CASE REPORT OF TWO SUCCESSFUL PREGNANCY OUTCOMES AFTER RADICAL TRACHELECTOMY

Currently, the development and implementation of organ-preserving methods for patients of reproductive age are the treatment priorities in modern oncology. We report a case of two successful pregnancy outcomes in a 29-year-old patient with stage IB invasive cervical cancer, who underwent laparoscopic radical trachelectomy using high-tech diagnostic and treatment techniques. Alotech, an innovative radiopharmaceutical, and Rad Pointer laparoscopic gamma scanner were used for intraoperative detection of sentinel lymph nodes. In addition, a uterine obturator was formed during surgery using a titanium nickelide shape memory implant. This case showed the feasibility of preserving the uterus after delivery by caesarean section, with no evidence of tumor recurrence according to the findings of intraoperative morphological examination.

Unilateral Multicanalicular Vestibular Lithiasis of Right Horizontal and Posterior Semicircular Canals: An Unusual Case

Vestibular lithiasis (canalolithiasis as well as cupulolithiasis) commonly exists in monocanalicular forms involving one of the three semicircular canals, frequent posterior, less frequent horizontal, and very rarely anterior. It is treated with canal clearing maneuvers intended to reposition the otoconia from the semicircular canal (where they have inappropriately entered) through the utricular exit in the nonampullary arm of the semicircular canal to the utricle (where they normally remain as a part of utricular gelatinous matrix). The cases of multicanalicular vestibular lithiasis with the involvement of more than one semicircular canal require meticulous identification of the involved canals and multiple different canal-clearing maneuvers for effective treatment. A 70-year-old male patient with no significant history of previous medical or otologic illnesses or head trauma presented with a 1-day history of vertigo with positional aggravation. A one-time performed diagnostic supine head roll test elicited three different patterns of positional nystagmus, each with an accurate localizing and lateralizing value. Diagnosis of unilateral multicanalicular vestibular lithiasis of right horizontal and posterior semicircular canals was entertained based on the pattern of the elicited positional nystagmi on the supine roll test. The upbeating torsional nystagmus that localizes the involvement to the posterior semicircular canal was paradoxically elicited by supine head roll test and not by the Dix–Hallpike test. As horizontal semicircular canalolithiasis causes severe symptoms, its treatment preceded that of concurrent posterior semicircular canalolithiasis. The patient was successfully treated with multiple sessions of canalith repositioning maneuvers (CRMs) spread over 24 hours. It is important to perform both positional tests, namely Dix–Hallpike maneuver, and supine head roll test, in cases suspected to have multicanalicular vestibular lithiasis. The positionings may need to be repeated several times to unveil multiple nystagmi, each with different localizing and lateralizing values. Identifying treatment priorities with CRM for the individual semicircular canals is crucial, and the canal that is liable to cause severe symptoms needs early clearance of the otoconial debris. If a CRM fails to clear a semicircular canal, an alternative maneuver may need to be executed. Clinicians involved in the care of cases with multicanalicular vestibular lithiasis should be well versed with all possible backup maneuvers for clearing each of the three semicircular canals.

Blunt Traumatic Aortic Injury

Traumatic aortic injuries represent a leading cause of death following motor-vehicular accidents. These injuries curry a very high mortality rate even though a significant number of patients reaches the hospital alive. These injuries are identified in the contest of a polytrauma work up and are almost always associated with multiple other severe traumatic injuries which makes the management of these patients very challenging. The technology advancements seen in recent years with radiologic imaging and the progress of the therapeutic options brought up by the uprise of endovascular therapy, along with the sophistication of the techniques of trauma resuscitation and intensive care management, have improved significantly the overall prognosis of these patients. Although traumatic aortic injuries need to be generally considered a life-threatening condition, their degree of severity may differ significantly from case to case requiring immediate repair in some patients, whereas their repair can be delayed in cases when the severity of the aortic injury does not represent an immediate threat to the patient life. Therefore, the challenge of treatment of the polytrauma patients with an aortic injury is to identify the best strategy of therapy able to prioritize the treatment of the injuries based on their lethal potential. In this contest, the ability of properly defining the severity of the aortic injury is the key-factor to allow the appropriate definition of a treatment strategy able to identify treatment priorities. In our experience, radiologic assessment of the aortic injury in correlation with the evaluation of clinical parameters and a comprehensive polytrauma assessment allows to optimize the ability of the trauma team to establish the most appropriate strategy for the care of this complex patients’ group.

Use, Usability, And Impact of A Tool To Support Conversations About End-of-Life Preferences In Residential Elder Care – A Qualitative Study of Staff Experiences

