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Our objective was to provide expert consensus on best practices for anatomy teaching and training on ultrasound-guided botulinum neurotoxin type A (BoNT-A) injection for specialists involved in treating spasticity and dystonia. Nine experts (three neurologists; six physical medicine and rehabilitation physicians) participated in a three-round modified Delphi process. Over three rounds, experts reached consensus on 15 of 16 statements describing best practices for anatomy and BoNT-A injection training. They unanimously agreed that knowledge of the target audience, including their needs and current competency, is crucial when designing training programs. Experts also agreed that alignment between instructors is essential to ensure consistency of approach over time and between regions, and that training programs should be simple, adaptable, and "hands-on" to enhance engagement and learning. Consensus was also reached for several other key areas of training program development. The best-practice principles identified by expert consensus could aid in the development of effective, standardized programs for anatomy teaching and BoNT-A injection training for the purposes of treating spasticity and dystonia. This will enhance the exchange of knowledge, skills, and educational approaches between global experts, allowing more specialists to treat important movement disorders and ultimately improving patient outcomes.

Objective: Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder., Method: We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded., Results: All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented., Conclusions: Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered., (© 2024. The Author(s).)

Issue : While over one-quarter of adult Americans have a disability, there is a paucity of disability-specific curricula in American medical schools and residency programs. Potential consequences of this educational dearth include persistent inaccessibility of health care facilities and delivery of inequitable health care to individuals with disabilities. Evidence : Several working groups have proposed disability-specific competencies for health professions education and means by which to integrate them into existing curricula. A limited number of medical schools and residency programs have formally introduced disability-specific materials into their curricula. To our knowledge, however, there are no generalist (internal medicine or family medicine) residency programs that offer specialized training in the clinical care of people with disabilities. Implications : Offering generalist physicians the opportunity to acquire the clinical and cognitive skills required to provide thorough and equitable health care to people with disabilities is critically important. There are too few physiatrists to see to their care needs. In this manuscript, we present a novel concentration in an Internal Medicine residency program in the care of individuals with a variety of disabilities. Our hope is that this work will initiate discussions among educational leaders about how to address the lack of graduate medical education-level training in disability care. We also hope it will afford program directors the opportunity to implement similar concentrations and tracks and will eventually produce a generation of generalists who are well-equipped to help care for people with disabilities.

Objective: For youth with anorexia nervosa (AN), remission requires high caloric goals to achieve weight restoration, consumption of a wide variety of calorically dense foods, and reintroduction of eliminated foods. Family-based treatment (FBT), the gold-standard treatment for youth with AN, empowers parents to renourish their child and restore them to health; yet, parents often report struggling with shifting meal planning and grocery shopping behaviors to focus on nutritional rehabilitation and weight restoration., Methods: This proof-of-concept study aimed to modify a simulated grocery store (Open Science Online Grocery [OSOG]) for parents of youth with AN and explore the acceptability and feasibility of its use as part of standard care. Study staff collaborated with six parent research partners to modify the OSOG prior to piloting it with participants. Participants were 10 parents of youth undergoing a first-time hospitalization for medical stabilization of AN or atypical AN. Parents completed a battery of measures and a semistructured interview assessing the acceptability and feasibility of OSOG., Results: Parents described the tool as credible and acceptable. Qualitative feedback highlighted common themes of caregiver burden, nutrition education, and acceptability of the tool., Discussion: Results point to the need for more work in supporting parents in Phase I of FBT., Public Significance: Families are instrumental in supporting youth to recover from anorexia nervosa. During treatment, parents are charged with selecting and serving their adolescent's meals, often requiring them to change grocery shopping and food preparation habits to meet their child's high caloric needs. Parents reported feeling overwhelmed by this task and noted struggling with learning different approaches to nourish their adolescent during an already stressful time. Collaboratively with parents, we modified a tool to support parents in shifting thier shopping habits, which they reported as being a helpful springboard in the early phase of treatment., (© 2023 Wiley Periodicals LLC.)

