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Biomedical subjects

Charlotte W Lewis

Publications and source records attributed to Charlotte W Lewis.

13 recordsLinked to original sources
PubMed2006

A comparison of nasendoscopy and multiview videofluoroscopy in assessing velopharyngeal insufficiency.

OBJECTIVES: 1) To compare nasendoscopy (NE) and multiview fluoroscopy (MVF) in assessing velopharyngeal gap size; and 2) to determine the relationship between these assessments and velopharyngeal insufficiency (VPI) severity. STUDY DESIGN AND SETTING: Retrospective review of consecutive patients with VPI at a tertiary care children's hospital, assessed with NE and MVF between 1996 and 2003. RESULTS: 177 subjects. NE and MVF gap areas were correlated (R = 0.34, 95% CI 0.26-0.41). In adjusted analysis, VPI severity was associated with: 1) NE gap area (OR = 2.78, 95% CI 1.96-3.95), 2) MVF gap area (OR 1.64, 95% CI 1.37-1.95), 3) age <5 years (OR 3.30, 95% CI 1.47-7.38), and 4) previously repaired cleft palate (OR 0.48, 95% CI 0.25-0.94). CONCLUSIONS AND SIGNIFICANCE: NE and MVF assessments provide complementary information and are correlated. Both are associated with VPI severity. However, the "bird's-eye view" provided by NE has a stronger correlation with VPI severity than MVF. EBM RATING: B-2b.

Adolescent↗
PubMed2005

Head and neck endocrine surgery in children: 1997 and 2000.

OBJECTIVES: To characterize children undergoing parathyroid, thyroid, and thyroglossal duct cyst surgery in 1997 and 2000 using a nationally representative discharge database to determine whether rates and outcomes of these surgical treatments vary by age, sex, and health care system attributes. DATA SOURCE: The 1997 and 2000 Kids' Inpatient Database, available through the Agency for Healthcare Research and Quality. STUDY SELECTION: All patients 18 years and younger undergoing head and neck endocrine (HNE) procedures were included. DATA EXTRACTION: The sampling scheme of this database allowed for calculation of national and regional estimates using Stata 7.0. DATA SYNTHESIS: An estimated 2077 and 1871 inpatient pediatric HNE procedures were performed nationally in 1997 and 2000, respectively. Most were performed at general (nonpediatric) teaching hospitals. There were an estimated 1102 thyroglossal duct cyst excisions, making this the most common HNE procedure and diagnosis. Thyroid lobectomy was the second most common HNE surgical treatment. Thyroid malignant neoplasm (usually treated by total thyroidectomy) was the second most common diagnosis. Neck dissections were performed in 32% of patients with thyroid malignant neoplasm. These HNE procedures accounted for more than 28 million dollars in hospital charges in 1997 and nearly 38 million dollars in 2000. CONCLUSIONS: Surgical treatment trends for pediatric HNE procedures remained stable between 1997 and 2000. Thyroglossal duct cyst excision and thyroid lobectomy are the most common procedures. There were regional differences in the rates of most HNE surgical treatments. In addition, hospital charges increased between 1997 and 2000.

Adolescent↗
PubMed2005

Pediatric admissions and procedures for lymphatic malformations in the United States: 1997 and 2000.

OBJECTIVE: To describe the incidence of discharges for lymphatic malformation (LM) and the various treatments rendered for this condition in a nationwide sampling of pediatric discharges from 1997 and 2000. DATA SOURCE: The 1997 and 2000 Kid's Inpatient Database (KID), available through the Agency for Healthcare Research and Quality (AHRQ). DATA EXTRACTION: The sampling scheme of this database allowed for calculation of national and regional estimates using STATA 8.2. DATA SYNTHESIS: There were an estimated 3200 admissions for the treatment of pediatric LM in 1997 and 2000 combined. These admissions were most common in urban teaching institutions (69% in 1997 and 81% in 2000). The mean age at admission was 3.7 years, while the median was 1 year. The most common procedure performed in these children was surgical excision of the malformation. Over half of these were done in children under age 2. Airway endoscopy was the second most common procedure. Sclerotherapy was infrequently performed. The estimated national hospital charges for these admissions were $26 million in 1997 and $35 million in 2000. CONCLUSIONS: This analysis reveals a national perspective on the total number of pediatric admissions for LM and their associated inpatient procedures. Treatment trends for pediatric LM have remained relatively stable between 1997 and 2000, but hospital charges have increased.

