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BACKGROUND: Angular deformity in the lower extremity can result in pain, gait disturbance, cosmetic deformity and joint degeneration. Up until the introduction of guided growth, which has since become the widely accepted treatment for frontal plane angular angular deformity around the knee in skeletally immature patients, treatment consisted of staples, corrective osteotomy or an angular epiphysiodesis. Guided growth modulation uses the tension band principle with the goal of treatment being to normalise the lower limb mechanical axis resulting in lower morbidity than previous treatments. In order to assess the success of this procedure we reviewed our results in an attempt to identify patients who may not benefit from this elegant procedure. METHODS: We performed a retrospective review of prospectively collected surgical records and diagnostic imaging in our paediatric tertiary national referral centre to identify all patients who had guided growth surgery for coronal plane angular deformity of the knee from 2007 to 2023. We noted the patient demographics, diagnosis, peri-operative experience and outcome. All patients were followed until skeletal maturity, until their hardware was removed or at least 2 years. RESULTS: Two hundred thirty-six patients were assessed for eligibility. Of the 282 treated knees which met the criteria for final assessment 55 (19.5%) were unsuccessful. Complications were few but included infection and metal-work prominence. Procedures that were less likely to be successfully included growth disturbances following trauma (18.8% failure) or infection (40%), tumour (66.6%), mucopolysaccharidoses type I (15.7%), spondyloepiphyseal dysplasia (25%) or Blount's disease (60%). Idiopathic angular deformity showed an 89.5% success rate with guided growth. CONCLUSION: In our hands, guided growth had an 80.5% success rate when all diagnoses were considered. We continue to advocate the use of guided growth as a successful treatment option for skeletally immature patients with limb deformity however caution should be employed when considering its use in certain patient groups. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
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BACKGROUND: Immobile patients with cerebral palsy can suffer with painful dislocated hips. Decision-making and surgical management can prove challenging in this cohort of patients, with hips that cannot be reconstructed. METHODS: We conduced a retrospective chart review of all patients who underwent prosthetic femoral interposition arthroplasty (PFIA) by two surgeons from 2013 to 2021, for unreconstructable hips. We compared pain and range of motion in preoperative period to the postoperative period. Caregiver reported outcomes were used to assess satisfaction post operatively. During the follow up, radiographs of the PFIA were obtained to assess for proximal migration, heterotopic ossification and loosening of implants. RESULTS: Eleven index surgeries, which met the inclusion criteria, were included in this study. These were performed in eleven patients with an average follow up of 45 months. Regarding pain and range of motion post-operatively an excellent or good result was seen in nine cases. Two patients were classified as having a fair result with none having a poor result. Most caregivers reported being satisfied or very satisfied with the post-operative outcomes. CONCLUSION: A prescriptive operative solution to the painful dislocated hip in children with spastic cerebral palsy remains elusive. In this study, we have demonstrated both clinically and radiologically satisfactory results post proximal femoral interposition arthroplasty, for those patients with unreconstructable hips. Patient caregiver reported outcomes, show that the majority of caregivers were satisfied or very satisfied with the outcome of the surgery.
