scholarly journals Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion

2020 ◽  
Vol 26 (2) ◽  
pp. 165-170
Author(s):  
Shawn R. Eagle ◽  
Anish Puligilla ◽  
Vanessa Fazio-Sumrok ◽  
Nathan Kegel ◽  
Michael W. Collins ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Recovery Time ◽  
Clinical Care ◽  
Late Presentation ◽  
Clinic Visit ◽  
Early Presentation ◽  
Prolonged Recovery ◽  
History Of ◽  
Presentation Group

OBJECTIVENo studies to date have investigated the role of early clinical care in time to recovery from concussion in a pediatric population. The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days [early] compared to 8–20 days [late] from injury) in concussion assessment performance and risk for prolonged recovery (> 30 days) in pediatric concussion.METHODSThis study is a retrospective cross-sectional study from a concussion clinic between April 2016 and January 2019, including 218 children and adolescents with diagnosed concussion, separated based on clinic presentation timing following injury: early (≤ 7 days) and late (8–20 days). Outcomes were recovery time, Postconcussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screen (VOMS), and demographics, medical history, and injury information. A general linear model and chi-square analyses were used to assess differences between early and late presentation, along with logistic regression, to predict prolonged recovery (> 30 days).RESULTSThose with early presentation reported higher symptoms on VOMS subtests (79%–85%) compared to those with late presentation (61%–78%), with the exception of near-point of convergence distance and visual motion sensitivity (VMS). The strongest predictor of prolonged recovery was number of days to first clinic visit (OR 9.8). Positive VMS (OR 5.18), history of headache/migraine (OR 4.02), and PCSS score (OR 1.04) were also predictive of prolonged recovery.CONCLUSIONSDespite patients in the early presentation group presenting with more positive VOMS scores, the early presentation group recovered sooner than patients in the late presentation group. Even after controlling for vestibular dysfunction, history of headache or migraine, and total symptom severity, days to first visit remained the most robust predictor of recovery > 30 days. These findings suggest that early, specialized medical care and intervention for children and adolescents with recent concussion is associated with normal recovery time. Clinicians should educate children and parents on the potential importance of early treatment to improve the odds of positive outcomes following concussion.

Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1119-1121
Author(s):  
Joseph Maytal ◽  
Gerald Novak ◽  
Catherine Ascher ◽  
Robert Bienkowski
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drug ◽  
Medical Records ◽  
Clinic Visit ◽  
Drug Levels ◽  
Progressive Encephalopathy ◽  
History Of ◽  
The Mean ◽  
Subtherapeutic Level

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy. Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records. Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults. Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.

scholarly journals Mentalizing Glasses: Multifocal Attention in Mentalization-Based Treatment and the Role of the Supervision

2021 ◽  
Vol 12 ◽  
Author(s):  
Pia Tohme ◽  
Martin Kolev
Keyword(s):  
Children And Adolescents ◽  
Crucial Role ◽  
Therapeutic Process ◽  
Short History ◽  
Therapeutic Setting ◽  
History Of

Bifocal attention has been conceptualized differently by various scholars; however, all converge in the idea that the therapeutic process includes the need for the therapist to focus his attention on more than one aspect of the therapeutic setting. We propose a novel view in the application of bifocal attention within the mentalizing framework (MBT) of working with children, adolescents, and their families. We start by providing a short history of the evolution of the construct of bifocal attention, followed by a brief description of the structure of MBT for children and adolescents, emphasizing the crucial role of bifocal and multiple attentions in the mentalizing therapist. We close by discussing the importance of continued supervision in facilitating the maintaining of mentalizing glasses in therapy.

scholarly journals Routine HIV clinic visit adherence in the African Cohort Study

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Nicole Dear ◽  
Allahna Esber ◽  
Michael Iroezindu ◽  
Emmanuel Bahemana ◽  
Hannah Kibuuka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Virologic Failure ◽  
Clinical Care ◽  
Clinic Visit ◽  
People Living With Hiv ◽  
The Past ◽  
Visit Adherence ◽  
Missed Visits ◽  
History Of ◽  
Clinic Visits

Abstract Background Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS). Methods In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits. Results Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19). Conclusions Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

scholarly journals Late Oesteoradionecrosis of Mandible Five Years after Radiotherapy for Carcinoma Base of Tongue

2018 ◽  
Vol 26 (2) ◽  
pp. 137-140
Author(s):  
Somesh Mozumder ◽  
Shirish Dubey ◽  
Aniruddha Dam ◽  
Anup Kumar Bhowmick
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
External Beam Radiotherapy ◽  
Late Presentation ◽  
Nodal Metastasis ◽  
High Dose ◽  
Invasive Squamous Cell Carcinoma ◽  
Early Presentation ◽  
History Of ◽  
The Right

Introduction Osteoradionecrosis (ORN) is a process where irradiated bone undergoes necrosis and becomes exposed through soft-tissue. It is a late effect of radiotherapy. Early presentation within 2 years, is thought to be related to high dose of Radiation therapy, whereas late presentation is usually secondary to trauma and delayed wound healing with in compromised tissue. We present a case of late presentation where there was no history of trauma to the associated region; therefore making the case unique. Case report                                              50 years old male patient from rural Bengal presented with history of invasive squamous cell carcinoma (SCC) of right base tongue with bilateral cervical nodal metastasis treated with external beam radiotherapy of 70 Gy in 35 fractions in 2009. In April 2014 he developed pain in the right side of lower jaw with foul breath and progressive difficulty and pain while opening mouth. Biopsy established the diagnosis of oesteoradionecrosis. Discussion ORN can be spontaneous, but most commonly results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury. The irradiated mandible, periosteum, and overlying soft tissue undergo hyperemia, inflammation, and endarteritis. Conclusion During follow up any lesion suspicious of recurrence or second malignancy with clinical features of pain, swelling, trismus, halitosis, mucosal ulceration, bare bone etc a differential diagnosis of oesteoradionecrosis should be kept in mind, even long time after radiotherapy & absence of trauma.

