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Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1207
Arnis Engelis ◽  
Liene Smane ◽  
Jana Pavare ◽  
Astra Zviedre ◽  
Timurs Zurmutai ◽  

This case series study consists of six children, aged 5–16 years, admitted to a centralized tertiary paediatric hospital serving a population of 1.9 million with acute appendicitis in the setting of SARS-CoV-2 infection. From the beginning of the pandemic in March 2020 until August 2021, 121 COVID-19-positive children were admitted to the hospital. A total of 49 (40.5%) of these patients presented with gastrointestinal symptoms, of which six were diagnosed with acute appendicitis. Five underwent an appendectomy, while one was treated conservatively. To date, it has been reported that appendicitis may have a plausible association with SARS-CoV-2 infection in children. With COVID-19 cases rising, every medical specialist, including all paediatric surgeons, must be ready to treat common acute diseases with SARS-CoV-2 infection as a comorbidity. Providers should consider testing for this infection in paediatric patients with severe gastrointestinal symptoms. Non-surgical treatment of acute appendicitis in children may gain new importance during and after the COVID-19 pandemic. Further studies are needed to prove the link of causality between COVID-19 and acute appendicitis in children.

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049487
Rose J Geurten ◽  
Arianne M J Elissen ◽  
Henk J G Bilo ◽  
Jeroen N Struijs ◽  
Chantal van Tilburg ◽  

ObjectivesWe aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an all-payer claims database.DesignRetrospective observational cohort study based on an all-payer claims database of the Dutch population.SettingThe Netherlands.ParticipantsThe whole Dutch type 2 diabetes population (n=900 522 in 2018), determined based on bundled payment codes for integrated diabetes care and medication use indicating type 2 diabetes.Outcome measuresAnnual prevalence of type 2 diabetes, comorbidities and characteristics of the type 2 diabetes population, as well as the distribution of healthcare utilisation and expenditures were analysed descriptively.ResultsIn 2018, 900 522 people (6.5% of adults) were identified as having type 2 diabetes. The most common comorbidity in the population was heart disease (12.1%). Additionally, 16.2% and 5.6% of patients received specialised care for microvascular and macrovascular diabetes-related complications, respectively. Most patients with type 2 diabetes received pharmaceutical care (99.1%), medical specialist care (97.0%) and general practitioner consultations (90.5%). In total, €8173 million, 9.4% of total healthcare expenditures, was reimbursed for the type 2 diabetes population. Medical specialist care accounted for the largest share of spending (38.1%), followed by district nursing (12.4%), and pharmaceutical care (11.5%).ConclusionsAll-payer claims databases can be used to delineate healthcare use: this insight can inform health policy and practice and, thereby, support better decisions to promote long-term sustainability of healthcare systems. The healthcare utilisation of the Dutch type 2 diabetes population is distributed across the health system and utilisation of medical specialist care is high. This is likely to be due to presence of concurrent morbidities and complications. Therefore, a shift from a disease-specific approach to a person-centred and integrated care approach could be beneficial in the treatment of type 2 diabetes.

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 59-60
Brian Downer ◽  
Lin-Na Chou ◽  
Soham Al Snih ◽  
Cheyanne Barba ◽  
Yong-Fang Kuo ◽  

