Using Panoramic Radiographs in Orthodontic Assessments

Using Panoramic Radiographs in Orthodontic Assessments

Understanding brackets: Types and functions in orthodontic treatment

Early orthodontic intervention plays an instrumental role ensuring optimal dental health during childhood development leading towards adulthood since many problems can become harder or impossible correct once facial growth stops around adulthood thus early treatment can help guide jaw growth prevent trauma caused protruding front teeth correct harmful habits such thumb suck beyond infancy improve teeth alignment simplify correct later orthodontics saving time expense future treatments via two phase treatment approach where phase one focuses guidance growth development whilst phase two addresses tooth position final alignment corrections ensuring permanent results improved oral health self esteem confidence growing child young adult its therefore crucial identify diagnose treat problems early panoramic radiograph proves vital tool orthodontists assessments evaluations due comprehensive view maxillofacial structures including erupted impacted teeth roots temporomandibular joint sinuses nasal area jaws bone irregularities pathology abnormalities allowing practitioner evaluate teeth positions eruption patterns root development resorption jaw relationships bone loss fractures wisdom teeth impactions pathologies accurately effectively formulating appropriate treatment plans determining treatment timing monitoring progress thus ensuring successful outcomes efficient treatments whilst minimizing radiation exposure compared traditional x ray methods besides affordability convenience ease use panoramic radiography essential component modern orthodontics contributing significantly improved diagnosis planning execution monitoring necessary procedures involved corrective measures aimed achieving functional aesthetically pleasing smiles lifelong benefits overall wellbeing patients hence importance incorporating technology standard practice cannot emphasized enough

Orthodontic expanders can create more space in the mouth for teeth Orthodontics for young children dental braces.

Panoramic radiographs, often referred to as OPGs or orthopantomograms, are a vital tool in orthodontic assessments, particularly for pediatric patients. They provide a comprehensive view of the teeth and surrounding structures, aiding orthodontists in diagnosis and treatment planning. Several key anatomical structures visible on these radiographs are especially relevant to pediatric orthodontic treatment.


Firstly, the developing dentition is a focal point. In children and adolescents, panoramic radiographs allow orthodontists to evaluate the presence, position, and stage of development of both erupted and unerupted teeth. This includes permanent teeth that are yet to erupt, as well as any supernumerary (extra) or impacted teeth that could potentially disrupt normal eruption patterns. For instance, the position and angulation of unerupted canines and premolars can be assessed to predict potential crowding or impaction issues.


Secondly, the maxillary sinuses and nasal cavity are crucial structures to examine. The relationship between the roots of upper posterior teeth and the maxillary sinus floor can be evaluated to prevent root resorption or sinus perforation during tooth movement. Additionally, any pathological conditions within the sinuses or nasal cavity that might affect orthodontic treatment can be identified.


The mandibular condyles and temporomandibular joints (TMJ) are also essential structures to consider. Orthodontists can assess the size, shape, and symmetry of the condyles, which are indicative of jaw growth patterns and potential temporomandibular disorders (TMD). This information is particularly useful when planning functional appliance therapy aimed at modifying jaw growth or treating TMD symptoms early on during developmental stages which may promote better orthodontic outcomes later on such conditions could interfere significantly otherwise without appropriate management strategies being implemented timely based off radiographic findings seen here initially assessed through panoramic radiographies performed routinely preemptively before commencing actual active phase work too begins thereafter accordingly alongside other necessary testing modalities required concurrently depending individual patient specific needs basis overall holistically speaking generally covering wider aspects involved comprehensively well enough detailed manner possible ensuring best results achieved ultimately successfully throughout entire course duration till completion final desired outcome eventually reached satisfactorily enough meeting expected goals set initially right beginning start itself altogether collectively taken everything considered together inclusively well planned executed precisely carefully monitored regularly followed up diligently progress tracked meticulously adjusted accordingly dynamically fine tuned periodically intervened appropriately timely fashion expert professionals involved closely working collaboratively cohesively harmoniously efficient team effort yielding fruitful positive end result outcome favorable prognosis conclusively evident post treatment followup observation comparatively evaluated objectively critically appraised subjectively interpreted realistically practically applied clinically effectively translated actually implementing learned lessons gained experienced insights acquired knowledge attained skillfully utilized beneficially helpful assisting facilitating enhancing further refining improving continuously learning evolving growing developing progressing advancing excelling masterfully proficient competent becoming adept skilled expert specialized experienced trained qualified professionals achieving high standards excellence setting benchmarks exemplary par excellence leading cutting edge forefront frontier innovative trailblaz

How brackets contribute to the alignment and movement of teeth

Panoramic radiographs, often referred to as orthopantomograms or OPGs, are a vital tool in orthodontic assessments, particularly when evaluating dental development and eruption patterns in children. These radiographs provide a comprehensive, single-image view of the upper and lower jaws, teeth, and surrounding structures, offering orthodontists a broader perspective compared to traditional intraoral X-rays.


In orthodontic assessments, timing is crucial. Panoramic radiographs help clinicians determine the stage of dental development with precision. By visualizing the entire dentition, including unerupted and developing teeth, orthodontists can anticipate future crowding, spacing, or impaction issues. For instance, the position and angulation of unerupted canines and premolars can be assessed, allowing for early intervention if necessary.


Eruption patterns are also clearly depicted in panoramic radiographs. Orthodontists can monitor the sequence and symmetry of tooth eruption, identifying any deviations that may indicate underlying issues such as physical obstructions or developmental anomalies. Early detection of abnormal eruption patterns can prompt timely interventions like space maintenance or guided eruption, preventing more complex problems later on.


Moreover, panoramic radiographs facilitate the evaluation of skeletal maturity indicators, such as cervical vertebral maturation (CVM) stages. By assessing these indicators, orthodontists can gauge a child's growth spurt status, which is crucial for timing treatments that modify skeletal growth, like functional appliances or headgear.


However, it's essential to remember that panoramic radiographs have their limitations. They may distort images or overlook small structures due to their two-dimensional nature. Therefore, they should be used in conjunction with clinical examinations and other diagnostic tools for a comprehensive orthodontic assessment.


In conclusion, panoramic radiographs play an indispensable role in assessing dental development and eruption patterns in children during orthodontic evaluations. They provide valuable insights into growth and development, aiding orthodontists in formulating appropriate treatment plans tailored to each child's unique needs and growth stage.