Background: Adolescents with anorexia nervosa have set-shifting inefficiencies that can be exacerbated by starvation and that may interfere with outcomes of treatment interventions. Cognitive Remediation Therapy (CRT), an adjunctive treatment focused on improving set-shifting, can target inefficiencies and may augment treatment effectiveness. The best way to add CRT to the standard of care (Family Based Treatment, FBT) for adolescents with anorexia remains understudied., Methods/design: This is a randomized controlled trial designed to determine if CRT is effective in increasing flexibility in adolescents with anorexia and/or their parents. Participants are adolescents 12-18 years old with anorexia and their parents. 54 family groups will be randomized into one of three groups: FBT only, FBT plus Parent-focused CRT, or FBT plus Adolescent-focused CRT. Psychosocial, neurocognitive, and behavioral measures will be collected throughout the study., Discussion: This is the first study of its kind to apply CRT to parents. All forms of CRT in the context of anorexia have targeted the individual with anorexia's thinking style. We propose that it may be impactful to target the parent of the adolescent with anorexia as parents carry the burden of treatment and re-nourishment of their child during FBT and may have similar thinking styles., Conclusion: This study takes an experimental therapeutics approach to further our understanding of the mechanisms of treatment for adolescents with anorexia. It focuses on increasing cognitive flexibility in patients or their parents and determining the appropriate dose of CRT needed to achieve positive change., Trial Registration: ClinicalTrails.gov Identifier NCT03928028., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Medical stabilization through inpatient nutritional rehabilitation is often necessary for patients with eating disorders (EDs) but includes the inherent risk of refeeding syndrome. Here we describe our experience of implementing and sustaining an inpatient nutritional rehabilitation protocol designed to strategically prepare patients with EDs and their families for discharge to a home setting in an efficient and effective manner from a general adolescent medicine unit. We report outcomes at admission, discharge, and 4-weeks follow-up., Methods: Protocol development, implementation, and unique features of the protocol, are described. Data were collected retrospectively as part of a continuous quality improvement (QI) initiative. Safety outcomes were the clinical need for phosphorus, potassium, and magnesium supplementation, other evidence of refeeding syndrome, and unexpected readmissions within one month of discharge. The value outcome was length of stay (LOS). Treatment outcomes were the percentage median BMI (MBMI) change from admission to discharge, and from discharge to 4-weeks follow-up visit., Results: A total of 215 patients (88% F, 12% M) were included. Patients averaged 15.3 years old (5.8-23.2y); 64% had AN, 18% had atypical anorexia (AtAN), 6% bulimia nervosa (BN), 5% purging disorder (PD), 4% avoidant-restrictive food intake disorder (ARFID), and 3% had an unspecified food and eating disorder (UFED). Average LOS was 11 days. Initial mean calorie level for patients at admission was 1466 and at discharge 3800 kcals/day. Phosphorus supplementation for refeeding hypophosphatemia (RH) was needed in 14% of inpatients; full-threshold refeeding syndrome did not occur. Only 3.8% were rehospitalized in the thirty days after discharge. Patients averaged 86.1% of a median MBMI for age and gender, 91.4% MBMI at discharge, and 100.9% MBMI at 4-weeks follow-up. Mean percentage MBMI differences between time points were significantly different (admission-discharge: 5.3%, p  <0.001; discharge-follow-up: 9.2%, p  <0.001)., Conclusions: Implementation of the CHOP inpatient nutritional rehabilitation protocol aimed at rapid, efficient, and safe weight gain and integration of caregivers in treatment of patients with diverse ED diagnoses led to excellent QI outcomes in percentage MBMI at discharge and 4-weeks follow-up, while maintaining a short LOS and low rates of RH phosphorus supplementation.

