General Article

Shifting Away From Opioids to Deal with Dental Ache

News Picture: Moving Away From Opioids to Treat Dental Pain

FRIDAY, Aug. 19, 2022 (HealthDay Information)

Many opioid abusers cite non permanent, authentic use of an opioid for reduction of joint or dental ache as their “gateway” into dependancy.

Now, analysis executed at one New York State health facility reveals that dentists can reduce their use of opioids all the way down to 0, the usage of different painkillers for sufferers as an alternative.

The outcome: “No opioids have been prescribed for dental ache from March 2021 to February 2022,” reported a crew of dentists on the College of Rochester Scientific Heart.

“Making an allowance for that 1,800 sufferers won greater than 20,000 opioid capsules every year in our health facility sooner than implementation of the opioid aid technique, getting rid of opioid prescriptions would possibly imply that roughly 105 people every year won’t broaden new and protracted opioid use related to remedy at our health facility,” concluded the crew led through Dr. Yanfang Ren. He’s professor and scientific leader on the college’s Howitt Pressing Dental Care.

They revealed their findings within the July 17 factor of JAMA Community Open.

An endemic of opioid abuse — the entirety from OxyContin and Percocet to heroin — nonetheless plagues the US. In reaction, clinical specialties are slicing again on using prescription opioids, particularly for the comfort of non permanent ache.

Dental ache is a type of eventualities. As Ren and his colleagues famous, “even if the American Dental Affiliation recommends nonsteroidal anti inflammatory medicine (NSAIDs) for managing ache, opioids proceed for use greater than non-opioids.” NSAIDs come with medicine corresponding to Advil (ibuprofen), Aleve (naproxen) and Celebrex (celecoxib).

In lots of circumstances, then again, sufferers can’t be handled with NSAIDs on account of their clinical histories, the Rochester dentists defined.

In order that they grew to become to what they referred to as a “multimodal” ache reduction technique, “with NSAIDs, acetaminophen and gabapentin.” It used to be was hoping that this array of possible choices would possibly fill the space as soon as opioids have been not used.

“We hypothesized that the usage of a mixture of the non-opioid ache medicines and including gabapentin to the combo for ache could be an efficient option to reduce or do away with opioids for dental ache,” Ren stated in a College of Rochester information unencumber.

How did it figure out? The learn about crew checked out prescribing practices on the health facility from March 2021 to February 2022 — a period of time when his crew stopped handing out opioids in want of the brand new routine.

In prior years, greater than a 3rd of sufferers were prescribed an opioid to ease their non permanent dental ache, the researchers stated. However no longer one of the most virtually 3,800 sufferers observed all through the learn about duration won an opioid painkiller.

As a substitute, maximum sufferers in search of reduction ache after a dental process used a combo of acetaminophen (easiest referred to as Tylenol) plus ibuprofen.

About 13% of sufferers could not take both ibuprofen or acetaminophen on account of well being problems or drug interactions. This workforce were given some mixture of non-opioid ache reduction that incorporated gabapentin (for instance, gabapentin plus ibuprofen or acetaminophen).

Now not handiest did maximum sufferers revel in efficient ache reduction, the non-opioid painkillers usually carried out higher than opioids, the researchers stated.

For instance, the “failure charge” for acetaminophen/ibuprofen ache reduction used to be simply 2.2%, in comparison to about 21% of people that were given an opioid in prior years.

The authors wired that their learn about concerned only one dental health facility, and a bigger learn about is almost definitely had to be sure that a shift clear of opioids is warranted for dental care most often.

Nonetheless, the addition of gabapentin — lengthy used to regard nerve ache — into the combo provides sufferers much more choices, the dental crew believes.




QUESTION


Medically talking, the time period “myalgia” refers to what form of ache?
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“Gabapentin isn’t metabolized within the frame and thus is protected together with different analgesics, corresponding to acetaminophen or NSAIDs, offering a possible choice to opioids, particularly when acetaminophen/NSAIDs are [not advised],” Ren’s workforce stated.

Additional information

There is extra on dental ache on the American Dental Affiliation.