Benefits of early orthodontic intervention with brackets for kids

Using Panoramic Radiographs in Orthodontic Assessments


In the realm of orthodontics, early identification of potential issues is crucial for timely intervention and effective treatment planning. One of the most valuable tools in this process is the panoramic radiograph, often referred to as a panorex or OPG (Orthopantomogram). This wide-view X-ray provides a comprehensive snapshot of the entire mouth, including the teeth, jaws, and surrounding structures, making it an indispensable asset for orthodontic assessments.


Panoramic radiographs play a pivotal role in identifying potential orthodontic issues in children. One of the primary concerns that can be detected is crowding. Crowding occurs when there is insufficient space for all the teeth to align properly within the jaw. By examining a panoramic image, orthodontists can evaluate the position and alignment of both erupted and unerupted teeth, allowing them to anticipate future crowding problems and plan accordingly. This might involve strategies such as arch expansion or extraction to create adequate space for proper tooth alignment.


Another common issue that panoramic radiographs help identify is spacing. Unlike crowding, spacing refers to excessive gaps between teeth. These gaps can be due to missing or undersized teeth, or simply natural spacing that needs correction. Panoramic images allow orthodontists to assess the overall distribution of spaces within the dental arch and design treatment plans that aim to close these gaps effectively, whether through braces, aligners, or other orthodontic appliances.


Impacted teeth are yet another critical concern that panoramic radiographs help diagnose. Impacted teeth are those that fail to erupt properly through the gum line and remain embedded within the bone or soft tissue. Canine impactions are particularly common and can lead to significant complications if not addressed early. The wide field of view offered by panoramic images enables orthodontists to locate impacted teeth accurately and determine their orientation relative to adjacent structures. This information is essential for planning interventions such as surgical exposure followed by guided eruption or other corrective measures.


Beyond these specific issues, panoramic radiographs provide a holistic view of dental development, helping orthodontists monitor growth patterns, assess jaw relationships, and detect any anomalies that could impact treatment outcomes. For instance, they can reveal skeletal discrepancies that might require orthognathic surgery or identify pathologies such as cysts or tumors that need attention before orthodontic treatment begins.


In conclusion, panoramic radiographs are an invaluable diagnostic tool in orthodontic assessments for children. They offer a comprehensive view that allows orthodontists to identify potential issues such as crowding, spacing, and impacted teeth early on. By leveraging this information, orthodontists can develop precise treatment plans tailored to each child's unique needs, ensuring optimal oral health and beautiful smiles well into adulthood

The role of parental support during orthodontic treatment with brackets

Panoramic radiograph (OPG) is an instrumental diagnostic tool frequently employed by orthodontists during various stages within orthodontic treatment among pediatric patients! It offers an extensive visualization which captures both jaws along their surrounding structures via single exposure! OPG facilitates comprehensive assessment regarding developmental aspects related toward teeth eruption sequence & timing alongside monitoring skeletal maturation indicators influencing growth modifications!


Initially, orthodontists leverage OPGs for diagnostic purposes when treating kids with misaligned teeth or jaws! It helps identify underlying issues such as missing teeth (agenesis), extra teeth (supernumerary), impacted canines etc., which might necessitate interceptive measures like space maintenance or early extractions! By evaluating root angulations & inclinations present within bone structure visually depicted through panoramic imagery allows precise planning regarding appliance placement etc!


During active orthodontic intervention phases like wearing braces or aligners - regular OPG follow-ups become crucial! They enable checking treatment progress by verifying bodily tooth movements & anchorage control besides determining if any necessary adjustments are required! Concurrently track changes occurring due to growth spurts thereby modifying treatment strategies accordingly achieving desired results efficiently!


Moreover, utilizing OPGs enables monitoring root resorption which could occur amidst force applications during treatments along with keeping check upon pathological conditions affecting dental tissues & supporting bones! Furthermore facilitates evaluating post-treatment stability outcomes ensuring satisfactory retention protocol adherence preventing relapse scenarios effectively thereby maintaining achieved corrections over time!


In essence, employing panoramic radiographs throughout pediatric orthodontic therapies contributes substantially towards accurate diagnosis initial planning midcourse corrections while ensuring excellent final outcomes rendering them indispensable adjunct within contemporary clinical practice standards!

Long-term effects and maintenance after bracket removal

Panoramic radiographss often playa crucial roleinorthodontic assessmentsforchildren , offering alow costandconvenient methodtoevaluate dentaldevelopmentandpotential anomalies .However ,thereareseverallimitationsandconsiderationsthat cliniciansshouldbeawareofwhenusingthesetoolsinpediatricpopulations .Oneofthemains concernswhenworkingwithchildrenistheradiationexposure associatedwithpanaromic radiographssAlthough advancementsintechnologyhave ledtoalower radiationdoescomparedtotraditionalradiographicmethods ,the riskassociatedwithexposuretos ionizingradiationsshouldneverbeundermined Childrentendtobemore susceptibletotheeffectsofradiation duetotheirtissuesbeingmore sensitiveandtheir longertimeframeforpotentiallatenteffectstot manifest .Therefore ,orthodontistsmustfollowtheALARA principle ,keeping radiationdoesaslowasreasonablyachievable ,andonlyprescribepanoramicradiographswhen clinically necessary Anothersignificantlimitationofpanoramicradiographsisimagedistortion Thetwo dimensionalnatureofpanaramic radiographscanneresultinmagnificationanddistortion ,particularlyinthehorizontalplane Thiscanleadtoinaccuraciesinmeasurementsand assessments ,affectingorthodontictreatmentplanning Furthermore ,theimagescanbeaffectedbypatientpositioninngandmovement ,which canbechallengindwhenworkingwithchildren To mitigatetheseissues ,it is essentialforclinicians too haveadeepunderstandingoftheradiographicanatomyandbe skilledininterpretation Additionally ,combiningpanaromicradiographswithotherimagingmodalities ,suchasc ephalometricradiographsorcone beamcomputedtomography CBCT canprovideamorecomprehensiveassessment ,althoughthisalsoincreasestheradiationburden Finally ,costandaccessibilitymayalso beconsiderations Somepracticesormaynot haveaccesstopanaromicradiographyequipmentortheexpertisetointeprettheradiographicimages Insummary ,whilepanoramicradiographareavaluabletoolinorthodonticassessmentsforchildren cliniciansmustcarefullyconsidertherisksofradiationexposure ,thelimitationsof image distortion ,andotherpotentialdrawbackswhenincrporatingthisdiagnostictoolinto their practice .Properpatientselection ,technicalexpertise ,and adherenceto radiation safety principlesare essentialfor effectiveand safeuseofpanaromicradiographsinpediatricorthodontics .Bydoingsoclinicianscanensurethattheappropriatebalanceisstruckbetween diagnosticyieldandpatient safety

A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW)[1] is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (such as family physician, internist, obstetrician, psychiatrist, radiologist, surgeon etc.), physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.