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Artroplastia de Quadril , Paralisia Cerebral , Luxação do Quadril , Humanos , Adulto , Criança , Paralisia Cerebral/complicações , Paralisia Cerebral/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Artroplastia/métodos , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Dor/cirurgia , Úmero/cirurgia , Seguimentos , Artroplastia de Quadril/métodosRESUMO
É categórico afirmar que, historicamente, as mulheres negras vivenciam a base da estrutura social. As especificidades das condições dessas mulheres estão estampadas em documentos e retratos estatísticos, revelando um cenário devastador que incide sobre todos os aspectos de suas vidas, da saúde, sobrevivência e moradia ao cárcere, violência e desemprego. Pelo exposto, pensar sobre saúde mental da mulher negra no Brasil demanda um aprofundamento nas entranhas do percurso histórico da formação social brasileira em correlação direta com a organização das sociedades de capitalismo central. A saúde mental é compreendida nesse texto enquanto termo e significado em disputa e movimento, e que corresponde a um vasto campo de alcance e que quando projetado numa direção emancipadora, gera revolta contra os mecanismos naturalizados hegemonicamente. Assim, este estudo objetivou mapear a produção científica nacional e internacional sobre a saúde mental das mulheres negras brasileiras, identificando lacunas e como o campo tem se apresentado. Para sua operacionalização, optou-se pela revisão de escopo que foi conduzida de acordo com a metodologia do Joanna Briggs Institute, com estratégias de busca completas para sete bases de dados e literatura de difícil alcance, a saber: BVS; Scielo; PubMed; Web Of Science; PsyInfo; Embase; Google Scholar e uma revista específica, a Revista da Associação Brasileira de Pesquisadores Negros. A pergunta que mobiliza esta revisão de escopo, formulada a partir da estratégia PCC, é: Qual a abrangência da produção científica sobre a saúde mental das mulheres negras brasileiras? Os dados demonstraram que as informações sobre a saúde mental das mulheres negras brasileiras são diversas e retratam, majoritariamente, as condições de mulheres negras residentes nas regiões Nordeste e Sudeste. Os resultados foram apresentados através de quatro categorias: Sofrimento psíquico, sobrecarga e saúde mental; Resistência e território; Sobre nós, mulheres negras; e Violência racial de gênero contra todas as mulheres negras. Conclui-se que as mulheres negras brasileiras, cotidiana, cíclica e intergeracionalmente têm a saúde mental exposta de maneira cruel por estarem envoltas à violência-racial-estrutural de gênero e classe
It is categorical to state that, historically, black women experience the base of the social structure. The specifics of these women's conditions are stamped in documents and statistical portraits, revealing a devastating scenario that affects all aspects of their lives, from health, survival and housing to prison, violence and unemployment. Based on the above, thinking about the mental health of black women in Brazil demands a deeper understanding of the historical path of Brazilian social formation in direct correlation with the organization of central capitalist societies. Mental health is understood in this text as a term and meaning in dispute and movement, which corresponds to a vast field of reach and which, when projected in an emancipatory direction, generates revolt against hegemonically naturalized mechanisms. Thus, this study aimed to map the national and international scientific production on the mental health of black Brazilian women, identifying gaps and how the field has presented itself. For its operation, we opted for a scope review, which was conducted in accordance with the Joanna Briggs Institute methodology, with complete search strategies for seven databases and hard-to-reach literature, namely: VHL; Scielo; PubMed; Web Of Science; PsyInfo; Base; Google Scholar and a specific journal, the Revista da Associação Brasileira de Pesquisadores Negros. The question that mobilizes this scope review, formulated from the PCC strategy, is: What is the scope of scientific production on the mental health of black Brazilian women? The data showed that information about the mental health of black Brazilian women is diverse and portrays, mostly, the conditions of black women living in the Northeast and Southeast regions. The results were presented through four categories: Psychic suffering, overload and mental health; Resistance and territory; About us black women; and Racial gender violence against all black women. It is concluded that, daily, cyclically and intergenerationally, black Brazilian women have their mental health cruelly exposed because they are involved in racial-structural violence of gender and class
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Humanos , Feminino , Saúde Mental , Saúde de Gênero , Saúde das Minorias ÉtnicasRESUMO
BACKGROUND: A fundamental tenent of treating developmental dysplasia of the hip is to identify patients with dislocated hips early so as to avoid the long-term sequelae of late diagnosis. The aim of this study was to develop a readily useable triage tool for patients with suspected hip dislocation, based on the clinical history and examination findings of the referring practitioner. METHODS: All primary care referrals (n=934) over a 3-year period for suspected developmental dysplasia of the hip to a tertiary pediatric center were evaluated. Defined parameters with respect to history and clinical examination were evaluated. Multivariable logistic regression was used to establish predictors of hip dislocation, and from this a predictive model was derived which incorporated significant predictors of dislocation. An illustrative nomogram translated this predictive model into a usable numerical scoring system called the Children's Hip Prediction score, which estimates probability of hip dislocation. RESULTS: There were 97 dislocated hips in 85 patients. The final predictive model included age, sex, family history, breech, gait concerns, decreased abduction, leg length discrepancy, and medical/neurological syndrome. The area under receiver operating curve for the model is 0.761. A Children's Hip Prediction score of≥5 corresponds to a sensitivity of 76.3% and a score of≥15 has a specificity of 97.8%, corresponding to an odds ratio of 27.3 for increased risk of dislocation. CONCLUSION: We found that a novel clinical prediction score, based on readily available history and examination parameters strongly predicted risk of dislocations in hip dysplasia referral. It is hoped that this tool could be utilized to optimize resource allocation and may be of particular benefit in less well-resourced health care systems. LEVEL OF EVIDENCE: Level II.
