A clinical case of hamartoma (teratoma) of the tongue in combination with a cleft palate in a newborn

2020 ◽  
pp. 42-45
Author(s):  
Yu.O. Volkov ◽  
Ad.A. Mamedov ◽  
L.M. Makarova ◽  
E.A. Ryzhov ◽  
B.A. Tkachenko
Keyword(s):  
Cleft Palate ◽  
Congenital Malformation ◽  
Clinical Case ◽  
Interdisciplinary Approach ◽  
Successful Implementation ◽  
Maxillofacial Region ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Newborn Child ◽  
Subsequent Rehabilitation

The article presents a rare clinical case of hamartoma of the tongue in combination with a cleft palate, diagnosed in a newborn child, as a manifestation of a severe congenital malformation of the maxillofacial region. The preparation and successful implementation of the first stage of treatment of this combined pathology and subsequent rehabilitation in a multidisciplinary children's hospital are described in detail on the basis of continuity in the work of specialists and an interdisciplinary approach.

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

2008 ◽  
Vol 18 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Lauren Hofmann ◽  
Joseph Bolton ◽  
Susan Ferry
Keyword(s):  
Tracheostomy Tube ◽  
Pediatric Population ◽  
Interdisciplinary Approach ◽  
Extended Period ◽  
Speech Development ◽  
Tube Placement ◽  
Background Information ◽  
Speaking Valve ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

scholarly journals A Cross-Sectional Analysis of the BC Children’s Hospital Cleft Palate Program Waitlist

2019 ◽  
Vol 27 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Leslie Tze Fung Leung ◽  
Christine A. Loock ◽  
Rebecca Courtemanche ◽  
Douglas J. Courtemanche
Keyword(s):  
Cleft Palate ◽  
Plastic Surgery ◽  
Wait Time ◽  
Wait Times ◽  
Service Needs ◽  
Cross Sectional ◽  
Clinical Assessments ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Sectional Analysis

Objective: A 2016 review of the BC Children’s Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program’s care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic. Design: Cross-sectional. Setting: BC Children’s Hospital Cleft Palate—Craniofacial Program. Patients: Five hundred seventy-six waitlisted patients. Main Outcome Measures: Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines. Results: Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis ( P = .019), a need for formal speech assessments or evaluations ( P < .001), or a requirement to see multiple specialists ( P < .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment. Conclusion: Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.

DOZ047.70: Prevalence of abnormal triple endoscopy findings for tracheoesophageal fistula patients in a multidisciplinary aerodigestive clinic

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S Chowdhuri ◽  
B Osterbauer ◽  
M Bansal ◽  
C Hochstim ◽  
V Bhardwaj
Keyword(s):  
Los Angeles ◽  
Tracheoesophageal Fistula ◽  
Multidisciplinary Approach ◽  
Growth Failure ◽  
Interdisciplinary Approach ◽  
Type I ◽  
Abnormal Finding ◽  
Complex Needs ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Introduction Tracheoesophageal fistula (TEF) is a rare congenital defect involving malformations of the esophagus and trachea, which can be life-threatening if left untreated. Children who have undergone TEF repair often present with symptoms such as cough, vomiting, and growth failure. Although the variety of these symptoms implies a necessity for a multidisciplinary approach to care of TEF repair patients, many are still followed by a single discipline such as gastroenterology or pulmonology. The purpose of this study is to describe the experience of Children's Hospital Los Angeles Aerodigestive team in evaluating TEF patients using an interdisciplinary approach. In particular, we aim to explore the findings obtained during triple endoscopy in order to confirm the necessity of care by multiple specialties, ideally in the setting of an Aerodigestive Clinic. Methods Consent was obtained for all children (birth to 18 years) seen in the Children's Hospital Los Angeles (CHLA) Aerodigestive (AERO) Clinic between June 2016 and August 2018. All patients with a diagnosis of TEF were included in the study and data collected included: age, sex, presenting diagnoses and symptoms, and triple endoscopy findings. Results Of the first 109 patients in the AERO Clinic, 18 had TEF. Of these, 7 (39%) were female with a mean age of 3.4 years (SD 3), and 44% were Hispanic. Ten TEF patients underwent triple endoscopy and all had at least one abnormal finding. Six were diagnosed with laryngeal cleft (LC); four type I, one type II, and one was unspecified. Other abnormal findings included: bronchomalacia (7), tracheomalacia (8), esophagitis (4), gastritis (2), and duodenitis (1). Additionally, 7 had an abnormal bronchoalveolar lavage (BAL) finding, with 6 culture positive results. Conclusion TEF patients can present with feeding and respiratory difficulties months to years after their surgical repair. The triple endoscopy findings of TEF patients presented in this study illustrate that symptoms may arise from the gastrointestinal or respiratory tract. Our experience with TEF patients at CHLA indicates that a multidisciplinary approach to evaluation and management is necessary to serve the complex needs of this population.

