Search

Aim: This study was conducted to understand the research hotspots, research trends and research frontiers for hypothermia in surgical patients and provide a reference for developing effective measures to reduce the incidence of hypothermia in these patients. Design: Using CiteSpace software, a visual analysis of 1288 included articles related to hypothermia in surgical patients was performed. Methods: CiteSpace software is a Java application that supports knowledge research, data visualization and analysis of literature databases. The following data were retrieved: title, abstract, year, keywords, author, academic institution, journal and citations. The included literature was analysed using CiteSpace visualization software, knowledge mapping, collaborative network analysis, cluster analysis and highlighting keywords for visualization. Results: A total of 1288 articles related to hypothermia in surgical patients were included, with the largest number of articles published in the United States (448), followed by in Germany (104) and China (102). The top three institutions, journals and authors were from the United States. The most common keywords were perioperative 'hypothermia', 'risk factors' and 'anesthesia'. [ABSTRACT FROM AUTHOR]

Background: Controversy exists on the acceptability of medical immobilization (MI). Aim: To identify regulations, professional conventions, and opinions on the acceptability of MI and to identify practice patterns through a pilot study of members of the International Association of Paediatric Dentistry (IAPD) and their colleagues. Design: A 22‐item questionnaire was developed and electronically distributed to 1191 members of the IAPD. Results: Responses were received from 182 dentists in 45 countries. The majority (74.9%) of respondents use MI, and 29.1% use an immobilization device. MI with an immobilization device was reported as professionally acceptable (58.1%) and permitted by medicolegal regulations (70.8%) in their countries of practice. Dentists rated acceptability of MI higher than they perceived parents would overall and perceived MI to be more acceptable by parents for emergency situations and for children with special healthcare needs but 19.8% of respondents found it totally unacceptable in all scenarios. Use and opinions of acceptability varied by geographical location with respondents from North America being more accepting of MI. Most dentists felt that the use of an immobilization device could lead to lasting psychological trauma (72.3%) and violation of the rights of the child (55.4%) but that it improves access to care (58.5%). Conclusion: The acceptability of MI remains an area of controversy for paediatric dentists internationally. [ABSTRACT FROM AUTHOR]

Abundant cryptospore-like microfossils have been collected from a sample of the 'Middle' Cambrian Log Cabin Member of the Pioche Shale in eastern Nevada, USA. Compared with organic-walled microfossils obtained from the Cambrian Kaili Formation in eastern Guizhou Province, China, some specimens of leiosphers may be inferred to be similar cryptospore-like microfossils. The new fossil record would be the oldest known specimens of cryptospore-like microfossils during the Cambrian Period. [ABSTRACT FROM AUTHOR]

Objective: This retrospective cohort study compared differences in age one dental visit use and age at first dental visit according to fluoride varnish receipt at the pediatric medical home., Methods: Enrollment and claims data were used from Partners For Kids, a pediatric accountable care organization covering Medicaid-enrolled children living in 47 of 88 counties in Ohio. The main outcomes were having an age one dental visit and the mean age at first dental visit. Descriptive statistics and bivariate comparisons were applied., Results: Among 17,675 children, 2.8% had an age one dental visit. The mean age at first dental visit was 4.8 years. Children who received fluoride varnish from their medical home (12% of study population) were significantly younger at their first dental visit (4.1 vs. 4.9 years, p < 0.001)., Conclusion: Despite longstanding recommendations for the age one dental visit, very few Medicaid-enrolled children in Ohio had one. The pediatric medical home lowered the age of first dental visit., (© 2024 The Authors. Journal of Public Health Dentistry published by Wiley Periodicals LLC on behalf of American Association of Public Health Dentistry.)

