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1.
Br Dent J ; 227(5): 387-391, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31520042

RESUMO

Introduction Child abuse and neglect present a significant global concern, therefore, it is imperative that dental professionals can identify children at risk. Previous literature has suggested that general dental practitioners (GDPs) do not feel adequately trained to do so and that there is a gap between the suspicion of abuse and onward referral.Aims To assess the experience of paediatric safeguarding reporting among GDPs in Greater Manchester and investigate the current barriers to reporting safeguarding concerns.Methods An anonymous questionnaire was distributed via email to a sample of general dental practices in Greater Manchester.Results Thirty-six questionnaires were completed, giving a 36% response rate. Fifty-eight percent of respondents had received undergraduate training and 83% had received postgraduate training. Eighty-one percent felt that GDPs require further training and support. Fifty-eight percent of GDPs had been suspicious of at least one case of child abuse or neglect, however, only 28% had completed an onwards referral. Common barriers to reporting included: fear of violence to the child; lack of certainty of diagnosis; and lack of confidence in their suspicions.Conclusion Barriers to the referral of suspected cases of abuse or neglect are still commonly reported. There is a strong demand for further child protection training among GDPs.


Assuntos
Maus-Tratos Infantis , Odontologia Geral , Atitude do Pessoal de Saúde , Criança , Bem-Estar da Criança , Humanos , Encaminhamento e Consulta , Inquéritos e Questionários
2.
Dent Traumatol ; 35(4-5): 241-250, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31038825

RESUMO

BACKGROUND/AIM: There is a lack of research into orthodontic movement and management strategies of traumatized teeth. The aim of this survey was to assess the knowledge of UK-based orthodontists in the orthodontic management of traumatized teeth. MATERIALS/METHODS: A 24-item questionnaire survey was electronically distributed to all members of the British Orthodontic Society. RESULTS: A total of 213 respondents completed the survey with the majority of these being UK registered specialists in orthodontics. Three responses were excluded as one was not based within the UK and two were orthodontic trainees with <1 year of experience, leaving a total of 210 respondents. The majority had orthodontically treated up to three patients with a history of dental trauma in the preceding 3 months. Obtaining a trauma history was done by the majority of respondents. A wide variation in times waited by respondents before orthodontically treating teeth with different types of traumatic injuries was observed. Similarly, the preferred orthodontic management strategies of traumatized teeth differed substantially among respondents. Almost all respondents were interested in further training in the management of dental trauma. CONCLUSIONS: The study showed a wide variation in the orthodontic management of traumatized teeth among UK-based orthodontists. Further training and national guideline establishment are indicated for orthodontic management of traumatized teeth in the UK.


Assuntos
Ortodontia , Ortodontistas , Traumatismos Dentários/reabilitação , Humanos , Sociedades Odontológicas , Inquéritos e Questionários , Reino Unido
3.
Br Dent J ; 226(7): 486-489, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979997

RESUMO

Objectives The aim of this article is to present an easy to use, conservative method for managing discolouration in enamel in general practice. Materials and methods Microabrasion was used in this case to remove superficial layers of discoloured enamel utilising abrasive acids, which was further improved by using ICON, a newly developed resin infiltrant. Results Significant improvement shown by the presented case suggests that this modality of treatment could be used more frequently. Discussion This simple yet extremely effective treatment can be used by the general dental practitioner despite not having the necessary equipment as readily available alternatives can be used. Conclusion Using minimally invasive options in managing superficial enamel lesions can be effective and prevent the use of invasive procedures in the first instance.