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Displasia do Desenvolvimento do Quadril , Luxação Congênita de Quadril , Luxação do Quadril , Luxações Articulares , Criança , Luxação do Quadril/diagnóstico , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/terapia , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , TriagemRESUMO
INTRODUCTION: Twenty-five-hydroxy-vitamin D3 (25-OH-vit D) is a prohormone that is essential for normal calcium homeostasis and bone metabolism. Understanding its role is an important component of the proper care of the pediatric orthopaedic patient. The aim of this study was to determine whether children in Ireland with fractures have increased prevalence of 25-OH-Vit D deficiency compared with age matched controls and to ascertain the relationship between a low 25-OH-vit D level and the incidence of fractures in Irish children. We hypothesised that children presenting to our centre following a fracture would have significantly lower 25-OH-vit D. METHODS: A prospective case-control study at a large urban tertiary referral academic hospital located in Dublin, Ireland was completed over a 14 month period from June 2014 to August 2015. A total of 116 subjects, distributed as cases (n = 58) and controls (n = 58) were included in this study. Whole blood (10 ml) was taken in two serum bottles from each patient. Serum 25-hydroxy-vitamin D3 levels were measured. An age matched control group was generated from other children attending the hospital, who also had vitamin D levels measured for different clinical reasons. We followed up both the fracture and control group for the next 5 years to assess the repeat fracture rate. RESULTS: Fifty-eight patients with a fracture requiring operative intervention, were included in the study. Statistical analysis was performed comparing to 58 age and sex-matched controls. The mean vitamin D level for the fracture group was 63.2 nmol/L (SD = 27.3), which was higher than the mean of the controls (62.5 nmol/L) (SD = 21.3) (p = 0.86), but this difference was found not to be statistically significant in unadjusted analysis. There was no statistically significant difference in the number of patients classified with low serum Vitamin D levels (<50 nmolL), with the fracture group consisting of 22 (37.9%) patients, and the control group of 17 patients (29.3%) (p = 0.33) with a level below 50 nmol/L. At five-year follow-up, 11 of the 58 patients (18.9%) in the fracture group went on to have a further fracture compared with eight patients (13.7%) from the control group. Out of these 11 from the fracture group five (45.45%) had been found to have a low serum 25-OH-Vit D level five years previously. Out of the eight controls that presented with a fracture within the five-year period, 3 (37.5%) had had a low vitamin D level at the origin of this study. CONCLUSION: The results of this study show that children presenting to our institution with low energy fractures have a prevalence of 38% 25-hydroxy-vitamin D deficiency. This study included children from age 1 to 16 primarily Caucasian encompassing all fracture types resulting from accidental trauma. Our findings suggest that in an Irish pediatric population vitamin D status may impact fracture risk with more than one-third being deficient in this review.
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Fraturas Ósseas , Deficiência de Vitamina D , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Seguimentos , Fraturas Ósseas/epidemiologia , Humanos , Lactente , Vitamina D , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologiaRESUMO
[This corrects the article DOI: 10.1302/1863-2548.14.200164.].