Fields

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NY College of Health Professions massage therapy class
US Navy doctors deliver a healthy baby
70% of global health and social care workers are women, 30% of leaders in the global health sector are women

The healthcare workforce comprises a wide variety of professions and occupations who provide some type of healthcare service, including such direct care practitioners as physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, dentists, pharmacists, speech-language pathologist, physical therapists, occupational therapists, physical and behavior therapists, as well as allied health professionals such as phlebotomists, medical laboratory scientists, dieticians, and social workers. They often work in hospitals, healthcare centers and other service delivery points, but also in academic training, research, and administration. Some provide care and treatment services for patients in private homes. Many countries have a large number of community health workers who work outside formal healthcare institutions. Managers of healthcare services, health information technicians, and other assistive personnel and support workers are also considered a vital part of health care teams.[2]

Healthcare practitioners are commonly grouped into health professions. Within each field of expertise, practitioners are often classified according to skill level and skill specialization. "Health professionals" are highly skilled workers, in professions that usually require extensive knowledge including university-level study leading to the award of a first degree or higher qualification.[3] This category includes physicians, physician assistants, registered nurses, veterinarians, veterinary technicians, veterinary assistants, dentists, midwives, radiographers, pharmacists, physiotherapists, optometrists, operating department practitioners and others. Allied health professionals, also referred to as "health associate professionals" in the International Standard Classification of Occupations, support implementation of health care, treatment and referral plans usually established by medical, nursing, respiratory care, and other health professionals, and usually require formal qualifications to practice their profession. In addition, unlicensed assistive personnel assist with providing health care services as permitted.[citation needed]

Another way to categorize healthcare practitioners is according to the sub-field in which they practice, such as mental health care, pregnancy and childbirth care, surgical care, rehabilitation care, or public health.[citation needed]

Mental health

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A mental health professional is a health worker who offers services to improve the mental health of individuals or treat mental illness. These include psychiatrists, psychiatry physician assistants, clinical, counseling, and school psychologists, occupational therapists, clinical social workers, psychiatric-mental health nurse practitioners, marriage and family therapists, mental health counselors, as well as other health professionals and allied health professions. These health care providers often deal with the same illnesses, disorders, conditions, and issues; however, their scope of practice often differs. The most significant difference across categories of mental health practitioners is education and training.[4] There are many damaging effects to the health care workers. Many have had diverse negative psychological symptoms ranging from emotional trauma to very severe anxiety. Health care workers have not been treated right and because of that their mental, physical, and emotional health has been affected by it. The SAGE author's said that there were 94% of nurses that had experienced at least one PTSD after the traumatic experience. Others have experienced nightmares, flashbacks, and short and long term emotional reactions.[5] The abuse is causing detrimental effects on these health care workers. Violence is causing health care workers to have a negative attitude toward work tasks and patients, and because of that they are "feeling pressured to accept the order, dispense a product, or administer a medication".[6] Sometimes it can range from verbal to sexual to physical harassment, whether the abuser is a patient, patient's families, physician, supervisors, or nurses.[citation needed]

Obstetrics

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A maternal and newborn health practitioner is a health care expert who deals with the care of women and their children before, during and after pregnancy and childbirth. Such health practitioners include obstetricians, physician assistants, midwives, obstetrical nurses and many others. One of the main differences between these professions is in the training and authority to provide surgical services and other life-saving interventions.[7] In some developing countries, traditional birth attendants, or traditional midwives, are the primary source of pregnancy and childbirth care for many women and families, although they are not certified or licensed. According to research, rates for unhappiness among obstetrician-gynecologists (Ob-Gyns) range somewhere between 40 and 75 percent.[8]

Geriatrics

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A geriatric care practitioner plans and coordinates the care of the elderly and/or disabled to promote their health, improve their quality of life, and maintain their independence for as long as possible.[9] They include geriatricians, occupational therapists, physician assistants, adult-gerontology nurse practitioners, clinical nurse specialists, geriatric clinical pharmacists, geriatric nurses, geriatric care managers, geriatric aides, nursing aides, caregivers and others who focus on the health and psychological care needs of older adults.[citation needed]

Surgery

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A surgical practitioner is a healthcare professional and expert who specializes in the planning and delivery of a patient's perioperative care, including during the anaesthetic, surgical and recovery stages. They may include general and specialist surgeons, physician assistants, assistant surgeons, surgical assistants, veterinary surgeons, veterinary technicians. anesthesiologists, anesthesiologist assistants, nurse anesthetists, surgical nurses, clinical officers, operating department practitioners, anaesthetic technicians, perioperative nurses, surgical technologists, and others.[citation needed]

Rehabilitation

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A rehabilitation care practitioner is a health worker who provides care and treatment which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. These include physiatrists, physician assistants, rehabilitation nurses, clinical nurse specialists, nurse practitioners, physiotherapists, chiropractors, orthotists, prosthetists, occupational therapists, recreational therapists, audiologists, speech and language pathologists, respiratory therapists, rehabilitation counsellors, physical rehabilitation therapists, athletic trainers, physiotherapy technicians, orthotic technicians, prosthetic technicians, personal care assistants, and others.[10]

Optometry

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Optometry is a field traditionally associated with the correction of refractive errors using glasses or contact lenses, and treating eye diseases. Optometrists also provide general eye care, including screening exams for glaucoma and diabetic retinopathy and management of routine or eye conditions. Optometrists may also undergo further training in order to specialize in various fields, including glaucoma, medical retina, low vision, or paediatrics. In some countries, such as the United Kingdom, United States, and Canada, Optometrists may also undergo further training in order to be able to perform some surgical procedures.

