Audiology Service Models in a Family Physician Practice Setting

This article illustrates the potential of placing audiology services in a family physician’s practice setting to increase referrals of geriatric and pediatric patients to audiologists. The primary focus of family practice physicians is the diagnosis/intervention of critical systemic disorders (e.g., cardiovascular disease, diabetes, cancer). Hence concurrent hearing/balance disorders are likely to be overshadowed in such patients. If audiologists get referrals from these physicians and have direct access to diagnose and manage concurrent hearing/balance problems in these patients, successful audiology practice patterns will emerge, and there will be increased visibility and profitability of audiological services. As a direct consequence, audiological services will move into the mainstream of healthcare delivery, and the profession of audiology will move further towards its goals of early detection and intervention for hearing and balance problems in geriatric and pediatric populations.

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Pediatric care coordination and risk tiering: Moving beyond claims data

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-200694 ◽

2021 ◽

pp. 1-9

Author(s):

Hillary E. Swann-Thomsen ◽

Jared Vineyard ◽

John Hanks ◽

Rylon Hofacer ◽

Claire Sitts ◽

...

Keyword(s):

Care Coordination ◽

Chronic Conditions ◽

Pediatric Patients ◽

Classification Model ◽

Pediatric Care ◽

Care Needs ◽

Accurate Identification ◽

Special Health Care ◽

Pediatric Populations ◽

Mean Differences

PURPOSE: The goal of this study was to evaluate the performance of a pediatric stratification tool that incorporates health and non-medical determinants to identify children and youth with special health care needs (CYSHCN) patients according to increasing levels of complexity and compare this method to existing tools for pediatric populations. METHODS: This retrospective cohort study examined pediatric patients aged 0 to 21 years who received care at our institution between 2012 and 2015. We used the St. Luke’s Children’s Acuity Tool (SLCAT) to evaluate mean differences in dollars billed, number of encounters, and number of problems on the problem list and compared the SLCAT to the Pediatric Chronic Conditions Classification System version2 (CCCv2). RESULTS: Results indicate that the SLCAT assigned pediatric patients into levels reflective of resource utilization and found that children with highly complex chronic conditions had significantly higher utilization than those with mild and/or moderate complex conditions. The SLCAT found 515 patients not identified by the CCCv2. Nearly half of those patients had a mental/behavioral health diagnosis. CONCLUSIONS: The findings of this study provide evidence that a tiered classification model that incorporates all aspects of a child’s care may result in more accurate identification of CYSHCN. This would allow for primary care provider and care coordination teams to match patients and families with the appropriate amount and type of care coordination services.

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Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Neurosurgical FOCUS ◽

10.3171/2011.8.focus11177 ◽

2011 ◽

Vol 31 (5) ◽

pp. E5 ◽

Cited By ~ 16

Author(s):

Geoffrey Appelboom ◽

Stephen D. Zoller ◽

Matthew A. Piazza ◽

Caroline Szpalski ◽

Samuel S. Bruce ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Pediatric Trauma ◽

Anatomical Variations ◽

Decompressive Surgery ◽

Pediatric Populations ◽

The Impact

Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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Enteral and parenteral nutrition considerations in pediatric patients

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz174 ◽

2019 ◽

Vol 76 (19) ◽

pp. 1492-1510

Author(s):

Mary Petrea Cober ◽

Kathleen M Gura

Keyword(s):

Best Practices ◽

Parenteral Nutrition ◽

Pediatric Patients ◽

Medication Administration ◽

Nutrition Support ◽

Disease States ◽

Pediatric Populations ◽

Enteral And Parenteral Nutrition ◽

Indications For Use ◽

Selection Of

Abstract Purpose Current clinical practice guidelines on management of enteral nutrition (EN) and parenteral nutrition (PN) in pediatric patients are reviewed. Summary The provision of EN and PN in pediatric patients poses many unique considerations and challenges. Although indications for use of EN and PN are similar in adult and pediatric populations, recommended EN and PN practices differ for pediatric versus adult patients in areas such as selection of EN and PN formulations, timing of EN and PN initiation, advancement of nutrition support, and EN and PN goals. Additionally, provision of EN and PN to pediatric patients poses unique compounding and medication administration challenges. This article provides a review of current EN and PN best practices and special nutrition considerations for neonates, infants, and other pediatric patients. Conclusion The provision of EN and PN to pediatric patients presents many unique challenges. It is important for pharmacists to keep current with pediatric- and neonatal-specific guidelines on nutritional management of various disease states, as well as strategies to address compounding and medication administration challenges, in order to optimize EN and PN outcomes.

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Applications of Fat Grafting in Pediatric Patients

Seminars in Plastic Surgery ◽

10.1055/s-0039-3402517 ◽

2020 ◽

Vol 34 (01) ◽

pp. 053-058

Author(s):

Linden Shih ◽

Amjed Abu-Ghname ◽

Matthew J. Davis ◽

Amy S. Xue ◽

Robert F. Dempsey ◽

...

Keyword(s):

Tissue Regeneration ◽

Pediatric Patients ◽

Fat Grafting ◽

Soft Tissue Defects ◽

Autologous Fat Grafting ◽

Reconstructive Procedures ◽

Autologous Fat ◽

Pediatric Setting ◽

Pediatric Populations ◽

Tissue Defects

AbstractAutologous fat grafting has become a widely utilized technique for a variety of cosmetic and reconstructive procedures. Its potential for volume restoration and tissue regeneration has made it a popular method for treating soft tissue defects in both adult and pediatric populations. While autologous fat grafting in the pediatric setting is not as well characterized as it is in the adult setting, various reports have demonstrated the safety and utility of its applications in nonadult patient populations. In this article, we present the first comprehensive review of the current applications of autologous fat grafting in pediatric patients. Specific challenges to fat grafting in the pediatric setting and future applications will also be discussed.

