Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

impact of virtual care on relationship centered care: Observations of a family physician

The COVID-19 pandemic propelled many physicians and their patients into an unfamiliar world of virtual care. This presentation is based on the perceptions of a family physician/ teacher/ researcher with 43 years of interest in, and promotion of, a strong doctor-patient relationship. It will describe a protocol that governed how tele-medicine and video-conferencing took place over nearly 18 months in his practice. It will then describe observed positive and negative impacts for the patients, their family members, the physician, and members of the family medicine health care team. Interpretation will be made about what such observations mean for the doctor-patient relationship.

Fournier Gangrene: Case Report & Litarature Review

Introduction: Necrotizing fasciitis of the perineal and vaginal region is a symptom of Fournier's gangrene, which is caused by a synergistic polymicrobic infection. The clinical presentation varies depending on the original aetiology, ranging from anorectal or vaginal pain with limited evidence of cutaneous necrosis to a rapidly spreading necrosis of the skin and soft tissue, to systemic sepsis without any obvious signs or symptoms. Case history: A 65-year-old male who was admitted in hospital with the chief complaint of Scrotal enlargement, discomfort, hyperemia, pruritus, crepitus, and fever. There may also be a foul-smelling discharge. Symptoms usually appear during a two- to seven-day period. Soft-tissue gas may be present before clinical crepitus is detected. The patient with Fournier gangrene frequently seems poorly on physical examination, with prodromal signs of fever and lethargy lasting 2-7 days. Edema of the overlaying skin is usually present, as is acute pain and tenderness in the genitalia; pruritus may also be present.Skin may show evidence of trauma, surgery, insect or human bites or injection sites, In Respiratory system, B/L Air entry present. In cardiovascular system, S1 and S2 sound heard and Patient get conscious and well oriented to time, place, and person. Then, as quickly as possible, treatment was began; he did not improve after treatment, and treatment would continue till the conclusion of my care. Conclusion: We focus on professional management and superior nursing care in this study so that we may provide the complete treatment that Fournier Gangrene requires while also effectively managing the complex case. After a full recovery, the patient's comprehensive health care team collaborates to help the patient regain his or her previous level of independence and happiness.

The contribution of family physicians to primary health care: Experiences from southwest Nigeria

Although an emerging speciality in Africa, family medicine contributes significantly to African health systems. Leadership from family physicians can enable the delivery of high-quality primary health care that is accessible, comprehensive, coordinated, continuous and person-centred. This short report chronicles how family physicians from a university teaching hospital in Ibadan, Nigeria, adopted a health post located in a home for persons with mild physical and mental disabilities and changed it into a hub of comprehensive, holistic and person-centred care for residents and staff of the home, as well as individuals and families in the neighbouring communities and its environs. The Department of Family Medicine of the University College Hospital, Ibadan, with the aid of a benefactor, reorganised a modest health facility to include the services of family medicine senior registrars (undergoing training-related rotations) with supervision by consultant family physicians. Family physicians led the primary health care team that provided both facility-based care and community outreach services. This report demonstrates how family physicians can improve the quality of primary health care and outcomes such as health equity in the community served.

Physiotherapy management of children with cerebral palsy

Cerebral palsy (CP) is a non-progressive developmental movement and posture disorder that occurs during fetal or infant development. It results from an insult to the developing brain before birth, during delivery, or after birth. CP is regarded as the leading cause of childhood disability in all parts of the world. The hallmark of CP is a motor disability, thus, physiotherapy has long been central to the clinical management of children with this disorders. Physiotherapy intervention in the management of this condition focuses on function, movement, and optimizing the child’s potential. Some of the approaches used are neurodevelopmental technique, neuromuscular electrical stimulation, exercise therapy, hydrotherapy, body weight support tread mill training, sensory integration training, and constraints induced therapy. Although, physiotherapy is generally recommended by all members of the health-care team. However, the effectiveness of physiotherapy is inconsistent. The objective of this review was to summarize the proven effectiveness of the most commonly used physiotherapy intervention in the management of children with CP.

Case Report on Chiari Syndrome

Chiari Malformation is a rare condition. A condition known as Chiari malformation occurs when brain tissue spreads into the spinal canal. When a portion of your skull is excessively small or malformed, it presses on your brain and forces it downward. Chiari malformation is a rare occurrence, although the increased use of imaging testing has resulted in more diagnosis. Case Presentation: A 18-year-old boy was admitted to the hospital with the following symptoms: Tingling sensation, numbness over left hand since 2 to 3 months. Neck bend toward right side, pain in left hand since 6 month. Difficulty during eating by hand since 2 to 3 month. On physical examination, indicated a bright attentive person with pale conjunctiva and no symptoms of icterus. He had a tachycardia, bilateral pitting pedal edema and a swollen abdomen with shifting dullness, all of which pointed to as cites. He had a history of intermittent abdominal pain. On admission he complaint of new onset of dyspnea on exertion, fatigue and abdominal swelling. The rest of all physical examination was normal, with no skin changes and an intact arterial pulses in all four extremities. Conclusion: The primary focus of this case study is on professional management and outstanding nursing care, which may provide the holistic care that Chiari Syndrome necessitates while also effectively managing the challenging case. After a full recovery, the patient's comprehensive health care team collaborates to help the patient regain his or her previous level of independence and satisfaction.