Diagnostics

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Medical diagnosis providers are health workers responsible for the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. This usually involves a team of healthcare providers in various diagnostic units. These include radiographers, radiologists, Sonographers, medical laboratory scientists, pathologists, and related professionals.[citation needed]

Dentistry

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Dental assistant on the right supporting a dental operator on the left, during a procedure.

A dental care practitioner is a health worker and expert who provides care and treatment to promote and restore oral health. These include dentists and dental surgeons, dental assistants, dental auxiliaries, dental hygienists, dental nurses, dental technicians, dental therapists or oral health therapists, and related professionals.

Podiatry

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Care and treatment for the foot, ankle, and lower leg may be delivered by podiatrists, chiropodists, pedorthists, foot health practitioners, podiatric medical assistants, podiatric nurse and others.

Public health

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A public health practitioner focuses on improving health among individuals, families and communities through the prevention and treatment of diseases and injuries, surveillance of cases, and promotion of healthy behaviors. This category includes community and preventive medicine specialists, physician assistants, public health nurses, pharmacist, clinical nurse specialists, dietitians, environmental health officers (public health inspectors), paramedics, epidemiologists, public health dentists, and others.[citation needed]

Alternative medicine

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In many societies, practitioners of alternative medicine have contact with a significant number of people, either as integrated within or remaining outside the formal health care system. These include practitioners in acupuncture, Ayurveda, herbalism, homeopathy, naturopathy, Reiki, Shamballa Reiki energy healing Archived 2021-01-25 at the Wayback Machine, Siddha medicine, traditional Chinese medicine, traditional Korean medicine, Unani, and Yoga. In some countries such as Canada, chiropractors and osteopaths (not to be confused with doctors of osteopathic medicine in the United States) are considered alternative medicine practitioners.

Occupational hazards

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A healthcare professional wears an air sampling device to investigate exposure to airborne influenza
A video describing the Occupational Health and Safety Network, a tool for monitoring occupational hazards to health care workers

The healthcare workforce faces unique health and safety challenges and is recognized by the National Institute for Occupational Safety and Health (NIOSH) as a priority industry sector in the National Occupational Research Agenda (NORA) to identify and provide intervention strategies regarding occupational health and safety issues.[11]

Biological hazards

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Exposure to respiratory infectious diseases like tuberculosis (caused by Mycobacterium tuberculosis) and influenza can be reduced with the use of respirators; this exposure is a significant occupational hazard for health care professionals.[12] Healthcare workers are also at risk for diseases that are contracted through extended contact with a patient, including scabies.[13] Health professionals are also at risk for contracting blood-borne diseases like hepatitis B, hepatitis C, and HIV/AIDS through needlestick injuries or contact with bodily fluids.[14][15] This risk can be mitigated with vaccination when there is a vaccine available, like with hepatitis B.[15] In epidemic situations, such as the 2014-2016 West African Ebola virus epidemic or the 2003 SARS outbreak, healthcare workers are at even greater risk, and were disproportionately affected in both the Ebola and SARS outbreaks.[16]

In general, appropriate personal protective equipment (PPE) is the first-line mode of protection for healthcare workers from infectious diseases. For it to be effective against highly contagious diseases, personal protective equipment must be watertight and prevent the skin and mucous membranes from contacting infectious material. Different levels of personal protective equipment created to unique standards are used in situations where the risk of infection is different. Practices such as triple gloving and multiple respirators do not provide a higher level of protection and present a burden to the worker, who is additionally at increased risk of exposure when removing the PPE. Compliance with appropriate personal protective equipment rules may be difficult in certain situations, such as tropical environments or low-resource settings. A 2020 Cochrane systematic review found low-quality evidence that using more breathable fabric in PPE, double gloving, and active training reduce the risk of contamination but that more randomized controlled trials are needed for how best to train healthcare workers in proper PPE use.[16]

Tuberculosis screening, testing, and education

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Based on recommendations from The United States Center for Disease Control and Prevention (CDC) for TB screening and testing the following best practices should be followed when hiring and employing Health Care Personnel.[17]

When hiring Health Care Personnel, the applicant should complete the following:[18] a TB risk assessment,[19] a TB symptom evaluation for at least those listed on the Signs & Symptoms page,[20] a TB test in accordance with the guidelines for Testing for TB Infection,[21] and additional evaluation for TB disease as needed (e.g. chest x-ray for HCP with a positive TB test)[18] The CDC recommends either a blood test, also known as an interferon-gamma release assay (IGRA), or a skin test, also known as a Mantoux tuberculin skin test (TST).[21] A TB blood test for baseline testing does not require two-step testing. If the skin test method is used to test HCP upon hire, then two-step testing should be used. A one-step test is not recommended.[18]

The CDC has outlined further specifics on recommended testing for several scenarios.[22] In summary:

  1. Previous documented positive skin test (TST) then a further TST is not recommended
  2. Previous documented negative TST within 12 months before employment OR at least two documented negative TSTs ever then a single TST is recommended
  3. All other scenarios, with the exception of programs using blood tests, the recommended testing is a two-step TST

According to these recommended testing guidelines any two negative TST results within 12 months of each other constitute a two-step TST.

For annual screening, testing, and education, the only recurring requirement for all HCP is to receive TB education annually.[18] While the CDC offers education materials, there is not a well defined requirement as to what constitutes a satisfactory annual education. Annual TB testing is no longer recommended unless there is a known exposure or ongoing transmission at a healthcare facility. Should an HCP be considered at increased occupational risk for TB annual screening may be considered. For HCP with a documented history of a positive TB test result do not need to be re-tested but should instead complete a TB symptom evaluation. It is assumed that any HCP who has undergone a chest x-ray test has had a previous positive test result. When considering mental health you may see your doctor to be evaluated at your digression. It is recommended to see someone at least once a year in order to make sure that there has not been any sudden changes.[23]

Psychosocial hazards

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Occupational stress and occupational burnout are highly prevalent among health professionals.[24] Some studies suggest that workplace stress is pervasive in the health care industry because of inadequate staffing levels, long work hours, exposure to infectious diseases and hazardous substances leading to illness or death, and in some countries threat of malpractice litigation. Other stressors include the emotional labor of caring for ill people and high patient loads. The consequences of this stress can include substance abuse, suicide, major depressive disorder, and anxiety, all of which occur at higher rates in health professionals than the general working population. Elevated levels of stress are also linked to high rates of burnout, absenteeism and diagnostic errors, and reduced rates of patient satisfaction.[25] In Canada, a national report (Canada's Health Care Providers) also indicated higher rates of absenteeism due to illness or disability among health care workers compared to the rest of the working population, although those working in health care reported similar levels of good health and fewer reports of being injured at work.[26]

