A Cross-sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States

xloma.fota.13 shared this article with you from Inoreader A Cross-sectional Analysis of High-Acuity Professional Services Performed by Urban and Rural Emergency Care Physicians Across the United States Via Annals of Emergency Medicine We seek to examine differences in the provision of high-acuity professional services between rural and urban physicians receiving reimbursement for emergency care evaluation and management services from Medicare fee-for-service Part B. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Managing a Cutaneous Abscess in the Emergency Department

xloma.fota.13 shared this article with you from Inoreader Managing a Cutaneous Abscess in the Emergency Department Via Annals of Emergency Medicine Cutaneous abscesses are a common type of skin and soft tissue infection observed in the emergency department (ED). Patients typically present with painful, erythematous nodules, which are often indurated and surrounded by an erythematous and edematous border.1,2 The overlying skin may have palpable fluctuance, surrounding cellulitis, and signs of spontaneous drainage.1,2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

IBCC – Alcoholic hepatitis

xloma.fota.13 shared this article with you from Inoreader IBCC – Alcoholic hepatitis Via EMCrit Blog - Emergency Department Critical Care We are seeing an increased volume of alcoholic liver disease due to the COVID pandemic.  Previously admissions to ICU for alcoholic hepatitis were rare, but these are now occurring with regularity. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes EMCrit Project by Josh Farkas. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence of hearing loss in school aged Nepalese children

xloma.fota.13 shared this article with you from Inoreader Prevalence of hearing loss in school aged Nepalese children Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110658. doi: 10.1016/j.ijporl.2021.110658. Epub 2021 Feb 19. ABSTRACT OBJECTIVES: The main objective of this study is to identify the prevalence of hearing loss in school aged children of Nepal. METHODS: This cross-sectional study was carried out on school aged children attending the government run schools of Nepal. A total of 79,340 children from grades 1 through 10 were included in the study. After taking brief history about ear diseases and hearing loss, children were screened for ear diseases in their respective classroom by otoscope. Hearing evaluation was carried out by pure tone audiometer and hearing threshold was obtained at 0.5-4 kHz. The results were then documented and analyzed. RESULTS: The prevalence of hearing impairment in school aged children in Nepal is found to be 5.73% (4551 of 79,340). Conductive hearing loss was the most common type of hearing loss and was o bserved in 70.47% (n = 3207) of the children. CONCLUSIONS: This study shows that hearing loss is a common problem in children of Nepal. With the main cause of hearing loss due to preventable conditions such as chronic otitis media, it is believed that early standardized screening, detection and timely management of chronic otitis media in these children can prevent hearing loss and its impact on their educational, social and language development. School based ear health programs are a useful community-oriented solution for prevention of deafness. It shows how important it is to introduce hearing screening for primary school aged children to prevent hearing loss. PMID:33636508 | DOI:10.1016/j.ijporl.2021.110658 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population

xloma.fota.13 shared this article with you from Inoreader Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110655. doi: 10.1016/j.ijporl.2021.110655. Epub 2021 Feb 20. ABSTRACT BACKGROUND: The objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities. METHODS: A randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: "FLACC-R" (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and "Wong Baker faces" for older children. Additional post-operati ve outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales. RESULTS: Significantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively. CONCLUSION: When compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics. PMID:33639493 | DOI:10.1016/j.ijporl.2021.110655 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The otolaryngologic manifestations of Sotos syndrome 1: A systematic review

xloma.fota.13 shared this article with you from Inoreader The otolaryngologic manifestations of Sotos syndrome 1: A systematic review Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110649. doi: 10.1016/j.ijporl.2021.110649. Epub 2021 Feb 12. ABSTRACT OBJECTIVES: Sotos syndrome 1 (SOTOS1; MIM:117550) is rare genetic disorder characterized by excessive physical growth before and after birth, distinctive facial features, a large and elongated head, and intellectual disability (Sotos et al., 1964; Tatton-Brown et al., 1993). This systematic review aims to determine otolaryngologic conditions and complications of SOTOS1 based on existing literature through a review of current and past case reports and studies regarding SOTOS1. METHODS: A systematic review of all published literature (1964-2020) describing otolaryngologic conditions and/or complications of patients with SOTOS1. Twenty journal articles met inclusion criteria. These articles included 160 patients diagnosed with SOTOS1. RESULTS: Of the 160 individuals with SOTOS1 included in this review, 22 (14%) we re reported to have otologic conditions. 4 (3%) individuals were reported to have conditions involving the thyroid and parathyroid glands. 2 (1%) individuals were reported to have head & neck tumors. 39 (24%) individuals were reported to have congenital malformations or abnormalities of the head & neck. 47 (29%) individuals were reported to have feeding difficulties. 16% of individuals were reported to have other otolaryngologic conditions. CONCLUSIONS: Our review found multiple otolaryngologic conditions present in patients with SOTOS1, including hearing loss, otitis, hyperthyroidism, hypothyroidism, head & neck tumors, congenital malformations (high arched palate, cleft lip and palate, macroglossia), feeding difficulties, respiratory difficulties, and speech disorders. Additional studies should be conducted to further assess these associations. PMID:33640723 | DOI:10.1016/j.ijporl.2021.110649 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Improving community-based care for children with a rare condition: The example of long-segment congenital tracheal stenosis and perceptions of health professionals, parents and teachers