Adolescent↗
PubMed2005

Furlow palatoplasty for management of velopharyngeal insufficiency: a prospective study of 148 consecutive patients.

BACKGROUND: The objectives of the study were to describe speech outcomes in a large series of patients undergoing Furlow palatoplasty for management of velopharyngeal insufficiency and to test whether preoperative velopharyngeal gap size and other patient characteristics significantly affect those outcomes. METHODS: Data collected included age at the time of surgery, surgeon, type of cleft, syndrome diagnosis, preoperative velopharyngeal gap size as determined by videonasendoscopy, and preoperative and postoperative perceptual speech assessments. Descriptive statistics were generated and ordinal logistic regression on the outcome variable, postoperative velopharyngeal insufficiency severity score, was performed. RESULTS: In this series of 154 patients, 148 had complete perceptual speech data. Of these 148 patients, 72 percent had improvement in velopharyngeal insufficiency severity after the procedure and 56 percent had complete resolution of velopharyngeal insufficiency. Postoperative insufficiency was scored as none or minimal (i.e., resolution) in 38 of 52 patients (73 percent) with a small preoperative velopharyngeal gap, 26 of 51 patients (51 percent) with a moderate preoperative gap, and four of 21 patients (19 percent) with a large preoperative gap. Preoperative velopharyngeal gap size was significantly associated (p < 0.0001) with postoperative insufficiency on ordinal multivariate logistic regression after controlling for preoperative insufficiency and other covariates. There was not a significant association between syndrome diagnosis, age at Furlow palatoplasty (younger than 5 years versus older), gender, surgeon, or presence of submucous cleft palate and postoperative speech outcome, in either the unadjusted or adjusted analyses. CONCLUSIONS: Preoperative velopharyngeal gap size, as determined with nasendoscopy, was significantly associated with postoperative velopharyngeal insufficiency severity after Furlow palatoplasty. Small gap size is associated with a greater likelihood of resolution.

Adolescent↗
PubMed2005

Community orthodontists and craniofacial care: results of a Washington state survey.

BACKGROUND: Little is known about community orthodontists' previous training in, experience with, or receptivity to caring for children with craniofacial disorders. OBJECTIVES: (1) To characterize the current level of participation by Washington state orthodontists in craniofacial care; and (2) to identify factors that promote or impede community orthodontists' involvement in caring for children with craniofacial conditions. DESIGN: Mail survey. METHODS: A 26-item questionnaire was designed and mailed to all active orthodontists in Washington state (N = 230). Question topics included practice characteristics, training and experience with craniofacial conditions, concerns related to public and private insurance, and communication with craniofacial teams. RESULTS: Of eligible respondents, 68% completed the survey. Most orthodontists' patient panels were made up of patients who either have private insurance or pay cash for services. On average, 2% of respondents' patients were Medicaid beneficiaries. Only 20% of respondents had seen more than three patients with cleft lip and/or palate in the past 3 years. Although a minority of orthodontists receive referrals from (27%) or are affiliated with (11%) craniofacial teams, most orthodontists perceived craniofacial care positively and were interested to learn more about craniofacial care and to accept additional patients with these conditions. CONCLUSIONS: Results of this survey can inform potential strategies to increase access to orthodontic care for children with craniofacial disorders. These would include developing an organized training, referral, and communication system between community orthodontists and state craniofacial teams and considering a case-management approach to facilitate this process.

Attitude of Health Personnel↗
PubMed2004

Oral health in the pediatric practice setting: a survey of Washington State pediatricians.

BACKGROUND: Pediatric health care providers may be the only source of preventive oral health education for families of young children who lack access to professional dental care. OBJECTIVE: We surveyed Washington State pediatricians in order to characterize their oral health-related educational needs and anticipatory guidance practices. METHODS: A 38-question survey was mailed to all 606 general pediatricians in Washington State. Topics included anticipatory practices and confidence in oral health-related activities. RESULTS: Of 483 eligible participants, 271 returned completed surveys (response rate: 57%). A median of 30 percent of the well-child visit was devoted to providing anticipatory guidance. A majority (83.7%) of respondents reported providing anticipatory guidance on oral health. CONCLUSION: Washington State pediatricians are already involved in providing oral health anticipatory guidance. Certain factors are identified that should be addressed to allow pediatricians to promote oral health more effectively.