There is some evidence that cognitive-behavioral therapy, relaxation training and therapy (including meditation and massage), and modifying schedules can reduce stress and burnout among multiple sectors of health care providers. Research is ongoing in this area, especially with regards to physicians, whose occupational stress and burnout is less researched compared to other health professions.[27]

Healthcare workers are at higher risk of on-the-job injury due to violence. Drunk, confused, and hostile patients and visitors are a continual threat to providers attempting to treat patients. Frequently, assault and violence in a healthcare setting goes unreported and is wrongly assumed to be part of the job.[28] Violent incidents typically occur during one-on-one care; being alone with patients increases healthcare workers' risk of assault.[29] In the United States, healthcare workers experience 23 of nonfatal workplace violence incidents.[28] Psychiatric units represent the highest proportion of violent incidents, at 40%; they are followed by geriatric units (20%) and the emergency department (10%). Workplace violence can also cause psychological trauma.[29]

Health care professionals are also likely to experience sleep deprivation due to their jobs. Many health care professionals are on a shift work schedule, and therefore experience misalignment of their work schedule and their circadian rhythm. In 2007, 32% of healthcare workers were found to get fewer than 6 hours of sleep a night. Sleep deprivation also predisposes healthcare professionals to make mistakes that may potentially endanger a patient.[30]

COVID pandemic

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Especially in times like the present (2020), the hazards of health professional stem into the mental health. Research from the last few months highlights that COVID-19 has contributed greatly  to the degradation of mental health in healthcare providers. This includes, but is not limited to, anxiety, depression/burnout, and insomnia.[citation needed]

A study done by Di Mattei et al. (2020) revealed that 12.63% of COVID nurses and 16.28% of other COVID healthcare workers reported extremely severe anxiety symptoms at the peak of the pandemic.[31] In addition, another study was conducted on 1,448 full time employees in Japan. The participants were surveyed at baseline in March 2020 and then again in May 2020. The result of the study showed that psychological distress and anxiety had increased more among healthcare workers during the COVID-19 outbreak.[32]

Similarly, studies have also shown that following the pandemic, at least one in five healthcare professionals report symptoms of anxiety.[33] Specifically, the aspect of "anxiety was assessed in 12 studies, with a pooled prevalence of 23.2%" following COVID.[33] When considering all 1,448 participants that percentage makes up about 335 people.

Abuse by patients

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  • The patients are selecting victims who are more vulnerable. For example, Cho said that these would be the nurses that are lacking experience or trying to get used to their new roles at work.[34]
  • Others authors that agree with this are Vento, Cainelli, & Vallone and they said that, the reason patients have caused danger to health care workers is because of insufficient communication between them, long waiting lines, and overcrowding in waiting areas.[35] When patients are intrusive and/or violent toward the faculty, this makes the staff question what they should do about taking care of a patient.
  • There have been many incidents from patients that have really caused some health care workers to be traumatized and have so much self doubt. Goldblatt and other authors  said that there was a lady who was giving birth, her husband said, "Who is in charge around here"? "Who are these sluts you employ here".[5]  This was very avoidable to have been said to the people who are taking care of your wife and child.

Physical and chemical hazards

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Slips, trips, and falls are the second-most common cause of worker's compensation claims in the US and cause 21% of work absences due to injury. These injuries most commonly result in strains and sprains; women, those older than 45, and those who have been working less than a year in a healthcare setting are at the highest risk.[36]

An epidemiological study published in 2018 examined the hearing status of noise-exposed health care and social assistance (HSA) workers sector to estimate and compare the prevalence of hearing loss by subsector within the sector. Most of the HSA subsector prevalence estimates ranged from 14% to 18%, but the Medical and Diagnostic Laboratories subsector had 31% prevalence and the Offices of All Other Miscellaneous Health Practitioners had a 24% prevalence. The Child Day Care Services subsector also had a 52% higher risk than the reference industry.[37]

Exposure to hazardous drugs, including those for chemotherapy, is another potential occupational risk. These drugs can cause cancer and other health conditions.[38]

Gender factors

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Female health care workers may face specific types of workplace-related health conditions and stress. According to the World Health Organization, women predominate in the formal health workforce in many countries and are prone to musculoskeletal injury (caused by physically demanding job tasks such as lifting and moving patients) and burnout. Female health workers are exposed to hazardous drugs and chemicals in the workplace which may cause adverse reproductive outcomes such as spontaneous abortion and congenital malformations. In some contexts, female health workers are also subject to gender-based violence from coworkers and patients.[39][40]

 

Workforce shortages

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Many jurisdictions report shortfalls in the number of trained health human resources to meet population health needs and/or service delivery targets, especially in medically underserved areas. For example, in the United States, the 2010 federal budget invested $330 million to increase the number of physicians, physician assistants, nurse practitioners, nurses, and dentists practicing in areas of the country experiencing shortages of trained health professionals. The Budget expands loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas. This funding will enhance the capacity of nursing schools to increase the number of nurses. It will also allow states to increase access to oral health care through dental workforce development grants. The Budget's new resources will sustain the expansion of the health care workforce funded in the Recovery Act.[41] There were 15.7 million health care professionals in the US as of 2011.[36]

In Canada, the 2011 federal budget announced a Canada Student Loan forgiveness program to encourage and support new family physicians, physician assistants, nurse practitioners and nurses to practice in underserved rural or remote communities of the country, including communities that provide health services to First Nations and Inuit populations.[42]

In Uganda, the Ministry of Health reports that as many as 50% of staffing positions for health workers in rural and underserved areas remain vacant. As of early 2011, the Ministry was conducting research and costing analyses to determine the most appropriate attraction and retention packages for medical officers, nursing officers, pharmacists, and laboratory technicians in the country's rural areas.[43]

At the international level, the World Health Organization estimates a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide to meet target coverage levels of essential primary health care interventions.[44] The shortage is reported most severe in 57 of the poorest countries, especially in sub-Saharan Africa.

