A Systematic Review of ADHD Knowledge Measures and Their Psychometric Support.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) knowledge is associated with reduced stigma, earlier identification, and increased intervention access. Several ADHD knowledge measures have emerged. However, the psychometric quality of these measures varies wildly, and a review of the current psychometric support for ADHD knowledge measures is lacking. METHODS: The current study is a systematic review of ADHD knowledge measures for the reported psychometric support and the populations in which they are validated. The databases PsycINFO, ERIC, and PubMed were searched using PRISMA guidelines for peer-reviewed publications using a direct ADHD knowledge measure for original data collection. An ancestral search and the inclusion of dissertations were used to reduce potential publication bias. Included articles were coded for psychometric support, population of interest, and validation sample characteristics. RESULTS: A total of 163 articles were identified, including a total of 96 ADHD knowledge measures. The majority of measures (71.8%) did not include adequate psychometric evidence to constitute an evidence-based measure. Within that, approximately a third of ADHD knowledge measures were not accompanied by any psychometric support. Many measures are designed for and validated in only one population. Most studies did not report racial and ethnic validation sample composition; among those that did, there is a lack of diversity. CONCLUSIONS: The lack of psychometric evidence for ADHD knowledge measures calls into question the current literature regarding ADHD knowledge, particularly related to racially and ethnically minoritized respondents with whom few measures have been validated. Implications for researchers and clinicians selecting an ADHD knowledge measure are discussed.

Establishing local manufacture of PPE for healthcare workers in the time of a global pandemic.

A face shield is a secondary personal protective equipment (PPE) for healthcare workers (HCW). Worn with the appropriate face masks/respirators, it provides short term barrier protection against potentially infectious droplet particles. Coronavirus disease 2019 (COVID-19) caused a spike in demand for PPE, leading to a shortage and risking the safety of HCW. Transport restrictions further challenged the existing PPE supply chain which has been reliant on overseas-based manufacturers. Despite the urgency in demand, PPE must be properly tested for functionality and quality. We describe the establishment of local face shields manufacture in Western Australia to ensure adequate PPE for HCW. Ten thousand face shields for general use (standard) and for ear, nose and throat (ENT) specialist use were produced. Materials and design considerations are described, and the face shields were vigorously tested to the relevant Standards to ensure their effectiveness as a protective barrier, including splash and impact resistance. Comparative testing with traditional and other novel face shields was also undertaken. Therapeutic Goods Administration (TGA) licence was obtained to manufacture and supply the face shields as a Class I medical device. The swiftness of process is a credit to collaboration from industry, academia and healthcare.

The Emerging Omicron Variant, Children and School.

Many publications have demonstrated the detrimental effects of school closures on children, families and communities in the past two years of the COVID-19 pandemic. Currently, there is a surge of Omicron cases as children prepare to return to school around the world. While many children are asymptomatic or have mild disease, it is nevertheless an important problem. As we focus on vaccinations in the 5-12-year-old group, we should consider other risk mitigation factors to keep school open, and children safe.

New-onset hallucinations with amiodarone: a case report.