Attitude of Health Personnel↗
PubMed2003

Tracheotomy in pediatric patients: a national perspective.

BACKGROUND: During the past 50 years, changes in the epidemiology of infectious diseases and the capabilities of medical technology have altered the indications for, and implications of, tracheotomy in children. Given the complexity of health care that these patients subsequently require, monitoring the performance of this procedure and patient outcomes across the diverse US health care system is warranted. OBJECTIVES: To characterize children who received tracheotomies in 1997 and to determine whether disposition and mortality vary by region or health care system attributes. DESIGN: A nationally representative retrospective cohort drawn from an 80% sample of administrative hospital discharge records from all pediatric admissions in 22 states during 1997. PARTICIPANTS: Patients aged 0 to 18 years who underwent tracheotomy. METHODS: The sampling scheme of the discharge records enabled the calculation of regional and national estimates and of age-stratified population-based rates of tracheotomies. Weighted descriptive statistical and Poisson analyses were performed. RESULTS: The 2065 tracheotomy procedures recorded in the Kids' Inpatient Database yielded a national estimate of 4861 tracheotomies performed in 1997. The mean length of hospital stay was 50 days, with a mean total facilities charge exceeding $200,000. The rate of tracheotomy was highest among infants and varied significantly across regions of the United States. Adjusting for other patient and health care system attributes, patients who received their tracheotomy in a children's hospital had half the risk of dying during the admission compared with patients who were cared for in a non-children's hospital. Hospitals that performed more pediatric tracheotomies had significantly lower mortality rates than hospitals with lesser case volume. Among patients who survived to discharge, those cared for in the Northeast were discharged to long-term care facilities at twice the rate of patients in the West. Children cared for in children's hospitals or in teaching hospitals were significantly less likely to be discharged to a long-term care facility. CONCLUSIONS: Pediatric tracheotomy is associated with significant variation in rates and outcomes across the United States and across different hospital types. Further research to clarify the reasons for these associations is warranted.

Adolescent↗
PubMed2003

Emergency department analgesia for fracture pain.

STUDY OBJECTIVES: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities. METHODS: Analysis of the ED component of the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for 1997 through 2000 was conducted. The proportion of patients with closed extremity and clavicular fracture that received any analgesic and narcotic analgesic medications was determined for each age category. Survey-adjusted regression analyses compared pain and narcotic medications by age and ED type (pediatric versus other). Analyses were repeated for the subset of patients with moderate or severe pain severity scores. RESULTS: Of 2,828 patients with isolated closed fractures of the extremities or clavicle, 64% received any analgesic and 42% received a narcotic analgesic. Pain severity scores were recorded for 59% of visits overall, 47% of children younger than 4 years, and 34% of children younger than 1 year. Among patients with documented moderate or severe pain, 73% received an analgesic and 54% received a narcotic analgesic. Compared with adults, a lower proportion of children (< or = 15 years) received either any analgesic or a narcotic analgesic (P <.001). After adjustment for confounders and survey design, the proportion of patients aged 0 to 3, 4 to 8, 9 to 15, 16 to 29, 30 to 69, and 70 years and older who received any analgesic was 54% (95% confidence interval [CI] 41% to 67%), 63% (95% CI 57% to 68%), 60% (95% CI 57% to 64%), 67% (95% CI 62% to 73%), 68% (95% CI 64% to 72%), and 58% (95% CI 52% to 65%), respectively; the proportion who received a narcotic analgesic was 21% (95% CI 11% to 31%), 30% (95% CI 22% to 37%), 27% (95% CI 23% to 32%), 47% (95% CI 40% to 54%), 51% (95% CI 46% to 56%), and 41% (95% CI 35% to 48%), respectively. Compared with children treated in other EDs, children treated in pediatric EDs were about as likely to receive any analgesia (adjusted relative risk [RR] 1.1; 95% CI 0.9 to 1.3) or narcotic analgesia (adjusted RR 0.9; 95% CI 0.6 to 1.2). CONCLUSION: In pediatric and adult patients, pain medications were frequently not part of ED treatment for fractures, even for visits with documented moderate or severe pain. Pain severity scores were often not recorded. Pediatric patients were least likely to receive analgesics, especially narcotics.

