Parental acceptability of pediatric forearm manipulations in a UK district hospital emergency department

PURPOSE

Pediatric forearm fractures are a common presentation to Accident and Emergency departments. Standard treatment for the majority of these is manipulation under sedation within the department, followed by cast application. Concerns have been raised about the acceptability of such interventions, and reluctance to perform these procedures has led to increased admissions and manipulations performed under general anesthetic.

METHODS

A prospective case series of all pediatric patients with forearm fractures who underwent a manipulation under sedation in the Accident and Emergency department was collected over 12 months. All parents were invited to complete an acceptability questionnaire, adapted from the Swedish Pyramid Questionnaire for Treatment, based on their experiences.

RESULTS

A total of 77 patients were included and their parents were asked to complete a Swedish Pyramid Questionnaire of Treatment. Forty-four parents (55%) agreed to fill out the questionnaire. Patient demographics and fracture characteristics were compared between the group that responded and those that did not, with no significant differences. Average level of satisfaction was 9.4/10 (range = 7-10). 98% of respondents were satisfied with the level of analgesia provided, but only 86% with the timeliness of administration.

CONCLUSION

This parent-focused evaluation of treatment confirms high levels of parental satisfaction with the management of pediatric forearm fractures in Accident and Emergency, with regard to care, analgesia, and information. It provides insights about parental concern relating to the injury and their anxiety as information useful to further improving care, a template for assessing quality improvement and should be considered as part of further studies in this field.

LEVEL OF EVIDENCE

Level IV case series.

Tricuspid valve repair with the Cardioband system: two-year outcomes of the multicentre, prospective TRI-REPAIR study

AIMS

Tricuspid regurgitation (TR) is associated with high morbidity and mortality rates with limited treatment options. We report one- and two-year outcomes of the Cardioband tricuspid valve reconstruction system in the treatment of ≥moderate functional TR in the TRI-REPAIR study.

METHODS AND RESULTS

Thirty patients were enrolled in this single-arm, multicentre, prospective study. Patients were evaluated as having ≥moderate, symptomatic functional TR and deemed inoperable due to unacceptable surgical risk. Clinical, functional, and echocardiographic data were prospectively collected up to two years (mean duration 604±227 days). At baseline, 83% were in NYHA Class III-IV, and the mean LVEF was 58%. Technical success was 100%. At two years, there were eight deaths. Echocardiography showed a significant reduction in septolateral annular diameter of 16% (p=0.006) and 72% of patients (p=0.016) with ≤moderate TR grade; 82% of patients were in NYHA Class I-II (p=0.002). Six-minute walk distance and KCCQ score improved by 73 m (p=0.058) and 14 points (p=0.046), respectively.

CONCLUSIONS

These results demonstrate that the Cardioband tricuspid system showed favourable results in patients with symptomatic, ≥moderate functional TR. Annular reduction and TR severity reduction remained significant and sustained at two years. Patients experienced improvements in quality of life and exercise capacity. ClinicalTrials.gov Identifier: NCT02981953.

Radioguided occult lesion localization and sentinel node and occult lesion localization in breast cancer: The future beckons

Wire Guided Localisation has been the traditional technique for occult breast lesions. However, ROLL has emerged as a safer alternative to WGL approach. ROLL provides an improvement on margin positive rates and offers better pain and cosmetic advantages to the patient combined with a shorter learning curves for both radiologists and surgeons. SNOLL adds to the advantages of the procedure by combining SLNB with ROLL hence offering an economic advantage. The use of ROLL as primary modality for occult lesion localisation is bound to increase with potential to replace WGL as the primary modality for such lesions.

Schizophrenia: four examples of historical retrospective diagnosis

It is difficult to know precisely the history of a functional disease, unlike the natural history of infectious agents, tumour processes or poly-malformative syndromes. In the case of psychiatry, and especially schizophrenia and psychotic disorders, a retrospective look at artistic productions (writings and drawings) makes it possible to reconstitute a whole section of this pathological context. Through four medieval and modern examples, we will see how it is possible to do a paleo-psychiatry: Opicinus de Canistris (14th c.), the Voynich manuscript (15th c.), Hieronymus Bosch (15th-16th c.), and the Codex Seraphinianus (20th c.).