Background: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments., Methods: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients)., Results: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2., Conclusions: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA., Practical Implications: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: Increasing evidence supports the influence of neighborhood factors on health care use and outcomes. This study measured the association between area-level social determinants of health (SDH) and type of dental care use among Ohio pediatric Medicaid beneficiaries., Methods: A retrospective dental claims analysis was completed for children aged 1 through 5 years enrolled in Ohio Medicaid with a dental visit in 2017. Dental care use was measured from 2017 through 2021 as 1 of 4 visit types: (1) preventive, (2) caries treatment, (3) dental general anesthesia (GA), and (4) dental emergency department. The Ohio Children's Opportunity Index defined area-level SDH at the census tract level. Exploratory analysis included descriptive statistics of area-level SDH for each outcome. Poisson regression models were developed to examine the associations between the number of each dental care use outcome and Ohio Children's Opportunity Index quintiles. Visualizations were facilitated with geospatial mapping., Results: Fifty-six percent of children (10,008/17,675) had caries treatment visits. Overall area-level SDH were positively associated with preventive (fifth vs first quintile incidence rate ratio [IRR], 1.09; 95% CI, 1.07 to 1.12), caries treatment (fifth vs first quintile IRR, 1.16; 95% CI, 1.08 to 1.24), and dental GA visits (fifth vs first quintile IRR, 2.13; 95% CI, 1.13 to 4.01)., Conclusions: Children with preventive, caries treatment, and dental GA visits were more likely to live in neighborhoods with better SDH. Future efforts should investigate the mechanisms by which area-level factors influence dental access and use., Practical Implications: Neighborhood factors influence pediatric dental care use. Patient home addresses might add value to caries risk assessment tools and efforts by care networks to optimize efficient care use., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization., Methods: This retrospective cohort study used enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013 to 2019 were included. We calculated 5 dental utilization outcomes: 1) Diagnostic only visits, 2) Preventive visits, 3) Treatment visits, 4) Treatment visits under general anesthesia (GA), and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities., Results: Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (eg, non-complex chronic comorbidity: odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.85-0.89), and significantly higher odds of a dental treatment under general anesthesia visit (eg, non-chronic comorbidity: OR = 3.69, 95% CI: 3.26-4.18). The total cumulative dental expenditures were $10.5M greater for children with BH., Conclusions: Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization., (Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background/aim: Participation in sports activities is a source of dental injury. Despite recommendations for the use of mouthguards, athletes underutilize them. The aim of this study was to provide estimates of dental injuries, the mechanism of injuries and the utilization of mouthguards in high school sports., Materials and Methods: This study was a secondary analysis of an existing dataset of a convenience sample of the National High School Sports-Related Injury Surveillance Study. Data of athletic exposures, dental injuries, mouthguard usage, and mechanism of injury from the 2005/2006 to the 2019/2020 academic years were analyzed., Results: During the study period, there were 459 dental injuries in 49,987,927 athletic exposures resulting in a dental injury rate of 0.9 per 100,000 athletic exposures (AE). Slightly more than half of the traumatic dental injuries were sustained during competition (n = 256; 55.8%) and the rest (n = 200; 43.6%) were sustained during practice. The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0-4.4). Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes. Among girls' sports, field hockey had the highest rate (3.5 per 100,000 AE) and among boys' sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury. The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%). In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained., Conclusions: Dental injuries were a small proportion of all injuries sustained by high school athletes. The majority of dental injuries were sustained when the athlete was not wearing a mouthguard., (© 2022 The Authors. Dental Traumatology published by John Wiley & Sons Ltd.)

Objectives: To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice., Design: Retrospective claims-based analysis cohort study., Setting: Children with Medicaid insurance through an Ohio pediatric accountable care organization., Participants: Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017., Intervention: FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider., Main Outcome Measure: Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes., Results: The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4)., Conclusions: Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment., Competing Interests: C.G. and H.M. were paid employees of Partners For Kids during the study period. The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Incorporation of patient safety and quality improvement into the educational framework of all health care trainees, including those in dentistry, is growing. The purpose of this study was to characterize the current state of patient safety training and education in US pediatric dentistry residency programs. Methods: A 19-item web-based survey was emailed to all US pediatric dentistry residency program directors in 2021. The survey collected information regarding program background, safety education, safety protocol and experience, attitudes toward safety, and potential support for safety education. Data were analyzed using descriptive statistics and Fisher's exact test. Results: Seventy-two directors (76 percent response rate) completed the survey. The majority felt safety education was somewhat (11 percent, N equals six) or extremely important (68 percent, N equals 49) for residents. Only six percent (N equals four) reported residents entered their program with an adequate understanding of safety science. Most (74 percent, N equals 53) taught safety science through both didactic seminars and clinical experience. Timeouts under general anesthesia (78 percent, N equals 56) and emergency simulations (72 percent, N equals 52) were more common modes of clinical safety training. Overall, a limited number of program directors had familiarity with many safety tools used to prevent adverse events. Program directors' experience with adverse events was not associated with opinions regarding the importance of safety education. The majority expressed interest in AAPD supporting safety education. Conclusions: Although program directors feel safety education is important, programs do not sufficiently address safety education and look for support to help integrate safety measures into education.

