Building a Multidisciplinary Clinic Dedicated to Upper-Extremity Limb Loss.

Complete care of the patient with upper limb loss mandates a long-term, multifaceted approach. Increased functionality and quality of life require collaborative efforts between the patient's surgeon, prosthetist, hand therapists, mental health professionals, and peers. An individual surgeon may find that initiating and maintaining a practice offering total integrated treatment for upper-extremity amputees is a formidable task, but with specific, actionable recommendations, the process can be demystified. The upper-extremity surgeon must be facile with operative techniques such as targeted muscle reinnervation (TMR), regenerative peripheral nerve interface (RPNI), and soft tissue reconstruction and focus on team recruitment strategy and promotion of the clinic within the community. Consistent communication and team decision-making shape each patient's preoperative and postoperative course. We aim to relay effective interventions at each step of recovery from each clinic member and describe clinic workflow designed to reinforce holistic care. We present a blueprint for creating a functional and comprehensive multidisciplinary center for patients with upper-extremity limb loss for those providers interested in providing care, but who are missing the logistical roadmap for how to do so.

This experience taught me the importance of sharing knowledge.

In my final year of learning disability nursing at Queen's University Belfast, I travelled to Romania with a team of nursing students for our 4-week elective placement.

Sarcoidosis of the pinnas in a 17-year-old.

A 17-year-old girl presented with persistent swelling and erythema of the midportion of the helix of the pinnas, with no associated history of pain, fever, or hearing loss. The area was erythematous, with crusting and a minimal amount of pus. Her otologic examination was otherwise normal. A culture grew Staphylococcus (nonaureus). Over a 9-month period, she had flair-ups of the lesions with minimal response to topical and oral antibiotics. A dermatology consultation was obtained, and she was started on topical steroids, with no clinical improvement. She then developed raised erythematous lesions. Blood work showed no obvious immune disorder or evidence of an infectious process. A full-thickness skin biopsy was then taken, and pathologic examination found noncaseating granulomatous dermatitis; the histopathologic diagnosis was sarcoidosis. The patient was then referred to rheumatology for further evaluation and treatment. Although sarcoidosis is rare in the pediatric population, skin lesions that do not respond to medical therapy should be considered for biopsy.

Persistent conductive or mixed hearing loss after the placement of tympanostomy tubes.

OBJECTIVE: Described is a case series of clinical findings in children with persistent conductive or mixed hearing loss following tympanostomy tube placement for serous otitis media. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary pediatric hospital. SUBJECTS/METHODS: Medical records of thirty-nine children who were referred for either conductive or mixed hearing loss post-tympanostomy tube placement were reviewed for clinical histories, physical examinations, audiological evaluations, diagnostic studies, consultations, and surgical findings. Approval was obtained from the Boston Children's Hospital Institutional Review Board. RESULTS: Causes of hearing loss included ossicular abnormalities, cochlear abnormalities, 'third window' effects, cholesteatomas, genetic syndromes, and unknown causes. In four patients with isolated mild low-frequency conductive hearing loss, the cause was the presence of functional tubes. All patients diagnosed with a genetic syndrome had bilateral hearing loss. Patients with mixed hearing loss were diagnosed with cochlear abnormalities, 'third window' effects, or genetic syndromes. Computed tomography led to diagnosis in sixteen of twenty-five patients. Vestibular-evoked myogenic potential testing suggested a diagnosis in three of four patients. CONCLUSION: In children with persistent hearing loss following tympanostomy tube placement, identifying the laterality and type of hearing loss appears to be of importance in diagnosis. Patients with bilateral hearing loss should be considered for genetic testing, given the possibility of a syndrome. Patients identified with a mixed hearing loss should be evaluated for inner ear anomalies. Patients with mild, low-frequency hearing losses should be monitored audiologically and investigated further only if the hearing loss progresses and/or there is no resolution following tube extrusion.

Effects of video games on adolescents and adults.

The present study compared a sample of American adolescents with a Spanish sample on a measure of video game addiction, the Problem Video Game Playing (PVP) survey developed in Spain. In addition, the study examined excessive video game playing and reported distress in social life, occupational activities, and school among high school students, college students, and adults. Samples taken from a large Eastern university, two suburban high schools, and an Internet survey were surveyed with an instrument developed by the authors and the PVP. Results show support for the PVP and a similarity between the Spanish and American samples but not for relationships between the PVP and assessments of distress in areas of daily functioning.