scholarly journals Correction of neonatal auricular deformities with DuoDERM: A simple technique

2020 ◽  
Author(s):  
Inayah Manji ◽  
Kim Durlacher ◽  
Cynthia Verchere
Keyword(s):  
Simple Technique ◽  
Neonatal Period ◽  
Cost Effective ◽  
Prominent Ear ◽  
Primary Physicians ◽  
At Home

Abstract Ear moulding in neonates has been shown to successfully correct congenital auricular anomalies. There are several available moulding techniques. However, commercially available moulding devices (e.g., EarWell and Ear Buddy) can be costly, and their alternatives have limited customizability. We present a technique using cost-effective and customizable materials for moulding common anomalies (Stahl’s ear, constricted ear, and prominent ear). DuoDERM Extra-thin, Steri-strips, and 3M Kind Removal Silicone tape are used to splint the ear in a preferred position. The DuoDERM is rolled into a putty, placed in the ear, and secured with tapes. This treatment is initiated in the clinic, with weekly splint changes carried out at home by caregivers, and intermittent follow-up appointments. DuoDERM moulding is a safe, inexpensive, highly customizable, and simple way to correct auricular deformities. Primary physicians/paediatricians should embed moulding into their practice, starting treatment as early as possible in the neonatal period.

scholarly journals Kangaroo Mother Care –Differences and Quantitative Benefits in Different Subgroups of Low Birth Weight Babies

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Head Circumference ◽  
Cost Effective ◽  
Kangaroo Mother Care ◽  
Daily Weight Gain ◽  
At Home

Objectives: To determine the effectiveness of Kangaroo Mother Care in subgroups of LBW babies-Preterm AGA, Preterm SGA and Term SGA, To assess any differences in benefits of KMC in relation to duration in the subgroups, To assess weight gain difference in NICU and at home at first follow up visit and up to 40 weeks of follow up to Preterm AGA, Preterm SGA and till gain of 2500g in Term SGA babies. Study design: Prospective observational study. Setting: NICU in a large teaching institute, department of pediatrics, Mahatma Gandhi Memorial Hospital, North Telangana. Subjects and Methods: 240 neonates with birth weight <2500g, hemodynamically stable. Intervention: The subjects are classified into three subgroups-based on gestational age (by new Ballard’s score) and by weight (Lubchenco’ s charts) into Preterm Appropriate for gestational age (PT AGA) (102), Preterm Small for Gestational Age (PT SGA) (88) and Term Small for Gestational age (T SGA) (50). Further categorized into <=32 wks,33-34wks,35- 36wks,>=37wks.KMC was given to all subgroups at hospital and home with mean duration of 9+2hrs at hospital and 5+2hrs at home. Outcome Measures: Growth measured by average daily weight gain, mean weight gain, (weight was measured by electronic weighing scale (seca), head circumference (measured by non-stretchable and non-metallic tape) and total length (measured by infant meter) in follow up to 40 weeks of corrected gestational age in Preterm and up to gain of 2500g in Term SGA were assessed with KMC. Results: Better weight gain was noticed in all the 3 subgroups of LBW neonates with KMC at hospital and home. In spite of lower duration of KMC at home PT AGA (33-34 weeks) subgroup has the highest weight gain (24.5+5.5g/day, p=0.003), highest head circumference gain (0.70+0.5cm/week, p=0.002), highest length gain (0.90+0.6cm/week, p <0.008). The time taken to reach full feeds and the time to reach initiation of direct breastfeeds were comparable in all subgroups but attained much earlier in PT AGA (33-34wks) and PT AGA (35-36wks). Duration of hospital stay is least in PT AGA with mean of 12.68 ± 6.37 days.KMC significantly reduced the incidence of apnea in all subgroups of LBW babies. All babies were on exclusive breastfeeds at the end of the study (98%). Conclusion: We conclude by this present study that KMC improves growth in all sub groups of LBW infants. KMC has significantly reduced the incidence of co mortifies like apnea, hypothermia, hypoglycemia in all the subgroups of LBW babies. KMC is cost effective, easily accessible and acceptable not only to mothers but also by majority of the family members

