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Purpose: Active engagement in one's therapy is a key contributor to successful outcomes. Research on child engagement in cognitive behaviour therapy (CBT) has largely focused on youth without autism. This longitudinal study examined multiple indicators of child engagement in relation to outcomes for autistic children who took part in CBT for emotion regulation. Method: Data were collected from 60 autistic children who were between 8 and 13 years of age (86.7% male; M[subscript age] = 9.58 years, SD = 1.44 years; 75% White). Indicators of child engagement included independent observer ratings of in-session involvement, as measured by the "Child Involvement Rating Scale", and therapist ratings of the therapeutic relationship and homework completion using single-item measures. Indicators of engagement were measured at early (i.e., first third), middle (i.e., mid third), and late (i.e., final third) stages of treatment. Parent-reported emotion regulation was the primary treatment outcome, as measured by the "Emotion Regulation Checklist." Results: After controlling for pre-treatment scores, in-session involvement significantly predicted some aspects of post-treatment emotion regulation, whereas therapeutic relationship and homework completion did not. Conclusions: Child in-session involvement throughout therapy may be particularly relevant for treatment change. Addressing issues related to in-session involvement early in treatment may help to promote therapeutic success for autistic children.

Dental injury is a common anesthesia-related adverse event, with a high incidence of damage to teeth and surrounding tissues during oro-endotracheal intubation. Poor oral hygiene, compromised periodontium, faulty or loose prosthesis, proclined maxillary incisors along with increased difficulty level of airway management, improper use of laryngoscope, and use of maxillary anterior teeth as a fulcrum for achieving accessibility to the airway are all risk factors for iatrogenic dental injury. This type of injury provides additional physical and psychological trauma to patients who have already undergone medical surgical procedures. The consequences of such mishaps might potentially result in medico-legal suits and financial claims.The present case series described three cases of managing iatrogenic dental lesions during oro-endotracheal intubation, after obtaining written informed consent, as well as methods for preventing such accidental injuries. This study emphasized the importance of collaboration between medical and dental professionals in preventing and successfully managing accidental dental injuries.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

Abstract Background Autistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings. Methods The 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020–2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers’ perception of the program’s acceptability and level of satisfaction, as well as their child’s social and emotional regulation skills and related mental health challenges. Results A total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child’s emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39). Conclusions As online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming. Trial registration This study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.

BackgroundSince the onset of the COVID-19 pandemic, telehealth has been an option for Veterans receiving urgent care through Veterans Health Administration Community Care (CC).ObjectiveWe assessed use, arrangements, Veteran decision-making, and experiences with CC urgent care delivered via telehealth.DesignConvergent parallel mixed methods, combining multivariable regression analyses of claims data with semistructured Veteran interviews.SubjectsVeterans residing in the Western United States and Hawaii, with CC urgent care claims March 1 to September 30, 2020.Key resultsIn comparison to having in-person only visits, having a telehealth-only visit was more likely for Veterans who were non-Hispanic Black, were urban-dwelling, lived further from the clinic used, had a COVID-related visit, and did not require an in-person procedure. Predictors of having both telehealth and in-person (compared with in-person only) visits were other (non-White, non-Black) non-Hispanic race/ethnicity, urban-dwelling status, living further from the clinic used, and having had a COVID-related visit. Care arrangements varied widely; telephone-only care was common. Veteran decisions about using telehealth were driven by limitations in in-person care availability and COVID-related concerns. Veterans receiving care via telehealth generally reported high satisfaction.ConclusionsCC urgent care via telehealth played an important role in providing Veterans with care access early in the COVID-19 pandemic. Use of telehealth differed by Veteran characteristics; lack of in-person care availability was a driver. Future work should assess for changes in telehealth use with pandemic progression, geographic differences, and impact on care quality, care coordination, outcomes, and costs to ensure Veterans' optimal and equitable access to care.

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/ kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p > 0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value < 0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value < 0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value < 0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group.