Journal of child neurology
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Pediatric patients with chronic tension-type headaches often experience significant school impairment. Although some improve after treatment with a neurologist, many require more comprehensive treatment. The authors examined whether school functioning and attendance improved after a multidisciplinary evaluation focusing on a return to functioning despite headaches. ⋯ Information regarding headache frequency, severity and duration, and school attendance was obtained from medical records. Using repeated measures analyses of variance, the authors found that school functioning and attendance improved significantly from evaluation to follow-up, as did headache frequency and duration. An emphasis on returning to functioning can help patients with chronic, difficult-to-treat tension-type headaches improve in their school functioning and experience fewer, shorter headaches.
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Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. ⋯ Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors' knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug-receptor interactions via different mechanisms.
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Medical mistakes, especially ones with significant adverse events, can erode the trust and bonds between and among parents, patients, and health care professionals. Prevention of medical mistakes should be the goal of every health care organization, and participation in quality improvement processes aimed at patient safety is an ethical duty for all health care professionals. ⋯ These duties of honesty, disclosure and apology are based ethically on core health care principles and values. Health care organizations should require disclosure-and-apology training, especially for front-line personnel; provide assistance to clinicians with these difficult conversations; and invest in resources to address the moral distress experienced by professionals, who are often the "second victims" of medical mistakes.