Assuntos
Microabrasão do Esmalte , Descoloração de Dente , Esmalte Dentário , Humanos
4.
J Clin Pediatr Dent ; 43(1): 46-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30289370

RESUMO

Autoimmune neutropenia is a self-limiting condition characterized by the presence of granulocyte-specific autoantibodies. This case report describes a 2-year-old female who presented to the Department of Pediatric Dentistry with a history of oral ulceration, complicated by high temperature, gingival hypertrophy and gingival hemorrhage. These symptoms had precipitated an admission to a district general hospital and diagnosis of viral tonsillitis. The severity of the presentation to the Pediatric Dental Department prompted a review of recent discharge blood investigations, which revealed a neutrophil count of 0.07×109/L(1.0-8.5 ×109/L) indicating severe neutropenia. Urgent referral to Pediatric Hematology resulted in same-day admission and a diagnosis of autoimmune neutropenia was established. The patient was managed with chlorhexidine mouthwash, prophylactic antimicrobial and antifungal medication and granulocyte colony stimulating factor (G-CSF). Neutropenia may present with features exclusive to the oral cavity. Recognition of atypical presentations such as oral ulceration with associated systemic illness may assist in early diagnosis.


Assuntos
Hemorragia Gengival , Hipertrofia Gengival , Neutropenia , Úlceras Orais/etiologia , Criança , Pré-Escolar , Feminino , Hemorragia Gengival/etiologia , Hipertrofia Gengival/etiologia , Fator Estimulador de Colônias de Granulócitos , Humanos , Neutropenia/complicações , Neutropenia/diagnóstico
5.
J Clin Psychopharmacol ; 35(4): 434-41, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26075489

RESUMO

In lithium-treated patients, polyuria increases the risk of dehydration and lithium toxicity. If detected early, it is reversible. Despite its prevalence and associated morbidity in clinical practice, it remains underrecognized and therefore undertreated. The 24-hour urine collection is limited by its convenience and practicality. This study explores the diagnostic accuracy of alternative tests such as questionnaires on subjective polyuria, polydipsia, nocturia (dichotomous and ordinal responses), early morning urine sample osmolality (EMUO), and fluid intake record (FIR). This is a cross-sectional study of 179 lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed the tests after completing an accurate 24-hour urine collection. The diagnostic accuracy of the individual tests was explored using the appropriate statistical techniques. Seventy-nine participants completed all of the tests. Polydipsia severity, EMUO, and FIR significantly differentiated the participants with polyuria (area under the receiver operating characteristic curve of 0.646, 0.760, and 0.846, respectively). Of the tests investigated, the FIR made the largest significant change in the probability that a patient experiences polyuria (<2000 mL/24 hours; interval likelihood ratio, 0.18 and >3500 mL/24 hours; interval likelihood ratio, 14). Symptomatic questioning, EMUO, and an FIR could be used in clinical practice to inform the prescriber of the probability that a lithium-treated patient is experiencing polyuria.


Assuntos
Lítio/efeitos adversos , Poliúria/induzido quimicamente , Poliúria/diagnóstico , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Testes Diagnósticos de Rotina/normas , Feminino , Humanos , Irlanda/epidemiologia , Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Poliúria/epidemiologia , Resultado do Tratamento
6.
Bipolar Disord ; 17(1): 50-62, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25070221

RESUMO

OBJECTIVES: Polyuria increases the risk of dehydration and lithium toxicity in lithium-treated patients. Risk factors have been inconsistently described and the variance of this adverse effect remains poorly understood. This study aimed to establish independent risk factors for polyuria in a community, secondary-level lithium-treated sample of patients. METHODS: This was a cross-sectional study of the lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed a 24-hour urine collection. Urine volume and the presence of polyuria were the outcomes of interest. The relationship between outcome and the participant's demographic and clinical characteristics was explored with univariable and multivariable analysis. RESULTS: A total of 122 participants were included in the analysis, with 38% being diagnosed with polyuria. Female gender and increased body weight independently predicted the presence of polyuria (standardized regression coefficient 1.01 and 0.94, respectively; p = 0.002 and p = 0.003, respectively). Female gender and increased body weight, lithium dose, and duration of lithium treatment independently predicted higher 24-hour urine volumes (standardized regression coefficients 0.693, p < 0.0005; 0.791, p < 0.0005; 0.276, p = 0.043; 0.181, p = 0.034, respectively). Of three different weight metrics, lean body weight was the most predictive. CONCLUSIONS: Female gender and increased body weight explain part of the variance of this adverse effect. Both risk factors offer fresh insights into the pathophysiology of this potentially reversible and dangerous adverse effect of lithium treatment. Future research should focus on understanding the differences between the genders and between different body compositions in terms of lithium pharmacokinetics and pharmacodynamics.


