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Addressing Fire Safety As Part of a Home Preparedness Intervention for Families With Children and Youth With Special Health Care Needs
Get PDFInvestigating Markers for Intracranial Hemorrhage Severity: Insights from CBC Changes and Beyond
Get PDFAortic Dissection: The Insidious Menace
Get PDFIntroduction:
Aortic dissection represents a critical emergency characterized by the cleavage of aortic wall layers, creating a deceptive false lumen. Associated with high mortality rates, prompt diagnosis and intervention are needed to ensure survival.
Case:
A 63-year-old male with no significant medical history presented to the emergency with two days of worsening mid-sternal chest pain. Upon presentation, he was hemodynamically stable. Blood pressure was 130/85 mm Hg (similar in both arms), heart rate 90 bpm, and saturating 98 % on room air. Physical examination did not reveal any new murmurs. EKG showed normal sinus rhythm, no ischemic changes, and a negative troponin50), but given low clinical suspicion for a pulmonary embolism, a CT angiography (CTA) was not pursued, especially since Wells Score was 3. The patient did meet one criterion (chest pain) for The Aortic Dissection Detection Risk Score, but unfortunately, neither a D-Dimer nor CTA was performed due to low clinical suspicion. Chest pain improved after Aspirin, sublingual Nitroglycerin, and Morphine. Troponin was negative x 2. A transthoracic echocardiogram, conducted after a delay of ten hours, disclosed a dilated aortic root measuring 4.7 cm and a 5 cm dilated ascending aorta. Additionally, a linear echo-density exhibiting flow, corroborated by color Doppler, raised suspicion of aortic dissection originating close to the right coronary cusp. Cardiothoracic surgery was immediately consulted, and a CTA was ordered. Regrettably, twenty minutes later, the patient became unresponsive with PEA cardiac arrest, and CPR was initiated. After 18 minutes of CPR, there was no return of spontaneous circulation, and the patient was pronounced deceased.
Discussion:
Our case underscores the deceptive nature of aortic dissection, which can present with benign physical examination, labs, and radiographic findings. In cases of uncertainty, prompt imaging with transthoracic/ transesophageal echocardiography or CTA should be performed as early detection and treatment can significantly improve prognosis
Treatment of Length-Unstable Pediatric Femur Fractures in Children Aged 5 to 11 years: A Focused Review.
No full textPediatric femur fractures in children aged 5 to 11 years are typically classified as length-stable versus length-unstable. For length-stable fracture patterns, there is frequent consensus among pediatric orthopaedic specialists regarding the appropriateness of flexible intramedullary nails, submuscular plates (SMP), or lateral-entry rigid intramedullary nails (LE-RIMN). With length-unstable fracture patterns, however, the decision is more complex. Age, weight, fracture pattern, fracture location, surgical technique, surgeon experience, several implant-specific details, and additional factors are all important when choosing between flexible intramedullary nail, SMP, and LE-RIMN. These familiar methods of fixation may all be supported by conflicting and sometimes heterogeneous data. When planning to treat length-unstable fractures in young children, surgeons should understand evidence-based details associated with each implant and how each patient-specific scenario affects perioperative decisions
Endoscopic Management of Gastric Band Erosion: a Systematic Review and Meta-Analysis.
No full textBACKGROUND: Gastric band erosion may be seen in up to 3% of patients. Endoscopic intervention has become increasingly utilized due to its minimally invasive nature. The purpose of this study was to perform a systematic review and meta-analysis to examine the role of endoscopic removal for eroded gastric bands.
METHODS: Individualized search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases in accordance with PRISMA and MOOSE guidelines. Outcomes included technical success, clinical success, procedure duration, adverse events, and surgical conversion. Pooled proportions were analyzed using random effects models. Heterogeneity and publication bias was assessed with I
RESULTS: Ten studies (n=282 patients) were included in this meta-analysis. Mean age was 40.68±7.25 years with average duration of band placement of 38.49±19.88 months. Pre-operative BMI was 42.76±1.06 kg/m
CONCLUSION: Endoscopic intervention is a highly effective and safe modality for the treatment of gastric band erosion
Risk of Adverse Cardiovascular Outcomes in Postmenopausal Women with Inflammatory Bowel Disease.