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BACKGROUND: Cancer diagnosis in childhood or adolescence impacts significantly on school attendance, experience and educational outcomes. While there is longstanding recognition in clinical practice that these effects span the whole illness trajectory and continue beyond treatment completion, further clarity is required on the specific barriers and facilitators to education during cancer treatment and beyond, as well as on the experiences of children and adolescents across the full range of education settings (hospital, home, virtual, original school of enrolment), in order to determine which interventions are successful in improving access and experience from their perspective. The aim of this review is to identify what is known from the existing literature about access to and experience of education for children and adolescents with cancer during and post treatment. METHODS: We have planned a scoping literature review searching the following databases from inception onwards: MEDLINE (Ovid), Embase and Embase Classic, Web of Science Core Collection, Education Resources Index, Sociological Abstracts, APA PsycINFO, SCOPUS, CINAHL Plus, Emcare and The Cochrane Library. In addition, DARE, conference abstracts, key journals, and institutional websites will be searched. Arksey and O'Malley's six-step process will be followed, including a consultation exercise. Studies, reports and policies from any country providing care and treatment for children and adolescents with cancer published in English will be considered eligible for inclusion. Two reviewers will independently screen all citations, full-text articles and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. DISCUSSION: This is a timely examination given the increased incidence of childhood cancer, more intensive treatment regimens and improved survival rates for childhood cancer. The inclusion of a substantive consultation exercise with families and professionals will provide an important opportunity to examine the scoping review outputs. Findings will assist the childhood cancer community in developing a comprehensive evidence-based understanding of a significant associated bio-psychosocial impact of cancer diagnosis and treatment and will form the first step towards developing effective interventions and policies to mitigate identified detrimental effects. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (osf/io/yc4wt).
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Atenção à Saúde , Neoplasias , Adolescente , Criança , Protocolos Clínicos , Instalações de Saúde , Humanos , Neoplasias/terapia , Políticas , Literatura de Revisão como Assunto , Instituições AcadêmicasRESUMO
BACKGROUND: The aim was to describe the introduction and operation of a virtual developmental dysplasia of the hip (DDH) clinic. Our secondary objectives were to provide an overview of DDH referral reasons, treatment outcomes, and adverse events associated with it. METHODS: A prospective observational study involving all patients referred to the virtual DDH clinic was conducted. The clinic consultant delivered with 2 DDH clinical nurse specialists (CNS). The outcomes following virtual review include further virtual review, CNS review, consultant review or discharge. Treatment options include surveillance, brace therapy, or surgery. Efficiency and cost analysis were assessed. RESULTS: Over the 3.5-year study period, 1002 patients were reviewed, of which 743 (74.2%) were female. The median age at time of referral was 7 months, (interquartile range of 5 to 11) with a median time to treatment decision of 9 days. Median waiting times from referral to treatment decision was reduced by over 70%. There were 639 virtual reviews, 186 CNS reviews, and 144 consultant reviews. The direct discharge rate was 24%. One hundred one patients (10%) had dislocated or subluxed hips at initial visit while 26.3% had radiographically normal hips. Over the study period 704 face to face (F2F) visits were avoided. Cost reductions of 170 were achieved per patient, with 588,804 achieved in total. Eighteen parents (1.8%) opted for F2F instead of virtual review. There were no unscheduled rereferrals or recorded adverse events. CONCLUSION: We report the outcomes of the first prospective virtual DDH clinic. This clinic has demonstrated efficiency and cost-effectiveness, without reported adverse outcomes to date. It is an option to provide consultant delivered DDH care, while reducing F2F consults. LEVEL OF EVIDENCE: Level III.
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Assistência Ambulatorial/métodos , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/terapia , Telemedicina/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/organização & administração , Braquetes , Redução de Custos/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Enfermeiros Clínicos/organização & administração , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Telemedicina/economia , Telemedicina/organização & administração , Tempo para o Tratamento , Resultado do Tratamento , Conduta ExpectanteRESUMO
Introducción. La enfermedad cerebrovascular (ECV) es la tercera causa de muerte en la mayoría de países desarrollados y una causa importante de morbilidad, discapacidad a térmi- no e ingreso hospitalario cuando hay un área cerebral afectada de forma transitoria o perma- nente, bien sea por causa isquémica o hemorrágica. Objetivo. Determinar la prevalencia de ECV en adultos de 30 a 80 años hospitalizados en el Hospital General del IESS de Babahoyo. Materiales y métodos. Estudio cuantitativo, retrospectivo, descriptivo y no experimental realizado en 659 pacientes con ECV registrados durante el 2019. Los datos se recolectaron del instrumento AS400 y la distribución porcentual de los participantes se determinó según su edad, su sexo y el tipo de hemorragias intracraneales que presentaron. Resultados. La prevalencia de ECV fue del 77%. En el sexo masculino prevaleció la hemorragia intraencefálica intraventricular (35,51%), seguida de la intracerebral en he- misferio subcortical (17%), la intracerebral en tallo cerebral (12,44%), la intracerebral en hemisferio no especificada (8,95%), la intracerebral en cerebelo (1,97%), la intracerebral de localización múltiple (1,52%) y la intracerebral en hemisferio cortical (0,76%). En el sexo femenino la hemorragia más común fue la intraencefálica no especi- ficada (16,69%), seguida de las hemorragias no especificadas (2,88%) y la intraencefálica intraventricular (2,28%). Conclusión. Las ECV son una patología prevalente que genera una demanda de cuidados con un considerable gasto sanitario y social. La rehabilitación en los pacientes se aplica en la fase hospitalaria y por tanto es necesario desarrollar estrategias de educación preventiva y curativa para promover estilos de vida saludables en la población.