Microcirculation of the fingers in Raynaud’s syndrome

2005 ◽  
Vol 44 (01) ◽  
pp. 29-32 ◽  
Author(s):  
I. Garai ◽  
J. Varga ◽  
G. Szücs ◽  
Z. Galajda ◽  
C. András ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Quantitative Data ◽  
Cost Effective ◽  
Semiquantitative Analysis ◽  
Perfusion Scintigraphy ◽  
Visual Evaluation ◽  
Raynaud’S Syndrome ◽  
Raynaud's Syndrome ◽  
Primary Form

Summary Aim: We investigated the circulatory characteristics of patients suffering of primary and secondary Raynaud’s syndrome. Patients, methods: We examined 106 patients presenting with the classical symptoms of Raynaud’s syndrom (47 primary, 59 secondary) by hand perfusion scintigraphy developed by our Department of Nuclear Medicine. After visual evaluation we analyzed the images semiquantitatively, using the finger to palm ratio. We statistically compared the patients with primary and those with secondary Raynaud’s syndrome. Results: By visual evaluation we constated regional perfusion disturbances in 42 from 59 patients with secondary Raynaud’s syndrome. However, this was observed in only 3 from 47 patients with the primary form of this disease. This difference was statistically significant (p <0.001). Semiquantitative analysis showed that the finger/palm ratios (FPR) were significantly lower (p <0.05) for the patients with primary Raynaud’s syndrome. No differences in the FPR values concerning sex or right and left side. Conclusion: The hand perfusion scintigraphy with 99mTc-DTPA is a noninvasive, cost effective diagnostic tool, which objectively reflects the global and regional microcirculatory abnormalities of the hands, and provides quantitative data for follow-up.

Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

2020 ◽  
Vol 19 (2) ◽  
pp. 64-68
Author(s):  
Mrinmoy Biswas ◽  
Sudip Das Gupta ◽  
Mohammed Mizanur Rahman ◽  
Sharif Mohammad Wasimuddin
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Surgical Outcome ◽  
Simple Technique ◽  
Anterior Segment ◽  
Maximum Flow ◽  
Anastomotic Site ◽  
Buccal Mucosal Graft ◽  
Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

scholarly journals Severe tricuspid regurgitation 14 years after diagnosis of “transient neonatal tricuspid regurgitation”

Heart ◽  
2001 ◽  
Vol 86 (1) ◽  
pp. 88-90
Author(s):  
D Boshoff ◽  
L Mertens ◽  
M Gewillig
Keyword(s):  
Tricuspid Regurgitation ◽  
Neonatal Period ◽  
Clinical Course ◽  
Subsequent Evolution ◽  
Severe Tricuspid Regurgitation ◽  
Echocardiographic Examination ◽  
Long Term Follow Up ◽  
Transient Tricuspid Regurgitation

A 14 year old girl presented with severe tricuspid regurgitation after she was diagnosed with “transient tricuspid regurgitation of the newborn”. In the neonatal period she had presented with severe tricuspid regurgitation without an obvious underlying anatomical cause. This spontaneously regressed during the first months of life. She was dismissed from follow up at the age of 5 years after complete normalisation of the clinical and echocardiographic examination. The subsequent evolution and management of the patient, as well as the possible pathogenesis responsible for the unusual clinical course, is discussed. This case stresses the importance of long term follow up of patients with transient tricuspid regurgitation.

scholarly journals Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
J. L. Palmer ◽  
H. J. Siddle ◽  
A. C. Redmond ◽  
B. Alcacer-Pitarch
Keyword(s):  
Musculoskeletal Diseases ◽  
Cost Effective ◽  
Time Frame ◽  
Teaching Hospitals ◽  
Potential Cost ◽  
Foot Health ◽  
Telephone Consultation ◽  
Face To Face ◽  
Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

scholarly journals Postnatal management of children with antenatal hydronephrosis

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Mohammed S. ElSheemy
Keyword(s):  
Renal Function ◽  
Urinary Tract Obstruction ◽  
Cost Effective ◽  
Voiding Cystourethrography ◽  
Main Body ◽  
Antenatal Hydronephrosis ◽  
Postnatal Management ◽  
Effective Manner ◽  
Lower Urinary Tract Obstruction