Background: In children acute liver failure is a rare but life-threatening condition from which two-thirds do not recover with supportive therapy. Treatment is limited by the availability of liver transplants. Molecular adsorbent recirculating system (MARS) dialysis is a bridge to transplantation that enhances the chances of survival during the waiting period for a transplant, although it cannot improve survival. Open albumin dialysis (OPAL) is a new mode of albumin dialysis developed to further improve dialysis efficiency., Case Diagnosis/treatment: We report a paediatric case of acute-on-chronic liver failure and compare the two modes of albumin dialysis, namely, the MARS and OPAL, used to treat this patient's cholestatic pruritus. Removal of total and direct bilirubin, ammonia and bile acids were measured by serial blood tests. There was an increased removal of bile acids with the OPAL mode, whereas the removal of total and direct bilirubin and ammonia was similar in both modes. The patient reported better improvement in pruritus following OPAL compared to dialysis with the MARS., Conclusion: OPAL may offer a better solution than the MARS in the treatment of refractory pruritus in liver failure.

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement.

Background: Circumcision for cultural reasons is routine in Pacific Island countries. In New Zealand routine circumcision for which there is no medical indication is uncommon and no longer publicly funded within the public hospital system. This has caused difficulties for the Pacific people of New Zealand., Aim: This study documents the differences in the attitudes of Pacific parents and their male children to cultural circumcision, and assesses the strength of their beliefs., Methodology: Pacific boys between the ages of 8-18 and their parents resident in Christchurch were given a questionnaire to complete and then were interviewed. The participants were obtained mainly through church organisations and after broadcast on Pacifica radio., Results: One hundred and sixteen of the 123 participants felt that they had strong ties to the Pacific community. The majority (89%) of the Pacific people felt that circumcision should be performed mainly for reasons of culture and hygiene. Only a small number were aware of the possible complications that might occur with circumcision. The average age that most Pacific people were circumcised and would want their children to be circumcised is between 6 and 10 years of age. Boys were less sure than their fathers that they would get their own sons circumcised., Conclusion: This study has shown that circumcision is expected and surprisingly well accepted by the boys of Pacific families despite the discomfort they know the procedure causes. There is a strong cultural demand from parents for circumcision. Guidance from church leaders or sexual health lessons at schools or elsewhere may alter the cultural importance of circumcision for Pacific Island people. However, the preference for circumcision is so well entrenched into their cultural beliefs and may take years to influence.

Aims: To assess current attitudes and practice toward antenatal human immunodeficiency virus (HIV) risk assessment, HIV testing and barriers towards implementation of these among midwives, general practitioners (GPs) and obstetricians in the upper South Island, Methods: A survey was conducted among maternity care providers by anonymous self-administered questionnaire. Most questions were dichotomous, forced choice or Likert scale format but there were four open- ended questions asking for a written response., Results: The response rate was 57% overall. The main finding was that 275 (66%) of respondents assessed risk of HIV in less than 10% of patients, and 328 (midwives 93, 85%; GP's 226,77%; obstetricians 9,64%) respondents had performed less than three HIV tests in the past twelve months. Most respondents strongly agreed that detection of HIV during pregnancy is beneficial to mother 318 (83%) and to baby 367 (96%) and to mother prior to pregnancy 353 (92%). 202 (52%) supported and 44 (11%) were opposed to an antenatal screening programme in New Zealand. Most knew how to assess risk for HIV saw themselves as having an important role in antenatal HIV testing, and were comfortable performing risk assessment. Multiple reasons for current practices were offered, including perceived reluctance by women to be tested, lack of time, skills, knowledge and support services, and low rates of HIV in the community., Conclusions: The current policy of routine HIV risk assessment is not working among respondents. A systematic reassessment and implementation of a workable strategy needs to be undertaken in New Zealand.

