scholarly journals Comparative study of Pre and Post-operative Drug Costs in Patients with Refractory Epilepsy Undergoing Hemispherectomy and Temporal Lobectomy at the National Children’s Hospital Dr. Carlos Sáenz Herrera

2020 ◽  
pp. 1-3
Author(s):  
Juan L Segura Masís ◽  
◽  
Rodrigo Masís Mejías ◽  
Katherine Alfaro Navas ◽  
Santiago Rodríguez Picado ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Surgical Procedures ◽  
Refractory Epilepsy ◽  
Epileptic Seizures ◽  
Clinical Results ◽  
Temporal Lobectomy ◽  
Surgical Interventions ◽  
Children's Hospital ◽  
Before And After ◽  
Children’S Hospital

Introduction: Refractory epilepsy can be defined as a failure of adequate trials of antiepileptic drug programs tolerated and appropriately chosen and used (either as monotherapy or in combination) to achieve sustained freedom from seizures. Surgical procedures for the control of epileptic seizures have spread throughout the world, however, large medical centers have mainly focused on studying and analyzing the clinical results of their surgical interventions. For this reason, this study aims to analyze the cost of pre and post-surgical anticonvulsant medications in patients. Objective: To analyze the relationship between preoperative cost / postoperative cost of antiepileptic drugs in patients undergoing hemispherectomy or temporary lobectomy at the National Children’s Hospital (Hospital Nacional de Niños-HNN). Materials and methods: This study is a retrospective, descriptive, quantitative and longitudinal type of a series of patients who were operated in the Epilepsy Monitoring and Surgery Unit (UMCE) of Costa Rica, between November 2000 and December 2018. Information on the history of medications is obtained from patients before and after having undergone hemispherectomy or temporal lobectomy to assess whether or not there is an economic saving in this aspect when comparing both periods of time. Results: 69 patients have undergone hemispherectomy and temporal lobectomy since the creation of the UMCE in November 2000. Of these, 18 (26%) underwent hemispherectomy and 51 (74%) underwent temporary lobectomy. A sample of 31 patients (45%) were obtained, which met the inclusion criteria. The average age of initiation of treatment at the HNN was 5.5 years old (66 months) and the average age at which they underwent surgery was 10.8 years old (130 months). There was one patient in the sample who received 9 anticonvulsant medications before undergoing the surgical procedure and the average number of medications used pre-surgically was 4.45 anticovulsivants per patient. The average postoperative medication was 2.35 anticonvulsivants per patient. The average monthly preoperative cost was $50.17, while the postoperative period was $31.26, with a difference of $18.91. A total of 9 patients in the sample increased the monthly postoperative cost. The total savings per month in the patients included in the sample was $586.36 and extrapolated to the population of 69 patients resulting in a saving of $1,305.14 per month. The projection according to the life expectancy of the patients in the sample translates into a saving of $409,188.59 while the projection to the 69 patients would result in a saving of $910,774.60 for the Caja Costarricense del Seguro Social (CCSS - Costa Rican Social Security Fund). Discussion: The effectiveness of these two surgeries in suitably selected patients is reflected in the economic savings represented by antiepileptic drugs administered after these surgical procedures. Conclusion: we consider that in this center the patients who have been operated have meant a saving for the Caja Costarricense del Seguro Social (CCSS) since they have diminished or completely eliminated the anti-epileptic medical treatment

A Community Occupational Therapy Summer Program for Children

1976 ◽  
Vol 43 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Alice Lehrer
Keyword(s):  
Occupational Therapy ◽  
Pilot Project ◽  
Significant Benefit ◽  
Summer Program ◽  
Children's Hospital ◽  
Advantages And Disadvantages ◽  
Before And After ◽  
Children’S Hospital ◽  
Therapy Services ◽  
Therapy Department

This article describes a pilot project in which eleven out-patients of the Occupational Therapy Department at the Montreal Children's Hospital were integrated into a summer day camp of a local YMCA. The objectives of this program are outlined, as well as the actual description of the camp program. An evaluation of the project examines the results of a questionnaire administered to the subjects' parents before and after the camp experience as well as a discussion of some additional advantages and disadvantages observed in the program. It appears that there are many indications for screening and treating children in the community, and that providing occupational therapy services to children in their natural milieu may be of significant benefit to the child. It is suggested that the integration of occupational therapy in the community be carried out permanently and extensively and that such programs deserve further study.

