scholarly journals Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients

2015 ◽  
Vol 16 (3) ◽  
pp. 340-345 ◽  
Author(s):  
Brian K. Owler ◽  
Kathryn A. Browning Carmo ◽  
Wendy Bladwell ◽  
T. Arieta Fa’asalele ◽  
Jane Roxburgh ◽  
...  
Keyword(s):  
Head Injuries ◽  
Pediatric Neurosurgery ◽  
Lessons Learned ◽  
Neurological Deficits ◽  
Pediatric Care ◽  
Start Time ◽  
Tertiary Center ◽  
Metropolitan Hospital ◽  
Time Critical ◽  
Median Interval

OBJECT Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients’ distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. METHODS A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. RESULTS Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29–05:20 hours). The median distance traveled to reach a patient was 232 km (range 23–637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47–03:37 hours). The estimated median “time saved” was approximately 3:00 hours (IQR 1:44–3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56–10:08 hours). CONCLUSIONS Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

Overcoming Obstacles to Breast-Feeding in a Large Municipal Hospital: Applications of Lessons Learned

PEDIATRICS ◽  
1987 ◽  
Vol 80 (3) ◽  
pp. 423-433
Author(s):  
Beverly Winikoff ◽  
Deborah Myers ◽  
Virginia Hight Laukaran ◽  
Richard Stone
Keyword(s):  
Breast Feeding ◽  
Professional Education ◽  
Routine Care ◽  
Control Site ◽  
Lessons Learned ◽  
Pediatric Care ◽  
Institutional Constraints ◽  
Municipal Hospital ◽  
Intervention Site ◽  
Intensive Training

A project to overcome institutional constraints to breast-feeding was implemented in a large municipal hospital. Interventions included staff education, intensive training of a team of physicians and nurses, development of user-tested educational materials, and day and evening staffing by a breast-feeding counselor. A nearby hospital served as a control. Project evaluation entailed chart reviews at the intervention site and a control hospital (n = 812); interviews with mothers during their postpartum hospital stay and at return clinic visits (n = 180); and field observations in all areas of the hospital that provided prenatal, intrapartum, postpartum, and pediatric care. Comparisons of the incidence and pattern of breast-feeding were made before, midway through, and after the project. At the intervention site, the incidence of breast-feeding increased from 15% to 56%, and exclusive breast-feeding for more than 3/4 of feedings increased from 0% to 15%. At the control site, the respective changes were from 28% to 41% and from 5% to 7%. Formula use by breast-feeding women decreased but was nonetheless extensive, and the usual reason given by breast-feeding women for supplementation was a perceived insufficiency of breast milk. This may be due, in part, to the fact that bedside assistance to breast-feeding mothers was not integrated into the routine care provided by staff nurses but was relegated to the lactation nurse/counselors who were not available at all times. It is concluded that the process to overcome institutional constraints to breast-feeding is difficult but feasible. Repeated and extensive professional education helps create the context whereby clinical and administrative staff can reassess routines and policies.

Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial

2021 ◽  
pp. 1-8
Author(s):  
Esmaeil Mohammadi ◽  
Sina Azadnajafabad ◽  
Mehrdad Goudarzi ◽  
Keyvan Tayebi Meybodi ◽  
Farideh Nejat ◽  
...  
Keyword(s):  
Single Dose ◽  
Multiple Dose ◽  
Antimicrobial Prophylaxis ◽  
Meta Analysis ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Total Cohort ◽  
Neurosurgical Patients ◽  
Tertiary Center

OBJECTIVE Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. METHODS All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score–matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88–1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. RESULTS The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27–1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12–3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14–2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13–3.31). CONCLUSIONS No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.

scholarly journals Exacerbation of Pre-existing Epilepsy by Mild Head Injury: a Five Patient Series

2004 ◽  
Vol 31 (3) ◽  
pp. 394-397 ◽  
Author(s):  
P.C. Tai ◽  
D.W. Gross
Keyword(s):  
Head Injury ◽  
Temporal Relationship ◽  
Seizure Control ◽  
Head Injuries ◽  
Neurological Deficits ◽  
Mild Head Injury ◽  
Primary Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
One Year ◽  
Patients With Epilepsy