BACKGROUND: Amiodarone is a commonly used antiarrhythmic for the treatment of atrial fibrillation with a unique pharmacokinetic profile. While general side effects can be frequently associated with amiodarone, psychiatric adverse reactions to this medication are uncommon. The relationship between amiodarone and hallucinations independent of delirium has been rarely reported in the literature. CASE PRESENTATION: We report the case of a 63-year-old female with a history of estrogen and progesterone receptor positive invasive ductal carcinoma with osseous metastases to the ribs and skull, major depressive disorder, and unspecified anxiety. She was diagnosed with invasive ductal carcinoma 12 years prior and underwent a lumpectomy with axillary lymph node dissection and radiation, currently maintained on anastrozole and trastuzumab for the past 11 years. Her symptoms of major depressive disorder and anxiety have remained in remission on a regimen of bupropion extended release, duloxetine, and trazodone without recent dose changes. This patient presented to the emergency department with dyspnea and was admitted to the general medical floor with new-onset atrial fibrillation. She was subsequently started on amiodarone for rhythm control. Shortly after its initiation, the patient developed new onset auditory and visual hallucinations with an unremarkable extensive medical evaluation. Auditory hallucinations consisted of music and unintelligible conversations, while visual hallucinations were of a family member crying on the floor and a man carrying a gun. The differential diagnoses included depression with psychotic features, delirium, and amiodarone-induced hallucinations. Given the lack of current depressive symptoms, absence of altered cognition, and the temporal relationship between the initiation of amiodarone and the onset of hallucinations, amiodarone was suspected to be probable etiology of her hallucinations. For this reason, amiodarone was replaced with dronedarone. Visual and auditory hallucinations ceased within less than 3 days after the discontinuation of amiodarone. CONCLUSIONS: Psychiatric adverse events from amiodarone are uncommon, and associated isolated hallucinations have only been rarely reported in the literature. While the risk of visual and auditory hallucinations appears to be low with amiodarone initiation, clinicians should be aware of this potential side effect.

The Use of Self-Assembling Peptides (PuraStat™) in Functional Endoscopic Sinus Surgery for Haemostasis and Reducing Adhesion Formation. A Case Series of 94 Patients.

INTRODUCTION: Functional endoscopic sinus surgery (FESS) is a treatment option for patients with chronic rhinosinusitis. Bleeding and adhesions are common complications postoperatively. OBJECTIVE: To assess the effectiveness of PuraStat™ (3-D Matrix Medical Technology Pty Ltd, Melbourne, Australia) for use in FESS to achieve haemostasis and reduce adhesion formation. MATERIALS AND METHODS: A retrospective chart review over four years was performed on 94 patients undergoing FESS by a single surgeon, using PuraStat™ in absence of nasal packing. RESULTS: Twenty-eight patients underwent complete FESS and 66 cases limited FESS most often combined with nasal surgery. Six patients had bleeding postoperatively, of which only four required additional treatment (4.25%). Twenty-three patients (24.47%) required debridement during the follow up, simply performed by suction for 13 or by scissors for 10. No patient required revision surgery for adhesion. CONCLUSION: PuraStat™ used for the first time in context of FESS seems to be effective in achieving haemostasis, reducing adhesion formation, and avoiding nasal packing in most patients.

Influences of student race/ethnicity and gender on autism special education classification considerations.

LAY ABSTRACT: Autism prevalence has continued to rise in recent years. However, females and children from Black, Latinx, and Asian backgrounds are often misidentified or identified less often than White males. These identification disparities make it difficult for children to receive appropriate special education and school intervention services. In this study, school psychologists read a vignette featuring a student with possible autism symptoms. The vignette varied by student race/ethnicity and gender. Afterward, participants rated the likelihood that they would classify the student with autism and their confidence in this rating. Student race/ethnicity and gender influenced both classification likelihood and confidence. These results suggest that school psychologists are influenced by implicit bias and do not fully consider cultural factors in school autism evaluations. This may contribute to identification disparities.

Brief Report: A Brief Video Intervention for Increasing Autism Knowledge in a General Population Sample.

As many individuals in the general population will likely interact with autistic persons in various contexts, ensuring adequate autism knowledge and awareness is important. Increased knowledge of autism has been linked to positive outcomes such as a reduction in explicit bias against autism by non-autistic adults and an increase in service quality for autistic individuals provided by indirect professionals. For this study we developed an informational video about autism and employed a randomized control trial to evaluate its effectiveness at increasing autism awareness in a general population sample. Participants were randomly assigned to the intervention (n = 80) or active control group (n = 72). Results from a repeated measures analysis of variance indicated that the video intervention was effective at increasing knowledge about autism. Results from this study can be applied to future educational efforts aimed at increasing awareness about autism among the general population.

