Pulmonary Implications of Pediatric Spinal Deformities.

"Pediatric spinal deformities may be associated with pulmonary complications in a patient's lifetime. A review of the diagnosis of spinal abnormalities includes classifications of scoliosis and kyphosis, correlating physical examination findings and radiographic interpretation. The natural history of untreated spine deformities is reviewed along with the associated altered pulmonary compromise. Treatment options for children affected by spinal deformities are discussed, including the relative indications, the efficacy, pros and cons of different treatment options, along with the evidence to support these. This overview of spine deformities includes research outcomes to support the care of these pediatric patients."

Late Presentation of Developmental Hip Dislocation: A Case Report.

CASE: We describe a patient who was diagnosed with developmental hip dislocation at 21 months of age despite having had normal ultrasonography findings at 5 weeks of age. CONCLUSION: This case report provides evidence that late developmental hip dislocation can occur despite normal clinical and sonographic findings early in life, and that it is difficult to know the cause of developmental hip dislocation when it presents late.

Reducing severe hypoglycaemia in hospitalised patients with diabetes: Early outcomes of standardised reporting and management.

BACKGROUND: Severe hypoglycaemic events (HGEs) in hospitalised patients are associated with poor outcomes and prolonged hospitalization. Systematic, coordinated care is required for acute management and prevention of HGEs; however, studies evaluating quality control efforts are scarce. OBJECTIVE: To investigate the effectiveness of system-based interventions to improve management response to HGEs. METHODS: System-based interventions were designed and implemented following a root cause analysis of HGE in adult patients with diabetes from two general medical wards with the highest incidence of HGE. Interventions included electronic medical record programming for a standardised order set for basal-bolus insulin regimen and hypoglycemia protocol, automated dextrose order, automated MD notification, and recommendation for endocrine consultation after two critical HGEs. The Pyxis MedStation was programmed to alert nurses to recheck blood glucose 15 min after the treatment. A card with the HGE management protocol was attached to each provider's ID badge and educational seminars were given to all providers. MAIN OUTCOMES AND MEASURES: Primary outcomes were to evaluate median time from HGE (glucose <50 mg/dL) to euglycemia (>100 mg/dL), and time from HGE to follow-up finger-stick (FS) testing preintervention and postintervention. Secondary outcomes were cumulative incidence of HGEs, recurrent hypoglycemia, rate of physician notification and use of standardised treatments among adults with diabetes on the two general medical wards. RESULTS: Among hospitalised adults with diabetes and HGE, median time from HGE to euglycemia declined from 225±46 min preintervention to 87±26 min postintervention (p=0.03). Median time from HGE to next FS testing also declined (76±14 min to 28±10 min, p<0.001). Standardised treatment administration for HGE improved significantly from 34% (12/35) to 97% (36/37); physician notification rate improved significantly from 51% (18/35) to 78% (29/37).Among hospitalised adults with diabetes, incidence of HGE decreased from 12% (35/295) over 3 months (preintervention period) to 6% (37/610) over 6 months (postintervention period) (p<0.001), while recurrent HGE did not show significant differences (37% (13/35) to 24% (9/37), p=0.09). CONCLUSIONS: System-based interventions had a clinically important impact on decreasing time from HGE to euglycemia and to next FS testing. This hypoglycemia bundle of care may be applied and tested in other community hospitals to improve patient safety.

Pediatric Scoliosis and Kyphosis: An Overview of Diagnosis, Management, and Surgical Treatment.

Evaluation of pediatric spinal deformity requires knowledge of special orthopaedic testing and radiographic interpretation. The determination of recommendations for treatment of spinal abnormalities in children can be challenging and at times complex, as treatment options are dependent upon a variety of factors. The etiology of scoliosis or kyphosis, presence or absence of vertebral anomalies, symptoms, magnitude of the curve, physiologic/skeletal age, and evidence of and risk of progression all require consideration and play a role in the shared decision-making process. This article provides an overview of relevant information and includes research outcomes to support the care of pediatric patients with spinal deformities. [Pediatr Ann. 2017;46(12):e472-e480.].

Urinary incontinence in adults with cerebral palsy: prevalence, type, and effects on participation.

OBJECTIVE: To assess the prevalence, type, and impact of urinary problems in adults with cerebral palsy and their relation with the Gross Motor Function Classification System for cerebral palsy. DESIGN: A cross-sectional prospective survey study. SETTING: An outpatient, urban, academic rehabilitation clinic. PARTICIPANTS: Ninety-one adults with cerebral palsy (45 women, 46 men). INTERVENTIONS: Subjects were approached at clinic presentation and were interviewed regarding current function, type and incidence of bladder issues, and concerns with bladder problems. MAIN OUTCOME MEASURES: The International Consultation on Incontinence Questionnaire-Female, or the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms Module, Gross Motor Function Classification System, employment, and type of residence. RESULTS: The mean age for both women and men was 36 years (range, 18-79 years). The subjects were currently assessed with the Gross Motor Function Classification System scales I-V: I, 4.4%; II, 19.8%; III, 13.2%; IV, 40.7%; and V, 22.0%. 95.6% of females and 84.7% of males were living at home. Twenty-three percent were currently employed. Twenty percent of the women indicated that they had bladder urgency most to all of the time and 46.7% of the women had leakage that occurred 2-3 times per week to several times per day. In men, urgency that occurred more often than "occasionally" was reported by 45.7%, and 19.6% reported this occurred "most to all of the time." Multivariable analyses found that obesity compared with normal weight was significantly related to leaking before reaching a toilet (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.3-14.7), to leaking with cough, exercise, or sneeze (OR 5.6, 95% CI 1.3-23.1), and to nocturia (OR 5.4, 95% CI 1.2-25.1). Women were more likely to leak with cough, exercise, or sneeze (OR 5.5, 95% CI 1.5-20.0). On scales that indicate symptom interference with life, high levels of interference were reported for women with symptoms of leaking and for men with urgency and leaking. No significant differences in living situation or employment were related to incontinence scores for women or men. CONCLUSION: There are high levels of incontinence in adults with cerebral palsy, and these individuals report interference with quality of life. Despite these issues, most participants were living in the community, and incontinence scores were not related to employment.

Wound care management of a patient with stage III lymphedema.

PURPOSE: The sequelae for patients living with stage III lymphedema, including immobility, functional impairment, isolation and emotional burden, that affect quality of life are highlighted. METHOD: The case patient's medical history upon initial evaluation, descriptive wound characteristics and treatment plan are described in detail. RESULTS: A comprehensive treatment regimen resolved the patient's wound. DISCUSSION: The definition, staging and prevalence of lymphedema are reviewed. CONCLUSION: Successful lymphedema wound treatment includes working with experienced healthcare providers, management of wound drainage and odor, the use of higher pressure compression, and complying with lifestyle changes.

Developing an outpatient wound care clinic in an acute rehabilitation setting.

People with disability are at high risk for skin breakdown,which requires ongoing prevention and management. An outpatient rehabilitation wound clinic was developed to handle a variety of acute and chronic wounds for this unique population. This article describes how two advanced practice nurses proposed the idea for the wound care clinic and formulated a business plan, which was critical to successfully administering an outpatient wound care service. Essential components of the business plan included the goals, scope of service, professional practice model, benefits, rationale, marketing analysis, predicted volumes, regulatory imperatives, and financial needs.