SO016SPREAD OF ACUTE KIDNEY INJURY IMPROVEMENT PROGAMME ACROSS A LARGE  MULTI SITED NHS HOSPITAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Prasanna Hanumapura ◽  
Leonard Ebah ◽  
Deryn Waring ◽  
Robert Henney ◽  
Michelle Murphy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Change Agent ◽  
Kidney Injury ◽  
Care Process ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Organization ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Incident Cases

Abstract Background and Aims Acute kidney injury (AKI) is a widely recognised serious health care issue. Up to 25% of hospital patients can develop it, with worse outcomes compared non AKI. A UK–wide audit in 2009 and our local audit in 2014 showed consistently poor AKI care including delays in detection and inconsistent management of cases. The trust set up the AKI Team in 2014 to improve AKI detection, care and outcomes. Successful implementation of a Multifaceted Quality Improvement (QI) Programme for AKI across the main hospital campus since 2015 saw significant improvement in AKI care and outcomes; recognition within 24hrs improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence, 26% reduction in AKI length of stay (LoS) ,42% reduction in AKI days (time to recovery) and 10% less AKI associated mortality. The Trust being one of the largest acute trusts in the UK (10 hospitals across 6 sites, over 2000 beds), the QI spread represented a formidable challenge. We describe the methodology and outcomes of AKI QI spread across the trust. Method Central Campus Hospitals Improvement on this site involved setting a bespoke electronic alert coupled with education, key stake holder engagement, gradual culture change and AKI Priority Care Checklist (PCC) and use of change agent (AKI Clinical Nurse Specialist-CNS) visiting local teams and empowering them to manage AKI using Demming’s Model for Improvement A stepwise staggered similar approach was implemented first in the Women’s and Eye Hospitals followed by Children’s Hospital after a local adaptation and testing of algorithm, PCC and appointment of local change agent, a Paediatric AKI CNS. West Campus Hospital A DGH with 230 beds, 1-2 incident cases of AKI/day required a bespoke approach. The central AKI team runs an AKI alerts report and remotely alert the local multidisciplinary teams and empowering them to implement the PCC. South Campus Hospitals A large tertiary hospital merged in 2018 with an existing AKI CNS team. Detection algorithms, education material, PCC, reporting, and approach have been progressively harmonized using the Central Campus model. Data is expressed using SPC charts and analysed by t-test. Results Care process and outcome measures have seen a consistent improvement across all sites. As reported in the Central Campus, recognition of AKI within 24hrs has improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence (p&lt;0.00001), 26% reduction in AKI LoS and a 42% reduction in AKI days (time to recovery). The Children’s Hospital had 24% reduction (p&lt;0.0001) in AKI incidence and a 34% reduction in hospital acquired AKI. Recognition of AKI has improved from 42% to 100%; 15% reduction in AKI LoS and 22% reduction in AKI days. In the South Campus recognition of AKI has improved from 67% to 100% and 19% reduction (p&lt;0.0015) in AKI incidence. LoS and AKI days data yet to be reported whilst IT systems are been harmonised. In West Campus recognition is 100% but the small numbers prevent any meaningful analysis of other outcomes. Conclusion This study demonstrates how a cluster of simple interventions and approach to AKI detection and care were successfully rolled out across a multisite large complex acute care organization taking into account the local realities of each site/Hospitals whilst maintaining the core interventions.

Introduction: a lifelong interdisciplinary approach to common arterial trunk, transposition of the great arteries, and other evolving challenges in paediatric and congenital cardiac disease

2012 ◽  
Vol 22 (6) ◽  
pp. 619-629 ◽  
Author(s):  
Jeffrey P. Jacobs
Keyword(s):  
Nursing Education ◽  
Cardiac Disease ◽  
Interdisciplinary Approach ◽  
Collaborative Project ◽  
Saint Petersburg ◽  
Children's Hospital ◽  
Common Arterial Trunk ◽  
Arterial Trunk ◽  
Congenital Cardiac Disease ◽  
Children’S Hospital

AbstractThis December Issue of Cardiology in the Young represents the tenth annual publication generated from the two meetings that compose “HeartWeek in Florida”. “HeartWeek in Florida”, the joint collaborative project sponsored by the Cardiac Center at the Children's Hospital of Philadelphia, together with All Children's Hospital of Saint Petersburg and Johns Hopkins Medicine, averages over 1000 attendees every year and is now recognized as one of the major planks of continuing medical and nursing education for those working in the fields of diagnosis and treatment of cardiac disease in the fetus, neonate, infant, child, and adult. “HeartWeek in Florida” combines the International Symposium on Congenital Heart Disease, organised by All Children's Hospital and Johns Hopkins Medicine and entering its 13th year, with the Annual Postgraduate Course in Pediatric Cardiovascular Disease, organised by The Children's Hospital of Philadelphia and entering its 17th year. The theme of this supplement generated from the 2012 HeartWeek in Florida is “A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease”. We would like to acknowledge the tremendous contributions made to medicine by Richard Jonas; and therefore, we dedicate this HeartWeek 2012 Supplement to him.