Screening in GI Cancers: The Role of Genetics

2015 ◽  
Vol 33 (16) ◽  
pp. 1721-1728 ◽  
Author(s):  
Elena M. Stoffel
Keyword(s):  
Clinical Care ◽  
Clinical History ◽  
Epigenetic Alterations ◽  
Hereditary Cancer Syndromes ◽  
Patients With Cancer ◽  
History Of ◽  
Cancer Types ◽  
Cancer Syndromes ◽  
Cell Signaling Pathways

Genetic and epigenetic alterations identified in tumors of different cancer types can provide insights regarding the roles played by different cell signaling pathways in carcinogenesis. Somatic mutation profiles of GI tumors are used to guide choice of chemotherapy and can facilitate identification of individuals whose cancers arise in the setting of genetic predisposition. This review provides a framework for how clinical history, family history of cancer, and tumor genomic phenotype can be used to screen patients with colorectal, gastric, or pancreatic cancer for hereditary cancer syndromes. Early identification of individuals who carry germline mutations can affect clinical care not only for patients with cancer but also for their at-risk relatives.

Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome

2019 ◽  
Vol 40 (01) ◽  
pp. 101-113
Author(s):  
Ammar Syed ◽  
Alexander Kobzik ◽  
David Huang
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Care ◽  
Blocking Agent ◽  
Multicenter Trial ◽  
Neuromuscular Blocking ◽  
History Of

AbstractThe pharmacology and history of neuromuscular blockade in clinical care are complex, with multiple theoretical and observed potential benefits and potential harms. Past studies raised concern for long-term paresis, but more recent studies have not found evidence for harm, possibly due to changes in background care, neuromuscular blocking agent, and duration of blockade. Current use is highly variable, likely due to limited evidence for efficacy beyond short-term physiologic improvement and lingering concerns for harm. A recently completed large multicenter trial will provide further information on the role of pharmacologic paralysis in acute respiratory distress syndrome.

Body Image in Children and Adolescents with Cancer

2018 ◽  
Author(s):  
Amanda L. Thompson ◽  
Lori Wiener
Keyword(s):  
Body Image ◽  
Children And Adolescents ◽  
Pediatric Patients ◽  
Clinical Care ◽  
Self Esteem ◽  
Illness Trajectory ◽  
Diagnosis Of Cancer ◽  
The Impact

Abstract: A diagnosis of cancer in childhood or adolescence has the potential to influence body image development and may have a lasting impact on self-perception and self-esteem. This chapter first describes existing research about body image in children and adolescents with cancer and then outlines key principles of clinical care of pediatric patients. Clinical assessment of precancer body image is discussed, followed by a review of the impact of treatment on appearance and perception of physical differences over the illness trajectory. Strategies to address body altering side effects of cancer, including the role of social support, are reviewed, and the chapter concludes by describing clinical interventions for more persistent and intrusive body image concerns that interfere with social functioning or cause significant emotional distress. A case study is presented throughout to illustrate key concepts and principles.

scholarly journals Nauczyć umierania. Tanatopedagogika na lekcjach języka polskiego w liceum na przykładzie literatury najnowszej

2021 ◽  
Vol 19 ◽  
pp. 101-115
Author(s):  
Jan Zdunik
Keyword(s):  
High School ◽  
Children And Adolescents ◽  
Recent Literature ◽  
Contemporary Literature ◽  
Death And Dying ◽  
Polish Literature ◽  
History Of ◽  
Polish Language ◽  
The Subject

The aim of this article is to present a didactic proposition on the introduction of thanatopedagogical themes in Polish language lessons in high school while discussing contemporary literature. The first part of the work presents the most important elements of thanatopedagogy as a science in the context of literary studies. The history of the concept is described in the context of changes in the cultural understanding of death, and the way of presenting the final things in the literature of children and adolescents — from didactic to personalistic — is discussed. In the following subsections, two texts from the latest Polish literature are interpreted: The Things I Didn’t Throw Out by Marcin Wicha and Mira Marcin’s Bezmatek. Proposals are made for using these works to introduce elements of reflection on the finality of things to Polish lessons (the subject of mourning, anthropology of death and dying, the language used for speaking about passing away). The text ends with a summary of the most crucial research conclusions: about the important role of recent literature in conversations on ultimate topics, the need for thanatopedagogical education for teachers, and the need for large psychological competences to conduct such conversations.

Elaborating the role of reflection and individual differences in the study of folk-economic beliefs

2018 ◽  
Vol 41 ◽  
Author(s):  
Kevin Arceneaux
Keyword(s):  
Decision Making ◽  
Individual Differences ◽  
Cognitive Processes ◽  
Evolutionary History ◽  
Behavioral Responses ◽  
History Of ◽  
Economic Beliefs

AbstractIntuitions guide decision-making, and looking to the evolutionary history of humans illuminates why some behavioral responses are more intuitive than others. Yet a place remains for cognitive processes to second-guess intuitive responses – that is, to be reflective – and individual differences abound in automatic, intuitive processing as well.

The role of a family history of adenocarcinomas in patients with Barrett oesophagus

2001 ◽  
Vol 120 (5) ◽  
pp. A442-A442
Author(s):  
P TSIBOURIS ◽  
M HENDRICKSE ◽  
P ISAACS
Keyword(s):  
Family History ◽  
History Of ◽  
Barrett Oesophagus
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