SOURCES: JAMA Community Open, Aug. 17, 2022; College of Rochester Scientific Heart, information unencumber, Aug. 17, 2022

By way of Ernie Mundell HealthDay Reporter

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General Article

Children Getting Spinal Surgical procedures Might Minimize Again on Opioids

News Picture: Kids Getting Spinal Surgeries May Cut Back on Opioids

THURSDAY, Aug. 11, 2022 (HealthDay Information) – Spinal surgical operation is painful, however fewer addictive opioid painkillers are wanted now to assist children and teenagers set up it, a brand new find out about unearths.

A analysis group from Michigan Medication discovered that scoliosis sufferers present process spinal fusion may also be prescribed fewer opioids and nonetheless get ok ache keep an eye on after surgical operation.

“Spinal fusion is arguably probably the most painful procedures we carry out in pediatric orthopaedics, however our findings display we will be able to supply superb ache keep an eye on via using multimodal ache control tactics and preoperative training,” stated senior find out about creator Dr. Ying Li, an orthopedic surgeon at C.S. Mott Kids’s Health facility in Ann Arbor.

The analysis incorporated 72 teenagers who underwent spinal fusion at College of Michigan Well being. Each and every used to be prescribed 30 doses of oxycodone, in addition to usual non-opioid medicines after their process.

Earlier than surgical operation, 49 sufferers and their caregivers gained an training at the dangers of opioids and the significance of non-opioid ache control. The opposite 35 gained no preoperative training.

Despite the fact that each teams gained the similar choice of opioids at discharge, 23% of those that gained no preoperative training requested for fill up — in comparison to simply 6% of the ones within the training staff.

In comparison to 77 teenagers who up to now had the surgical operation with out usual discharge prescription pointers, sufferers within the find out about used much less oxycodone and for fewer days.

On moderate, the former sufferers used a mean 29 doses when receiving a bigger amount of oxycodone. Realizing that, medical doctors prescribed those new sufferers 30 doses. However they just took about 16, whilst additionally reporting very low ache ratings.

“Our effects display that once we prescribe sufferers much less narcotics, they’re going to take fewer narcotics, so prescription amount is extremely necessary after a process like this,” Li stated. “We need to keep away from eventualities the place somebody is overprescribed opioids and takes too many or leftover opioids are diverted to others.”

He stated preoperative training and use of a multi-pronged option to ache control are key to decreasing hurt and fighting drug issues and overdose.

The findings had been just lately printed within the Magazine of Pediatric Orthopaedics.

Additional info

The Nationwide Library of Medication has extra on scoliosis surgical operation for kids.

SOURCE: Michigan Medication, information free up, Aug. 3, 2022

By way of Cara Murez HealthDay Reporter

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General Article

Telehealth, Telephone Visits a Lifesaver for Veterans Hooked on Opioids

Newest Psychological Well being Information

News Picture: Telehealth, Phone Visits a Lifesaver for Veterans Addicted to Opioids

THURSDAY, July 28, 2022 (HealthDay Information)

There are lots of stumbling blocks to opioid dependancy remedy, however a brand new learn about presentations person who one outgrowth of the COVID pandemic — telehealth — is enabling extra U.S. veterans to get lend a hand.

Researchers tested care given to vets prior to and after a transition to telehealth visits in early 2020 for remedy in their opioid use dysfunction. Telehealth for sufferers receiving the prescription drug buphrenorphine to regard opioid dependence was once somewhat new within the Veterans Affairs well being machine prior to the pandemic, mentioned lead writer Dr. Allison Lin.

“The fast transfer to digital visits for many sufferers saved other folks from falling by the wayside of care, and phone visits [also] performed a key function,” mentioned Lin, an dependancy psychiatrist on the Ann Arbor VA in Michigan and investigator on the VA Middle for Scientific Control Analysis.

In 2020, telephone appointments considerably outnumbered video and in-person visits, the learn about discovered. Even in early 2021, telephone visits made up 50% of per thirty days visits for vets the use of buprenorphine; video visits, 32%; and in-person care, 17%.

In comparison to March 2019, on a per thirty days foundation there was once a 14% build up in selection of vets receiving buphrenorphine remedy in February of remaining yr. Over that very same length, 6% fewer vets general won any more or less dependancy remedy.

Lin and her colleagues on the VA Ann Arbor Healthcare Machine and the College of Michigan revealed their findings July 28 within the American Magazine of Psychiatry.