COVID-19 in Children: A Narrative Review.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic is caused by the third known zoonotic coronavirus. It is a disease that does not spare any age group. The scientific community has been inundated with information since January. This review aims to summarise pertinent information related to COVID-19 in children. METHODS: A literature search was conducted in 2020 on the PubMed, MEDLINE, and Embase databases, with the keyword "COVID 19" and "children". A bibliographic search of articles included was also undertaken. The abstracts were scanned to assess their appropriateness to be included in this narrative review. This was updated on the 11th April, 2020. RESULTS: The aetiology, transmission, incubation, pathophysiology, clinical features and complications, and management are discussed. CONCLUSION: Our understanding of COVID-19 is evolving as more reports are published. The growth of SARS-CoV2 is limited in children and they are often asymptomatic. The disease course is also milder. Continued research to understand its effect on children is important to help us manage the disease in these vulnerable populations in a timely fashion.

Modified Minerva Cervical Thoracic Orthosis for Postoperative Management of Cricotracheal Resection.

The worst complication of cricotracheal resection (CTR) is anastomotic dehiscence, and to limit it, postoperative management at Michigan Medicine included the use of a modified Minerva cervical-thoracic orthosis (MMCTO). To date, there has been no analysis of the risks and benefits of the brace's use following CTR. We analyze this with our retrospective study. A search with the keywords "cricotracheal resection" and "laryngotracheal reconstruction" was performed in the Electronic Medical Record Search Engine to identify patients retrospectively. The Statistical Package for Social Sciences was used for analysis; t test, χ2, and Fisher exact tests were used to analyze data. Fifteen males and 13 females with a median age of 4 years were identified, and almost 2/3 had a supra- and/or infrahyoid release performed. Postoperatively, 12 had a Grillo stitch and an MMCTO for a mean of 7 days. Most had no complications, but the most common complications were agitation due to brace discomfort and skin irritation. The worst complication was stroke. Our MMCTO's design allowed for better head and neck control with relative comfortability, and most patients had no complications with its short-term use. Our modification may be useful adjunct in the postoperative management.

The COVID-19 pandemic, personal protective equipment and respirator: A narrative review.

INTRODUCTION: The coronavirus disease 2019 pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. METHOD: A literature search was conducted on the PubMed, MedLine and Embase databases with the keywords "personal protective equipment," "COVID 19," "n95," "health care worker" and "mortality." RESULTS: SARS-nCoV-2 is highly contagious. About 3.5%-20% of HCW has been reported to be infected. The mortality ranges from 0.53% to 1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. Powered air-purifying respirators if available should be used in high-risk procedures. CONCLUSION: Transmission of viruses is multimodal and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.

Unilateral vocal fold palsy & dysphagia: A review.

OBJECTIVES: Unilateral vocal fold palsy (UVFP) is the commonest neurological laryngeal disorder. Much of the research have focused on its implication on voice, with limited data on its impact on swallowing. The aim of this paper is to examine the current evidence on the pathophysiology, impact and management of UVFP and swallowing. METHODS: A literature search was conducted on the PubMed, MedLine, and Embase databases based on the keywords "unilateral vocal cord palsy" and "dysphagia" for this narrative review. RESULTS: Dysphagia is common in UVFP. A safe and effective swallow is more than just glottic competence but coordination of complex events within the aerodigestive tract's sensory and motor systems. It is an important secondary outcome which has short- and long-term impact on our patient's quality of life. It should be managed in a multi-disciplinary manner to optimise patient's outcome. CONCLUSION: It is important to consider the disease, patient and surgical factors when deciding on the type and timing of management options. There is increasing evidence of benefits with early surgical interventions, challenging the traditional conservative management to rule out spontaneous recovery and compensation.

Non-O blood group thrombotic thrombocytopenic purpura patients take longer to recover as measured by number of therapeutic plasma exchanges needed for platelet recovery.

