Velopharyngeal insufficiency after maxillary advancement in patients with cleft palate − a survey of risk assessment in the United Kingdom and Ireland

2019 ◽  
Vol 57 (1) ◽  
pp. 58-61 ◽  
Author(s):  
R. Fitzgerald ◽  
A. Smyth
Keyword(s):  
Risk Assessment ◽  
United Kingdom ◽  
Cleft Palate ◽  
Velopharyngeal Insufficiency ◽  
The United Kingdom ◽  
Maxillary Advancement

A Closer Look at Delayed Primary Cleft Surgery and Unrepaired Cleft Lip and/or Palate in 5 UK Cleft Centers

2021 ◽  
pp. 105566562110217
Author(s):  
Sophie Butterworth ◽  
Clare Rivers ◽  
Marnie Fullarton ◽  
Colm Murphy ◽  
Victoria Beale ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Medical Problems ◽  
Primary Surgery ◽  
The United Kingdom ◽  
Number Of Patients ◽  
Primary Palate ◽  
Palate Repair ◽  
Cleft Surgery

Background: There may be many reasons for delays to primary cleft surgery. Our aim was to investigate the age of children undergoing primary cleft lip or primary cleft palate repair in 5 cleft centers within the United Kingdom. Identify the reasons for delayed primary cleft lip repair (beyond 6 months) and delayed primary palate repair (beyond 13 months). Identify children who had a cleft lip and/or palate (CL±P) that was intentionally unrepaired and the reasons for this. Methods: A retrospective, multicenter review of patients born with a CL±P between December 1, 2012, and December 31, 2016. Three regional cleft centers, comprising of 5 cleft administrative units in the United Kingdom participated. Results: In all, 1826 patients with CL±P were identified. Of them, 120 patients had delayed lip repair, outside the expected standard of 183 days. And, 178 patients in total had delayed palate repair, outside the expected standard of 396 days. Twenty (1%) patients had an unrepaired cleft palate. Conclusions: This large retrospective review highlights variations between centers regarding the timing of lip and palate surgery and details the reasons stated for delayed primary surgery. A small number of patients with an unrepaired cleft palate were identified. All had complex medical problems or comorbidities listed as a reason for the decision not to operate and 50% had a syndromic diagnosis. The number of patients receiving delayed surgery due to comorbidities, being underweight or prematurity, highlights the importance of the cleft specialist nurse and pediatrician within the cleft multidisciplinary team.

scholarly journals An Exploratory Study of Speech and Language Therapy Intervention for Children Born With Cleft Palate ± Lip

2020 ◽  
pp. 105566562095473
Author(s):  
Caroline Williams ◽  
Sam Harding ◽  
Yvonne Wren
Keyword(s):  
Decision Making ◽  
United Kingdom ◽  
Service Delivery ◽  
Cleft Palate ◽  
Speech And Language ◽  
Language Therapy ◽  
Speech And Language Therapy ◽  
Service Delivery Models ◽  
The United Kingdom ◽  
Delivery Models

Introduction: Children born with a cleft palate ± lip are at risk of developing speech and language difficulties, which may require intervention from a speech and language therapist (SLT). To date, there is no strong evidence to support one approach to intervention over another, neither is it clear which approaches or methods of provision are commonly used. Objectives: To describe the range of speech and language therapy interventions being used with children born with cleft palate in the United Kingdom up to 5 years of age. To explore the different ways, interventions are being delivered. Design: A prospective study to conduct 9 semi-structured focus groups. Iterative content analysis was completed. Setting: Regional Cleft Lip and Palate Centers in the United Kingdom. Participants: Sixty-two speech and language therapy professionals from specialist cleft teams and community services. Results: Four main codes were identified: “intervention approaches,” “service delivery models,” “decision-making and rationale,” and “patient-centered care.” Participants frequently discussed how they adopt an eclectic style when delivering intervention, the importance of an individualized approach for each child and service delivery constraints, such as a lack of resources. Conclusion: Insight into the multitude of intervention approaches used by SLTs, aspects which influence their decision-making and the variability of service delivery models were gained. Uncertainty regarding which intervention approaches and methods for delivery are most effective provides rationale for future research, to improve the effectiveness of speech and language intervention for children with cleft palate ± lip.

Is failure to provide venous thromboprophylaxis negligent?

2007 ◽  
Vol 22 (4) ◽  
pp. 186-191 ◽  
Author(s):  
J R H Scurr ◽  
J H Scurr
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
United Kingdom ◽  
Venous Thromboembolism ◽  
Retrospective Analysis ◽  
Expert Witness ◽  
Surgical Patients ◽  
Vascular Surgeon ◽  
The United Kingdom ◽  
Is Failure

Objectives: To report the outcome of 100 consecutive medicolegal claims referred to one of the authors (1990–2003) following the development of venous thromboembolism (VTE) in surgical patients. Methods: A retrospective analysis of the experience of a vascular surgeon acting as an expert witness in the United Kingdom. Results: Prophylaxis had been provided to 43 claimants with risk factors, who, unfortunately, still developed a VTE and alleged negligence. Twenty-nine claims involved patients who had not received prophylaxis because they were at low risk. In 25/28 claims where no prophylaxis was provided, despite identifiable VTE risk factors, the claim was successful. Claimants who developed a VTE that had been managed incorrectly were successful whether they had received prophylaxis or not. Settlement amounts, where disclosed, are reported. Conclusions: Failure to perform a risk assessment and to provide appropriate venous thromboprophylaxis in surgical patients is considered negligent. Clinicians looking after all hospitalized patients who are not assessing their patients' risk for VTE and/or not providing appropriate prophylaxis are at risk of being accused of negligence.

Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

2021 ◽  
pp. 105566562198913
Author(s):  
Sophie Butterworth ◽  
Emma L. Hodgkinson ◽  
David C.G. Sainsbury ◽  
Peter D. Hodgkinson
Keyword(s):  
United Kingdom ◽  
Surgical Technique ◽  
Cleft Palate ◽  
Thematic Analysis ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
The United Kingdom ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Intravelar Veloplasty

Background: Although cleft surgeons in the United Kingdom follow a similar training pathway, and cleft centers adhere to similar protocols regarding timing of palate surgery and surgical technique, speech outcomes still vary significantly between centers. Objective: To explore if differences in technique exist between individual surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP). Design: An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP for primary cleft palate repair and to discuss what was important in the adoption, adaptation, and evolution of this technique within their own practice. Method: A semistructured interview schedule was designed. Interviews were conducted in person or via videoconferencing, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. Results: Fourteen cleft consultants from the United Kingdom participated (3 females and 11 males). Seven of the consultants were trained in plastic surgery and 4 in oral and maxillofacial surgery. Eight themes were identified from the thematic analysis. One theme—Surgical Variation—is discussed. Conclusions: The findings provide insight into areas of variation seen within one surgical technique of cleft palate repair. These variations may have arisen to accommodate heterogeneity in the patient population or may have evolved in relation to different experiences of training or influences of colleagues. Further work is needed to explore the reasons for these differences in technique and to identify if any of these subtle differences contributed to variability in outcomes.

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