Background: If EOL care is to be person-centred and value-concordant, proactive conversations about individual preferences between residents, relatives, and staff are required. Nevertheless, the prevalence of conversations about preferences for EOL care is still low in residential care homes (RCHs), often relating to staff’s perceived lack of skills and confidence. Conversation tools may be useful to support staff in facilitating EOL conversations, but often focus more on documenting treatment priorities than on exploring underlying values and reasoning for preferences. In this study, we use the DöBra cards, the Swedish version of the GoWish cards, to support discussions about EOL care values and preferences in RCHs, and explore staff perspectives on use, usability, and impact. Methods: This qualitative study was based on data generated from two participatory action research processes in which RCH staff tested and evaluated use of DöBra cards in EOL conversations. Data comprise 6 interviews and 8 group meetings with a total of 13 participants from 7 elder care facilities. Qualitative content analysis was performed to identify key concepts in relation to use, usability, and impact of the DöBra cards with residents and/or relatives.Results: Based on participants’ experiences of using the DöBra cards as an EOL conversation tool in RCHs, we identified three main categories in relation to its usefulness. Outcomes of using the cards (1) included the outlining of content of conversations and supporting connection and development of rapport. Perceived impact (2) related to enabling openings for future communication and aligning care goals between stakeholders. Use and usability of the cards (3) were influenced by supporting and limiting factors on the personal and contextual level.Conclusions: This study demonstrates how the DöBra cards was found to be useful by staff for facilitating conversations about EOL values, influencing both the content of discussion and interactions between those present. The tool encouraged reflection and interaction, which staff perceived as potentially helpful in building preparedness for future care-decision making. The combination of providing a shared framework and being adaptable in use appeared to be key features for the DöBra cards usability in the RCH setting.

Primary health professionals’ beliefs, experiences, and willingness to treat minor attracted persons

There is a desire and need among minor attracted persons (MAPs) to access support within the community, and this often begins with an approach to healthcare providers working in general medical/mental health settings. However, little is known about the experiences of these non-specialist professionals in relation to their beliefs, knowledge, and decision-making processes when working with patients who disclose sexual attractions to children. Using an online survey, this study explored the knowledge, comfort, competence, and treatment willingness of 220 non-specialist healthcare providers when faced with patients who disclose sexual attractions to children. We investigated the prevalence of these disclosures, clinician stigma, treatment priorities, and professionals’ willingness to report MAPs to external agencies because of their sexual attractions. Some key differences were found when comparing primary medical vs mental health professionals, including increased likelihood to view MAPs as dangerous, unable to control behaviors and that sexual attractions are an avoidable choice, in the former group. Both groups prioritized mental health treatment targets above controlling attractions and living with stigmatized attractions, although controlling or changing attractions were still relatively high priorities. Results indicated a need for further training, focusing on increasing comfort around working with MAPs, as this was associated with a greater willingness to work with this group. We identify current gaps in service provision for MAPs seeking professional support and discuss recommendations for professional training.

Treatment priorities for idiopathic generalized epilepsy

The report presents the current principles of treatment of various types of epileptic seizures and forms of epilepsy. High efficacy and good tolerability in mono- and combination therapy with lamotrigine are shown, including its beneficial effects on cognitive function, behavior, and mood in children.

Proceedings of the Sleep and Epilepsy Workgroup: Section 2 Comorbidities: Sleep Related Comorbidities of Epilepsy

Epilepsy is a chronic disease with multiple, complex comorbidities. Bidirectional relationships exist among seizures, sleep, circadian rhythms, and diseases within and outside of the central nervous system. Seizures fragment sleep and can contribute to development of sleep disorders, which in turn leads to worse overall health and more seizures. Moreover, treatment options are often limited by interactions with anti-seizure medications. Advances in the fields of epilepsy and in sleep medicine have been made separately, and therefore treating patients with these comorbidities necessitates interdisciplinary approach. The focus of this section of the Sleep and Epilepsy Workgroup was to identify methods of collaboration and outline investigational, educational, and treatment priorities to mutually advance what we consider a combined field.

“People Associate Us with Movement so It’s an Awesome Opportunity”: Perspectives from Physiotherapists on Promoting Physical Activity, Exercise and Sport

Insufficient physical activity (PA) is a critical public health issue especially in the context of COVID-related deconditioning. Health professionals are well placed to promote community-based PA but there is little supporting implementation research. We aimed to explore physiotherapists’ knowledge, views, attitudes and experiences regarding the promotion of physical activity, exercise and sport within daily clinical practice in order to guide development of strategies to support implementation of PA promotion by physiotherapists, in particular those treating older people, and adults and children with a disability. We conducted interviews and focus groups with 39 physiotherapists. Two researchers coded transcripts with an iterative coding approach. Analysis returned five main themes: putting principles into practice; working with conflicting priorities; multiple client barriers; connections build confidence; and the battle for information. The physiotherapists accepted their legitimate role in PA promotion. Limited clinical and administrative time and acute treatment priorities often superseded PA promotion but the lack of updated information regarding suitable community-based PA opportunities and lack of trust in community providers were the biggest barriers. Strategies to enhance PA promotion by physiotherapists should address time and information constraints, and build partnership connections between health professionals and community-based PA providers.

Identification of halal risk in risoles production using house of risk method

This research was conducted at Food Micro, Small and Medium Enterprises (MSMEs) in Medan City. In this study, observations were made on all activities, so that the process stages and risks that affect halal in each stage of the process are known. Furthermore, the risk factors are identified, and the House of Risk (HOR) method is used to find the dominant cause through the calculation of the Aggregate Risk Potential (ARP). The results showed that there were 9 processes, 31 risk events, and 26 risk agents. Ideally, no risk agent can affect the halal of the product. However, treatment priorities can be set to address the risk agent that has the greatest impact, which is based on the highest ARP value. In this study, the focus of handling is five risk agents, namely raw materials that are not entirely Halal certified, cleaning of machinery and equipment is not routinely carried out before starting production, raw materials received from suppliers are not following demand, working environmental conditions make it difficult for workers to concentrate, and lack of halal management and information system.