scholarly journals Overcoming Barriers to Accessing Surgery and Rehabilitation in Low and Middle-Income Countries: An Innovative Model of Patient Navigation in Nepal

2021 ◽  
Author(s):  
Jennifer L. Ibbotson ◽  
Bijata Luitel ◽  
Bikash Adhikari ◽  
Kathryn R. Jagt ◽  
Erik Bohler ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Patient Navigation ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Tertiary Hospital ◽  
Congenital Talipes Equinovarus ◽  
Access To Treatment ◽  
Wide Range ◽  
Talipes Equinovarus ◽  
Staff Meet

Abstract Background Injury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death. Methods Sundar Dhoka Saathi Sewa (SDSS), a non-government organization, provides a patient navigation service which facilitates referrals to tertiary centers from Nepal’s most remote areas. Specific criteria ensure that patient referrals are appropriate in regard to clinical and socioeconomic need, while comprehensive counselling helps guide the patient and family. The SDSS staff meet patients upon arrival in Kathmandu and facilitate admission to the appropriate tertiary hospital. They advocate for the patient, provide medicine, supply food and cover all treatment costs. Results This project has enabled access to treatment for more than 1200 children for conditions leading to long-term disability and/or congenital heart disease. Interventions include a wide range of surgical and rehabilitative procedures such as complex orthopedics, cleft lip and palate, congenital talipes equinovarus, burn contractures, neurological cases, and cardiac surgery for valvular disease, septal defects and other congenital malformations. Discussion The SDSS model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal. The success is owed to committed international donors, capacity building, effective counselling, advocacy, compassion, and community. We believe that this model could be replicated in other LMICs.

Paediatric and neonatal anaesthesia

2016 ◽  
Author(s):  
Simon Berg ◽  
Stewart Campbell
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Ductus Arteriosus ◽  
Fluid Management ◽  
Anaesthetic Techniques ◽  
Anaesthetic Management ◽  
Medical Problems ◽  
Nerve Blocks ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus

This chapter discusses the anaesthetic management of the neonate, infant, and child. It begins with a description of neonatal physiology, then discusses fluid management, anaesthetic equipment, and the conduct of anaesthesia in children, including post-operative analgesia. Regional anaesthetic techniques in children are discussed, including caudal, epidural, spinal, and regional nerve blocks. Surgical procedures covered include repair of diaphragmatic hernia, gastroschisis/exomphalos, tracheo-oesophageal fistula, patent ductus arteriosus, pyloric stenosis, intussusception, herniotomy, penile circumcision, orchidopexy, hypospadias, cleft lip and palate, congenital talipes equinovarus, femoral osteotomy, and inhaled foreign body. It concludes with a discussion of paediatric medical problems, stabilization of the critically ill child, and paediatric sedation.

Congenital Palatal Ulcers in Newborn Infants with Cleft Lip and Palate: Diagnosis, Frequency, and Significance

1996 ◽  
Vol 33 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Margit Bacher ◽  
Gernot Göz ◽  
Thinh Pham ◽  
Thomas Ney ◽  
Michael Ehrenfeld
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Newborn Infants ◽  
Posterior Part ◽  
Newborn Period ◽  
Wide Range ◽  
Palatal Plate ◽  
Large Cohort Study ◽  
Decubital Ulcer

Congenital decubital ulcers were found in 94% of newborn infants with unilateral cleft lip and palate in the course of a systematic study of a large cohort study (N = 52). The procedures for diagnosis, documentation, and follow-up are described. The ulceration area at birth varied over a wide range. The ulcerations were usually located in the posterior part of the vomer. Sonographic evidence supports the hypothesis that the ulcerations are caused mechanically by the motor activity of the tongue during the fetal and newborn period. The decubital ulcer disappeared in each case within 5 days following the implementation of a palatal plate.

Paediatric and neonatal anaesthesia

2021 ◽  
pp. 899-966
Author(s):  
Simon Berg ◽  
Stewart Campbell
Keyword(s):  
Cleft Lip ◽  
Life Support ◽  
Cleft Lip And Palate ◽  
Ductus Arteriosus ◽  
Fluid Management ◽  
Anaesthetic Techniques ◽  
Medical Problems ◽  
Nerve Blocks ◽  
Congenital Talipes Equinovarus ◽  
Neonatal Physiology