Abstract Background Postnatal management of infants with antenatal hydronephrosis (ANH) is still one of the most controversial issues. The majority of infants with ANH are asymptomatic with only few children who develop renal insufficiency. Thus, the biggest challenge for pediatric urologists is to distinguish children who will require further investigations and possible intervention prior to the development of symptoms, complications or renal damage in a cost effective manner without exposing them to the hazards of unnecessary investigations. Main body In this review article, literature on ANH were reviewed to present the current suggestions, recommendations, guidelines and their rational for postnatal management of ANH. It is agreed that a large portion of infants with ANH will improve; thus, the protocol of management is based mainly on observation and follow-up by ultrasound to detect either resolution, stabilization or worsening of hydronephrosis. The first 2 years of life are critical for this follow-up as the final picture is mostly reached during that period. Advanced imaging using voiding cystourethrography or renal scintigraphy are required for children at risk. Then, surgical intervention is selected only for a subgroup of these infants who showed worsening of hydronephrosis or renal function. Conclusions The protocol of management is based mainly on observation and follow-up by US to detect either resolution, stabilization or worsening of hydronephrosis. Postnatal evaluation should be performed for any neonate with a history ANH at any stage during pregnancy even if it was resolved during third trimester. Exclusion of UTI should be performed by urinalysis for all cases followed by urine culture if indicated. Serum creatinine should be performed especially in patients with bilateral ANH. US is the initial standard diagnostic imaging technique. Other imaging modalities like VCUG and nuclear renal scans may be required according to the results of the US evaluation. The most important items in decision making are the presence of bilateral or unilateral hydronephrosis, presence or absence of hydroureter, presence of lower urinary tract obstruction and degree of hydronephrosis on the initial postnatal US. Then an intervention is selected only for a subgroup of these patients who showed deterioration in renal function or degree of hydronephrosis or were complicated by UTIs. All these recommendations are based on the available literature. However, management of ANH is still a controversial issue due to lack of high evidence-based recommendations. Randomised controlled studies are still needed to provide a high level evidence for different aspects of management.

scholarly journals Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

2021 ◽  
Vol 10 (1) ◽  
pp. e001270
Author(s):  
Jonathan James Hyett Bray ◽  
Elin Fflur Lloyd ◽  
Firdaus Adenwalla ◽  
Sarah Kelly ◽  
Kathie Wareham ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Community Setting ◽  
Cost Effective ◽  
Ventricular Rate ◽  
Service Improvement ◽  
Community Monitoring ◽  
Ventricular Response ◽  
Community Diagnosis ◽  
New Onset

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

scholarly journals Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

2021 ◽  
pp. bmjsrh-2020-200954
Author(s):  
Chelsey Porter Erlank ◽  
Jonathan Lord ◽  
Kathryn Church
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Abortion ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Post Procedure ◽  
High Satisfaction ◽  
First Choice ◽  
Patient Reported ◽  
At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

scholarly journals Current Perspectives on Neonatal Screening for Propionic Acidemia in Japan: An Unexpectedly High Incidence of Patients with Mild Disease Caused by a Common PCCB Variant

2021 ◽  
Vol 7 (3) ◽  
pp. 35
Author(s):  
Go Tajima ◽  
Reiko Kagawa ◽  
Fumiaki Sakura ◽  
Akari Nakamura-Utsunomiya ◽  
Keiichi Hara ◽  
...  
Keyword(s):  
Neonatal Screening ◽  
Acid Metabolism ◽  
Neonatal Period ◽  
Propionic Acidemia ◽  
Cardiac Complications ◽  
Mild Disease ◽  
Follow Up Study ◽  
Organic Acid Metabolism ◽  
High Incidence

Propionic acidemia (PA) is a disorder of organic acid metabolism which typically presents with acute encephalopathy-like symptoms associated with metabolic acidosis and hyperammonemia during the neonatal period. The estimated incidence of symptomatic PA in Japan is 1/400,000. The introduction of neonatal screening using tandem mass spectrometry has revealed a far higher disease frequency of approximately 1/45,000 live births due to a prevalent variant of c.1304T>C (p.Y435C) in PCCB, which codes β-subunit of propionyl-CoA carboxylase. Our questionnaire-based follow-up study reveals that most of these patients remain asymptomatic. However, reports on symptomatic patients exhibiting cardiac complications such as cardiomyopathy and QT prolongation have been increasing. Moreover, there were even cases in which these cardiac complications were the only symptoms related to PA. A currently ongoing study is investigating the risk of cardiac complications in patients with neonatal screening-detected PA caused by this common variant.

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