Objective:While the risk of developing seizures following a mild head injury has been reported and is thought to be low, the effect of mild head injury on patients with a pre-existing seizure disorder has not been reported. We present a series of cases where a strong temporal relationship between mild head injury and worsening of seizure frequency was observed.Methods:Five cases were identified and reviewed in detail. Information was derived from clinic and hospital charts with attention to the degree of injury, pre- and postinjury seizure patterns and frequency.Results:One patient has primary generalized epilepsy and four have localization related epilepsy. Prior to the head injury, three of the patients were seizure free (range: two to 24 years). The patients suffered from mild head injuries with no or transient loss of consciousness and no focal neurological deficits. In all cases, the patients experienced a worsening of seizure control within days of the injury. In one case, the patient's seizure pattern returned to baseline one year after the accident, while in the remaining four cases, the patients continue to have medically refractory seizures.Conclusion:A close temporal relationship between mild head injury and a worsening of seizure control was observed in five patients with epilepsy. Although further study is required, this observation suggests that a head injury that would be considered benign in the general population can have serious consequences such as recurrence of seizures and medical intractability in patients with epilepsy.

scholarly journals A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Bo Wang ◽  
Oliver Van Oekelen ◽  
Tarek H. Mouhieddine ◽  
Diane Marie Del Valle ◽  
Joshua Richter ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Lessons Learned ◽  
Tertiary Center

Prospective Staged Volume Radiosurgery for Large Arteriovenous Malformations: Indications and Outcomes in Otherwise Untreatable Patients

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 17-27 ◽  
Author(s):  
Sait Sirin ◽  
Douglas Kondziolka ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
Ann H. Maitz ◽  
...  
Keyword(s):  
Target Volume ◽  
Neurological Deficits ◽  
University Of Pittsburgh ◽  
Brain Avm ◽  
Last Stage ◽  
Two Stages ◽  
The University ◽  
Median Margin ◽  
Median Interval

Abstract OBJECTIVE: The obliteration response of an arteriovenous malformation (AVM) to radiosurgery is strongly dependent on dose and volume. For larger volumes, the dose must be reduced for safety, but this compromises obliteration. In 1992, we prospectively began to stage anatomic components in order to deliver higher single doses to symptomatic AVMs &gt;15 ml in volume. METHODS: During a 17-year interval at the University of Pittsburgh, 1040 patients underwent radiosurgery for a brain AVM. Out of 135 patients who had multiple procedures, 37 patients underwent prospectively staged volume radiosurgery for symptomatic otherwise unmanageable larger malformations. Twenty-eight patients who were managed before 2002 were included in this study to achieve sufficient follow-up in assessing the outcomes. The median age was 37 years (range, 13–57 yr). Thirteen patients had previous hemorrhages and 13 patients had attempted embolization. Separate anatomic volumes were irradiated at 3 to 8 months (median, 5 mo) intervals. The median initial AVM volume was 24.9 ml (range, 10.2–57.7 ml). Twenty-six patients had two stages and two had three-stage radiosurgery. Seven patients had repeat radiosurgery after a median interval of 63 months. The median target volume was 12.3 ml. (range, 4.2–20.8 ml.) at Stage I and 11.5 ml. (range, 2.8–22 ml.) at Stage II. The median margin dose was 16 Gy at both stages. Median follow-up after the last stage of radiosurgery was 50 months (range, 3–159 mo). RESULTS: Four patients (14%) sustained a hemorrhage after radiosurgery; two died and two patients recovered with mild permanent neurological deficits. Worsened neurological deficits developed in one patient. Seizure control was improved in three patients, was stable in eight patients and worsened in two. Magnetic resonance imaging showed T2 prolongation in four patients (14%). Out of 28 patients, 21 had follow-up more than 36 months. Out of 21 patients, seven underwent repeat radiosurgery and none of them had enough follow- up. Of 14 patients followed for more than 36 months, seven (50%) had total, four (29%) near total, and three (21%) had moderate AVM obliteration. CONCLUSIONS: Prospective staged volume radiosurgery provided imaging defined volumetric reduction or closure in a series of large AVMs unsuitable for any other therapy. After 5 years, this early experience suggests that AVM related symptoms can be stabilized and anticipated bleed rates can be reduced.

scholarly journals Endovascular treatment of acute ischemic stroke: the end or just the beginning?