Introduction. Cerebrovascular disease (CVD) is the third leading cause of death in most developed countries and an important cause of morbidity, thermal disability and hospital admission when a brain area is transiently or permanently affected, either by ischemic or hemorrhagic causes. Objective. To determine the prevalence of CVD in adults aged 30 to 80 years hospitalized at the IESS General Hospital of Babahoyo. Materials and methods. Quantitative, retrospective, descriptive and non-experimental study conducted in 659 patients with CVD registered during 2019. Data were collected from the AS400 instrument and the percentage distribution of the participants was determined according to their age, sex and the type of intracranial hemorrhages they presented. Results. The prevalence of CVD was 77%. In the male sex, intraventricular intraencephalic hemorrhage prevailed (35.51%), followed by intracerebral hemorrhage in the subcortical hemisphere (17%), intracerebral hemorrhage in the brain stem (12.44%), intracerebral hemorrhage in the brain stem (12.44%), and intracerebral hemorrhage in the subcortical hemisphere (17%), intracerebral in unspecified hemisphere (8.95%), intracerebral in cerebellum (1.97%), intracerebral in multiple locations (1.52%) and intracerebral in cortical hemisphere (0.76%). In the female sex, the most common hemorrhage was unspecified intracerebral hemorrhage (16.69%), followed by unspecified hemorrhage (2.88%) and intraventricular intracerebral hemorrhage (2.28%). Conclusion. CVD is a prevalent pathology that generates a demand for care with considerable health and social costs. Rehabilitation in patients is applied in the hospital phase and therefore it is necessary to develop preventive and curative education strategies to promote healthy lifestyles in the population.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , EquadorRESUMO
PURPOSE: In this article we report the results of a pilot study analysing the implications of performing pelvic osteotomies for developmental dysplasia of the hip (DDH) as a day case. We assess the advantages of performing paediatric pelvic osteotomies as day-case procedures from a financial perspective and from an in-patient bed resource point of view. METHODS: This was a prospective cohort study analysing Salter and Pemberton pelvic osteotomies performed for DDH over a three-year period from 1st January 2017 to 30th September 2019. All patients residing within 50 km of the hospital were eligible for day-case procedures. All other cases were performed as in-patients. A detailed financial costing analysis was performed and the in-patient resources utilized were documented and compared between the two models of care. RESULTS: In total, 84 Salter and Pemberton osteotomies were performed between 1st January 2017 to 30th September 2019. Of these cases, 35 were performed as day-case procedures. A total reduction in 70 in-patient bed days was reported. Total costs for a single in-patient requiring two nights of admission amounted to 5,752, whereas the discharge cost of a day case was reported at 2,670. The savings made by our institution amounted to 3,082 per day case. A total saving of 102,696 was made over three years. In all, seven day-case patients re-attended due to inadequate pain control. They required overnight admission and were discharged uneventfully the following day. CONCLUSION: Day-case pelvic osteotomies significantly reduce the number of in-patient bed days used in an elective paediatric orthopaedic setting. Significant financial savings in excess of 3,000 per case are possible. The introduction of day-case pelvic osteotomy procedures can significantly improve the cost-effectiveness of managing DDH provided there are clear protocols in place with close clinical follow-up. LEVEL OF EVIDENCE: IV.
