 55), MSUD (n = 32), GSDs (n = 26) or FAODs (n = 17). Ninety-eight of these patients (52%) received ETF (OA subgroup: n = 40 (67%); UCDs: n = 12 (22%); MSUD: n = 9 (28%); GSDs: n = 23 (88%); FAODs: n = 14 (82%)). Indications for ETF were feeding difficulties in 64 (65%) patients, cessation of fasting in 39 (40%), and recurrent metabolic decompensation in 14 (14%). Complications of ETF were recorded in 48% of cases, more frequently with nasogastric tube (NGT) than with gastrostomy. Among patients in whom ETF was withdrawn, the mean duration of ETF was 5.9 (SD: 4.8) years (range: 0.6-19.8 years). The duration of ETF was found to vary from one disease subgroup to another (p = 0.051). While the longest median duration was found in the GSD subgroup (6.8 years), the shortest one was found in the UCD subgroup (0.9 years). CONCLUSION: ETF is an integral part of the dietary management of IMDs. The long duration of ETF and the specific risks of NGT highlights the potential value of gastrostomy.In this study at a French tertiary hospital, we documented the indications, modalities, duration and complications of enteral tube feeding in a cohort of patients with inherited metabolic diseases.