2014 ◽  
Vol 36 (1) ◽  
pp. E5 ◽  
Author(s):  
Maxim Mokin ◽  
Alexander A. Khalessi ◽  
J Mocco ◽  
Giuseppe Lanzino ◽  
Travis M. Dumont ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Trials ◽  
Intravenous Thrombolysis ◽  
Lessons Learned ◽  
Neurological Deficits ◽  
Medical Community ◽  
Current Status

Various endovascular intraarterial approaches are available for treating patients with acute ischemic stroke who present with severe neurological deficits. Three recent randomized trials—Interventional Management of Stroke (IMS) III, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke (SYNTHESIS Expansion)—evaluated the efficacy of endovascular treatment of acute ischemic stroke and, after failing to demonstrate any significant clinical benefit of endovascular therapies, raised concerns and questions in the medical community regarding the future of endovascular treatment for acute ischemic stroke. In this paper, the authors review the evolution of endovascular treatment strategies for the treatment of acute stroke and provide their interpretation of findings and potential limitations of the three recently published randomized trials. The authors discuss the advantage of stent-retriever technology over earlier endovascular approaches and review the current status and future directions of endovascular acute stroke studies based on lessons learned from previous trials.

The impact-absorbing effects of facial fractures in closed-head injuries

1987 ◽  
Vol 66 (4) ◽  
pp. 542-547 ◽  
Author(s):  
K. Francis Lee ◽  
Louis K. Wagner ◽  
Y. Eugenia Lee ◽  
Jung Ho Suh ◽  
Seung Ro Lee
Keyword(s):  
Head Injuries ◽  
Closed Head Injury ◽  
Neurological Deficits ◽  
Facial Fractures ◽  
Contingency Table Analysis ◽  
Chi Square ◽  
Content Type ◽  
Closed Head ◽  
Table Analysis ◽  
The Impact

✓ A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.

scholarly journals Effect of Designed Practice Guidelines on Nurses’ Performance and Outcome of Children with Head Injuries

2020 ◽  
Vol 1 (2) ◽  
pp. 12
Author(s):  
Khadiga M. Said ◽  
Safaa F. Deraz ◽  
Amal G. Sebaq
Keyword(s):  
Brain Injury ◽  
Head Injury ◽  
Practice Guidelines ◽  
Head Injuries ◽  
Management Strategies ◽  
Pediatric Neurosurgery ◽  
Personal Characteristic ◽  
University Hospital ◽  
Knowledge And Practice ◽  
Nurses Knowledge

Contexts Acute head injury resulting from a trauma to the head, leading to brain injury or bleeding within the brain, it can cause edema and hypoxia. Head injury is the leading cause of death in the first four decades of life. Effective nursing management strategies for children with severe traumatic brain injury are still a remarkable issue and a difficult task for neurologists, neurosurgeons, and nurses. Aim: To evaluate the effect of designed practice guidelines on nurses' performance regarding the care of children with head injuries. Methods: A quasi-experimental research design utilized to conduct the current study on pediatric neurosurgery departments of Benha University Hospital and Benha Teaching Hospital. A purposive sample of 72 children with head injuries and a convenient sample of all available nurses. They were 62 nurses who are working on the previously mentioned study settings. Four tools used to collect data in this study. A structured interviewing questionnaire sheet developed to assess the studied nursing personal characteristic of the studied nurses and nurses' knowledge regarding head injuries. Child medical data record developed to assess children's personal and head injuries characteristics for children. Glasgow coma scale adopted to assess the child conscious level. Observational checklists to assess the actual nurses' practices regarding the care of children with head injuries. Results: There was a statistically significant improvement in nurses' knowledge and practice regarding the care of children with head injuries before and after the implementation of designed practice guidelines (p˂0.001). There was a statistically significant improvement regarding the occurrence of convulsion after the implementation of the program. Conclusion: The study concluded that the implementation of designed practice guidelines for nurses improves their knowledge and practice as well as reduced occurrence of frequency, duration, and timing of convulsion, which support the current research hypotheses. The study emphasizing the importance of implementing of designed practice guidelines for nurses caring of children with a head injury to reduce the occurrence of head injury complications, which is an effective and safe non-invasive intervention in neurosurgery and emergency departments as a standard of care for all head-injured children.

Management of Penetrating Head Injuries: Lessons Learned

2014 ◽  
Vol 82 (1-2) ◽  
pp. 25-26 ◽  
Author(s):  
Gerald A. Grant
Keyword(s):  
Head Injuries ◽  
Lessons Learned
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