This chapter discusses the anaesthetic management of the neonate, infant and child. It begins with a description of neonatal physiology, then discusses fluid management, anaesthetic equipment and the conduct of anaesthesia in children, including postoperative analgesia. Regional anaesthetic techniques in children are discussed, including caudal, epidural, spinal and regional nerve blocks. Surgical procedures covered include repair of diaphragmatic hernia; gastroschisis/exomphalos; tracheo-oesophageal fistula (TOF); patent ductus arteriosus (PDA); pyloric stenosis; intussusception; herniotomy; circumcision; hypospadias repair; orchidopexy; cleft lip and palate; congenital talipes equinovarus (CTEV); femoral osteotomy, and inhaled foreign body. It includes a discussion of paediatric sedation, paediatric medical problems, paediatric advanced life support, resuscitation of the neonate, the collapsed septic child, stabilisation of the critically ill child, and paediatric drug doses and equipment.

scholarly journals An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Pratik B. Patel ◽  
Marguerite Hoyler ◽  
Rebecca Maine ◽  
Christopher D. Hughes ◽  
Lars Hagander ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Surgical Care ◽  
Surgical Capacity ◽  
Middle Income ◽  
Humanitarian Emergencies ◽  
Resource Limited ◽  
Care Delivery Model

Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.

Internationally Adopted Children With Unilateral Cleft Lip and Palate—Consonant Proficiency and Perceived Velopharyngeal Competence at the Age of 5

2020 ◽  
Vol 57 (7) ◽  
pp. 849-859 ◽  
Author(s):  
AnnaKarin Larsson ◽  
Carmela Miniscalco ◽  
Hans Mark ◽  
Johnna Sahlsten Schölin ◽  
Radi Jönsson ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Tertiary Hospital ◽  
Speech Disorders ◽  
Adopted Children ◽  
Daily Lives ◽  
Speech Characteristics ◽  
The Impact ◽  
Percentage Correct ◽  
Internationally Adopted

Objective: To compare consonant proficiency, consonant errors, and the perceived velopharyngeal (VP) competence in internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) and nonadopted (NA) children with the same cleft–palate type at age 5. Design: Case–control study based on phonetic transcriptions of standardized speech recordings of 5-year-olds at a tertiary hospital. Participants: Twenty-five IA children were compared to 20 NA children. All consecutive patients at a cleft lip and palate center participated. Main Outcome Measure(s): Consonant proficiency was measured using percentage consonants correct, percentage consonants correct–adjusted for age, percentage correct place, percentage correct manner, and consonant inventory. Cleft speech characteristics (CSCs), developmental speech characteristics (DSCs), and the perceived VP competence were also measured. Results: The IA children had significantly lower values for all consonant proficiency variables ( p < .05) and a smaller consonant inventory ( p = .001) compared to the NA children. The IA children had a higher frequency of CSCs (IA = 84%, NA = 50%, p < .05) and DSCs (IA = 92%, NA = 65%, p = .057), and twice as many IA children as NA children had perceived VP incompetence (IA = 52%, NA = 25%, p = .17). Conclusions: Severe speech disorder was more common in IA children than in NA children at age 5. Most importantly, the speech disorders seem to be not only cleft-related. More detailed speech assessments with a broader focus are needed for IA children with UCLP. Longitudinal studies are recommended to further investigate the impact of speech difficulties in IA children’s daily lives.

Three-Dimensional Analysis of the Pharyngeal Airway Volume and Craniofacial Morphology in Patients With Bilateral Cleft Lip and Palate

2020 ◽  
pp. 105566562094698
Author(s):  
Wenying Kuang ◽  
Jie Zheng ◽  
Shaolin Li ◽  
Shiyu Yuan ◽  
Hong He ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Tertiary Hospital ◽  
Craniofacial Morphology ◽  
Class I ◽  
Oropharyngeal Airway ◽  
Pharyngeal Airway ◽  
Bilateral Cleft Lip ◽  
Maxilla And Mandible