Nurses are the most common type of medical field worker to face shortages around the world. There are numerous reasons that the nursing shortage occurs globally. Some include: inadequate pay, a large percentage of working nurses are over the age of 45 and are nearing retirement age, burnout, and lack of recognition.[45]

Incentive programs have been put in place to aid in the deficit of pharmacists and pharmacy students. The reason for the shortage of pharmacy students is unknown but one can infer that it is due to the level of difficulty in the program.[46]

Results of nursing staff shortages can cause unsafe staffing levels that lead to poor patient care. Five or more incidents that occur per day in a hospital setting as a result of nurses who do not receive adequate rest or meal breaks is a common issue.[47]

Regulation and registration

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Practicing without a license that is valid and current is typically illegal. In most jurisdictions, the provision of health care services is regulated by the government. Individuals found to be providing medical, nursing or other professional services without the appropriate certification or license may face sanctions and criminal charges leading to a prison term. The number of professions subject to regulation, requisites for individuals to receive professional licensure, and nature of sanctions that can be imposed for failure to comply vary across jurisdictions.

In the United States, under Michigan state laws, an individual is guilty of a felony if identified as practicing in the health profession without a valid personal license or registration. Health professionals can also be imprisoned if found guilty of practicing beyond the limits allowed by their licenses and registration. The state laws define the scope of practice for medicine, nursing, and a number of allied health professions.[48][unreliable source?] In Florida, practicing medicine without the appropriate license is a crime classified as a third degree felony,[49] which may give imprisonment up to five years. Practicing a health care profession without a license which results in serious bodily injury classifies as a second degree felony,[49] providing up to 15 years' imprisonment.

In the United Kingdom, healthcare professionals are regulated by the state; the UK Health and Care Professions Council (HCPC) protects the 'title' of each profession it regulates. For example, it is illegal for someone to call himself an Occupational Therapist or Radiographer if they are not on the register held by the HCPC.

See also

[edit]
  • List of healthcare occupations
  • Community health center
  • Chronic care management
  • Electronic superbill
  • Geriatric care management
  • Health human resources
  • Uniform Emergency Volunteer Health Practitioners Act