Guillain Barre Syndrome: A Case Report and Literature Review

Introduction: The arrival of Guillain-Barre Syndrome is sudden. It’s a type of neuropathy caused by the immune system. Nutrition is very crucial. In impoverished countries, it is a disabling disease. Autoantibodies against diverse antigens can be seen in the outlying site. The occurrence links 0.4 to 1.7 million individuals per year. Case Presentation: A 5-year-old boy was taken to the hospital with chief complaints of Weakness in bilateral upper and lower limbs, trouble in swallowing, inability to hold the neck, mouth-frothing, fever spikes. On physical examination, the patient has experienced weakness in bilateral upper and lower limbs, Bulbar weakness is present, pain experienced in both legs, the gag reflex is absent, In Cardiovascular System, S1 and S2 sound are present, In Respiratory System, Air entry is bilaterally equal, pupils are reflected light, tone, and power of upper and lower limbs are decreased, then treatment was started as soon as possible, he has not improved after receiving treatment, and the patient is on ventilator support, with treatment continuing until the end of my care. Conclusion: In this study, we primarily focus on professional management, and outstanding nursing care may give the holistic care that Guillain Barre Syndrome requires while also effectively managing the challenging case. The comprehensive health care team collaborates to help the patient achieve their prior level of independence and satisfaction after a full recovery.

A Case Report on Tuberculous Meningitis

Introduction: The most common cause of tuberculous meningitis is a hematogenous spread of mycobacteria from the lungs. tuberculous meningitis is a fatal disease. Symptoms typically worsen over time, and there are three clinical stages to the disease (prodromal phase, phase of neurological symptoms and phase of paresis) Case Presentation: The chief complaint of a one-year-old boy was fever, irritability, vomiting, and Generalized Tonic-Clonic Seizure convulsions. The patient's pupils were found to be unequal on physical examination, prompting a repeat neuroimaging. It was done on MRI (magnetic resonance imaging) with T1 hyperintensity on T2 and restricted diffusion on DWI (diffusion-weighted imaging) he has not improved after taking treatment and the patient is on a ventilator as well, we nasogastric tube also. I was receiving treatment and will continue to do so until the end of my care. Conclusion: In our environment, tuberculous meningitis that presents late is not uncommon. It arrived late at our medical facility. After a full recovery, the patient's comprehensive health care team collaborates to help him regain his previous level of independence and satisfaction. This report is intended to raise clinician awareness of tuberculous meningitis' unusual clinical presentation. Tuberculous meningitis is treated holistically with a focus on medical and nursing management.

Emotional Intelligence among Nurses working in a Tertiary Care Hospital, Kerala, South India

The nursing profession is labor intensive and nurses needs to regulate their emotions for the sake of their patients, their families and health care team member’s needs. The aim of the present study was to determine the level of emotional intelligence among nurses working in a selected tertiary care private hospital. A quantitative cross-sectional survey method, data was collected using a self-reported-questionnaires developed by Schutte from 717 registered nurses working in a tertiary care private hospital. A convnininece sampling technique was used to recruit the study participants. Data was analyzed using SPSS Version 24. The mean age of participants was 31.26±4.86 years; 93.4% (670) were females and 6.6% (47) were males. The total EI score ranged from 46 to 155 with a mean of 127.2311±10.1. Out of all, only 12% of the participants had above average, 3.5% had less than average and the remaining 84% had moderate levels of levels of EI levels. A statistically significant relationship was found between emotional intelligence and type of educational qualification and the total years of professional experience in the current area of work at 0.01 level. The moderate level of EI among majority of the participants revealed in the present study necessitates the need for conscious effort, education and training to improve the EI levels among nurses.

Integrated Clinical Pathways: Communication and Participation in a Multidisciplinary Team

BACKGROUND: An integrated clinical pathway (ICP) is a key method for structuring or planning processes of care, enabling the modernization of health-care delivery and coordination of multiple roles, forming a complete, patient-centered multidisciplinary health-care team and establishing the sequence of activities, promoting individual and team communication, collaboration, networking, and transparency, and reducing the cost of care. AIM: As there is a research gap in the area of communication among members of a multidisciplinary team for the treatment of patients through an ICP, the aim of this study was to determine the impact of communication of a member of a multidisciplinary team on the active participation of an individual in this multidisciplinary team. METHODS: A cross-sectional study of three ICPs, forchronic kidney disease, stroke, and total hip arthroplasty was conducted in a typical Slovenian general hospital. RESULTS: The results show that in the analyzed hospital, two of the three clinical pathways are not yet fully integrated. CONCLUSION: There is a weak influence of staff communication within a multidisciplinary team on an individual’s participation in this multidisciplinary team, indicating the need for various activities to actually implement clinical pathway “integration,” and promote better communication within teams to strengthen participation in multidisciplinary patient care pathways.