They mentioned this new knowledge on telephone, video and in-person remedy may provide vital coverage insights at a an important time.

Federal, state and VA policymakers are all debating selections about the way forward for telehealth regulations followed throughout COVID generation. Ahead of the pandemic, audio-only visits had been normally no longer allowed and video visits to sufferers at house had been ceaselessly no longer reimbursed.

Lin hopes policymakers will weigh the proof moderately prior to making ultimate regulations.

Having telephone get admission to may well be specifically an important for the ones with opioid use problems, lots of whom lack strong housing, get admission to to a pc or high-speed web.

“Telephone visits would possibly supply flexibility to enable you stay other folks engaged in care over the years,” Lin mentioned in a college information liberate. “Those also are ceaselessly probably the most sickest sufferers we take care of, who’ve probably the most best chance for overdose. Protecting those sufferers in care is a big precedence.”

Insurance policies that make it so simple as conceivable for other folks to proceed receiving dependancy remedy can have an important have an effect on on their basic results, she mentioned.

Extra learn about is had to perceive the personal tastes and reviews of sufferers and clinicians, and to evaluate the effectiveness of care delivered by means of telehealth, Lin mentioned.

Additional information

The U.S. Well being Sources and Services and products Management has extra about telehealth.

SOURCE: College of Michigan/Michigan Drugs, information liberate, July 28, 2022

Via Sydney Murphy HealthDay Reporter

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General Article

Nerve-Cooling Implant May Ease Ache With out Opioids

News Picture: Nerve-Cooling Implant Could Ease Pain Without OpioidsBy means of Amy Norton HealthDay Reporter

FRIDAY, July 1, 2022 (HealthDay Information)

Hinting at a long term selection to opioid painkillers, scientists have advanced a tiny implant designed to ease post-surgery ache after which dissolve as soon as the process is completed.

Up to now, the analysis has been restricted to lab animals, and it’s going to be a number of years prior to the generation may well be able for human trying out.

However the hope is to sooner or later have a substitute for managing postoperative ache that is determined by engineering, reasonably than medicine, mentioned researcher John Rogers, a professor at Northwestern College Feinberg College of Drugs in Chicago.

The implant is made of soppy, water-soluble fabrics that shape a cuff that may wrap round a peripheral nerve — the sort that ship ache alerts from the frame to the backbone and mind. The tool delivers centered cooling to the nerve, inhibiting the ones ache alerts from attaining the mind.

And as soon as it is not wanted, the implant dissolves into the frame’s fluids.

In step with Rogers, the implant may just probably supply ache reduction after many varieties of surgical procedure — decreasing and even negating the will for painkillers like opioids.

“We are hoping it may possibly utterly exchange opioids,” Rogers mentioned, including that a large number of paintings stays prior to there may also be any real-world use.

“We are speaking about a lovely radically new generation,” he mentioned.

The implant — described within the July 1 factor of Science, which additionally printed an accompanying editorial — cools nerves by means of the acquainted idea of evaporation. It incorporates a liquid coolant this is prompted to evaporate at explicit spots alongside a peripheral nerve, very similar to the way in which the frame cools itself by way of sweating.

That cooling is in a position to sluggish after which sooner or later prevent any ache alerts touring alongside the nerve.

In lab research with rats, Rogers and his colleagues used the tool to chill actual centered peripheral nerves and switch off ache alerts “on call for.”

The implant itself is tiny, simply 5 millimeters at its widest level, consistent with Rogers. One finish curls right into a cuff that wraps round a unmarried nerve. Inside of are two “microfluidic” tubes. One incorporates the liquid coolant perfluoropentane, which is already utilized in medication — in ultrasound distinction brokers, for instance. The opposite tube incorporates dry nitrogen.

When the fuel and the coolant combine in a shared chamber, the liquid evaporates and creates the cooling impact. On the identical time, Rogers mentioned, an digital sensor within the implant displays the temperature of the nerve, to make sure it does now not get too chilly.

The gadget does contain “exterior {hardware},” Rogers identified. The implanted tool connects to a pump outdoor the frame — very similar to an IV line, he mentioned — that permits the person to turn on the implant, after which dial the depth up or down.

