Diagnosis and management of deformational plagiocephaly

2009 ◽  
Vol 3 (4) ◽  
pp. 284-295 ◽  
Author(s):  
Shenandoah Robinson ◽  
Mark Proctor
Keyword(s):  
Physical Therapy ◽  
Parental Education ◽  
Well Being ◽  
Class Ii ◽  
Deformational Plagiocephaly ◽  
Subsequent Increase ◽  
Diagnosis And Management ◽  
Healthy Infants ◽  
Objective Evidence ◽  
Life Threatening

Object The increase in the prevalence of nonsynostotic occipital deformational plagiocephaly in infants, which resulted from the American Academy of Pediatrics' 1992 recommendation to have healthy infants sleep supine, has been accompanied by significant controversy in diagnosis and management. The controversy was exacerbated by the 1998 FDA classification of cranial orthotic devices as Class II devices requiring premarket notification, and the subsequent increase in treatment-associated costs. Methods Two independent reviews of the literature were conducted to clarify the objective evidence available within the context of pediatric craniofacial knowledge. Results . Although deformational plagiocephaly is not a life-threatening problem, it is a source of disfigurement for children that may be detrimental to their well-being. Current methods for quantifying the degree of disfigurement have limited interrater reliability, and no prospective randomized controlled trials comparing the efficacy of cranial orthoses to repositioning and physical therapy protocols have been published. Despite this lack of Class I evidence, cranial orthoses are routinely and effectively used to treat persistent severe deformational plagiocephaly. The need for the current FDA regulations has not been supported by clinical experience and reported complications. Conclusions This review resulted in the following recommendations: 1) more parental education is needed to minimize the development and progression of deformational plagiocephaly; 2) mild deformity can be treated with repositioning and physical therapy protocols; and 3) severe deformity is likely to be corrected more quickly and effectively with cranial orthosis (when used during the appropriate period of infancy) than with repositioning and physical therapy. The available data do not support the need for FDA classification for cranial orthoses as Class II devices requiring premarket notification. Removal of the regulations, which centralized production of the orthoses to larger companies and markedly increased charges, will probably eliminate much of the controversy and parental anxiety generated by marketing strategies.

scholarly journals Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine

2021 ◽  
Author(s):  
Andreas Brännström ◽  
Albin Dahlquist ◽  
Jenny Gustavsson ◽  
Ulf P. Arborelius ◽  
Mattias Günther
Keyword(s):  
Fluid Management ◽  
Class Ii ◽  
Balloon Occlusion ◽  
Metabolic Effects ◽  
Total Blood ◽  
Crystalloid Fluid ◽  
Vasopressor Support ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Abstract Purpose Pelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg. Methods 60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion. Results Cumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support. Conclusion Zone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

scholarly journals Concussion Knowledge among Medical Students and Neurology/Neurosurgery Residents

2012 ◽  
Vol 39 (3) ◽  
pp. 361-368 ◽  
Author(s):  
Miranda Boggild ◽  
Charles H. Tator
Keyword(s):  
Medical Students ◽  
Chronic Traumatic Encephalopathy ◽  
Sample Population ◽  
Diagnosis And Management ◽  
University Of Toronto ◽  
Concussion Management ◽  
Life Threatening ◽  
Concussion History ◽  
The University ◽  
Impact Syndrome

Background and Objectives:Concussion is a prevalent brain injury in the community. While primary prevention strategies need to be enhanced, it is also important to diagnose and treat concussions expertly and expeditiously to prevent serious complications that may be life-threatening or long lasting. Therefore, physicians should be knowledgeable about the diagnosis and management of concussions. The present study assesses Ontario medical students’ and residents’ knowledge of concussion management.Methods:A survey to assess the knowledge and awareness of the diagnosis and treatment of concussions was developed and administered to graduating medical students (n= 222) and neurology and neurosurgery residents (n = 80) at the University of Toronto.Results:Residents answered correctly significantly more of the questions regarding the diagnosis and management of concussions than the medical students (mean = 5.8 vs 4.1, t= 4.48, p<0.01). Gender, participation in sports, and personal concussion history were not predictive of the number of questions answered correctly. Several knowledge gaps were identified in the sample population as a whole. Approximately half of the medical students and residents did not recognize chronic traumatic encephalopathy (n = 36) or the second impact syndrome (n = 44) as possible consequences of repetitive concussions. Twenty-four percent of the medical students (n = 18) did not think that “every concussed individual should see a physician” as part of management.Conclusions:A significant number of medical students and residents have incomplete knowledge about concussion diagnosis and management. This should be addressed by targeting this population during undergraduate medical education.

