Pediatrician
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Review Clinical Trial
Assessment and management of postoperative pain in children.
This paper focuses on the knowledge base about the assessment and management of postoperative pain in children. The first section deals with the nature and characteristics of postoperative pain. A description of current pain management practices with children, focusing on analgesic administration, is derived from available research literature. ⋯ Recent advances in pain assessment and measurement in all age groups, particularly with verbal children and the new self-report measures, are discussed. The latest developments in pharmacological and nonpharmacological techniques for the relief of children's postoperative pain are also described. Finally, the paper concludes with a few suggestions for pediatricians relative to their role in assisting in the search for better assessment and management techniques in the care of postoperative children.
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Review Case Reports
Smokeless tobacco addiction: a threat to the oral and systemic health of the child and adolescent.
The use of smokeless tobacco (ST) within the United States has increased greatly in recent years, especially among adolescent boys and young men. Recent national data completed from several large scale studies indicate that 10-12 million Americans use some form of ST. Representing a significant systemic and oral health risk, ST usage can produce a wide range of negative effects on both soft and hard oral tissues. ⋯ Several recent Surgeon General's Reports list ST as being addictive. It is highly possible that ST users will 'graduate' to cigarettes if they eventually conclude that these products are socially unacceptable, inconvenient or out of vogue. Health professionals, educators, parents and schoolchildren need to be informed about the significant health risks associated with ST use.
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Children's typical modes of responding to stress influence their ability to manage painful events. Coping skills mediate a child's response to pain that is associated with illness, injuries, and medical procedures. ⋯ There has been recent progress in the assessment of children's coping with distressing and/or painful experiences. Research in this area is providing a foundation upon which interventions can be tailored to a particular child's specific needs to assist him or her in the management of pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical tests with improved disposable diapers.
Etiologic factors in the development of episodic diaper dermatitis include skin wetness and skin damage from fecal enzymes. In addition, when urine and feces mix, the activities of fecal enzymes increase as the pH rises from production of ammonia. An improved disposable diaper has been developed to provide better control of these factors by improved wetness and pH control. ⋯ Skin wetness as measured by transepidermal water loss immediately after diaper removal, skin pH, and blinded visual evaluation of diaper dermatitis were used as skin condition measures. The use of AGM disposable diapers was associated with significantly reduced skin wetness and closer to normal skin pH as compared with the use of conventional disposable or home-laundered cloth diapers. Considered as an aggregate, the four clinical studies showed that AGM disposable diapers provide a better diaper environment and are associated with significantly lower degrees of diaper dermatitis than conventional disposable and home-laundered cloth diapers.
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Some of the clinical and research problems associated with so-called attention deficit disorder (ADD), minimal brain dysfunction (MBD) and hyperactivity in childhood are surveyed. It is concluded that there is no international consensus as regards diagnostic criteria, prevalence of severe disorders is in the range of 1-5% of all preschool children, management is dependent on a wide variety of treatment facilities and that outcome is relatively poor in the 5- to 10-year perspective but that it may be somewhat better if the children are followed up to adult life.