References

[edit]
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  4. ^ "Difference Between Psychologists and Psychiatrists". Psychology.about.com. 2007. Archived from the original on April 3, 2007. Retrieved March 4, 2007.
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  6. ^ Johnson, Cheryl L.; DeMass Martin, Suzanne L.; Markle-Elder, Sara (April 2007). "Stopping Verbal Abuse in the Workplace". American Journal of Nursing. 107 (4): 32–34. doi:10.1097/01.naj.0000271177.59574.c5. ISSN 0002-936X. PMID 17413727.
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  9. ^ Araujo de Carvalho, Islene; Epping-Jordan, JoAnne; Pot, Anne Margriet; Kelley, Edward; Toro, Nuria; Thiyagarajan, Jotheeswaran A; Beard, John R (2017-11-01). "Organizing integrated health-care services to meet older people's needs". Bulletin of the World Health Organization. 95 (11): 756–763. doi:10.2471/BLT.16.187617 (inactive 5 December 2024). ISSN 0042-9686. PMC 5677611. PMID 29147056.cite journal: CS1 maint: DOI inactive as of December 2024 (link)
  10. ^ Gupta N et al. "Health-related rehabilitation services: assessing the global supply of and need for human resources." Archived 2012-07-20 at the Wayback Machine BMC Health Services Research, 2011, 11:276. Published 17 October 2011. Retrieved 20 October 2011.
  11. ^ "National Occupational Research Agenda for Healthcare and Social Assistance | NIOSH | CDC". www.cdc.gov. 2019-02-15. Retrieved 2019-03-14.
  12. ^ Bergman, Michael; Zhuang, Ziqing; Shaffer, Ronald E. (25 July 2013). "Advanced Headforms for Evaluating Respirator Fit". National Institute for Occupational Safety and Health. Archived from the original on 16 January 2015. Retrieved 18 January 2015.
  13. ^ FitzGerald, Deirdre; Grainger, Rachel J.; Reid, Alex (2014). "Interventions for preventing the spread of infestation in close contacts of people with scabies". The Cochrane Database of Systematic Reviews. 2014 (2): CD009943. doi:10.1002/14651858.CD009943.pub2. ISSN 1469-493X. PMC 10819104. PMID 24566946.
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  18. ^ a b c d "Testing Health Care Workers | Testing & Diagnosis | TB | CDC". www.cdc.gov. March 8, 2021.
  19. ^ "Health Care Personnel (HCP) Baseline Individual TB Risk Assessment" (PDF). cdc.gov. Retrieved 18 September 2022.
  20. ^ "Signs & Symptoms | Basic TB Facts | TB | CDC". www.cdc.gov. February 4, 2021.
  21. ^ a b "Testing for TB Infection | Testing & Diagnosis | TB | CDC". www.cdc.gov. March 8, 2021.
  22. ^ "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005". www.cdc.gov.
  23. ^ Spoorthy, Mamidipalli Sai; Pratapa, Sree Karthik; Mahant, Supriya (June 2020). "Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review". Asian Journal of Psychiatry. 51: 102119. doi:10.1016/j.ajp.2020.102119. PMC 7175897. PMID 32339895.
  24. ^ Ruotsalainen, Jani H.; Verbeek, Jos H.; Mariné, Albert; Serra, Consol (2015-04-07). "Preventing occupational stress in healthcare workers". The Cochrane Database of Systematic Reviews. 2015 (4): CD002892. doi:10.1002/14651858.CD002892.pub5. ISSN 1469-493X. PMC 6718215. PMID 25847433.
  25. ^ "Exposure to Stress: Occupational Hazards in Hospitals". NIOSH Publication No. 2008–136 (July 2008). 2 December 2008. doi:10.26616/NIOSHPUB2008136. Archived from the original on 12 December 2008.
  26. ^ Canada's Health Care Providers, 2007 (Report). Ottawa: Canadian Institute for Health Information. 2007. Archived from the original on 2011-09-27.
  27. ^ Ruotsalainen, JH; Verbeek, JH; Mariné, A; Serra, C (7 April 2015). "Preventing occupational stress in healthcare workers". The Cochrane Database of Systematic Reviews. 2015 (4): CD002892. doi:10.1002/14651858.CD002892.pub5. PMC 6718215. PMID 25847433.
  28. ^ a b Hartley, Dan; Ridenour, Marilyn (12 August 2013). "Free On-line Violence Prevention Training for Nurses". National Institute for Occupational Safety and Health. Archived from the original on 16 January 2015. Retrieved 15 January 2015.
  29. ^ a b Hartley, Dan; Ridenour, Marilyn (September 13, 2011). "Workplace Violence in the Healthcare Setting". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on February 8, 2014.
  30. ^ Caruso, Claire C. (August 2, 2012). "Running on Empty: Fatigue and Healthcare Professionals". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on May 11, 2013.
  31. ^ Di Mattei, Valentina; Perego, Gaia; Milano, Francesca; Mazzetti, Martina; Taranto, Paola; Di Pierro, Rossella; De Panfilis, Chiara; Madeddu, Fabio; Preti, Emanuele (2021-05-15). "The "Healthcare Workers' Wellbeing (Benessere Operatori)" Project: A Picture of the Mental Health Conditions of Italian Healthcare Workers during the First Wave of the COVID-19 Pandemic". International Journal of Environmental Research and Public Health. 18 (10): 5267. doi:10.3390/ijerph18105267. ISSN 1660-4601. PMC 8156728. PMID 34063421.
  32. ^ Sasaki, Natsu; Kuroda, Reiko; Tsuno, Kanami; Kawakami, Norito (2020-11-01). "The deterioration of mental health among healthcare workers during the COVID-19 outbreak: A population-based cohort study of workers in Japan". Scandinavian Journal of Work, Environment & Health. 46 (6): 639–644. doi:10.5271/sjweh.3922. ISSN 0355-3140. PMC 7737801. PMID 32905601.
  33. ^ a b Pappa, Sofia; Ntella, Vasiliki; Giannakas, Timoleon; Giannakoulis, Vassilis G.; Papoutsi, Eleni; Katsaounou, Paraskevi (August 2020). "Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis". Brain, Behavior, and Immunity. 88: 901–907. doi:10.1016/j.bbi.2020.05.026. PMC 7206431. PMID 32437915.
  34. ^ Cho, Hyeonmi; Pavek, Katie; Steege, Linsey (2020-07-22). "Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses". Journal of Nursing Management. 28 (6): 1250–1258. doi:10.1111/jonm.13071. ISSN 0966-0429. PMID 32564407. S2CID 219972442.
  35. ^ Vento, Sandro; Cainelli, Francesca; Vallone, Alfredo (2020-09-18). "Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences". Frontiers in Public Health. 8: 570459. doi:10.3389/fpubh.2020.570459. ISSN 2296-2565. PMC 7531183. PMID 33072706.
  36. ^ a b Collins, James W.; Bell, Jennifer L. (June 11, 2012). "Slipping, Tripping, and Falling at Work". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on December 3, 2012.
  37. ^ Masterson, Elizabeth A.; Themann, Christa L.; Calvert, Geoffrey M. (2018-04-15). "Prevalence of Hearing Loss Among Noise-Exposed Workers Within the Health Care and Social Assistance Sector, 2003 to 2012". Journal of Occupational and Environmental Medicine. 60 (4): 350–356. doi:10.1097/JOM.0000000000001214. ISSN 1076-2752. PMID 29111986. S2CID 4637417.
  38. ^ Connor, Thomas H. (March 7, 2011). "Hazardous Drugs in Healthcare". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on March 7, 2012.
  39. ^ World Health Organization. Women and health: today's evidence, tomorrow's agenda. Archived 2012-12-25 at the Wayback Machine Geneva, 2009. Retrieved on March 9, 2011.
  40. ^ Swanson, Naomi; Tisdale-Pardi, Julie; MacDonald, Leslie; Tiesman, Hope M. (13 May 2013). "Women's Health at Work". National Institute for Occupational Safety and Health. Archived from the original on 18 January 2015. Retrieved 21 January 2015.
  41. ^ "Archived copy" (PDF). Office of Management and Budget. Retrieved 2009-03-06 – via National Archives.
  42. ^ Government of Canada. 2011. Canada's Economic Action Plan: Forgiving Loans for New Doctors and Nurses in Under-Served Rural and Remote Areas. Ottawa, 22 March 2011. Retrieved 23 March 2011.
  43. ^ Rockers P et al. Determining Priority Retention Packages to Attract and Retain Health Workers in Rural and Remote Areas in Uganda. Archived 2011-05-23 at the Wayback Machine CapacityPlus Project. February 2011.
  44. ^ "The World Health Report 2006 - Working together for health". Geneva: WHO: World Health Organization. 2006. Archived from the original on 2011-02-28.
  45. ^ Mefoh, Philip Chukwuemeka; Ude, Eze Nsi; Chukwuorji, JohBosco Chika (2019-01-02). "Age and burnout syndrome in nursing professionals: moderating role of emotion-focused coping". Psychology, Health & Medicine. 24 (1): 101–107. doi:10.1080/13548506.2018.1502457. ISSN 1354-8506. PMID 30095287. S2CID 51954488.
  46. ^ Traynor, Kate (2003-09-15). "Staffing shortages plague nation's pharmacy schools". American Journal of Health-System Pharmacy. 60 (18): 1822–1824. doi:10.1093/ajhp/60.18.1822. ISSN 1079-2082. PMID 14521029.
  47. ^ Leslie, G. D. (October 2008). "Critical Staffing shortage". Australian Nursing Journal. 16 (4): 16–17. doi:10.1016/s1036-7314(05)80033-5. ISSN 1036-7314. PMID 14692155.
  48. ^ wiki.bmezine.com --> Practicing Medicine. In turn citing Michigan laws
  49. ^ a b CHAPTER 2004-256 Committee Substitute for Senate Bill No. 1118 Archived 2011-07-23 at the Wayback Machine State of Florida, Department of State.
[edit]
  • World Health Organization: Health workers

 

 

Pediatrics
A pediatrician examines a neonate.
Focus Infants, Children, Adolescents, and Young Adults
Subdivisions Paediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below)
Significant diseases Congenital diseases, Infectious diseases, Childhood cancer, Mental disorders
Significant tests World Health Organization Child Growth Standards
Specialist Pediatrician
Glossary Glossary of medicine

Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth until the age of 18.[1] The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25.[2][3] Worldwide age limits of pediatrics have been trending upward year after year.[4] A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παá¿–ς (pais "child") and á¼°ατρÏŒς (iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties (e.g. neonatology requires resources available in a NICU).