Assuntos
Transtorno Bipolar/tratamento farmacológico , Compostos de Lítio , Poliúria , Adulto , Idoso , Antimaníacos/administração & dosagem , Antimaníacos/efeitos adversos , Antimaníacos/farmacocinética , Disponibilidade Biológica , Índice de Massa Corporal , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Irlanda/epidemiologia , Compostos de Lítio/administração & dosagem , Compostos de Lítio/efeitos adversos , Compostos de Lítio/farmacocinética , Masculino , Pessoa de Meia-Idade , Poliúria/induzido quimicamente , Poliúria/diagnóstico , Poliúria/epidemiologia , Fatores de Risco , Fatores Sexuais
7.
Early Interv Psychiatry ; 8(3): 291-7, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23826636

RESUMO

AIM: Ensuring a seamless transition from child to adult mental health services poses challenges for services worldwide. This is an important process in the ongoing care of young people with mental illness; therefore, it is incumbent on all countries to probe their individual structures to assess the quality of mental health service delivery to this vulnerable cohort. To date, there have been no published studies on the transition from Child to Adult Mental Health Services in the Republic of Ireland. To this end, a nationwide survey of transition policies of community mental health teams in both services was conducted in order to compare best practice guidelines for transition with current process and experience in clinical practice. METHOD: Structured interviews were conducted with 57 consultant psychiatrists (representing 32 CAMHS teams and 25 AMHS teams) to obtain information on annual transition numbers, existing transition policies and operational practice from the professional perspective. RESULTS: Numbers of young people considered suitable for transfer to adult services (M = 7.73, SD = 9.86, n = 25) were slightly higher than numbers who actually transferred (M = 4.50, SD = 3.33, n = 20). There is a lack of standardized practice nationwide regarding the service transition boundary, an absence of written transition policies and protocols, and minimal formal interaction between child and adult services. CONCLUSIONS: The findings suggest that there are critical gaps between current operational practice and best practice guidelines. Future studies will investigate the impact this has on the transition experiences of young people, their carers and health-care professionals.


Assuntos
Serviços de Saúde do Adolescente/normas , Serviços de Saúde da Criança/normas , Serviços Comunitários de Saúde Mental/normas , Continuidade da Assistência ao Paciente/normas , Fidelidade a Diretrizes , Adolescente , Criança , Feminino , Humanos , Irlanda , Masculino
8.
J Physiother ; 58(4): 231-40, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23177225

RESUMO

QUESTION: Is electrical stimulation and splinting more effective than splinting alone for the management of wrist contracture following acquired brain injury? DESIGN: A multi-centre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Thirty-six adults with first stroke or traumatic brain injury and mild to moderate wrist flexion contractures. INTERVENTION: The experimental group received electrical stimulation to the wrist and finger extensor muscles for 1 hour a day over 4 weeks while the control group did not. Both groups wore a splint for 12 hours a day during this 4-week period. OUTCOME MEASURES: The primary outcome was passive wrist extension measured with a 3Nm torque and with the fingers in extension. Secondary outcomes included passive wrist extension, wrist and finger extensor strength, wrist flexor spasticity, motor control of the hand, and Global Perceived Effect of Treatment, and perception of treatment credibility. Outcome measures were taken at baseline, at the end of the intervention period (4 weeks), and after a 2-week follow-up period (6 weeks). RESULTS: At 4 and 6 weeks, the mean between-group difference (95% CI) for passive wrist extension was 7 degrees (-2 to 15) and -3 degrees (-13 to 7), respectively. Secondary outcomes were statistically non-significant or were of borderline statistical significance. CONCLUSION: It is not clear whether electrical stimulation and splinting is more effective than splinting alone for the management of wrist contracture after acquired brain injury. Therapists' confidence in the efficacy of electrical stimulation for contracture management is not yet justified.