Purpose: To assess the impact of the Covid-19 pandemic on applicants for advanced education programs in pediatric dentistry in the United States and provide recom- mendations for virtual interviews (VI).
Methods: A cross-sectional survey was emailed to pediatric dentistry applicants in the 2020-2021 cycle.
Results: One hundred seventy-five applicants responded. Virtual interviews were the universal format during this timeframe. Forty-four percent admitted to applying to programs they were not initially strongly considering and 42 percent accepted inter- views they would have declined if they had to travel. Applicants found social events with residents only (80 percent), a program overview presentation (86 percent), a virtual tour (77 percent) and a question-and-answer session with residents (85 percent) to be helpful. One-on-one or paired faculty interviews were the most preferred inter- view method. More than half (55 percent) thought programs were not able to learn about them as effectively through virtual compared to an in-person format.
Conclusions: VI caused different applicant behavior due to the low time and financial investment. Applicants valued their time with residents to learn about programs, but were split in their preferences for virtual, in-person or hybrid interviews. Programs can use findings from this study to plan future recruitment cycles.

Background/aim: It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits., Material and Methods: Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients., Results: During the study period, 6 281 658 ED visits were associated with traumatic injuries. DAT was recorded in 93 408 (1.5%) and TBI was recorded in 996 334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6 188 250 encounters), 989 299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P < .0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT., Conclusions: There was an inverse association between DAT and TBI in this study population., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Early childhood dental care ( ECDC ) is a significant public health opportunity since dental caries is largely preventable and a prime target for reducing healthcare expenditures. This study aims to discover underlying patterns in ECDC utilization among Ohio Medicaid-insured children, which have significant implications for public health prevention, innovative service delivery models, and targeted cost-saving interventions. Methods: Using 9 years of longitudinal Medicaid data of 24,223 publicly insured child members of an accountable care organization ( ACO ), Partners for Kids in Ohio, we applied unsupervised machine learning to cluster patients based on their cumulative dental cost curves in early childhood (24-60 months). Clinical validity, analytical validity, and reproducibility were assessed. Results: The clustering revealed five novel subpopulations: (1) early-onset of decay by age (0.5% of the population, as early as 28 months), (2) middle-onset of decay (3.0%, as early as 35 months), (3) late-onset of decay (5.8%, as early as 44 months), (4) regular preventive care (67.7%), and (5) zero utilization (23.0%). Patients with early-onset of decay incurred the highest dental cost [median annual cost ( MAC ) = $9,499, InterQuartile Range ( IQR ): $7,052-$11,216], while patients with regular preventive care incurred the lowest dental cost (MAC = $191, IQR: $99-$336). We also found a plausible correlation of early-onset of decay with complex medical conditions diagnosed at 0-24 months. Almost one-third of patients with early-onset of decay had complex medical conditions diagnosed at 0-24 months. Patients with early-onset of decay also incurred the highest medical cost (MAC = $7,513, IQR: $4,527-$12,546) at 0-24 months. Conclusion: Among Ohio Medicaid-insured children, five subpopulations with distinctive clinical, cost, and utilization patterns were discovered and validated through a data-driven approach. This novel discovery promotes innovative prevention strategies that differentiate Medicaid subpopulations, and allows for the development of cost-effective interventions that target high-risk patients. Furthermore, an integrated medical-dental care delivery model promises to reduce costs further while improving patient outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Peng, Zeng, Townsend, Liu, Huang and Lin.)

Purpose: U.S. pediatric dentists require access to hospital operating rooms (ORs) to deliver safe and effective dental care to some children but have reported denial of access to ORs for general anesthesia (GA), causing long waiting times, deferral of medically necessary dental care, and unmeasured pain and anxiety for patients. The purpose of this pilot study was to examine the extent and possible underlying causes of operating room access denial. Methods: Public policy advocates (PPAs) of the American Academy of Pediatric Dentistry completed a written or electronic questionnaire about state-specific OR denials during March 2020. Results: Responses from 50 states and the District of Columbia showed 34 PPAs (67 percent) acknowledging OR access problems, with 14 out of 34 (41 percent) reporting a moderate or major problem. Western district PPAs reported the fewest states affected (four out of 11; 36 percent). Hospitals and reimbursement emerged as frequent foci for denials in comment analysis. Conclusions: Operating room access denial is a problem for pediatric dentists in the majority of U.S. states and the District of Columbia; in those states reporting it as a problem, it was considered moderate or major in significance by almost half.

Purpose: Presenteeism, or working while sick, results in loss of productivity and risk of spreading disease. The purpose of the present study was to identify current work practices and beliefs related to presenteeism, including demographic and practice factors that may significantly relate to presenteeism among practicing dentists in the United States. Methods: A survey of American Academy of Pediatric Dentistry members assessed dentists' practices and beliefs regarding presenteeism. Data were analyzed using descriptive statistics, chi-square test, and multi-variate logistic regression. Results: Most respondents (86 percent) worked at least once while sick in the last year. Years in practice, region, and student debt level were significantly associated with presenteeism after adjusting for confounders. Reasons for presenteeism were related to practice type, gender, years in practice, region, and salary type. Conclusions: The majority of pediatric dentists treat patients while sick. Pediatric dentists are influenced to practice while sick due to perceived economic and social pressures, including meeting expectations of colleagues and patients.

