optimal outcomes
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2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Brian D. Kelly ◽  
Rebecca Moorhead ◽  
David Wetherell ◽  
Tracey Gilchrist ◽  
Marcalain Furrer ◽  
...  

Objectives Placenta accreta spectrum (PAS) significantly increases the complexity of childbirth and frequently involves urologic organs. Multidisciplinary team (MDT) care is paramount to ensure optimal outcomes. We aimed to evaluate urologic interventions in patients with PAS at a centralised, tertiary referral centre. Methods An analysis of a prospectively collected data set, consisting of all women presenting with PAS at our institution between November 2013 and June 2019. Patients who required urological intervention were identified, and perioperative details were retrieved. Results Forty-two cases of PAS were identified. The mean maternal age was 35 years, and mean gestational age at delivery was 34 weeks. Thirty-seven cases were managed electively, with 5 cases managed conservatively (no hysterectomy) and 5 requiring emergency management. Fifteen patients (36%) had suspected bladder invasion on MRI. A total of 36 patients (86%) had ureteric catheters inserted, 14 (33%) required bladder repair, and 2 had ureteric injuries (5%). Conclusions PAS frequently requires urological intervention to prevent and repair injury to the urinary bladder and ureter. PAS is a rare condition that is best managed in an MDT setting in a centralised, tertiary, high-volume centre with access to a variety of medical and surgical sub-specialities.


2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Bassam Khaleel Al-Abbasi

Abstract Background Diphallus (duplication of phallus) is rarely encountered in surgical practice with only 100 cases reported in literature. Some cases may be isolated but mostly associated with other anomalies, without clear data about its etiology. Case presentation We reported a 1-day-old newborn baby who was presented with complete duplication of the phallus, one of them being hypospadic associated with a high type imperforate anus, omphalocele, congenital pouch colon, sacral meningocele, and other congenital anomalies not reported before in such combinations. Multiple stages surgical corrective procedures were performed over a period of 4 years with 4–6 months interval between each stage, starting with the management of omphalocele and colostomy, ended by excision of the abnormal phallus with abdominoplasty and closure of colostomy. The outcome was evaluated, and literatures were reviewed in relation to types, presentations, and options for surgical correction with optimal outcomes. Conclusion A combination of diphallia and other abnormalities in our patient are not reported previously in such manner and were very difficult to be corrected. Only expert pediatric surgeons should treat such conditions as every case is unique in nature. In all conditions, the abnormal phallus should be excised, and the final aim is to achieve a continent child with cosmetically acceptable genitalia.


Author(s):  
Erin Kennedy ◽  
Kristen Munyan

AbstractThe American Academy of Pediatrics (AAP) recommends screening mothers for Postpartum Depression (PPD) during the postpartum period. Research shows depression in parents is associated with impaired growth and development in their children. The National Perinatal Association (NPA) encourages screening fathers for depression at least twice during the first postpartum year, however a preferred screening tool has yet to be determined. To promote optimal outcomes for children, providers must assess the mental health of all new parents, regardless of gender. Therefore, the purpose of this integrative review is to examine previous scientific evidence regarding the sensitivity of screening measures for postpartum depression in fathers. Future research should be directed towards describing the psychometric properties of a tool to assess postpartum mood disorders in American fathers while analyzing appropriate screening intervals during the postpartum period.


2022 ◽  
pp. 146-183
Author(s):  
Molly Turner ◽  
Stephanie J. Gardiner-Walsh

In education today, there is an increasing population of individuals who are d/Deaf/Hard of Hearing and English Learners (d/DHH/ELs). This population of students need innovative teaching strategies to achieve optimal outcomes. Schools are challenged with providing education to these students, and there are many barriers to overcome. Teachers receive little to no education on how to teach this combined population of learners. Knowing this, the chapter will discuss characteristics of the population, literacy and language acquisition, barriers, and strategies to promote literacy development in the d/DHH/EL population.