Abstract There is lack of data on the frequency and correlates of dementia being documented as a cause of death in Hispanic populations. We investigated characteristics associated with dementia as a cause of death among Mexican-American decedents diagnosed with dementia. Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims files, and the National Death Index. Of the 744 decedents diagnosed with dementia before death, 26.9% had dementia documented as a cause of death. More health comorbidities (OR=0.38, 95% CI=0.25-0.57), older age at death (OR=1.05, 95% CI=1.01-1.08), and longer dementia duration (OR=1.09, 95% CI=1.03-1.16) were associated with dementia as a cause of death. In the last year of life, any ER admission with (OR=0.56, 95% CI=0.32-0.98) or without (OR=0.31, 95% CI=0.14-0.70) a hospitalization, more physician visits (OR=0.95, 95% CI=0.92-0.98) and seeing a medical specialist (OR=0.41, 95% CI=0.24-0.70) were associated with lower odds for dementia as a cause of death. In the last 30-days of life, any hospitalization with an ICU stay (OR=0.57, 95% CI=0.37-0.88) and ER admission with (OR=0.58, 95% CI=0.40-0.84) or without (OR=0.48, 95% CI=0.25-0.94) a hospitalization were associated with lower odds for dementia as a cause of death. Receiving hospice care in the last 30-days of life was associated with 2.09 (95% CI=1.38-3.16) higher odds for dementia as a cause of death. The possible under-documentation of dementia as a cause of death on death certificates may result in underestimation of healthcare resource need of dementia care for Mexican-Americans.

2021 ◽  
pp. 49-58
Svetlana Gennadievna Pavlova

The development of health schools for patients makes it possible to implement one of the fundamental principles of reforming disease prevention through mutual understanding and empathy, the ability of a medical specialist to explain and persuade, and to bring authoritative sources of information in the classroom.

2021 ◽  
Vol 215 (7) ◽  
pp. 336
Caitlyn Withers ◽  
Christy Noble ◽  
Caitlin Brandenburg ◽  
Paul P Glasziou ◽  
Paulina Stehlik

Kerem C. Celebi ◽  
Shannon K. T. Bailey ◽  
Micheal W. Burns ◽  
Kunal Bansal

Telementoring in healthcare education has been used successfully to teach technical skills and clinical reasoning when in-person instruction is not feasible; however, previous technology for telementoring had limitations such as narrow field-of-view and high latency. Novel virtual reality (VR) livestreaming technology may address issues in traditional 2-dimensional (2D) systems by expanding the field of view while streaming with low latency. Low latency streaming of video and audio is necessary for smooth communication between a medical specialist and remote trainees. If latency is low between the instructor and the remote trainees, conversations can be held without a noticeable delay, supporting synchronous instruction and collaboration. This research reports the first latency test results of a novel VR system that livestreams stereoscopic video and audio to remote VR headsets. Results showed the one-way audio and video latency was less than half a second, confirming the viability of live VR for medical telementoring.

2021 ◽  
pp. 156-180
Mark Selikowitz

There are many different medications used for ADHD, and these should only be prescribed by a medical specialist experienced in this field. Many children with ADHD do not need to take their medication every day of the week. The availability of long-acting medication means that most children with ADHD do not need to take medication at school. This chapter presents a detailed guide to specific medicines for ADHD, including short-acting stimulant medicines (Ritalin, Focalin, dexamphetamine, and Adderall IR), long-acting stimulant medications (Concerta, Ritalin LA, Focalin XR, Daytrana, Adderall XR, Metadate CD, and Vyvanse), and non-stimulant medications (imipramine [Tofranil], Clonidine, guanfacine [Intuniv], and atomoxetine [Strattera]).

2021 ◽  
Vol 8 ◽  
Pooja Maddela ◽  
Jane Frawley ◽  
Jon Adams ◽  
David Sibbritt

Background: Back pain affects a substantial proportion of the adult population, and back pain sufferers tend to explore a wide range of health care options. This study investigates the use of medical and physiotherapy services by Australian women with back pain. Method: This is a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. The study focuses on 1,851 women aged 59-64 years, who had indicated that they had previously sought help from a health care practitioner for back pain. Results: Half of the women (56.5%) with back pain had consulted a general practitioner (GP), 16.2% had consulted a medical specialist, and 37.3% had consulted a physiotherapist for their back pain. Women with regular or continuous back pain were more likely to consult a GP (OR=3.98), medical specialist (OR=5.66) and a physiotherapist (OR=1.63). Conclusion:  Australian women with back pain were more likely to consult a GP, medical specialist or physiotherapist if they had more regular/continuous back pain. Future research needs to investigate further the consultation and referral patterns identified in this study.

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