scholarly journals Breathing: A Sign of Life and a Unique Area for Reflection and Action

2008 ◽  
Vol 88 (7) ◽  
pp. 832-840 ◽  
Author(s):  
Kirsten Ekerholt ◽  
Astrid Bergland
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
Well Being ◽  
Qualitative Approach ◽  
Breathing Patterns ◽  
Daily Lives ◽  
The World ◽  
Body And Soul ◽  
Bodily Sensations ◽  
Conscious Attention

Background and Purpose The aim of this study was to clarify patients’ experiences of breathing during therapeutic processes in Norwegian psychomotor physical therapy (NPMP). Subjects and Methods A qualitative approach was used based on interviews with 9 women and 1 man aged between 41 and 65 years. The data were analyzed with the aid of grounded theory. Results Three categories were identified from the participants’ experiences: (1) “Breathing: An Incomprehensible and Disparate Phenomenon,” (2) “Breathing: Access to Meaning and Understanding,” and (3) “Breathing: Enhancing Feelings of Mastery.” Initially, breathing difficulties and bodily pains were described as physical reactions that seemed utterly incomprehensible to the participants. Communication, both verbal and nonverbal, between the patient and the physical therapist was described as vitally important, as was conscious attention to occurrences during the treatment sessions. The participants learned to recognize changes in their breathing patterns, and they became familiar with new bodily sensations. Consequently, they acquired new understanding of these sensations. The feeling and understanding of being an entity (ie, “body and soul”) emerged during therapy. The participants increased their understanding of the interaction between breathing and internal and external influences on their well-being. Their feelings of mastery over their daily lives were enhanced. The therapeutic dialogues gave them the chance to explore, reflect, and become empowered. Discussion and Conclusion In experiencing their own breathing, the participants were able to access and identify the muscular and emotional patterns that, linked to particular thoughts and beliefs, had become their characteristic styles of relating to themselves and the world.

Catastrophic Antiphospholipid Syndrome Following Lower Extremity Arterial Bypass Surgery: Case Report and Evidence Review

2021 ◽  
pp. 153857442110462
Author(s):  
Ahmed A. Sorour ◽  
Levester Kirksey ◽  
Sarah Keller ◽  
Michael S. O’Connor ◽  
Sean P. Lyden
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Antiphospholipid Syndrome ◽  
Current Literature ◽  
Bypass Surgery ◽  
Multidisciplinary Approach ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Diagnosis And Management ◽  
Life Threatening ◽  
Evidence Review

Catastrophic antiphospholipid syndrome (CAPS) is a rare life threatening presentation of antiphospholipid syndrome. Surgery has been proposed as one of the triggering factors for this life threatening entity. There are no detailed published reports in the current literature describing CAPS as a complication after surgery. We report a case of a 21 year old that developed CAPS postoperatively and discuss the multidisciplinary approach for diagnosis and management.

scholarly journals Understanding parent concerns about children’s diet, activity and weight status: an important step towards effective obesity prevention interventions

2009 ◽  
Vol 13 (8) ◽  
pp. 1221-1228 ◽  
Author(s):  
Amy Slater ◽  
Jane Bowen ◽  
Nadia Corsini ◽  
Claire Gardner ◽  
Rebecca Golley ◽  
...  
Keyword(s):  
Parental Education ◽  
Weight Status ◽  
Well Being ◽  
Computer Assisted ◽  
Parental Education Level ◽  
Parental Concerns ◽  
Parental Characteristics ◽  
Prevention Interventions ◽  
Influence Of Food ◽  
Parent Concerns