History

[edit]
Part of Great Ormond Street Hospital in London, United Kingdom, which was the first pediatric hospital in the English-speaking world.

The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus, published in the fifth century B.C., and the famous Sacred Disease. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus, Soranus of Ephesus, Aretaeus, Galen, and Oribasius, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.[5] Already Hippocrates, Aristotle, Celsus, Soranus, and Galen[6] understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men").[7] Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya.[6]

Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. Sushruta Samhita, an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics.[8] Another ayurvedic text from this period is Kashyapa Samhita.[9][10] A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics.[11] Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field.[6] The Byzantines also built brephotrophia (crêches).[6] Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children.[12][13] Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.[14][5] In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.[6]

While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.[15] It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.[5] The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,[16][17] while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject".[18] However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.[19]

Etymology

[edit]

The term pediatrics was first introduced in English in 1859 by Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."[20] Jacobi is known as the father of American pediatrics because of his many contributions to the field.[21][22] He received his medical training in Germany and later practiced in New York City.[23]

The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage.[24] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[25] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the nearby Necker Hospital, founded in 1778.[26]

In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now WrocÅ‚aw), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.[24] The first Children's hospital in Scotland opened in 1860 in Edinburgh.[27] In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).[28] Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.[29]

Differences between adult and pediatric medicine

[edit]

The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.[30]

Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults.[30][31][32] Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.[30]

Absorption

[edit]

Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.[31][30][32] Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.[31]

Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.[31][32]

Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.[31][32] Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.[31]

Distribution

[edit]

Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin.[31] Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.[31][30]

Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.[30]

Metabolism

[edit]

Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.[31] Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.[31][32] Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.[30]

Elimination

[edit]

Drug elimination is primarily facilitated via the liver and kidneys.[31] In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine.[32] In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.[30][31] Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.[31]

Pediatric autonomy in healthcare

[edit]

A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.[citation needed]

History of pediatric autonomy

[edit]

The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic.[33] Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.[34]  

In ancient times, society did not view pediatric medicine as essential or scientific.[35] Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.[5] As a result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors.[35] Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.[5]

In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.[34]

Parental authority and current medical issues

[edit]

The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family, argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights.[36] The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.[37]

In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.[37] Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults.[38] Hence, continuing the discussion on whether children are capable of making important health decisions until this day.

Modern advancements

[edit]

According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.[37]

Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions.[39] Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.

Education requirements

[edit]

Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.[citation needed]

In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.[40]

Training of pediatricians

[edit]
Pediatrics
Occupation
Names
  • Pediatrician
  • Paediatrician
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
  • Doctor of Medicine
  • Doctor of Osteopathic Medicine
  • Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB)
Fields of
employment
Hospitals, Clinics

The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".

Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and the degree of specialization.

In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.[41]

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of 'pediatric organizations (see below) rather than universities and depends on the jurisdiction.

Subspecialties

[edit]

Subspecialties of pediatrics include:

(not an exhaustive list)

  • Addiction medicine (multidisciplinary)
  • Adolescent medicine
  • Child abuse pediatrics
  • Clinical genetics
  • Clinical informatics
  • Developmental-behavioral pediatrics
  • Headache medicine
  • Hospital medicine
  • Medical toxicology
  • Metabolic medicine
  • Neonatology/Perinatology
  • Pain medicine (multidisciplinary)
  • Palliative care (multidisciplinary)
  • Pediatric allergy and immunology
  • Pediatric cardiology
    • Pediatric cardiac critical care
  • Pediatric critical care
    • Neurocritical care
    • Pediatric cardiac critical care
  • Pediatric emergency medicine
  • Pediatric endocrinology
  • Pediatric gastroenterology
    • Transplant hepatology
  • Pediatric hematology
  • Pediatric infectious disease
  • Pediatric nephrology
  • Pediatric oncology
    • Pediatric neuro-oncology
  • Pediatric pulmonology
  • Primary care
  • Pediatric rheumatology
  • Sleep medicine (multidisciplinary)
  • Social pediatrics
  • Sports medicine

Other specialties that care for children

[edit]

(not an exhaustive list)

  • Child neurology
    • Addiction medicine (multidisciplinary)
    • Brain injury medicine
    • Clinical neurophysiology
    • Epilepsy
    • Headache medicine
    • Neurocritical care
    • Neuroimmunology
    • Neuromuscular medicine
    • Pain medicine (multidisciplinary)
    • Palliative care (multidisciplinary)
    • Pediatric neuro-oncology
    • Sleep medicine (multidisciplinary)
  • Child and adolescent psychiatry, subspecialty of psychiatry
  • Neurodevelopmental disabilities
  • Pediatric anesthesiology, subspecialty of anesthesiology
  • Pediatric dentistry, subspecialty of dentistry
  • Pediatric dermatology, subspecialty of dermatology
  • Pediatric gynecology
  • Pediatric neurosurgery, subspecialty of neurosurgery
  • Pediatric ophthalmology, subspecialty of ophthalmology
  • Pediatric orthopedic surgery, subspecialty of orthopedic surgery
  • Pediatric otolaryngology, subspecialty of otolaryngology
  • Pediatric plastic surgery, subspecialty of plastic surgery
  • Pediatric radiology, subspecialty of radiology
  • Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation
  • Pediatric surgery, subspecialty of general surgery
  • Pediatric urology, subspecialty of urology

See also

[edit]
  • American Academy of Pediatrics
  • American Osteopathic Board of Pediatrics
  • Center on Media and Child Health (CMCH)
  • Children's hospital
  • List of pediatric organizations
  • List of pediatrics journals
  • Medical specialty
  • Pediatric Oncall
  • Pain in babies
  • Royal College of Paediatrics and Child Health
  • Pediatric environmental health

References

[edit]
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Further reading

[edit]
  • BMC Pediatrics - open access
  • Clinical Pediatrics
  • Developmental Review - partial open access
  • JAMA Pediatrics
  • The Journal of Pediatrics - partial open access
[edit]
  • Pediatrics Directory at Curlie
  • Pediatric Health Directory at OpenMD