xloma.fota.13 shared this article with you from Inoreader Improving community-based care for children with a rare condition: The example of long-segment congenital tracheal stenosis and perceptions of health professionals, parents and teachers Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110651. doi: 10.1016/j.ijporl.2021.110651. Epub 2021 Feb 14. ABSTRACT BACKGROUND: Long segment congenital tracheal stenosis (LSCTS) is a rare, complex condition which is often poorly understood by community-based health professionals (HPs). Anecdotally, such HPs often lack confidence providing care for children, resulting in children being brought to the tertiary centre more frequently than necessary. We wanted to identify the information and support needs of HPs in primary and secondary care looking after a child with LSCTS, the views of those providing education to these children, and elicit parents' perceptions about community-based services, to improve overall care for children and families. METHOD: Questionnaires were sent to 175 community-based HPs and 34 teachers involved in the care of children with LSCTS. Face-to-face or telephone interviews were conducted with 12 parents of p atients with LSCTS to establish their perceptions of community-based services. RESULTS: Ninety (51%) completed questionnaires were returned from HPs and 18 (53%) from teachers. Responses indicated low levels of knowledge of LSCTS. Physical, practical and communication information needs were identified by all respondent groups, together with general and condition-specific concerns. Interviews with parents indicated that they thought the level of knowledge about LSCTS in the community was low, which had a negative impact on their willingness to consult local services. Better information provision for HPs, teachers and parents was identified as a means of improving outcomes. CONCLUSION: Professionals caring for children with LSCTS in the community and in schools have unmet information and support needs, with consequences for children, families, HCPs in both the community and tertiary hospital, and teachers. PMID:33662711 | DOI:10.1016/j.ijporl.2021.110651 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Challenges faced by parents when seeking diagnosis for children with sensorineural hearing loss

xloma.fota.13 shared this article with you from Inoreader Challenges faced by parents when seeking diagnosis for children with sensorineural hearing loss Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Apr;143:110656. doi: 10.1016/j.ijporl.2021.110656. Epub 2021 Feb 19. ABSTRACT INTRODUCTION: The Joint Committee of Infant Hearing (JCIH) recommended hearing screening by one month of age, diagnosis of hearing loss by three months of age, and intervention initiated by six months of age. In Malaysia however, the age of diagnosis of hearing loss in children is relatively late. This study aimed to identify the challenges faced by parents in seeking a diagnosis of hearing loss for their children. METHOD: The study utilized a semi-structured interview with open-ended questions to obtain information about parents' experiences during the diagnosis period and their challenges when going through that process. In this study, a total of 16 parents of children who were diagnosed with moderate to profound sensorineural hearing loss and received intervention within three years at the time of the study partic ipated. Ten of the children were cochlear implant users, and six were hearing aid users. RESULTS: Thematic analysis was used to analyse themes generated from the data according to the study objective. Four main themes and 17 subthemes were identified from this study. The four main themes were 1) Parents' emotion; 2) Parental knowledge; 3) Others; 4) Profesional services. Challenges that parents faced often include emotional behaviours such as feeling guilty and devastated during the diagnosis, lack of information-sharing from healthcare givers, lack of knowledge on childhood hearing loss among parents, support from families, seek for a second opinion, worry about others' acceptance, longer time for diagnosis to confirm, late referral to other related profesionals and no priority for the appointment. CONCLUSION: Emotion is identified as the biggest challenge faced by parents in the process of diagnosis for their children with hearing loss. Hence, management of parental em otion needs to be emphasized by health profesionals as it influences the acceptance of parents towards their child's diagnosis. PMID:33662710 | DOI:10.1016/j.ijporl.2021.110656 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Persistence of choking injuries in children

xloma.fota.13 shared this article with you from Inoreader Persistence of choking injuries in children Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Mar 21;144:110685. doi: 10.1016/j.ijporl.2021.110685. Online ahead of print. ABSTRACT BACKGROUND: Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts. OBJECTIVE: To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics. METHODS: A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention's WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP's recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses. RESULTS: From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians. CONCLUSIONS: Overall rate of nonfatal ch oking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities. PMID:33819896 | DOI:10.1016/j.ijporl.2021.110685 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision

xloma.fota.13 shared this article with you from Inoreader Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision Via Modern Pathology - AOP - nature.com science feeds Modern Pathology, Published online: 06 April 2021; doi:10.1038/s41379-021-00796-9 Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Short lingual frenulum and head-forward posture in children with the risk of obstructive sleep apnea

xloma.fota.13 shared this article with you from Inoreader Short lingual frenulum and head-forward posture in children with the risk of obstructive sleep apnea Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Int J Pediatr Otorhinolaryngol. 2021 Mar 29;144:110699. doi: 10.1016/j.ijporl.2021.110699. Online ahead of print. ABSTRACT BACKGROUND: Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children. METHODS: Children from pre-, primary, secondary, and high school, aged 3-17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups. RESULTS: A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58-15.94]). CONCLUSIONS: The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters. PMID:33823467 | DOI:10.1016/j.ijporl.2021.110699 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.