Improving Stethoscope Disinfection at a Children's Hospital

2013 ◽  
Vol 34 (11) ◽  
pp. 1189-1193 ◽  
Author(s):  
Justin Zaghi ◽  
Jing Zhou ◽  
Dionne A. Graham ◽  
Gail Potter-Bynoe ◽  
Thomas J. Sandora
Keyword(s):  
Pathogenic Bacteria ◽  
Healthcare Providers ◽  
Future Research ◽  
Healthcare Facilities ◽  
Logistic Regression Models ◽  
Children's Hospital ◽  
Contact Precautions ◽  
Before And After ◽  
Children’S Hospital ◽  
The Impact

Objective.Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes.Design.Prospective intervention study.Setting. Inpatient units and emergency department of a major pediatric hospital.Participants.Physicians and nurses with high anticipated stethoscope use.Methods.Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection.Results.Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P < .001). In adjusted analyses, the postintervention period was associated with improved disinfection among both physicians (odds ratio [OR], 2.3 [95% confidence interval (CI), 1.4-3.5]) and nurses (OR, 14.3 [95% CI, 4.6-44.6]). Additional factors independently associated with disinfection included subspecialty unit (vs general pediatrics; OR, 0.5 [95% CI, 0.3-0.8]) and contact precautions (OR, 2.3 [95% CI, 1.2-4.1]).Conclusions.Providing stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.

The milk kitchen, Sheffield Children's Hospital, before and after a review

1989 ◽  
Vol 13 (2) ◽  
pp. 179-185 ◽  
Author(s):  
I.A. Burnett ◽  
B.L. Wardley ◽  
J.T. Magee
Keyword(s):  
Children's Hospital ◽  
Before And After ◽  
Children’S Hospital

scholarly journals Application of surgical periodontics for accelerated orthodontic correction of class ll division l malocclusion with skeletal discrepancy

2017 ◽  
Vol 5 (7) ◽  
pp. 2870
Author(s):  
Suryakanta Narendra ◽  
N. C. Sahani ◽  
Sanghamitra Jena
Keyword(s):  
Surgical Procedures ◽  
Comparative Evaluation ◽  
Alveolar Bone ◽  
Cone Beam ◽  
Bone Thickness ◽  
Surgical Interventions ◽  
Division 1 ◽  
Before And After ◽  
Surgical Options ◽  
Accelerated Orthodontics

Background: There is a constant pursuit for substituting orthognathic surgical options by minimally invasive pre-orthodontic surgical procedures. Application of osseous resective surgery for alveolar reshaping is referred to here as "surgical periodontics for accelerated orthodontics". A parallel randomized clinical trial was designed to evaluate the clinical outcome of class 2 division 1 malocclusion with skeletal discrepancy using pre-orthodontic surgical procedures, comparing periodontally accelerated osteogenic orthodontics with surgical periodontics for accelerated orthodontics.Methods: Twenty-four adult orthodontics patients selected for this study were randomly divided into 2 equal groups. One group was treated with periodontally accelerated osteogenic orthodontics with augmentation grafting and the other was with surgical periodontics for accelerated orthodontics. These procedures were followed by fixed orthodontics treatment. Comparative evaluation of alveolar bone thickness was done by cone beam computed tomogram for both the groups.Results: The cephalometric parameters, A point nasion B point (ANB) angle and over jet of these subjects before and after the surgical interventions at three, six and twelve month’s intervals were compared to the base values, showing changes within 3 months when treated with surgical periodontics for accelerated orthodontics and within 6 months when treated with periodontally accelerated osteogenic orthodontics, without significant change in periodontal supporting alveolar bone thickness.Conclusions: Surgical periodontics for accelerated orthodontics and periodontally accelerated osteogenic orthodontics are effective pre-orthodontics surgical procedures for accelerating orthodontic treatment, without bringing any change in periodontal alveolar bone thickness.

Centralization of Pediatric Surgical Procedures in the United Kingdom

2017 ◽  
Vol 27 (05) ◽  
pp. 416-421 ◽  
Author(s):  
Natalie Durkin ◽  
Mark Davenport
Keyword(s):  
United Kingdom ◽  
Surgical Procedures ◽  
Full Range ◽  
Bladder Exstrophy ◽  
Outcome Data ◽  
Outcome Analysis ◽  
England And Wales ◽  
Children's Hospital ◽  
The United Kingdom ◽  
Children’S Hospital

AbstractThe NHS provides more than 98% of all surgical procedures in infants and children in the United Kingdom through a comprehensive network of secondary (typically for the general surgery of childhood) and tertiary (specialist neonatal and specialist pediatric surgery) centers [n = 22]), typically located within large conurbations. It was originally envisaged that these specialized centers would be able to provide the full range of surgical interventions (aside from organ transplantation). However, there has been a trend toward centralization of some key procedures, previously thought to be within general neonatal surgery.The architype for centralization is the management of biliary atresia (BA). Since 1999, within England and Wales, this has been exclusively managed in three centers (King's College Hospital, London; Birmingham Children's Hospital and Leeds General Infirmary). All of these provide facilities for the diagnosis of BA, primary surgical management (Kasai portoenterostomy), and liver transplantation if required. The case for centralization was made by rigorous national outcome analysis during the 1990s showing marked disparity based on case volume and driven by parents' organizations and national media. Following centralization, national outcome data showed improvement and provided a benchmark for others to follow.The management of bladder exstrophy was later centralized in England and Wales, albeit not based on strict outcome data, to two centers (Great Ormond Street, London and Royal Manchester Children's Hospital).

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