A three-year small grants scheme in Canterbury and the West Coast, New Zealand aims to influence the health promoting climate of schools by adopting totally smokefree policies. The Smokefree Environments Act of 1990 established the legal imperative for school policies. The principles of the Treaty of Waitangi and the strategies of the Ottawa Charter provide the programmatic and evaluation framework. Evaluation indicators include the organizational and policy context, status of school smoking policies, reasons for participation, stakeholder involvement, the value of additional funding, and the extent of media coverage. Partnerships among local smokefree partners, schools and whanau/communities, and between the health and education sectors are a priority. Interim findings indicate the Crown Public Health Smokefree Schools Grant program has positively influenced policy development toward totally smokefree schools. Based on these results and the changing environment, the smokefree efforts are being integrated into the broader context of health promoting schools.

The Radio Communication Project (RCP) in Nepal is an ongoing, theory-based, multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and postpanel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation. Implications for the design of integrated, multimedia, entertainment-education campaigns and integrated evaluation designs are discussed.

To evaluate the characteristics of peritoneal kinetics in the young, we investigated solute and water transfer rates by a modified Peritoneal Equilibration Test (PET) in 20 pediatric patients aged 1.9 to 19.8 years. 1000 ml/m2 body surface area of a 2.3% glucose PD solution were instilled in the peritoneal cavity. Glucose, creatinine, urea, sodium, potassium and phosphate were measured in the dialysate (D), 7 times during 4 hours and in plasma (P) after 2 hours dwell time. At 4 hours, the mean (+/- SD) D/P ratio was 1.06 +/- 0.16 for urea, 0.79 +/- 0.14 for creatinine, 0.82 +/- 0.21 for potassium, 0.92 +/- 0.04 for sodium and 0.79 +/- 0.30 for phosphate. Mean D/D0 of glucose was 0.36 +/- 0.13. The 4-hour solute equilibration curves were analytically best approximated by logarithmic functions for urea (mean R2 = 0.983), creatinine (R2 = 0.973) and potassium (R2 = 0.979), by a linear function for phosphate (R2 = 0.964), and by an exponential model for glucose (R2 = 0.969). The linear or exponential regression coefficients were used to express the peritoneal solute transfer rates. Although the transfer rates of most solutes were correlated with each other, the individual variation of peritoneal permeability for different solutes was high. Close associations were observed between the glucose and creatinine transfer rates (r = 0.91, p < 0.0001) and between ultrafiltration rate and glucose (r = -0.90, p < 0.0005) and creatinine (r = -0.88, p < 0.005). Peritoneal permeability for all solutes tended to be inversely correlated with body size (urea transfer rate vs. height: r = 0.49, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

To obtain comprehensive information about the knowledge, attitudes, and practices of Minnesota dental hygienists and registered dental assistants, a questionnaire was mailed to random samples of both groups in the fall of 1988. Most assistants and hygienists claimed to always wear gloves, but substantially fewer indicated always wearing a mask. Use of eye protection showed even lower compliance, with less than half of either group routinely using protective eyewear or a face shield. Assistants and hygienists reported incurring numerous needlesticks and instrument injuries. A contributing factor may be that many staff were still recapping needles with an unprotected hand. Most people who had not been vaccinated against hepatitis B said that they would be immunized if their employer or health insurance paid for it. Less than one-half of either group felt knowledgeable about infection control. Only one-third of assistants and less than one-half of hygienists claimed to be familiar with the Centers for Disease Control's "Recommended Infection Control Practices for Dentistry." This is consistent with assistants' and hygienists' reported infection control related behaviors. Other than gloving, many recommended infection control measures--masking, wearing protective eyewear and uniforms, hepatitis B immunization, and proper handling of sharps--were not employed by a substantial number of respondents. Many respondents indicated insufficient knowledge to safely and effectively care for patients with hepatitis B, hepatitis B carriers, or individuals infected with the human immunodeficiency virus (HIV). This is reflected in the relatively small percentages of respondents who indicated willingness to treat these patients.(ABSTRACT TRUNCATED AT 250 WORDS)