INTRODUCTION: Therapeutic plasma exchange (TPE) is mainstay therapy for thrombotic thrombocytopenic purpura (TTP). However, it remains controversial if ABO type influences diagnosis or time to remission. MATERIALS AND METHODS: We investigated if ABO type influences length of TPE regimen in TTP patients with ADAMTS13 deficiency at our institution. Seventy out of 71 patients with suspected TTP who had ADAMTS13 activity measured were included. ADAMTS13 activity <10% defined those with idiopathic/acquired TTP (41/70). RESULTS: We found that among patients with ADAMTS13 deficiency, non-O patients required a significantly greater number of TPE (NoP) compared to O patients (p = 0.039). Additionally, patients with ADAMTS13 deficiency regardless of ABO type needed more TPE to achieve platelet recovery compared to those patients without deficiency (p = 0.00002). In regard to other variables that may affect response to therapy in TTP patients, we found no association between obesity and NoP; however, obesity rate was higher among ADAMTS13 deficient patients compared to overall obesity rate of our regional general population. Likewise, were found that blood group O did not occur with greater frequency in our cohort. CONCLUSIONS: Our data indicates that ABO may affect the NoP patients required for disease remission. We found that non-O patients needed more procedures to overcome their disease. Further work with greater number of patients will be needed to determine if specific non-O blood types require more procedures to recover their platelet count.

Inhalational injury and the larynx: A review.

OBJECTIVE: To review and discuss the existing research on the pathophysiology, impact and management of inhalational injury on the larynx and lower respiratory tract. DATA SOURCES: A literature search was conducted on the PubMed, MedLine, Embase, Web of Science and Google Scholar databases based on the keywords "airway burn", "inhalational injury" and "larynx". REVIEW METHODS: Inclusion criteria included English language studies containing original and review data on airway injury. Data was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. CONCLUSIONS: Abnormal laryngeal and lower airway findings are common in burns patients and the incidence tends to increase with severity of the burns. Most patients with abnormal findings remain dysphonic decades after the initial injury. Larynx, the inlet to the airway, is exposed to the most intense thermal damage and highest concentration of chemical in inhalational injury. Airway injury is common and may result in long term morbidity. Healing of this tissue architecture is prolonged and different from cutaneous burn. Many patients receive prolonged intubation for medical complications that arise due to the burn injury. The degree of subglottic damage, however, is more extensive and occurs sooner compared with those without inhalational injuries. IMPLICATIONS FOR PRACTICE: With advances in acute medical and surgical management of burn and inhalational injury, airway injury is an important secondary outcome with lasting impact. Awareness of these potential complications and early involvement of medical and allied health team are important steps in improving patient care. A multi-disciplinary approach to management will optimise the short and long-term morbidity management and ultimately our patients' quality of life.

Massive Macroglossia After Posterior Cranial Fossa Surgery: A Case Report.

A 16-year-old boy with Chiari 1 malformation presented for an elective suboccipital craniectomy and C1 laminectomy. His intraoperative course was uneventful. At the conclusion of the procedure, he met extubation criteria and followed commands. After extubation, he developed progressive upper airway obstruction and became obtunded. He was reintubated via videolaryngoscopy, which showed edema not only to the tongue, but also to the posterior pharynx and blisters over the vocal folds and epiglottis. The patient was transferred to the pediatric intensive care unit intubated and sedated. This report describes the clinical course of his massive macroglossia and discusses short- and long-term management.

Absolute immature platelet counts in the setting of suspected heparin-induced thrombocytopenia may predict anti-PF4-heparin immunoassay testing results.