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BACKGROUND: We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS: A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS: Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS: The new radiographic clinic reduced the cost of reviewing one patient by 162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS: A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
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Luxação Congênita de Quadril/radioterapia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
AIM AND OBJECTIVE: Fibular autograft is a known technique for the reconstruction of traumatic and non-traumatic bone defects in both adult and paediatric populations. We aim to describe our outcomes using various stabilisation methods for non-vascularised fibular autograft to reconstruct both benign and malignant tumours in a paediatric population in a National Paediatric Centre over the past 14 years. MATERIALS AND METHODS: This was a retrospective review of 10 paediatric cases with non-traumatic primary bone defects in a National Paediatric Centre. Criteria for inclusion were all non-traumatic primary bone defects requiring reconstruction with a non-vascularised fibular autograft in the diaphyseal or metaphyseal regions of the bone. The primary outcome measures were union and time to union (weeks). Time to union was illustrated using Kaplan-Meier curves. Secondary outcome measures included postoperative fracture, infection (deep and superficial), time to full weight-bearing and all-cause revision surgery. RESULTS: The mean length of follow-up was 63 months for the entire cohort (9-168, SD = 48.6). There was no loss to follow-up. Six lesions were located in the tibia, two in the femur and the remaining two were located in the ulna and third metacarpal. Union was ultimately achieved in 8 of the 10 patients using this donor autograft. The mean time to union was 28 weeks (10-99, SD = 29.8). There were four complications of autograft fracture. The mean time to fracture was 17 weeks (9-32, SD = 10.71). In all four of these cases, the patient achieved union at final follow-up. There were two superficial and two deep infections recorded. Three resolved with the use of antimicrobial therapy and one deep infection ultimately required insertion of an intercalary prosthesis to treat the infected non-union of the fibular graft site. CONCLUSION: The use of non-vascularised fibular autograft for the reconstruction of tumours is an effective surgical technique in a paediatric cohort. We report the largest known series of malignant paediatric tumours treated with this technique to date. CLINICAL SIGNIFICANCE: Non-vascularised fibular autograft is successful in the reconstruction of large bone defects secondary to malignant paediatric bone tumours. HOW TO CITE THIS ARTICLE: Sheridan GA, Cassidy JT, Donnelly A, et al. Non-vascularised Fibular Autograft for Reconstruction of Paediatric Bone Defects: An Analysis of 10 Cases. Strategies Trauma Limb Reconstr 2020;15(2):84-90.
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This study explored the feasibility of generating reliable information on the frequency, nature and management of breakthrough pain (BTP) in children with life-limiting conditions and life-threatening illnesses (LTIs) from narrative clinical records. In the absence of standardized ways for documenting BTP, we conducted a consensus exercise to develop a glossary of terms that could denote BTP in the records. Thirteen clinicians who contributed to the records reached consensus on 45 terms which could denote BTP, while emphasizing the importance of contextual information. The results of this approach together with guidance for improving the reliability of retrospective reviews informed a data extraction instrument. A pilot test of this instrument showed poor agreement between raters. Given the challenges encountered, we do not recommend a retrospective review of BTP using narrative records. This study highlighted challenges of data extraction for complex symptoms such as BTP from narrative clinical records. For both clinical and research purposes, the recording of complex symptoms such as BTP would benefit from clear criteria for applying definitions, a more structured format and the inclusion of validated assessment tools. This study also showed the value of consensus exercises in improving understanding and interpretation of clinical notes within a service.
