Context:Orofacial and dental trauma continues to be a commonly encountered issue for the sports medicine team. All sports have some risk for dental injury, but “contact sports” presumably incur more risk. Immediate evaluation and proper management of the most common injuries to dentition can result in saving or restoration of tooth structure. Despite the growing body of evidence, mouth guard use and dental protection have not paralleled the increase in sports participation.Evidence Acquisition:A PubMed search from 1960 through April 2012 was conducted, as well as a review of peer-reviewed online publications.Results:Common dental injuries in sports include tooth (crown) fractures; tooth intrusion, extrusion, and avulsion; and temporomandibular joint dislocation. Mouth guards help prevent most injuries and do not significantly affect ventilation or speech if fitted properly.Conclusion:A working knowledge of the presentation as well as management of commonly encountered dental trauma in sports is essential to the immediate care of an athlete and returning to play. Mouth guard use should be encouraged for athletes of all ages in those sports that incur significant risk.
Objective: This pilot study aimed to determine the effects of therapeutic clowns for hospitalized children on their nurses. Methods: Semi-structured interviews with 13 nurses explored perceptions of the clowns. Measures of physiological arousal, emotion and anxiety were also obtained from nine of these 13 nurses under two conditions -the presence or absence of therapeutic clowns on the unit. Results: Physiologically, the automatic nervous system signals of eight of the nine nurses exhibited consistent changes in patterns of responding when the clowns were present. Emotionally, nurses' reports of negative mood states were also reduced; no changes in anxiety were found. Qualitative data corroborated these findings and suggest that although therapeutic clowns expressly work with children, they also have a relational impact. Conclusions: Clowning seems to improve communication, role negotiation and the meaning of the unit as a social and physical place. A recommendation for mixed method research designs is offered to determine varied effects of arts-based interventions on stakeholders within healthcare settings.
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Purpose
Healthcare professionals need a clear understanding of information about gene-drug interactions in order to make optimal use of pharmacogenetic (PGx) testing. In this report, we compare PGx information in the US Food and Drug Administration (FDA) Table of Pharmacogenetic Associations with information presented in Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines.
Summary
Information from CPIC guidelines and the FDA Table of Pharmacogenetic Associations do not have a high level of concordance. Many drugs mentioned in CPIC guidelines are not listed in the FDA table and vice versa, and the same gene-drug association and dosing recommendation was reported for only 5 of the 126 drugs included in either source. Furthermore, classification of drugs in specific sections of the FDA table does not correlate well with CPIC-assigned or provisionally assigned clinical actionability levels. The Pharmacogenomics Knowledge Base (PharmGKB) clinical annotation levels are generally high for drugs mentioned in CPIC guidelines. PharmGKB clinical annotation levels are often unassigned or are lower level for drugs listed on the FDA table but not in CPIC guidelines. These differences may be due in part to FDA having access to PGx information that is unavailable in published literature and/or because PGx classifications are based on criteria other than clinical actionability.
Conclusion
There are important differences between the PGx information presented in the FDA Table of Pharmacogenetic Associations and in CPIC guidelines. FDA and CPIC have different perspectives when evaluating PGx associations and use different approaches and information resources when considering clinical validity related to specific medicines. Understanding how information sources developed by each group differ and can be used together to form a holistic view of PGx may be helpful in increasing adoption of these information sources in practice.
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