BACKGROUND: Heparin-induced-thrombocytopenia (HIT) is a disease mediated by antibodies to platelet factor 4 (PF4)-heparin complexes. Immature platelet fraction (%-IPF) and absolute immature platelet count (A-IPC) measure newly-released platelets into circulation and can prove useful in differentiating patients with thrombocytopenic presentations due to consumptive or hypoproduction processes. Therefore, we evaluated utility of A-IPC in a cohort of thrombocytopenic patients suspected of HIT. PATIENTS AND METHODS: Twenty-six thrombocytopenic patients (<150 × 109/L) tested for anti-PF4-heparin and 36 non-thrombocytopenic controls were included. Platelet count, %-IPF, and A-IPC were determined at time of anti-PF4-heparin testing. RESULTS: Sixteen patients tested anti-PF4-heparin negative and 10 tested positive. Patients with positive anti-PF4-heparin did not differ in A-IPC from normal range (7.2 ±â€¯2.9 × 109/L vs. 7.1 ±â€¯3.2 × 109/L respectively; p = 0.97). However, there was a significant A-IPC decrease in patients negative for anti-PF4-heparin compared to normal range and those testing anti-PF4-heparin positive (4.2 ±â€¯3.1 × 109/L vs. 7.1 ±â€¯3.2 × 109/L vs. 7.2 ±â€¯2.9 × 109/L respectively, p < 0.01). An A-IPC of greater than 5 × 109/L characterized 80% of anti-PF4-heparin positive cases. CONCLUSION: A-IPC measurements can complement anti-PF4-heparin testing of patients suspected of HIT while potentially predicting anti-PF4-heparin immunoassay results.

Treatment of extensive post tonsillectomy oropharyngeal stenosis secondary to fibromatosis.

Aggressive fibromatosis is an uncommon, benign tumor of fibroblastic origin with high potential for local invasion. Less than a quarter of these lesions are located in the head and neck, and although extremely rare, associations have been demonstrated with physical trauma. We describe a unique case of oropharyngeal fibromatosis with traumaticetiology, managed successfully with surgical excision of the lesion with negative surgical margins. A 5-year old patient was found to have an aggressive fibromatosis causing oropharyngeal stenosis following tonsillectomy. We demonstrate that surgical resection with a clear margin allowed for alleviation of stenosis without recurrences reported since the procedure.

Pediatric laryngeal cleft repair and dysphagia.

OBJECTIVE: To describe changes in diet and swallow function in patients with a laryngeal cleft after surgical repair of the laryngeal cleft. METHODS: Retrospective case series performed using chart review. Primary outcomes were diet and swallow function before and after laryngeal cleft repair. Clinical evaluation and video fluoroscopic swallow studies (VFSS) were used to assess pre- and post intervention swallowing. RESULTS: 16 pediatric patients were included in this study. Preoperatively, 14 (88%) patients had diet restrictions. Postoperatively, 12 (75%) patients tolerated a regular diet without limitation. 4 (25%) patients had no reduction in diet restrictions over the course of this study. For the 10 patients who transitioned to a regular diet postoperatively, a median of 300 days (range: 26 days - 3 years) passed to document achieving a regular diet. This was corroborated by an increase in normal oral and pharyngeal phase swallow function on VFSS postoperatively when compared with preoperative VFSS results. CONCLUSION: Dysphagia improves in most patients after laryngeal cleft repair. The range in time to a normal diet was wide. This may facilitate improved preoperative counseling and preparation of families' expectations.

Laryngotracheal reconstruction and swallowing: A review.

OBJECTIVES: Significant advances in laryngotracheal reconstruction over the last few decades have revolutionised the management of paediatric patients with complex congenital or acquired airway stenosis. The primary aim of laryngotracheal reconstruction has focused primarily on airway and surgery specific outcomes, often at the expense of voice, as well as swallowing function, which are all intricately related. There is currently a paucity of data on swallowing outcome. The goal of this paper is to review and discuss the existing research on the impact of laryngotracheal on swallowing. METHODS: Narrative review. RESULTS: Successful and safe oral feeding in children requires a highly complex and integrated sensorimotor system for proper timing and coordination, beginning with a well-coordinated suck-swallow-breathe sequence in infancy. Factors to consider include the normal laryngeal anatomy, nutrition as a stimulus and the development of feeding skills on swallowing, the underlying aetiology and other risk factors, LTR procedures and their adjuncts. All these impact on the children's growth. Swallow assessments and rehabilitation is therefore an important part of the post-operative care. CONCLUSIONS: As airway reconstructive surgeries have improved in airway and surgery specific outcomes, swallowing function is an important secondary outcome that impacts on the children's and their families' life. Management in a multi-disciplinary manner will optimise the outcome and improve their quality of life.