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Dor Irruptiva , Documentação , Narração , Neoplasias/complicações , Medição da Dor , Dor Irruptiva/diagnóstico , Dor Irruptiva/tratamento farmacológico , Criança , Técnica Delphi , Estudos de Viabilidade , Feminino , Humanos , Projetos Piloto , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To determine among general practitioners (GPs) the most common clinical findings that raised concern for developmental dysplasia of the hip (DDH) and necessitated an orthopedic outpatient referral. In addition, we assessed the sensitivity and specificity of the most common of these clinical findings. STUDY DESIGN: We performed a multicenter retrospective review of all referrals by GPs to local orthopedic outpatient departments for DDH over a 12-month period. All patients had undergone pelvic radiographs, and the acetabular index (AI) was measured. The AI was used as a reference test to assess the accuracy of the clinical examination in diagnosing DDH. Sensitivity and specificity of each clinical sign was calculated. RESULTS: Twenty-six of 174 (14.9%) referred patients were diagnosed with DDH, defined as an AI score > 30. The most common indication for referral, per the GP letter was asymmetrical skin folds (97 patients, 45.8%), followed by hip click (42 patients, 19.8%), and limb shortening (34 patients, 16%). Sensitivities and specificities, respectively, among findings were asymmetric skin folds 46.2% (95% CI 26.6%-66.6%) and 42.6% (95% CI 34.5%-51.0%), hip click 23.1% (95% CI 9.0%-43.6%) and 75.7% (95% CI 67.9%-82.3%), limb shortening 30.8% (95% CI 14.3%-51.8%) and 82.4% (75.3%-88.2%), and reduced abduction 19.2% (95% CI 6.6%-39.4%) and 91.9% (95% CI 86.3%-95.7%). Using logistic regression analysis, no clinical sign was found to be a statistically significant indicator of an abnormal AI. CONCLUSIONS: Clinical examination by GPs does not reliably detect radiographically-defined DDH. None of the clinical findings by the GP showed an acceptable level of sensitivity. Absence of reduced abduction and limb shortening are relevant negatives given the high level of specificity of these signs.
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Competência Clínica , Medicina Geral/normas , Luxação do Quadril/diagnóstico , Exame Físico/normas , Encaminhamento e Consulta , Estudos de Coortes , Feminino , Medicina Geral/tendências , Clínicos Gerais/normas , Clínicos Gerais/tendências , Luxação do Quadril/epidemiologia , Luxação do Quadril/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Exame Físico/tendências , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Early engagement in advance care planning (ACP) is seen as fundamental for ensuring the highest standard of care for children and young people with a life-limiting condition (LLC). However, most families have little knowledge or experience of ACP. OBJECTIVE: To investigate how parents of children and young people with LLCs approach and experience ACP. METHODS: Open-ended, semi-structured interviews were conducted with parents of 18 children; nine children who were currently receiving palliative care services, and nine children who had received palliative care and died. Verbatim transcripts of audiotaped interviews were analysed following principles of grounded theory while acknowledging the use of deductive strategies, taking account of both the child's condition, and the timing and nature of decisions made. RESULTS: Parents reported having discussions and making decisions about the place of care, place of death and the limitation of treatment. Most decisions were made relatively late in the illness and by parents who wished to keep their options open. Parents reported different levels of involvement in a range of decisions; many wished to be involved in decision making but did not always feel able to do so. DISCUSSION: This study highlights that parents' approaches to decision making vary by the type of decision required. Their views may change over time, and it is important to allow them to keep their options open. We recommend that clinicians have regular discussions over the course of the illness in an effort to understand parents' approaches to particular decisions rather than to drive to closure prematurely.
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Planejamento Antecipado de Cuidados , Tomada de Decisões , Pais/psicologia , Doente Terminal/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Teoria Fundamentada , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Cuidados Paliativos , Doente Terminal/psicologiaRESUMO
BACKGROUND: Dysostosis multiplex contributes substantially to morbidity in patients with Hurler syndrome (mucopolysaccharidosis type I Hurler phenotype [MPS I-H]), even after successful hematopoietic stem cell transplantation (HSCT). One of the hallmarks of dysostosis multiplex in MPS I-H is hip dysplasia, which often requires surgical intervention. We sought to describe in detail the course of hip dysplasia in this group of patients, as assessed by radiographic analysis, and to identify potential outcome predictors. METHODS: Longitudinal data were obtained from digitally scored pelvic radiographs of patients with MPS I-H using OrthoGon software for parameters including, but not limited to, the acetabular index, migration percentage, Smith ratio, and neck-shaft angle. Scoring was performed independently by two blinded observers. Additional information on genotype, enzyme replacement therapy pre-HSCT, donor chimerism, and enzyme activity post-HSCT were obtained. General trends and potential correlations were calculated with mixed-model statistics. RESULTS: Fifty-two patients (192 radiographs) were included in this analysis. Intraobserver and interobserver variation analysis showed an intraclass correlation coefficient ranging from 0.78 to 1.00. Among the twenty-one patients with follow-up beyond the age of five years, the acetabular index was in the range of severe hip dysplasia in up to 86% of the patients. Severe coxa valga was seen in 91% of the patients. Lateral and superior femoral displacement were highly prevalent, with the migration percentage outside the reference range in up to 96% of the patients. Finally, anterior pelvic tilt increased with age (p = 0.001). No correlations were identified between clinical parameters and radiographic findings. CONCLUSIONS: Our study shows that progressive acetabular dysplasia as well as coxa valga and hip displacement are highly prevalent and progressive over time in patients with MPS I-H, despite successful HSCT. These data may provide essential natural history determinations for the assessment of efficacy of new therapeutic strategies aimed at improving skeletal outcomes in patients with MPS I-H.