Objective: This study aimed to determine the correlations between the craniofacial morphology and pharyngeal airway volume in patients with complete bilateral cleft lip and palate (BCLP). Design: Retrospective study. Setting: Tertiary hospital. Participants: Twenty-seven patients with complete BCLP and 27 class I control patients, aged 10 to 14 years. Main Outcome Measure: The pharyngeal airway volume and craniofacial morphology were evaluated using cone-beam computed tomography. Measurements were compared between groups and any correlations were identified. Results: A significantly smaller total pharyngeal airway volume (TPV), oropharyngeal airway volume, and upper (UOPV) and lower (LOPV) oropharyngeal airway volume were found in patients with BCLP than in class I control patients, with no difference in the nasopharyngeal volume between groups. Furthermore, the craniofacial morphology measurements of N-Me, S-Go, Or-C, Ptm-C, Me-C, Co-Go, Go-Me, Ptm-Or, N-S-Ar, and Ar-Go-Me significantly differed between the BCLP and control groups (all P < .05). Multiple regression analysis indicated that Ptm-C and Me-C; Ptm-C, Or-C, and Me-C; and Me-C explained 20.3%, 38.9%, and 17.1% of the variations in TPV ( P = .025), UOPV ( P = .002), and LOPV ( P = .018), respectively. Conclusions: Total pharyngeal airway volume, TPV, OPV, UOPV, and LOPV were significantly smaller in patients with BCLP than in class I controls. In patients with BCLP, the maxilla showed inhibited sagittal development and a retrograde position; moreover, the pharyngeal airway volume was weakly associated with the position of the maxilla and mandible relative to the coronal plane.

scholarly journals COMPLEX TREATMENT EFFICIENCY, ANALYZED IN CHILDREN WITH CONGENITAL CLEFT LIP AND PALATE, USING INTERNATIONAL CLASSIFICATION OF FUNCTIONING

2018 ◽  
Vol 35 (3) ◽  
pp. 74-78
Author(s):  
L I Aleksandrova
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
International Classification ◽  
International Classification Of Functioning ◽  
Functional Disorders ◽  
Group I ◽  
Wide Range ◽  
Bilateral Cleft Lip ◽  
Congenital Cleft

Aim. To determine the structure of functional disorders and their dynamic changes in children with congenital cleft lip and palate from the position of International Classification of Functioning. Materials and methods. The indices, included into International Classification of Functioning, were assessed in 77 children (age range 1 to 6 years) with congenital cleft lip and palate, who received a complex five-stage therapy. Results. Direct correlation between the type of cleft and the value of disorders in classification constituents “function” and “structure” was revealed. Thus, in patients with bilateral cleft lip and palate, disorders of functions reached 82 %, in children with one-sided cleft lip and palate - 45 %. In children of group I, more marked structural disorders were observed, forming from 24 to 96 %, in children of groups 2 and 3 - from 5 to 49 %. In children with bilateral cleft lip and palate, there were observed more marked abnormalities in the category “activity and participation” (25-95 %) compared to children of groups 2 and 3 (0-24 %). Conclusions. Application of International Classification of Functioning for children with congenital cleft lip and palate shows a wide range of the assessed functional disorders and the possibility of using it for dynamic analysis of efficiency and treatment.

New Syndrome in Three Affected Siblings

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 235-237
Author(s):  
James P. Crane ◽  
Robin L. Heise
Keyword(s):  
Prenatal Diagnosis ◽  
Autosomal Recessive ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cervical Vertebrae ◽  
Autosomal Recessive Inheritance ◽  
Recessive Inheritance ◽  
Talipes Equinovarus ◽  
Mode Of Transmission ◽  
Ocular Hypertelorism

A previously undescribed syndrome is reported. Major features include: (1) poorly mineralized calvarium, (2) dysmorphic facies (cleft lip and palate, micrognathia, upturned nares, apparent ocular hypertelorism), and (3) extracranial musculoskeletal anomalies (absence of cervical vertebrae and clavicles, talipes equinovarus, and soft tissue syndactyly). Autosomal recessive inheritance is the most likely mode of transmission. Prenatal diagnosis via ultrasonography was successful in two fetuses at risk.

Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery

2017 ◽  
Vol 54 (5) ◽  
pp. 535-539 ◽  
Author(s):  
Christopher Hughes ◽  
Jacob Campbell ◽  
Swagoto Mukhopadhyay ◽  
Susan Mccormack ◽  
Richard Silverman ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Plastic Surgery ◽  
Cleft Lip ◽  
Digital Video ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Short Term ◽  
Middle Income ◽  
Alveolar Cleft ◽  
Middle Income Countries

Objective Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. Setting The setting for this study was a district hospital located in Latacunga, Ecuador. Patients Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. Main Outcome Measures We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Results Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P .01). There was an 82.6% agreement between observers for cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P .74). Conclusions Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

Reviewing the Orthognathic Surgical Care of the Patient With Cleft Lip and Palate

2009 ◽  
Vol 20 (Suppl 2) ◽  
pp. 1895-1904 ◽  
Author(s):  
David K. Chong ◽  
Jason E. Portnof ◽  
Haisong Xu ◽  
Kenneth E. Salyer
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Care
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