Assuntos
Lesões Encefálicas/reabilitação , Contratura/reabilitação , Terapia por Estimulação Elétrica/métodos , Modalidades de Fisioterapia , Contenções , Adulto , Idoso , Lesões Encefálicas/complicações , Contratura/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Physiother ; 58(2): 105-12, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22613240

RESUMO

QUESTIONS: Can circuit class therapy provide sufficient exercise dosage (at least 20 minutes at ≥ 50% heart rate reserve or total caloric expenditure ≥ 300 kilocalories) to induce a cardiorespiratory fitness effect in adults with traumatic brain injury? Can feedback from heart rate monitors influence exercise intensity? DESIGN: Randomised controlled trial within an observational study. PARTICIPANTS: Fifty-three people with severe traumatic brain injury, of whom 40 progressed into the trial. INTERVENTION: All participants undertook circuit class therapy. Participants allocated to the experimental group received exercise intensity feedback from a heart rate monitor and the control group received no feedback. OUTCOME MEASURES: Proportion of participants exercising at ≥ 50% heart rate reserve for at least 20 minutes or expending ≥ 300 kilocalories during circuit class therapy. The primary outcome measure for the trial was the time spent in the heart rate training zone (ie, at ≥ 50% heart rate reserve) during the intervention and re-assessment periods. RESULTS: Circuit class therapy provided sufficient cardiorespiratory exercise dosage for 28% (95% CI 18 to 42) of the cohort according to the heart rate reserve criteria and 62% (95% CI 49 to 74) according to the caloric criteria. Feedback did not increase the time in the training zone during the intervention (mean difference 4.8 minutes, 95% CI -1.4 to 10.9) or re-assessment (1.9 minutes, -4.4 to 8.3) periods. CONCLUSION: The low intensity, long duration structure of circuit class therapy can provide sufficient exercise dosage for a fitness training effect for 62% of people with traumatic brain injury. Feedback from heart rate monitors does not necessarily influence exercise intensity. TRIAL REGISTRATION: ACTRN12607000522415.


Assuntos
Lesões Encefálicas/reabilitação , Terapia por Exercício/métodos , Exercício Físico , Modalidades de Fisioterapia , Caminhada , Adulto , Austrália , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aptidão Física , Resultado do Tratamento , Adulto Jovem
10.
J Ir Dent Assoc ; 55(3): 144-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19591314

RESUMO

The alveolar lymphangioma is a benign but relatively rare condition found only in the oral cavities of black infants. Dentists practising in Ireland may be unaware of this condition due to its racial specificity. This paper presents two case reports of multiple alveolar lymphangiomas found in black infants in a children's hospital in Ireland. The epidemiology, aetiology, clinical presentation, histology, and management options are discussed. The photographs should aid the practitioner in recognising these lesions.


Assuntos
Processo Alveolar/patologia , Neoplasias Maxilomandibulares/patologia , Linfangioma/patologia , Grupo com Ancestrais do Continente Africano , Humanos , Lactente , Irlanda , Masculino
11.
Ir J Psychol Med ; 26(3): 127-130, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30282306

RESUMO

OBJECTIVES: To assess patient satisfaction with mental health services. Client satisfaction with mental health services is attracting increasing attention and is now considered a key outcome variable in evaluating mental health services. The Quality Framework (Mental Health Commission (MHC)), and Vision for Change (VFC) support such evaluation. However, there are no published quantitative data from Irish users of a community mental health service. METHOD: We invited outpatients attending a Dublin community mental health service to complete a standardised self-report instrument (Client Satisfaction Questionnaire, CSQ-8) and provide qualitative feedback. RESULTS: Of the seventy-nine respondents, 80% report they were 'satisfied' or 'very satisfied' with the service. However, they were critical of; access to, operation of, and communication with the mental health services. CONCLUSIONS: Although satisfied, when given the opportunity to comment, service users can be critical of aspects of the service they receive. Only using quantitative evaluation of outpatient client satisfaction levels may fail to capture important consumer suggestions for service development. Recent recommendations and upcoming changes would address a number of the criticisms of mental health services identified in this study.

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