Comparison of Endoscopic and Ultrasonographic Measurements of the Subglottic Airway in Children

2020 ◽  
Vol 163 (6) ◽  
pp. 1264-1269
Author(s):  
Elton M. Lambert ◽  
Huy D. Tran ◽  
Julina Ongkasuwan
Keyword(s):  
Tertiary Care ◽  
Vocal Folds ◽  
Strongly Correlated ◽  
Comparison Of Methods ◽  
Pediatric Hospital ◽  
Pearson Coefficient ◽  
Subglottic Space ◽  
Cervical Trachea ◽  
Endoscopic Assessment ◽  
Anterior Posterior

Objective To compare measurements of the pediatric subglottis obtained by surgeon-performed ultrasound and endoscopy. Study Design Prospective observational comparison-of-methods study. Setting Tertiary care pediatric hospital. Subjects and Methods Thirty-one patients who underwent direct laryngoscopy from May 2017 to July 2018 were recruited. Transcervical ultrasound was used to visualize the vocal folds, subglottis, and cervical trachea. The anterior-posterior (AP) and transverse (TV) diameter of the subglottic space were measured endoscopically and via ultrasound by 2 independent evaluators. Measurements were compared for correlation, bias, and agreement. A clinically acceptable bias for subglottic diameter was assumed to be 0.5 mm or less. Results The median age of enrolled patients was 2.6 years (range, 4 months–13.3 years). Endoscopic subglottic AP and TV measurements ranged from 3.33 mm to 14.81 mm and from 4.44 mm to 11.65 mm, respectively, while ultrasonographic AP and TV measurements ranged from 4.57 mm to 9.85 mm and from 3.77 mm to 8.96 mm. Pearson coefficient showed strong a correlation for both endoscopic and ultrasound AP ( R = 0.8081, P < .0001) and TV ( R = 0.8796, P < .001) measurements of the subglottis. Bland-Altman plots revealed a bias (average discrepancy) for AP measurements of 0.22 mm and 0.11 mm for TV measurements. Conclusion Endoscopic and ultrasonography measurements of the pediatric subglottic airway were strongly correlated. The discrepancy between AP and TV measurements was less than 0.5 mm. Ultrasound of the subglottis may be an alternative to endoscopic assessment of the airway for measurement of the subglottic airway in children in select cases.

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

scholarly journals Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

2016 ◽  
Vol 8 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Kim Bjorklund ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Broad Spectrum ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P &lt; .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P &lt; .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

scholarly journals Drug utilization pattern in outdoor patients of pediatric tertiary care hospital: a cross sectional study

2020 ◽  
Vol 9 (11) ◽  
pp. 1725
Author(s):  
Sonal M. Parekar ◽  
Girish K. Maindarkar ◽  
Vishal V. Maindarkar
Keyword(s):  
Drug Utilization ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Drug Formulation ◽  
Oral Drug ◽  
Care Hospital ◽  
Pediatric Hospital ◽  
Sectional Study ◽  
Utilization Pattern ◽  
Cross Sectional

Background: Drug utilization study is essential, as safe and effective therapeutic regimen in paediatric population is challenging. Pattern of use of drugs in pediatrics vary as compared to adults, also there is limited data available. The objective of this study was to study drug utilization pattern in pediatric patients attending pediatric outpatient department of Maindarkar pediatric hospital, Latur.Methods: A cross sectional study was carried out for a period of six months from September 2019 to February 2020, by analysing a total 1000 prescriptions of patients who had visited the OPD of Maindarkar pediatric hospital. Prescriptions were selected by simple random sampling method.Results: In our study, out of the total of 1000 prescriptions, 244 (24.4%) were of neonates, 556 (55.6%) were of infants (1 month to 1 year) and 200 (20%) were of children above 1 year. 547 (54.7%) prescriptions were of male patients and 453 (45.3%) were of female patients. The most frequent classes of drugs prescribed were nonsteroidal anti-inflammatory drugs 704 (70.4%), followed by drugs used for respiratory disorders 655 (65.5%) and supplements (60%). Antimicrobials were prescribed in 498 (49.8%) prescriptions. The average number of drugs per prescription was 2.45. About two third of all the prescribed drugs (74.41%) were from national essential medicine list. Most of the prescriptions had oral drug formulation 825 (82.5%) followed by inhalational 208 (20.8%) followed by injectables 150 (15%). All the drugs were prescribed by brand names.Conclusions: Our study helps health-care system to understand, interpret and improve prescribing, administration, to minimize adverse events and promote rational use of medicines.

SONOGRAPHIC MEASUREMENTS OF SCROTAL WALL THICKNESS

2021 ◽  
pp. 31-32
Author(s):  
Sahil Gandhi ◽  
Asit Natekar
Keyword(s):  
Wall Thickness ◽  
Tertiary Care ◽  
The Body ◽  
Wall Thickening ◽  
Temperature Sensitive ◽  
Main Function ◽  
Care Hospital ◽  
Sperm Production ◽  
Time Duration ◽  
Anterior Posterior