Academic Medical Centers↗
PubMed2003

Fluoride.

Explore the source record for details and available documents.

Child↗
PubMedDate not supplied

Stretching the safety net too far waiting times for dental treatment.

PURPOSE: The objective of this study was to survey pediatric dentistry program directors on perceived resource needs and changes over the last 5 years in the characteristics of their patient population and on waiting times for dental treatment with sedation or general anesthesia (GA) for children with complex dental and medical histories in hospital- and dental school-based training programs. METHODS: A 47-question survey was sent electronically to all pediatric dentistry program directors in the United States using the University of Washington's Catalyst Tools program. Two reminder messages were sent. After 3 months, the data was downloaded and descriptive statistics were performed using the SPSS for Windows version 8.0. RESULTS: Twenty-eight of 54 program directors responded with 26 usable survey responses (48%). Thirty-one percent reported outpatient clinics located in a dental school, 31% reported that their clinics were in a hospital, and 38% had clinics in both settings. Program directors perceive that the number of new, recall and emergency patients and the number of pre-school aged children and children with special health care needs had increased in their programs in the last 5 years. Payment by Medicaid was the most common insurance for children cared for in these settings. The mean waiting time for scheduling treatment with GA for a child in pain is 28 days; without pain 71 days. The mean waiting time for scheduling treatment with sedation is 36 days. The majority of program directors reported they had an adequate number of faculty and residents (61% and 66%, respectively) even though 52% of the directors were presently actively recruiting faculty. CONCLUSIONS: 1. Dental school and hospital-based training programs are an important source for an increasing number of children with complex dental needs; 2. The majority of patients treated in the programs are Medicaid beneficiaries; 3. Average waiting times for complex dental care for children in pain is 28 days with GA; without pain and need for GA 71 days; 4. There was an average 36-day wait for treatment with sedation.

Anesthesia, Dental↗
PubMedDate not supplied

Oral health of young Alaska Native children and their caregivers in Southwestern Alaska.

OBJECTIVE: We sought to determine the prevalence of caries and associated risk factors in young Native children and their caregivers in two communities in rural Alaska. METHODS: A random sample of Alaska Native children between 12-36 months and a subset of their caregivers from two Southwestern Alaska communities were examined for dental decay. Caregivers completed a 43-item questionnaire about oral hygiene, dietary and other practices. RESULTS: Of the 65 children examined, 59% had evidence of decay. Among the 41 primary caregivers examined, 98% had experienced dental decay with an average of 11.4 decayed, missing, and filled teeth. On linear regression analyses, factors significantly associated with more decay in the children included a child taking a juice-containing bottle to bed, eating candy 1 or more times per day, and higher caregiver oral S. mutans counts. CONCLUSIONS: Our results suggest that preventive efforts for children at high risk for dental decay should begin early in life, should emphasize decreasing candy and bedtime juice bottle use, and should consider the caregivers' oral health status in addition to the child's.

Adult↗
PubMedDate not supplied

Availability of dental appointments for young children in King County, Washington: implications for access to care.

PURPOSE: The purpose of this study was to determine the proportion of dental offices in King County willing to provide a new appointment to young children and young children on Medicaid. METHODS: A simulated parent phone call was made to 508 randomly chosen dental offices in King County. Of these, 291 offices provided preventive dental care to children. Data were collected on: (1) youngest age seen (options ranged from less than 1 to older than 5 years); (2) whether Medicaid was accepted; and (3) time to first available appointment. RESULTS: In King County, more than 99% of dental offices providing care to children would see new patients 5 years of age or older, but only 15% of these offices would accept 5-year-olds on Medicaid. Nine percent of dental offices accepted patients younger than 1 for a new preventive visit, but just 3% accepted Medicaid-insured children in this age group. CONCLUSIONS: Adhering to recommendations for early initiation of dental care is difficult, given the limited availability of dental appointments for young and Medicaid-insured children.

Appointments and Schedules↗