Assuntos
Progressão da Doença , Transplante de Células-Tronco Hematopoéticas , Luxação do Quadril/fisiopatologia , Mucopolissacaridose I/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Humanos , Masculino , Modelos Estatísticos , Mucopolissacaridose I/complicações , Variações Dependentes do Observador , Prognóstico , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Método Simples-Cego , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: After successful hematopoietic stem cell transplantation, maintaining function and mobility have become key goals in the management of patients with Hurler syndrome, (mucopolysaccharoidosis type 1H). The aim of this study was to establish the functional and radiologic outcomes after hip surgery in patients with this condition who had reached skeletal maturity. METHODS: We prospectively followed 13 mucopolysaccharoidosis type 1H patients with closed triradiate cartilages who had undergone hip surgery in a single institution (Our Lady's Children's Hospital, Crumlin) in early childhood, after successful hematopoietic stem cell transplantation. Functional assessment was performed using the Harris Hip Score. Acetabular and femoral head morphology were defined using a pelvic radiograph. RESULTS: The average age at follow-up was 18.6 years (range, 13.2 to 23.8 y). The average length of follow-up from surgical intervention was 14.6 years (range, 10.3 to 21.6 y). The average Harris Hip Score at follow-up was 61.0 (range, 19 to 91). At follow-up, 4 patients were either wheelchair bound or required a walking frame to mobilize in the community. At follow-up, all hips were in-joint with an average center edge angle of 37.7 degrees (range, 0 to 63 degrees). All hips displayed characteristic medial flattening of the femoral head. Ten hips (of 26 hips) showed radiologic degenerative changes with loss of joint space <2 mm. CONCLUSIONS: Despite the surgical provision of stable well-covered hips, active intervention did not prevent the development of radiologic deterioration and clinically significant hip arthritis. We recommend that pediatric hip surgery in Hurler syndrome be designed with the possibility of early hip replacement in mind. LEVEL OF EVIDENCE: Level III.
Assuntos
Artroplastia de Quadril , Previsões , Luxação do Quadril/cirurgia , Articulação do Quadril/cirurgia , Mucopolissacaridose I/complicações , Amplitude de Movimento Articular/fisiologia , Adolescente , Criança , Pré-Escolar , Feminino , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Lactente , Masculino , Estudos Prospectivos , Radiografia , Resultado do TratamentoRESUMO
BACKGROUND: The focus of work submitted to an international conference can reflect the changing landscape of a specialty and prove important for identifying trends, uncovering gaps, and providing new directions for nurse-led research and clinical practice. We present an analysis of trends in presentations in the nursing program at the SIOP congress from 2003 to 2012 based on all accepted abstracts. PROCEDURE: A total of 462 abstracts were analyzed. A data extraction form was used to ensure consistency of data retrieved. Paired researchers were assigned 2 years of abstracts for assessment: approximately 80-100 abstracts each. Data were entered into REDCap data management software. RESULTS: Most abstracts came from presenters affiliated with institutions in Europe and North America with a noticeably significant under-representation from developing countries. There was an equal representation of papers focused on empirical research with family members and clinical practice focused on the professional role, although this varied in some years. Analysis of research methodology revealed a predominance of surveys, with a recent increase in qualitative and mixed method studies. Out of all abstracts only 18% were subsequently published. CONCLUSIONS: Gaps have been identified, such as the limited involvement of nurses in developing countries, and lack of studies self-reporting from children. Much needs to be done to promote a greater diversity of research frameworks and more dynamic research designs. The small percentage of abstracts from nurses that are eventually published may hinder translation of the findings into clinical practice.