Objective : To use the 2006⁻2013 Nationwide Emergency Department Sample (NEDS) database to describe trends of age-adjusted rates of pediatric traumatic brain injuries (TBI) treated in U.S. emergency departments. Methods : Time trend analysis was conducted on age-adjusted rates among children ≤17 years in the U.S. The annual percent change (APC) was calculated by fitting a least squares regression to the logarithm of the rates, using the calendar year as an independent variable. Results : In males, motor-vehicle-related trauma (APC -2.5%) and severe TBI (APC -3.6%) decreased over the study time period. Conversely, concussion (APC 5.1%), unspecified head injury (APC 6.6%), fall-related TBI (APC 7.1%), and mild TBI (APC 5.9%) increased. In females, severe TBI (APC -3.3%) decreased over the study time period and concussion (APC 6.5%), unspecified head injury (APC 7.2%), fall-related TBI (APC 7.6%), and mild TBI (APC 6.8%) increased. Conclusion : The overall age-adjusted rates of pediatric TBI-related emergency department (ED) visits increased from 2006 to 2013, which is largely caused by pediatric mild TBIs, especially unspecified injury to the head (ICD-9-CM code 959.01) and concussion. In comparison, age-adjusted rates of pediatric severe TBIs decreased. A major contributing factor might be a reduced number of traffic-related head trauma.

Objective: To investigate factors associated with follow-up care adherence in children hospitalized because of traumatic brain injury (TBI)., Design: An urban level 1 children's hospital trauma registry was queried to identify patients (2-18 years) hospitalized with a TBI in 2013 to 2014. Chart reviewers assessed discharge summaries and follow-up instructions in 4 departments., Main Measures: Three levels of adherence-nonadherence, partial adherence, and full adherence-and their associations with care delivery, patient, and injury factors., Results: In our population, 80% were instructed to follow up within the hospital network. These children were older and had more severe TBIs than those without follow-up instructions and those referred to outside providers. Of the 352 eligible patients, 19.9% were nonadherent, 27.3% were partially adherent, and 52.8% were fully adherent. Those recommended to follow up with more than 1 department had higher odds of partial adherence over nonadherence (adjusted odds ratio [AOR] = 5.8, 95% CI: 1.9-17.9); however, these patients were less likely to be fully adherent (AOR = 0.1; 95% CI: 0.1-0.3). Privately insured patients had a higher AOR of full adherence., Conclusions: Nearly 20% of children hospitalized for TBI never returned for outpatient follow-up and 27% missed appointments. Care providers need to educate families, coordinate service provision, and promote long-term monitoring.

Background: Prior studies of undertriage have not made comparisons across multiple trauma levels., Methods: Emergency department data was extracted from the Nationwide Emergency Department Sample for major trauma patients. We considered patients with moderate injuries (Injury Severity Score, ISS=16-24) and severe injuries (ISS=25-75) separately. Conditional logistic regression modeling was used to compare the odds of ED mortality for level I trauma centers (TC I) vs. nontrauma centers (NTC) and level II trauma centers (TC II) vs. NTC. An innovative 1:1:1 optimal matching (an extension of the traditional pair matching) was used to balance patient characteristics in three groups. To facilitate matching of all NTC patients, 3 subgroups were developed for ISS=16-24 and 2 subgroups for ISS=25-75. Sensitivity analyses were performed to assess the strength of the association between trauma center designation and ED mortality., Results: For ISS=16-24, 2 of 3 subgroups had marginally significant reduced odds of ED mortality when properly triaged (TC I vs. NTC [T1:OR=0.63; 95%CI: 0.45 - 0.89, T2:OR=0.71;95%CI:0.51-0.99]). For ISS=25-75, both subgroups had significantly reduced odds of emergency department mortality when properly triaged (H1: TC I vs. NTC [OR=0.61; 95%CI: 0.50-0.74]; TC II vs. NTC [OR=0.49; 95%CI: 0.38 - 0.63]; H2: TC I vs. NTC [OR=0.50; 95%CI: 0.41 - 0.60]; TC II vs. NTC [OR=0.42; 95%CI: 0.33 - 0.53]). Conclusions for ISS 25-75 were robust to a hypothesized unobserved confounding variable as shown in sensitivity analysis., Conclusions: Trauma patients with ISS≥25 received most benefit from proper triage. Efforts to reduce undertriage should focus on this population., (Copyright © 2015 Elsevier Inc. All rights reserved.)