scholarly journals Friend or Frenotomy: A Single Institution’s Experience With Ankyloglossia

2021 ◽  
Author(s):  
Aine Kelly ◽  
Mel Corbett ◽  
Eoin Cleere ◽  
Aishan Patil ◽  
Matthew G Davey ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Hospital Setting ◽  
Clinical Information ◽  
District General Hospital ◽  
Outpatient Setting ◽  
Developmental Problems ◽  
Clinical Consultation ◽  
Lactation Consultants ◽  
Available Information ◽  
Nose And Throat

Abstract Introduction/AimAnkyloglossia, or ‘tongue-tie’, is a common congenital anomaly in which a short lingual frenulum or genioglossus muscle restricts tongue movement. Ankyloglossia can be graded from 1 (most severe) to 4 (least severe). The effects of ankyloglossia can include breastfeeding and articulation issues; however, many infants will have no symptoms or developmental problems. The surgical intervention for ankyloglossia is frenotomy. This can be performed in the outpatient setting in small infants. Ankyloglossia referrals in neonates and small infants necessitate an urgent referral to the ear nose and throat (ENT) clinic in order to facilitate breast feeding and weight gain. We sought to analyse the ankyloglossia service in a district general hospital setting from referral to outpatient clinic. MethodsWe retrospectively analysed a consecutive cohort of babies referred to the Ear Nose and Throat service for consideration of frenotomy over an 18 month period, We analysed data from referral including demographics and clinical information, we recorded information from the clinical consultation and procedure details if frenotomy was performed.ResultsBetween 1 January 2019 and 31 January 2021 referrals were made for consideration of frenotomy, all appointments were seen within 2 weeks. 55.3% of referrals were sent from public health nurses, 25.5% from primary care, 10.6% from lactation consultants and 8.5% from paediatric consultants. Of 47 referrals, a frenotomy was performed in 30 babies. All frenotomies were performed without complications.ConclusionInformation on ankyloglossia is varied and available information is conflicting, without any clear standardised guideline or treatment algorithm. Referral indications can be unclear and result in unnecessary clinic appointments in an already heavily burdened service. Frenotomy can be performed safely by a trained clinician in an outpatient setting with minimal equipment.

scholarly journals 307 Improving Compliance with Standard of Care Guidelines for Suspected Cauda Equina Syndrome Across A District General Hospital Network

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
D Richardson ◽  
F Greenway ◽  
A Mostofi ◽  
E Pereira
Keyword(s):  
Cauda Equina Syndrome ◽  
Guideline Implementation ◽  
Cauda Equina ◽  
Clinical Information ◽  
Standard Of Care ◽  
District General Hospital ◽  
Service Improvement ◽  
Local Policy ◽  
National Guidelines ◽  
Care Guidelines

Abstract Introduction Cauda equina syndrome (CES) is a spinal emergency that cannot be reliably detected through clinical examination alone and as a result requires prompt MR imaging to provide a diagnosis. This audit examined compliance to standard of care following service improvements in line with the updated SBNS/BASS national guidelines for CES. Method A retrospective analysis of 200 patients referred to neurosurgery for suspected CES: 100 pre- and 100 post-service improvement SBNS guideline implementation. The online neurosurgical database was reviewed, cases assessed for completeness of referral information (including appropriate exam and pre-referral MRI) with patient demographics, referring hospital and outcome also recorded. Results Prior to the SBNS guidelines only 19 patients received MRI prior to referral, 70% of all referrals were incomplete or contained erroneous clinical information. Post-service improvements there was a 68% increase of pre-referral MRI (32 cases), and an improvement in quality of clinical information with only 19% of referrals providing insufficient or unreliable information. Conclusions Through relatively simple changes to local policy, patient care flow and education of emergency department clinicians we have significantly improved pre-referral MRI rates as well as overall referral quality across the whole DGH network.

scholarly journals The workload of stroke thrombolysis: A prospective study in a district general hospital setting

2011 ◽  
Vol 10 (1) ◽  
pp. 10-12
Author(s):  
Seán J Slaght ◽  
◽  
Nic U Weir ◽  
Joanna K Lovett ◽  
◽  
...  
Keyword(s):  
Prospective Study ◽  
General Hospital ◽  
Hospital Setting ◽  
District General Hospital ◽  
Service Planning ◽  
Stroke Severity ◽  
Southampton General Hospital ◽  
Stroke Thrombolysis ◽  
Few Data ◽  
A Prospective Study

Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated. We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 – January 2010, in Southampton General Hospital. 128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%). Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.

scholarly journals Contributions of Robotics to the Safety and Efficacy of Invasive Monitoring With Stereoelectroencephalography

2020 ◽  
Vol 11 ◽  
Author(s):  
Amir H. Faraji ◽  
Madison Remick ◽  
Taylor J. Abel
Keyword(s):  
Clinical Information ◽  
Epileptogenic Zone ◽  
Invasive Monitoring ◽  
Monitoring Methods ◽  
Robot Assisted ◽  
Safety And Efficacy ◽  
Implantation Techniques ◽  
Available Information ◽  
Single Technique ◽  
Low Rate

The purpose of this review is to provide a discussion of the history and utility of robotics in invasive monitoring for epilepsy surgery using stereoelectroencephalography (sEEG). The authors conducted a literature review of available sources to describe how the advent of surgical robotics has improved the efficacy and ease of performing sEEG surgery. The sEEG method integrates anatomic, electrographic, and clinical information to test hypotheses regarding the localization of the epileptogenic zone (EZ) and has been used in Europe since the 1950s. One of the primary benefits of robot-assisted sEEG implantation techniques is the ability to seamlessly transition between both orthogonal and oblique trajectory types using a single technique. Based on available information, it is our view that, when applied appropriately, robotic sEEG can have a low rate of complications and many advantages over both non-robotic sEEG implantation and traditional craniotomy-based invasive monitoring methods.

scholarly journals ECG in suspected pulmonary embolism

2019 ◽  
Vol 95 (1119) ◽  
pp. 12-17 ◽  
Author(s):  
Duncan Thomson ◽  
Georgios Kourounis ◽  
Rebecca Trenear ◽  
Claudia-Martina Messow ◽  
Petr Hrobar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Setting ◽  
District General Hospital ◽  
Diagnostic Value ◽  
Suspected Pulmonary Embolism ◽  
Ecg Changes ◽  
Retrospective Case ◽  
Strain Pattern ◽  
Pulmonary Angiogram ◽  
Large Clot

ObjectiveTo establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).MethodsRetrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE.Results20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005).ConclusionAn ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.

scholarly journals L’INTERVENTO NUTRIZIONALE NEI DISTURBI DEL COMPORTAMENTO ALIMENTARE

2020 ◽  
Author(s):  
Maria Letizia Petroni
Keyword(s):  
Quality Of Life ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Hospital Setting ◽  
Nutritional Intervention ◽  
Outpatient Setting ◽  
Therapeutic Education ◽  
Motor Rehabilitation ◽  
Nutritional Rehabilitation

The nutritional intervention is a cornerstone of the treatment of eating disorders. Most serious cases are being treated first by parenteral and/or enteral nutrition, carefully to prevent the re-feeding syndrome that can have fatal consequences. Once patient is clinically stable, integrated intervention can be started: medical, nutritional, psychological, motor, rehabilitation and therapeutic education may take place initially in a hospital setting and then in an outpatient setting. The nutritional rehabilitation in anorexia nervosa can be conducted with the mode of the mechanical feeding or with that of desensitization of anxiety by food. Goal is the gradual normalization of weight and nutrition and improving the quality of life of the patient.

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