“The implant isn’t self-contained and wirelessly managed,” Rogers mentioned. However, he added, the hope is to refine the generation in order that it may be, with the person controlling the cooling with a wrist-worn tool.

First, there are extra speedy inquiries to be replied. Rogers mentioned his group shall be having a look at whether or not there are “organic penalties” to extended cooling of peripheral nerves.

A pain-medicine skilled now not concerned within the find out about known as the paintings “interesting.”

In contrast to the sprouting that happens when a nerve is heated, cooling lets in nerves to stick intact, mentioned Dr. David Dickerson, chairman of the American Society of Anesthesiologists’ Committee on Ache Drugs.

He agreed that it is vital to evaluate the consequences of long-term cooling.

“We wish to ensure that there aren’t any pathological adjustments presented — no new nerve disorder,” Dickerson mentioned.

If the generation pans out in people, he mentioned he may just envision the generation getting used for surgical procedures that have a tendency to purpose extra, or longer lasting, ache in a while.

In the true global, Dickerson famous, cost-effectiveness is a key attention: Insurers must be prepared to pay for a posh generation reasonably than usual ache medicine.

Already, Dickerson mentioned, medical doctors and researchers were having a look at new techniques to regulate ache and cut back opioid use after surgical procedure. He pointed to the instance of peripheral nerve stimulation, through which a tiny insulated cord is positioned along a peripheral nerve and hooked up to a battery-powered generator that sends gentle electric pulses to the nerve.

A 2021 find out about discovered that the manner lowered sufferers’ post-surgery ache within the first week, and considerably curbed their want for opioids.

General Article

Leftover Opioids After Surgical treatment? Mailed Kits Double Charge of Right kind Disposal

News Picture: Leftover Opioids After Surgery? Mailed Kits Double Rate of Proper Disposal

WEDNESDAY, Would possibly 11, 2022 (HealthDay Information)

May just giving surgical procedure sufferers ready-to-use mailed disposal kits for unused opioids decrease the chance of abuse of the medicine?

Sure, claims a brand new find out about that discovered sufferers with unused opioid ache capsules are a lot more more likely to put off them correctly when given the kits.

There is a possibility that leftover opioid drugs is also misused by means of the individual they have been prescribed to or by means of others. If they are put within the trash, they might be discovered by means of youngsters or animals, or would possibly hurt the surroundings. Flushing them down the bathroom additionally poses environmental dangers, the researchers defined.

There are protected disposal websites, corresponding to positive pharmacies, however sufferers steadily do not use them as a result of they is also out of the way in which or it takes further effort.

On this find out about, College of Pennsylvania researchers assessed whether or not mailed protected disposal kits would possibly make a distinction.

The find out about incorporated 235 sufferers who have been prescribed opioid painkillers after orthopedic or urologic procedures. The standard process was once adopted for approximately part of the sufferers, who have been texted directions to put off their unused capsules together with a hyperlink to places of native protected disposal websites.

The opposite sufferers won the similar textual content message however have been mailed disposal kits 4 to seven days after their procedures.

Leftover opioids have been disposed of correctly by means of 60% of those that won the disposal package, when put next with 43% of the sufferers who did not obtain the kits, the investigators discovered.

Some research display that handiest about 20% to 30% of U.S. sufferers correctly put off unused opioid drugs, so those findings recommend that mailed disposal kits may just double or triple that price, in step with the authors of the find out about revealed on-line Would possibly 6 in JAMA Community Open.

The researchers famous that the usage of mailed disposal kits by means of 125 sufferers within the find out about resulted within the protected disposal of 480 unused opioid capsules.

“I used to be happy to peer that this type of easy, ‘snail mail’ way may just exchange habits and advertise self-reported disposal,” stated find out about lead writer Dr. Anish Agarwal, an assistant professor of emergency drugs and leader wellness officer of the dep. of emergency drugs at Penn Medication.

“The opioid epidemic obviously is still entrance and heart for sufferers, and the worries with opioid use and misuse are changing into an actual a part of the dialog between physicians and sufferers,” Agarwal added in a college information unlock. “I feel sufferers are extra acutely aware of the hazards and penalties of the use of opioids and storing them of their properties.”

Additional information

For extra at the protected disposal of substances, pass to the U.S. Division of Well being and Human Services and products.