No full textBACKGROUND: Individuals with inflammatory bowel disease (IBD) who lack traditional cardiovascular disease (CVD) risk factors, such as young females, are observed to experience adverse CVD outcomes. Whether women with IBD have increased CVD risk after the menopause transition is unclear.
METHODS: We conducted a survival analysis of Women\u27s Health Initiative (WHI) participants and excluded those with missing IBD diagnosis, model covariate data, follow-up data, or a baseline history of the following CVD outcomes: coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), peripheral arterial disease (PAD). Risk of outcomes between IBD and non-IBD women was performed using Cox proportional hazard models, stratified by WHI trial and follow-up. Models were adjusted for age, socio-demographics, comorbidities (e.g., hypertension, diabetes, hypercholesterolemia, etc.), family history, and lifestyle factors (e.g., smoking, alcohol, physical activity, body mass index, etc.).
RESULTS: Of 134,022 WHI participants meeting inclusion criteria, 1367 (1.0%) reported IBD at baseline. Mean baseline age was 63.4 years. After adjusting for age and other confounders, no significant difference was observed between IBD and non-IBD women for the risk of CHD (HR 0.96, 95% CI 0.73-1.24), VTE (HR 1.11, 95% CI 0.81-1.52) or PAD (HR 0.64, 95% CI 0.28-1.42). After adjusting for age, risk of ischemic stroke was significantly higher (HR 1.41, 95% CI 1.06-1.88) in IBD than non-IBD women. With further adjustment, the excess risk of ischemic stroke among IBD women was attenuated and no longer statistically significant (HR 1.31, 95% CI 0.98-1.76).
CONCLUSIONS: Among postmenopausal women with IBD, risk of ischemic stroke may be higher than in non-IBD women
The Kent-Collins Protocol for Symptom Management in Post-Radiotherapy Eustachian Tube Dysfunction: A Case Report
Get PDFIntroduction: Eustachian tube dysfunction is a common side effect of radiotherapy for head and neck cancers or brain tumors, although few effective treatments exist. The Kent-Collins Protocol represents a novel therapeutic option for post-radiotherapy Eustachian tube dysfunction.
Case Description: The Kent-Collins Protocol was employed in one patient with Eustachian tube dysfunction following fractionated stereotactic radiotherapy for cerebral metastases from HER-2 positive breast cancer. The Kent-Collins Protocol provided relief of symptoms (conductive hearing loss, aural fullness, and otalgia) for a range of 5 to 45 minutes. The protocol could be repeated when symptoms returned to provide additional relief. The patient also reported psychological benefit from this protocol, knowing the hearing loss was reversible and not likely to be permanent.
Discussion: This case demonstrates the potential of The Kent-Collins Protocol for the treatment of post-radiotherapy Eustachian tube dysfunction. The protocol is effective, inexpensive, easy to teach, and safe, offering an alternative to invasive therapies currently in existence
Trauma-Informed Leadership in Quality Improvement: What We Learned From Practicing in a Pandemic.
No full textIn 2020, midway through the Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity project, the coronavirus disease 2019 pandemic erupted and caused significant disruptions for the 10 participating state teams, the project leadership, and collaborative partner organizations. Clinics shut down for in-person care, a scramble ensued to quickly leverage telehealth to fill the gap, and the trauma caused by anxiety, isolation, and exhaustion affected the health and wellbeing of children, families, and clinicians alike. We conducted a series of key informant interviews and surveys, alongside other process measures, to learn from state teams what it was like on the ground to try to continue improving care delivery, child quality of life, and family wellbeing under such upheaval. In this article, we synthesize qualitative and descriptive findings from these varied data sources within the framework of the trauma-informed principles we applied as a leadership team to prevent burnout, increase resilience, and maintain progress among all project participants, especially clinicians and the uniquely vulnerable family leaders. Lessons learned will be offered that can be applied to future natural and human-made emergencies that impact responsive pediatric care delivery improvement