["Palimpsest scar" lesions in a context of torture (Darfur, Sudan)]

BACKGROUND

As a result of the current exponentially growing refugee population from the Middle-East and East Africa (Sudan, Darfur, Eritrea), clinicians (including forensic pathologists) are seeing atypical skin lesions, mainly of a traumatic nature, but in some cases associated with long-standing lesions related to ethnic practices.

PATIENTS AND METHODS

A case of torture sequelae is presented herein in a patient originally from Darfur (Sudan): cutaneous incisions were made on old scars several times using a knife.

DISCUSSION

The clinical presentation of scarification lesions and that of atypically healed wounds (presumably an effect of inflammation induced by the introduction of irritating foreign bodies such as sand, salt, etc.) are completely different: in all cases they indicate a relative timeframe of the facts, which the clinician should not overlook in reconstructing the patient's course and the injuries to which he has been subjected (hence the proposed designation of "palimpsest scar", in the sense that a palimpsest is a manuscript on a parchment that previously contained writing but has been scratched clean to be overwritten). Thus, a "palimpsest scar" constitutes a fresh scar on top of and hiding another (ritual) scar in a context of ethnic cleansing. The diagnostic and clinical significance comes from the importance of differentiating between ethnic-type lesions and those induced by physical violence and abuse in a context of war.

A new definition of health? An open letter of autochthonous peoples and medical anthropologists to the WHO

Currently, for many practitioners (hospital and liberals) and researchers (including public health), the WHO definition of health is outdated: first it seems more utopian than pragmatic; then, it proves unsuitable for a large part of the world population. There is clearly a need to refine this definition or propose additional criteria to be more relevant or discriminating. In this perspective, what can indigenous people offer in the elaboration of a new definition of health? In this article, leaders or representatives of autochthonous peoples, anthropologists and physicians from many cultural origins (Amazonia, Patagonia, Papua New-Guinea, Inuit, North-American Indian, sub-Saharan Africa, India, China, Melanesia and Polynesia) have tried to identify and explain several key concepts that WHO should reintegrate into its new definition of health: human equilibrium in nature, accepted spirituality and adaptation. On the sidelines of the application of COP21 decisions that should give back to man his place into the environment, autochthonous people leaders, anthropologists and MDs explain why these three concepts are fundamental and universal health determinants, and need to be included in a new WHO definition of health.

Status of medico legal service in Nepal: Problems along with suggestions

Forensic medicine deals with the application of medicine for the purpose of law. It is now commonly used to describe all aspects of forensic caseworks; including forensic pathology, that branch of forensic medicine which investigates death, and clinical forensic medicine, which involves interaction between the law, judiciary and the police involving (generally) living persons. The medico legal investigation system in our country still lags far behind the developed countries. The doctors doing the medico legal and post-mortem work at the district level hospitals are often untrained in this sensitive job. It is a job of great responsibility and to leave it to inexperienced doctors is actually doing injustice to the society. Forensic experts handle a very small part of total medico-legal work as most of them work in private medical colleges which are not permitted to handle the work. Mortuaries are housed in outdated facilities. Exposure to the medical students on medico legal cases including autopsy is done only on a sporadic basis taking them to nearby government hospitals and even if they visit the hospitals, inadequate infrastructure prevents better learning. Private medical colleges are conducting postgraduate course in forensic medicine without handling medico legal cases. There should be a post of forensic medicine specialist, at least at the zonal hospitals and the district hospitals handling more medico legal cases. The private medical colleges, especially those enrolling postgraduate students in the field, must seek permission to conduct medico legal works and the government also should not be reluctant in permitting so as it’s not producing adequate experts in itself as per the need of the country. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12769 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 49-54