SOURCE: College of Pennsylvania, information unlock, Would possibly 6, 2022

By way of Robert Preidt HealthDay Reporter

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Medical doctors Devise More secure Selection to Opioids Throughout, After Surgical procedures

News Picture: Doctors Devise Safer Alternative to Opioids During, After SurgeriesVia Denise Mann HealthDay Reporter

THURSDAY, April 28, 2022 (HealthDay Information)

It is been rather greater than a 12 months since Jonathan Akinrele, 23, underwent weight-loss surgical treatment, and thus far, so excellent.

He’s now down 130 kilos, and he used to be ready to get thru gastric sleeve surgical treatment and restoration with out taking any opioids for ache.

“The ache proper after surgical treatment used to be extra like a abdomen pain. It used to be somewhat uncomfortable, however totally manageable,” mentioned Akinrele, who manages a safety company in Lengthy Island, N.Y.

There’s a large push throughout all of drugs to seek out possible choices to opioids because of the national opioid epidemic. Many of us first transform addicted to those tough painkillers following surgical treatment.

And the danger for dependancy is also even upper for individuals who go through weight-loss surgical treatment. That is why tips from 5 clinical societies, together with the American Society for Metabolic and Bariatric Surgical procedure, name for opioid-free or opioid-sparing ache reduction right through and after weight-loss surgical treatment.

About 3% to 4% of people that obtain opioids for the primary time after surgical treatment are nonetheless taking them a 12 months later, and this jumps to eight% to ten% for individuals who had weight-loss surgical treatment, mentioned Dr. Dominick Gadaleta, chair of surgical treatment at South Shore College Health facility in Bay Shore, N.Y.

Higher ache reduction

As an alternative of opioids, folks present process weight-loss surgical procedures at Northwell Well being Hospitals in New York obtain intravenous acetaminophen or nonsteroidal anti inflammatory medication (NSAIDs) ahead of surgical treatment. That is adopted by means of an intravenous infusion of non-opioid anesthetics and a nerve block of the surgical space. Thus far, surgeons at Northwell hospitals have carried out greater than 200 procedures the use of this protocol, together with gastric sleeve surgical treatment and hernia operations.

“We necessarily flip the nerve endings down or off ahead of surgical treatment with preemptive acetaminophen or NSAIDs,” defined Dr. Don Decrosta, chair of anesthesia at South Shore College Health facility, which is a part of the Northwell well being device. “Once we get harm or go through surgical treatment, the nerve endings within the injured space fireplace at a miles upper charge, but when we blunt or get rid of this pressure reaction with preemptive [pain relief], you get in the course of the early therapeutic days with out the will for opioids.”

Opioids block ache alerts between your mind and frame, whilst the brand new protocol is extra centered, he mentioned,

Folks do not get despatched house with a prescription for opioids as a result of they are not looking for them, mentioned Dr. Andrew Bates, director of minimally invasive surgical treatment at South Shore College Health facility.

Those other people are not essentially pain-free within the days following their process, and that is the reason a excellent factor, Bates famous. “They are going to have some soreness later on and that is the reason OK as a result of it is a main surgical treatment and ache may give us necessary knowledge,” Bates mentioned. “We by no means wish to totally quilt up ache.”

Shorter restoration

Along with a heightened possibility of dependancy and overdose, opioids reason many temporary unwanted side effects that may abate restoration, together with nausea, itching, fatigue, dizziness and constipation, mentioned Dr. David Pechman, a bariatric surgeon at South Shore College Health facility. He’s the surgeon who carried out Akinrele’s gastric sleeve process in March 2021. Opioids decelerate your intestines so that you would not have bowel actions, however “with the brand new protocol, sufferers have common bowel actions and are strolling across the afternoon in their surgical treatment.”




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Ache Control: Unexpected Reasons of Ache
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When Pechman used to be in coaching, weight-loss surgical treatment sufferers stayed within the medical institution for 2 to 3 days. Now, maximum handiest keep for one night time, and that’s in part as a result of opioids don’t seem to be a part of the combination any further, he mentioned.

Individuals who go through weight-loss surgical treatment have a tendency to be extra liable to different opioid-related headaches reminiscent of bother respiring, nausea and vomiting, Pechman famous.

This is a double whammy as weight-loss procedures might also build up possibilities of nausea and vomiting, he mentioned.

