Hyperbaric Oxygen following Bilateral Skin-sparing Mastectomies: A Case Report.

We describe a case in which hyperbaric oxygen therapy was used to salvage ischemic skin flaps after nipple-sparing mastectomy.

Positional plagiocephaly: experience with a passive orthotic mattress.

Positional plagiocephaly (deformational or occipital plagiocephaly) is the most common head-shape deformity, which is presented to specialist craniofacial units. The aim of management is to reduce pressure on the affected area in the expectation that brain growth will drive normalization of the head shape. Current management includes a variety of protocols based on repositioning advice or helmet orthotics. The aim of this study is to document changes in head shape associated with use of a passive orthotic mattress for the management of positional plagiocephaly of a series of 30 patients at Alder Hey Children's Hospital between April 2008 and June 2010. Cranial vault asymmetry was assessed before treatment and was classified into mild, moderate, or severe plagiocephaly. Follow-up demonstrated a significant improvement in cranial vault asymmetry in those treated with the passive orthotic mattress.

Early rehabilitation in head injury; can we improve the outcomes?

BACKGROUND: The quality of care after head injury is still very variable with a little coordination between different specialties. Acute care dominates, often with little regard to rehabilitation needs. OBJECTIVES: To improve the outcomes of all head injury admissions to hospital, including mild and moderate, by creating a head injury team to supervise a rehabilitation clinical pathway. PATIENTS AND METHODS: A head injury team was established to manage the care of all non-neurosurgical admissions with head injury to a large teaching hospital. Apart from inpatient care, the team coordinates various services involved in the care of head injuries, arranged suitable follow-ups, supported relatives and trained healthcare staff on general wards in the treatment of head injured patients. Follow-up clinics at 6 weeks and 6 months were arranged. RESULTS: In the first three years, the team managed the care of 812 admissions. Mean age was 44.3 years (SD = 24.8) and mean length of hospital stay was 6.1 days (SD = 10.9). Of these individuals, 674 attended for 6 month follow-up with 52.2% having a good outcome on Extended Glasgow outcome score. Patients and their relatives' feedbacks were excellent with an average score of 4.7/5 on overall satisfaction rating. Following presentations at national meetings and elsewhere, other centers in the United Kingdom are now setting up similar pathways. CONCLUSIONS: A dedicated clinical pathway and head injury team can improve the quality of care for all admissions with head injury and enhance the role for rehabilitation medicine input at an early stage.

Clinical pathways in head injury: improving the quality of care with early rehabilitation.

PURPOSE: To improve the management of all hospital admissions with head injuries, including mild and moderate by developing a clinical pathway and a head injury team. METHODS: A head injury team was set up to take over the care of all admissions with head injury and to manage appropriate referrals and discharges. A key role was to facilitate communication between the different services involved in head injury care, arrange follow-up, support relatives and to educate healthcare staff. RESULTS: In the first year, the team took over the care of 196 admissions of whom 128 attended for 3-month follow-up with 66% having a good outcome. Patients and relatives feedback was excellent with an average score of 4.8/5 on overall satisfaction rating. Other centers in the United Kingdom are aiming to set up similar pathways, and the team has presented on head injury pathways extensively. CONCLUSIONS: A clinical pathway can improve the quality of care for all admissions with head injury and enhance the role for rehabilitation at an early stage.