scholarly journals Foreign Body Ingestion in Neurologically Impaired Children: A Challenging Diagnosis and Management in Pediatric Surgery

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 956
Author(s):  
Francesca Destro ◽  
Anna Maria Caruso ◽  
Cecilia Mantegazza ◽  
Luciano Maestri ◽  
Milena Meroni ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pediatric Surgery ◽  
Foreign Bodies ◽  
Neurologically Impaired ◽  
Neurodevelopmental Delay ◽  
Dangerous Situation ◽  
Management Protocol ◽  
Impaired Children ◽  
Mean Time

Children with intellectual disability/neurodevelopmental delay (ID-ND) commonly ingest foreign bodies (FB) and often present complications due to peculiar aspects of their condition. The aim of this paper is to report the experience of two centers in the management of ID-ND patients after FB ingestion and to discuss a possible algorithm for clinical practice. We retrospectively evaluated data of patients managed for FB ingestion (period: 2017–2021), focusing on those with ID-ND, specifically demographics and baseline diagnosis, elements related to the event, symptoms, time to endoscopy, FB location, endoscopic details, and follow-up. A total of 457 patients were managed in the study period and 19 had ID-ND (mean age 9.8 ± 3.5 years, 15 males). A total of 16/19 (84.2%) were symptomatic and required an operative approach. Recurrent ingestions and multiple FB were found in 2 and 11 patients, respectively. Endoscopy (mean time 65.6 ± 41 min) was effective in 14 cases (73.6%) and 6 patients (31.6%) developed a complication. FB ingestion in ID-ND patients represents a challenging condition for the clinician and a potentially dangerous situation. It should be addressed specifically by a multidisciplinary team considering a tailored diagnostic and management protocol.

Thoracoscopic Splanchnectomy: A new treatment for Disorders of Motility: A Case Report

2009 ◽  
Vol 54 (3) ◽  
pp. 1-5
Author(s):  
M Steven ◽  
N Brindley ◽  
J Currie ◽  
R Carachi
Keyword(s):  
Congenital Malformations ◽  
Conventional Treatment ◽  
Failure To Thrive ◽  
Neurologically Impaired ◽  
Management Protocol ◽  
Intestinal Dysmotility ◽  
History Of ◽  
New Treatment ◽  
Impaired Children ◽  
Difficult Cases

The case of a 15 year old female born with multiple anomalies, who subsequently developed severe gastro-intestinal dysmotility is discussed. Motility disorders are often seen in neurologically impaired children, those with a history of gastro-oesophageal reflux disease (GORD), and congenital malformations of the gut. It is characterized by abdominal pain, vomiting and failure to thrive. Once this condition develops, it is difficult to treat. This girl failed to improve with conventional treatment including repeated fundoplication. We hypothesised that her symptoms maybe due to antral dysmotility and sympathetic over-activity. She underwent celiac plexus blockade which was immediately curative but temporary and therefore underwent minimally invasive thoracic splanchnectomy. She continues to be asymptomatic. We discuss the relevant anatomy and management protocol which should be considered in such difficult cases.

scholarly journals Assessment of nutritional status and bone health in neurologically impaired children: a challenge in pediatric clinical practice

2019 ◽  
Author(s):  
Elena Crehuá-Gaudiza ◽  
Mónica García-Peris ◽  
Caterina Calderón ◽  
Carmen Jovaní-Casano ◽  
María Antonia Moreno ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Nutritional Status ◽  
Bone Health ◽  
Neurologically Impaired ◽  
Neurologically Impaired Children ◽  
Impaired Children

scholarly journals Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 22
Author(s):  
Elisa Zambaiti ◽  
Calogero Virgone ◽  
Silvia Bisoffi ◽  
Roberta Stefanizzi ◽  
Francesco Fascetti Leon ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Respiratory Complications ◽  
Long Term Outcomes ◽  
Neurologically Impaired ◽  
Respiratory Problems ◽  
Adequate Food ◽  
Impaired Children ◽  
Term Analysis

Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.

Subtotal functional sialoadenectomy vs four‐duct ligation for the treatment of drooling in neurologically impaired children: Long‐term follow‐up

2020 ◽  
Vol 46 (1) ◽  
pp. 222-228
Author(s):  
Francesco De Peppo ◽  
Romina Caccamo ◽  
Maria Carmen Garganese ◽  
Emanuela Ceriati ◽  
Paola Marchetti ◽  
...  
Keyword(s):  
Neurologically Impaired ◽  
Neurologically Impaired Children ◽  
Duct Ligation ◽  
Long Term Follow Up ◽  
Impaired Children

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Automatic Remote Monitoring of Implantable Cardiac Devices in Clinical Practice – The Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) Trial

2010 ◽  
Vol 6 (3) ◽  
pp. 87
Author(s):  
Niraj Varma ◽  
Keyword(s):  
Clinical Practice ◽  
Remote Monitoring ◽  
Home Monitoring ◽  
Implantable Devices ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Enhance Patient Safety ◽  
Implantable Cardiac Devices ◽  
Post Implantation

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.

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