scholarly journals A Review of Hearing Loss in Cleft Palate Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Bilal Gani ◽  
A. J. Kinshuck ◽  
R. Sharma
Keyword(s):  
Hearing Loss ◽  
Cleft Palate ◽  
Hearing Aids ◽  
Complication Rate ◽  
Otitis Media With Effusion ◽  
Related Complication ◽  
Children's Hospital ◽  
Retrospective Audit ◽  
Children’S Hospital ◽  
Alder Hey

Background. Cleft palate is associated with recurrent otitis media with effusion and hearing loss. This study analysed the way these patients’ hearing is managed in Alder Hey Children’s Hospital.Method. A retrospective audit was carried out on cleft palate patients in Alder Hey Children’s Hospital. Audiology assessment and treatment options were reviewed. Comparisons were made between the use of ventilation tubes (VTs) and hearing aids (HAs). The types of cleft, types of hearing loss, and the management output of the audiology regions were also reviewed.Results. The audiology assessments of 254 patients were examined. The incidence of VT insertion in this group of patients was 18.9%. The hearing aid incidence rate was 10.1%. The VT-related complication rate was 25.5% and the HA related complication rate was 9.1%.Conclusion. The data demonstrates that both treatments are viable, and a new protocol which combines the short term benefit of VT insertion with the lower complication rate of HA is required.

scholarly journals Knowledge and practice of feeding plate obturators among medical doctors in Kanti children’s hospital

2021 ◽  
Vol 4 (1) ◽  
pp. 20-28
Author(s):  
B Pathak ◽  
KR Joshi ◽  
S Bhattarai ◽  
H Joshi
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Treatment Protocol ◽  
Medical Doctors ◽  
Feeding Difficulties ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Knowledge And Practice ◽  
Feeding Plate ◽  
Study Participants

Introduction: Cleft lip and cleft palate (CLCP) affects several systems and functions of the child and result in social and psychological problems.Therefore early repair of CLCP is imperative. Every cleft center follows its own surgical treatment protocol. Before closure of palatal defects, babies with cleft palate have great difficulty in feeding. To overcome this feeding difficulties, use of special bottles, nipples, initial palatal obturator therapy are used. The first exposure of those children are primarily the medical doctors including pediatricians from where they are generally referred to the concerned speciality for repair of CLCP. The aim of this study was to assess the knowledge and practice of orofacial clefts and feeding plate obturator among medical doctors working in Kanti Children’s Hospital (KCH). Method: This was a questionnaire based survey among medical doctors working in KCH. The pretested questionnaire with 7 questions each on the knowledge and practice of feeding plate obturator was distributed among the medical doctors and data was collected. The data collected were subjected to statistical analysis using frequency of responses and percentages. Results: Of the total 57 study participants, 32 (56.1%) were males and 25 (43.9%) were females. Majority i.e. 61.4% belonged to 31-40 years age group. 91.2% study participants faced the cleft lip/ palate related feeding difficulties 0-5 times/month while 5 (8.8%) faced this condition 6-10 times/ month. Majority of the infants who were less than 28 days (43.9%) attended the OPD due to difficultyin feeding/ swallowing (57.9%) followed by regurgitation/ aspiration (22.8%). 49.1% of the participants thought feeding plate oburator as the best way to feed a cleft patient on discharge from hospital. In their clinical practice, three fourth of paticipants (70.2%) had never seen a patient with feeding plate obturator, half of the participants (50.9%) didn’t advise for feeding plate obturator for patients withcleft palate and 89.5% were not aware of the replacement of feeding plate obturator. Conclusion: There is low exposure regarding the feeding plate obturator among medical doctors in KCH which needs to be reinforced through meaningful continuing education and training programs.

scholarly journals Assessing the Social Determinants of Health and Adverse Childhood Experiences in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program

2021 ◽  
pp. 105566562110487
Author(s):  
Ethan Ponton ◽  
Rebecca Courtemanche ◽  
Tanjot K. Singh ◽  
Damian Duffy ◽  
Douglas J. Courtemanche ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Adverse Childhood Experiences ◽  
Determinants Of Health ◽  
Childhood Experiences ◽  
Children's Hospital ◽  
Adverse Childhood ◽  
The Social ◽  
Children’S Hospital

This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional “non-medical” factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions. Single-site, cross-sectional study using a questionnaire. Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada. 290 families completed the questionnaire. 34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey. Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients.

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