Comparison of Triple Combination Oral Sedation Regimens for Pediatric Dental Treatment

Purpose: Compare the efficacy of two benzodiazepines (diazepam or midazolam) in combination with meperidine and hydroxyzine for pediatric dental sedation. Methods: A randomized, double blind observation study of behaviors and outcomes related to two sedation groups. Frankl and Houpt behavior scores were recorded at three time points: injection time, initiation of treatment and at the end of treatment. Postoperative phone call surveys were conducted within eight hours of discharge to assess sleep, activity, and behavior. Results: A total of 40 sedation subjects were included in the study, of which 20 were treated with diazepam triple Combination (Di+M+H) and 20 with midazolam triple regime (Mi+M+H). Treatment was successful for 45% of cases with midazolam and 70% with diazepam (P value=.20). Houpt sleep scores were significantly higher for diazepam than midazolam at injection (P-value=.0043) and during treatment (P-value=.0152). Although Frankl scores, Houpt move and Houpt cry scores tended to favor diazepam, none were statistically significantly different. More abnormal behavior was reported with midazolam, though not statistically significant (35% vs 6%, P-value=.0854). Postoperative sleep time was longer for midazolam, but not significantly different (median sleep time: 61 vs 45 minutes, P-value=.2071). Conclusion: The diazepam, meperidine, hydroxyzine triple combination sedation regimen shows promising results as a successful alternative to midazolam triple combination. Longer postoperative monitoring may be required with diazepam, but this study has shown postoperative sleep times to be less than previously reported. Larger sample size is needed to determine if the current trend will be maintained

Diagnostic Efficacy of Morphological Characters of Larval \u3ci\u3eTramea Lacerata\u3c/i\u3e Hagen and \u3ci\u3eTramea Onusta\u3c/i\u3e Hagen (Odonata: Libellulidae) in the Prairie Region of Missouri

Distinguishing among species of larvae of the dragonfly genus Tramea historically has been problematic, largely due to conflicting characterizations of the larvae of T. lacerata Hagen and T. onusta Hagen (Odonata: Libellulidae) in the literature. The various systematic treatments usually focused on relative lengths of morphological characters to distinguish the species, but often contradicted one another and themselves as to what the diagnostic values actually were. We traced much of the confusion back to errors in the original larval description of T. onusta. We used morphometric analyses to determine the efficacy of previously published characterizations to distinguish between the larvae of T. lacerata and T. onusta. Previous characterizations, especially those involving relative lengths of the caudal appendages, were generally found to be inadequate for distinguishing larvae of the two species. The most reliable characteristic for distinguishing the two species was found to be the length of the epiproct relative to the length of the paraprocts

Hypothermia in trauma patients: predicting the big chill

Physicians commonly ignore hypothermia, an often-underappreciated event associated with mortality in trauma patients, in general due to its prevalence and belief that it is secondary to the injury itself (secondary hypothermia). Over the past several decades, hypothermia in trauma has been studied concerning its effects on mortality; however, very little has been done to identify the major risk factors associated with it. The study by Lapostolle and colleagues has attempted to incorporate environmental risk factors and prehospital care along with more traditional variables for the prediction of hypothermia at admission

Disability Prevention Among Michigan Employers

This chapter briefly discusses the magnitude of the problem of disability in the workplace. It also presents an overview of the three and one-half year research project for which this Final Report is the product. It highlights the origins of the project and the major design elements that are reflected in this report. It concludes with a discussion of the remaining limitations of the research