Main function of scrotum is to hold testes at optimal temperature for spermatogenesis. Sperm production in the testes is a temperature sensitive process. It requires an environment that is 2 to 6°C cooler than the body core. The temperature of the testes is regulated by the scrotal wall. Tunica dartos muscle changes the surface area of the scrotal skin by contracting or relaxing depending on the ambient temperature. This study postulates that if the thickness or the tone of this muscle is more thereby contributing to scrotal wall thickening, it will hamper the thermoregulation and spermatogenesis leading to poor sperm production. This could be an besides varicocoele another cause of male infertility which has been an established cause. This study will help to suspect the patients of infertility caused by thick scrotal wall. This study is aimed to study scrotal wall thickness and with the help of Ultrasonography. to establish norms The study was conducted at department of Radio-diagnosis at the tertiary care hospital, Sangli. The study started after approval of institutional ethical committee. This is a cross sectional observational study for the duration of 4 months. Total number of 50 cases was achieved in this time duration which satised the inclusion criteria. Statistical method used was Student's T test. Scrotal ultrasonography was performed using linear and curvilinear probe with sta (5-12 MHz) (2-5 MHz) on Philips Afniti50, after ndoff pad allowing some time for the dartos muscle to relax and scrotal wall thickness is measured on either side on three surfaces (anterior, posterior and lateral) and means were obtained. This study found that there was no difference between anterior, posterior, lateral wall thicknesses on ipsilateral side or contralateral side. There is no need to take three different wall thicknesses and convenience and suitability of any scrotal wall thickness would be equally effective.

scholarly journals Monitoring of Sugammadex Dosing at a Large Tertiary Care Pediatric Hospital

2018 ◽  
Vol 3 (5) ◽  
pp. e113 ◽  
Author(s):  
Faizaan Syed ◽  
Mehdi Trifa ◽  
Joshua C. Uffman ◽  
Dmitry Tumin ◽  
Joseph D. Tobias
Keyword(s):  
Tertiary Care ◽  
Pediatric Hospital ◽  
Large Tertiary Care

scholarly journals Relationship between Drug-Induced Sleep Endoscopy Findings, Tonsil Size, and Polysomnographic Outcomes of Adenotonsillectomy in Children

2019 ◽  
Vol 161 (3) ◽  
pp. 507-513 ◽  
Author(s):  
Derek J. Lam ◽  
Natalie A. Krane ◽  
Ron B. Mitchell
Keyword(s):  
Rating Scale ◽  
Tertiary Care ◽  
Case Series ◽  
Apnea Hypopnea Index ◽  
Strongly Correlated ◽  
Sleep Endoscopy ◽  
Retrospective Case ◽  
Drug Induced ◽  
Failure Assessment ◽  
The Relationship

Objective (1) Determine the correlation of awake tonsil scores and preadenotonsillectomy (pre-AT) sleep endoscopy findings. (2) Assess the relationship between polysomnographic AT outcomes with awake tonsil scores and sleep endoscopy ratings of tonsil and adenoid obstruction. Study Design Retrospective case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods Children aged 1 to 18 years who underwent sleep endoscopy and AT from January 1, 2013, to August 30, 2016, were included. Pre-AT sleep endoscopy findings were scored with the Sleep Endoscopy Rating Scale. Awake tonsil scores and sleep endoscopy ratings were compared with Spearman correlation. Associations between changes in pre- and post-AT polysomnography parameters and (1) awake tonsil scoring and (2) sleep endoscopy scoring were assessed with 1-way analysis of variance and linear regression. Results Participants included 36 children (mean ± SD age, 6.8 ± 4.3 years; 68% male, 44% obese). Awake tonsil scores and sleep endoscopy ratings were strongly correlated ( R = 0.58, P = .003). Awake tonsil scores were not associated with changes in any polysomnography parameters after AT (all P > .05), while sleep endoscopy ratings of adenotonsillar obstruction were significantly associated (all P < .05, R2 = 0.16-0.35). Patients with minimal adenotonsillar obstruction during sleep endoscopy had less improvement than those with partial or complete obstruction (mean obstructive apnea-hypopnea index change: −8.2 ± 11.5 vs −15.9 ± 14.3, and −46.8 ± 31.3, respectively; P < .001). Conclusions In children at risk for AT failure, assessment of dynamic collapse with sleep endoscopy may better predict the outcome of AT than awake tonsil size assessment, thus helping to inform surgical expectations.

scholarly journals Sacred Cow University: Revealing the Evidence About Intramuscular Injections by Pediatric Nurses in a Tertiary Care Pediatric Hospital

2019 ◽  
Vol 48 ◽  
pp. 123-126
Author(s):  
Melissa Davis ◽  
Iva Scroggins ◽  
Bobby Bellflower ◽  
Janet Tucker ◽  
Leslie N. Rhodes ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Pediatric Nurses ◽  
Pediatric Hospital ◽  
Intramuscular Injections

Botulinum toxin as adjunctive therapy in refractory laryngeal granuloma

2007 ◽  
Vol 122 (8) ◽  
pp. 824-828 ◽  
Author(s):  
E J Damrose ◽  
J F Damrose
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Tertiary Care ◽  
Voice Quality ◽  
Vocal Folds ◽  
Botulinum Toxin Type ◽  
Care Hospital ◽  
Percutaneous Injection ◽  
Vocal Process

AbstractObjective:This study evaluated the role of botulinum toxin type A in the treatment of refractory laryngeal granulomas.Study design and setting:Retrospective clinical review at a tertiary care hospital. Seven patients with vocal process granulomas underwent percutaneous injection of botulinum toxin into both vocal folds, performed in an office setting. Total doses ranged from 10 to 25 U, divided between both vocal folds.Results:All patients experienced resolution of their granulomas over two to seven weeks. No patient developed aspiration pneumonia. All patients experienced hoarseness secondary to the injections, but voice quality returned to baseline in all patients as the toxin was degraded.Conclusions:Botulinum toxin is safe and effective therapy in resolving vocal process granulomas in patients refractory to traditional therapy. The optimal treatment dose remains to be determined.Significance:Percutaneous botulinum toxin injection is helpful in resolving laryngeal granulomas.

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