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Pediatric Central Venous Catheter Management: A Review of Current Practice

Journal of the Association for Vascular Access ◽

10.1016/j.java.2013.04.002 ◽

2013 ◽

Vol 18 (2) ◽

pp. 93-98 ◽

Cited By ~ 6

Author(s):

Mary Beth Hovda Davis

Keyword(s):

Current Practice ◽

Pediatric Patients ◽

Venous Catheter ◽

Central Venous Catheters ◽

Common Complication ◽

Successful Therapy ◽

Central Venous ◽

Vessel Size ◽

Intravenous Treatment ◽

Pediatric Populations

Abstract Due to small vessel size, obtaining stable access in pediatric patients is difficult. In addition, because needle stick pain is a concern for patients with chronic illness, central venous catheters are often utilized to provide intravenous treatment. Catheter occlusion is a common complication in pediatric patients and must be addressed to salvage the catheter and ensure successful therapy. The use of fibrinolytics for occlusion treatment have been successful in pediatric populations.

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The current practice patterns of mechanical ventilation for respiratory failure in pediatric patients

Heart & Lung ◽

10.1016/s0147-9563(98)90035-8 ◽

1998 ◽

Vol 27 (4) ◽

pp. 238-244 ◽

Cited By ~ 12

Author(s):

Yaron Harel ◽

Vis Niranjan ◽

Barry J. Evans

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Current Practice ◽

Pediatric Patients ◽

Practice Patterns

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Current use of medical expulsive therapy among endourologists

Canadian Urological Association Journal ◽

10.5489/cuaj.4978 ◽

2018 ◽

Vol 12 (9) ◽

pp. E384-90 ◽

Cited By ~ 1

Author(s):

Donald Charles Fedrigon ◽

Rajat Jain ◽

Sri Sivalingam

Keyword(s):

Online Survey ◽

Current Practice ◽

Practice Patterns ◽

Index Case ◽

Index Patient ◽

Ureteral Stones ◽

Practice Setting ◽

Medical Expulsive Therapy ◽

American Urological Association ◽

International Status

Introduction: We aimed to characterize current practice patterns among endourologists on medical expulsive therapy (MET) for treatment of ureteral calculi.Methods: An online survey was administered to Endourological Society members. Respondents’ MET usage, index case management, and awareness of recent guidelines and literature were compared based on international status, practice setting, interval since training, and endourological fellowship training.Results: Of the 237 complete responses, 65% were international, 61% were academic, 66% had >10 years in practice, and 71% were endourology fellowship-trained. MET was used by 88%, with no differences between international, academic, practice length, and fellowship-trained groups. MET was used more frequently for <8 mm and distal stones and more U.S.-based respondents reported use for proximal/mid-ureteral stones (68% vs. 43%; p<0.001). For the index patient, 70% preferred MET as the initial approach and respondents <10 years from training were more likely to choose MET (82% vs. 64%; p=0.006). While 82% of respondents were aware of the SUSPEND trial, 70% reported that it had not altered their use of MET. Current American Urological Association (AUA) guideline awareness was 90%. Mean MET prescription length was 19.9±10.3 days, and was statistically significantly longer for respondents who were U.S.-based, academic, and <10 years from training.Conclusions: MET is the preferred approach for patients with ureteral calculi <10 mm among endourologists despite conflicting data in the literature. While current AUA practice guidelines are followed by the majority of respondents, our survey suggests MET is being used more liberally than the guideline criteria, specifically in proximal and mid-ureteral stones.

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EP.FRI.1023 Clinical Portal: a clinician-led IT solution to the ‘surgical list’

British Journal of Surgery ◽

10.1093/bjs/znab312.147 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Cait Bleakley ◽

Chloe Wright ◽

Rola Salem ◽

Kirk Bowling

Keyword(s):

Patient Information ◽

Single Point ◽

Direct Consequence ◽

Direct Access ◽

Accurate Information ◽

Junior Doctors ◽

Post Intervention ◽

It Systems ◽

The Creation ◽

The Impact

Abstract Aim Burnout amongst junior doctors is an emotive topic, with time pressures during busy on-call shifts negatively impacting efficiency and morale. Historically, within busy surgical firms the most junior team members commonly worked beyond scheduled hours. It has been highlighted within our trust that our IT systems significantly contributed to this. Thus leading to the creation of a clinician-led IT solution, enabling direct access to accurate information at a single point. This study aims to measure the impact of the systems introduction on efficiency and shift experience of our junior doctors. Methods 'Clinical Portal’ was introduced in August 2019. This IT system enables all patient information to be collated in one place, with the added benefit of simplifying the creation of patient lists. Number and duration of Exception Reports (ER) by on-call surgical juniors were measured for two months pre and post intervention. A qualitative survey was also distributed to this cohort to measure satisfaction and experience during on-call shifts within this period. Results Following introduction of 'Clinical Portal', the total length of time included in ERs reduced. Surgical juniors expressed an improvement in their on-call experience, most notably dedicating less time to collating patient information and ward list formation. The overall experience improved despite time required to become proficient at using the new system. Conclusions Streamlining of IT systems used during on-call shifts demonstrates improved efficiency amongst juniors reflected in a reduction of ERs. A direct consequence of these implemented changes is significant improvement in morale amongst our juniors.

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