For probably the most section, sufferers are on board with this opioid-sparing protocol. “Sufferers are very excited once they listen that they may not want opioids as they incessantly know someone who has been adversely affected or hooked on opioids, or have observed what opioids can do in pop culture and at the information,” Pechman mentioned.

It is catching on throughout america, too. Many different

General Article

Large Drop Noticed in Children Getting Opioids After Surgical procedure

News Picture: Big Drop Seen in Kids Getting Opioids After SurgeryBy way of Denise Mann HealthDay Reporter

MONDAY, April 4, 2022 (HealthDay Information)

Efforts to reduce on dangerous opioid use for ache after surgical treatment are trickling all the way down to youngsters.

New analysis presentations that fewer American citizens underneath the age of 18 have been prescribed narcotics to regard surgical ache between 2014 and 2017, and those numbers dropped much more hastily starting in past due 2017.

Whilst opioids can assist youngsters arrange gentle or average ache, contemporary research have proven that children just do as smartly with restricted or no opioids. Moreover, opioids raise their fair proportion of dangers for youngsters, together with breathing melancholy (gradual and shallow respiring) and the opportunity of abuse. The U.S. Facilities for Illness Regulate and Prevention not too long ago steered docs to prescribe different ache medicine on every occasion imaginable to be able to assist stem the national epidemic of opioid use and overdose deaths.

“Our findings recommend that surgical suppliers are prescribing fewer opioids for procedures the place they will not be obligatory,” mentioned find out about creator Dr. Tori Sutherland, an attending anesthesiologist at Kids’s Clinic of Philadelphia. “If suitable on your kid, nonsteroidal anti inflammatory medicine [NSAIDs] like ibuprofen may well be as excellent or higher than opioids for procedures related to gentle to average ache, like dental surgical treatment or adenoidectomy,” mentioned Sutherland.

For the find out about, Sutherland’s group tapped into insurance coverage information on greater than 124,000 youngsters more youthful than 18 who underwent considered one of 8 surgical procedures between 2014 and 2019, together with tonsillectomies, dental surgical procedures, appendix removing or knee surgical treatment.

The full proportion of youngsters who had an opioid prescription crammed within the week after their surgical treatment dropped throughout teenagers, school-aged youngsters, and preschool-aged youngsters throughout the five-year find out about duration.

Damaged down by way of age team, prescriptions dropped from simply over 78% to 48% for teenagers, from just about 54% to twenty-five.5% amongst school-aged youngsters, and from about 30% to 11.5% for preschool-aged youngsters, the investigators discovered.

What is extra, the common morphine milligram identical declined by way of roughly 50% throughout all 3 age teams. (Morphine is an opioid ache killer.)

Folks will have to ask about non-opioid choices if their youngsters are having probably painful surgical treatment, Sutherland mentioned.

“If the process is related to gentle to average ache, and they’re allowed to take an NSAID [or Tylenol], they won’t want opioids most often,” she mentioned. “For main surgical procedures requiring an inpatient keep, oldsters can talk over with their docs if choices, like a nerve block or non-opioid drugs, may well be suitable.”

The find out about was once revealed on-line April 4 within the magazine Pediatrics.

Dr. Lorraine Kelley-Quon is a pediatric surgeon at Kids’s Clinic, Los Angeles. She has studied opioid use amongst youngsters prior to now.

“This find out about provides much-needed epidemiologic information outlining how opioid prescribing practices have modified lately for kids present process surgical treatment,” mentioned Kelley-Quon, who was once now not concerned with the brand new analysis. “Folks will have to proceed to interact their surgeons and well being care suppliers in discussions about the way to safely use, retailer and cast off prescription opioids when obligatory and choices for non-opioid ache reduction methods.”

Additional information

The American Academy of Pediatrics gives pointers for folks on the way to arrange a kid’s ache after surgical treatment.

SOURCES: Tori Sutherland, MD, attending anesthesiologist, Kids’s Clinic of Philadelphia; Lorraine Kelley-Quon, MD, pediatric surgeon, Kids’s Clinic, Los Angeles; Pediatrics, April 4 2022, on-line

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QUESTION


The abbreviated time period ADHD denotes the situation recurrently referred to as:
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