2021 ◽  
Vol 9 (4) ◽  
pp. 1-41
Author(s):  
Nawal Benabbou ◽  
Mithun Chakraborty ◽  
Ayumi Igarashi ◽  
Yair Zick

In this article, we present new results on the fair and efficient allocation of indivisible goods to agents whose preferences correspond to matroid rank functions . This is a versatile valuation class with several desirable properties (such as monotonicity and submodularity), which naturally lends itself to a number of real-world domains. We use these properties to our advantage; first, we show that when agent valuations are matroid rank functions, a socially optimal (i.e., utilitarian social welfare-maximizing) allocation that achieves envy-freeness up to one item (EF1) exists and is computationally tractable. We also prove that the Nash welfare-maximizing and the leximin allocations both exhibit this fairness/efficiency combination by showing that they can be achieved by minimizing any symmetric strictly convex function over utilitarian optimal outcomes. To the best of our knowledge, this is the first valuation function class not subsumed by additive valuations for which it has been established that an allocation maximizing Nash welfare is EF1. Moreover, for a subclass of these valuation functions based on maximum (unweighted) bipartite matching, we show that a leximin allocation can be computed in polynomial time. Additionally, we explore possible extensions of our results to fairness criteria other than EF1 as well as to generalizations of the above valuation classes.


2021 ◽  
pp. 174239532110674
Author(s):  
Suebsarn Ruksakulpiwat ◽  
Witchuda Thongking ◽  
Wendie Zhou ◽  
Chitchanok Benjasirisan ◽  
Lalipat Phianhasin ◽  
...  

Objective To evaluate the existing evidence of a machine learning-based classification system that stratifies patients with stroke. Methods The authors carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations for a review article. PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text were searched from January 2015 to February 2021. Results There are twelve studies included in this systematic review. Fifteen algorithms were used in the included studies. The most common forms of machine learning (ML) used to classify stroke patients were the support vector machine (SVM) (n = 8 studies), followed by random forest (RF) (n = 7 studies), decision tree (DT) (n = 4 studies), gradient boosting (GB) (n = 4 studies), neural networks (NNs) (n = 3 studies), deep learning (n = 2 studies), and k-nearest neighbor (k-NN) (n = 2 studies), respectively. Forty-four features of inputs were used in the included studies, and age and gender are the most common features in the ML model. Discussion There is no single algorithm that performed better or worse than all others at classifying patients with stroke, in part because different input data require different algorithms to achieve optimal outcomes.


2021 ◽  
Vol 8 (1) ◽  
pp. e001037
Author(s):  
Pamela MacTavish ◽  
Joanne McPeake ◽  
Antoin Breslin ◽  
Ruth Forrest ◽  
Rakesh Kishore ◽  
...  

BackgroundCritically ill patients often experience several transitions of care following critical illness. Research has explored the challenges which patients have with medication management across these transitions. It is unclear whether patients admitted to critical care due to COVID-19 will have similar challenges. The aim of this study was to explore medication management in critical care survivors following severe COVID-19.MethodsBetween 3 and 7 months post hospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. During the clinic consultation a medication review was performed by a pharmacist. This included medicines reconciliation, assessing the appropriateness of each of the prescribed medications and identification of medication changes. We also assessed changes to pain management in the discharge period.ResultsIn total, 78 patients had a full medication review available. Over 70% of patients were taking an increased dose of medicine or a new medicine at clinic. There was a significant overall increase in new medication during the clinic consultation, across different British National Formulary classifications (OR: 1.73 (95% CI: 1.28 to 2.34), p<0.001). Compared with pre critical care admission, there was a significant increase in the number of patients taking regular analgesia following severe COVID-19 infection (23 (29.5%) vs 39 (50%), p<0.001).ConclusionFollowing severe COVID-19, patients may require new or increasing doses of medicines. Ongoing review of these patients is crucial to ensure optimal outcomes.


2021 ◽  
pp. 014556132110546
Author(s):  
Tom Shokri ◽  
Shivam Patel ◽  
Kasra Ziai ◽  
Jonathan Harounian ◽  
Jessyka G Lighthall

Introduction Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life. 1 This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis. Methods A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were “facial,” “synkinesis,” “palsy,” and various combinations of the terms. Results The resultant inability to control the full extent of one’s facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms. Discussion A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.


Neurology ◽  
2021 ◽  
Vol 97 (20 Supplement 2) ◽  
pp. S115-S125
Author(s):  
Rashi Krishnan ◽  
William Mays ◽  
Lucas Elijovich

Multiple randomized clinical trials have supported the use of mechanical thrombectomy (MT) as standard of care in the treatment of large vessel occlusion acute ischemic stroke. Optimal outcomes depend not only on early reperfusion therapy but also on post thrombectomy care. Early recognition of post MT complications including reperfusion hemorrhage, cerebral edema and large space occupying infarcts, and access site complications can guide early initiation of lifesaving therapies that can improve neurologic outcomes. Knowledge of common complications and their management is essential for stroke neurologists and critical care providers to ensure optimal outcomes. We present a review of the available literature evaluating the common complications in patients undergoing MT with emphasis on early recognition and management.


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