Impact of protein-losing enteropathy in children who underwent the Fontan operation.

Previous reports have identified risk factors associated with development of post-Fontan protein-losing enteropathy. Less is known about the economic impact and resource utilisation required for post-Fontan protein-losing enteropathy in the current era. We conducted a single-centre retrospective study to assess the impact of post-Fontan protein-losing enteropathy on transplant-free survival. We also described resource utilisation and treatment variations among post-Fontan protein-losing enteropathy patients. Children who received care at our centre between 2009 and 2017 after the Fontan surgery were eligible. Initial admissions for the Fontan operative procedure were excluded. Demographics, hospital admissions, resource utilisation, medications and charges were reviewed. Patients were divided into two groups based on the presence of post-Fontan protein-losing enteropathy. Of the 343 patients screened, 147 met the eligibility criteria. Of these, 28 (19%) developed protein-losing enteropathy. After adjusting for follow-up duration, the protein-losing enteropathy group had higher number of encounters (2.15 ± 2.16 versus 1.47 ± 2.56, p 0.002), hospital length of stay (days) (25 ± 51.3 versus 11.4 ± 41.7, p < 0.0001) and total charges (2018US$) (388,489 ± 759,859 versus 202,725 ± 1,076,625, p < 0.0001). Encounters for patients with protein-losing enteropathy utilised more therapies. Among those with protein-losing enteropathy, use of digoxin was associated with slightly decreased odds for mortality and/or transplant (0.95, confidence interval 0.90-0.99, p 0.021). The 10-year transplant-free survival for patients with/without protein-losing enteropathy was 65.7/97.3% (p 0.002), respectively. Post-Fontan protein-losing enteropathy is associated with reduced 10-year transplant-free survival, higher resource utilisation, charges and medication use compared with the non-protein-losing enteropathy group. Practice variation among post-Fontan protein-losing-enteropathy patients is common. Further larger studies are needed to assess the impact of standardisation on the well-being of children with post-Fontan protein-losing enteropathy.

Patient-Focused Online Resources for Melanoma: Highly Variable Content and Quality.

When patients are diagnosed or concerned with the diagnosis of melanoma, they commonly use the Internet for information. We assessed the content of patient-focused websites about melanoma. We searched for "melanoma" in four search engines then assessed the first 30 websites in each search. Among included sites, we describe potentially useful content about melanoma: website quality, readability, popularity, and social media sharing. In 31 included websites, > 80% mentioned the definition and risk factors for melanoma, when to seek medical help, how to diagnose, and treatment options, and > 70% described preventive measures. However, website quality was variable: 61% of websites had disclosures, 54% were dated, 41% had a clear author, and 41% had references. Average readability ranged from 8th to 12th grade, which is above recommended reading levels for patient websites. Despite this variation and high reading levels, we identified many high-quality melanoma websites for patients.

800 Gram Infant with A bronchial foreign body.

Report of successful foreign body removal in a micro-preemie infant utilizing instruments outside of the normal armamentarium. Challenges encountered during the removal process of the foreign body and technique utilized are explained with the intention of providing steps that can be reproducible in a similar clinical setting.