AbstractObjectiveTo identify parents’ concerns and attitudes towards children’s diets, activity habits and weight status.DesignComputer-assisted telephone interviewing administration of a 37-item survey. Data were weighted for parental education level. Descriptive results are presented, and comparisons are made by the age, gender and parental characteristics of the child.SettingOnline research panel of Australian parents.SubjectsA total of 1202 randomly selected parents of children aged 2–16 years, broadly representative of the Australian population.ResultsParents were concerned about their child’s education (reported by 35 % of respondents), child’s health and well-being (25 %), and violence, drugs and alcohol (20 %). Concern about nutrition was indicated by 14 % of respondents and concern about fitness/exercise was indicated by 3 % of the sample. Factors perceived as making a healthy diet difficult to achieve for their child were child resistance (89 %), the availability of healthy food (72 %), a busy lifestyle (67 %) and the influence of food advertising (63 %). Ninety-two per cent of parents thought that it was realistic for their child to be active for at least 1 h/d, with 75 % of parents feeling that it was realistic for their child to have less than 2 h recreational screen time per d. Despite this, common barriers to achieving the activity guidelines were lack of time, weather and keeping children occupied.ConclusionsInsights into parental concerns from the current study may be useful in guiding development of interventions to improve children’s nutrition and physical activity habits by framing messages in a way that are most likely to resonate with parents.

Relations of Post-traumatic Growth and Resilience in Cancer Experience

2017 ◽  
Vol 41 (S1) ◽  
pp. S672-S672 ◽  
Author(s):  
Y.S. Uzar Ozcetin ◽  
D. Hicdurmaz
Keyword(s):  
Human Life ◽  
Well Being ◽  
Traumatic Experience ◽  
Physical Problems ◽  
Post Traumatic Growth ◽  
Life Threatening ◽  
Post Traumatic ◽  
Competing Interest ◽  
Mutual Relations ◽  
Cancer Experience

IntroductionEach individual experience cancer in a different way. While some perceive cancer as a complex and traumatic experience by developing some psychosocial and additional physical problems, others overcome cancer-related difficulties by gaining benefits such as post-traumatic growth (PTG) owing to their resilience. Resilience and PTG that are very valuable concepts in human life to adapt positively to cancer process have relations which need to be better understood.ObjectivesWe aimed to provide a better understanding of relations between resilience and PTG and relations of these two concepts with cancer experience.MethodsLiterature review.ResultsSuccessful adjustment to life-threatening illnesses such as cancer, require resilience. On the other hand, resilience provides a barrier toward stressors by helping improvement of PTG and so, is an antecedent factor of PTG. PTG ensures a deeper perspective and strength to people after traumatic events. Hence, individuals having higher levels of PTG feel powerful enough to handle the problems in their life and can easily adapt to cancer process by focusing on the positive outcomes of trauma, having improved coping mechanisms and an improved psychological well-being.ConclusionsResilience and PTG have strong mutual relations and this phenomenon should be considered for a qualified cancer care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Scapulothoracic dissociation

2019 ◽  
Vol 92 (1101) ◽  
pp. 20190090
Author(s):  
Kimia Khalatbari Kani ◽  
Felix S Chew
Keyword(s):  
Differential Diagnosis ◽  
Shoulder Girdle ◽  
High Energy ◽  
Imaging Evaluation ◽  
Acute Setting ◽  
High Energy Trauma ◽  
Diagnosis And Management ◽  
Life Threatening ◽  
Spectrum Imaging ◽  
Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

scholarly journals A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Andy Hau Yan Ho ◽  
Oindrila Dutta ◽  
Geraldine Tan-Ho ◽  
Toh Hsiang Benny Tan ◽  
Casuarine Xinyi Low ◽  
...  
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Well Being ◽  
Mobile App ◽  
Pediatric Palliative Care ◽  
Writing Intervention ◽  
Open Label ◽  
Web Based ◽  
Randomized Controlled ◽  
Life Threatening

BACKGROUND A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. OBJECTIVE This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. METHODS The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. RESULTS Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. CONCLUSIONS NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. CLINICALTRIAL ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17561

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