Incidence and Management of Neonatal Pneumothorax in a 10-Hospital Regional Perinatal Network in Switzerland: A Retrospective Observational Study.

OBJECTIVE: Pneumothorax (PTX) is a potentially life-threatening condition that affects neonates, with an incidence of 0.05 to 2%. Its management includes conservative treatment, chest tube (CT) drainage, and needle aspiration (NA). Aims were to evaluate the incidence of PTX in a 10-hospital perinatal network, its clinical characteristics and risk factors, and to compare the different treatment options. STUDY DESIGN: All neonates diagnosed with PTX and hospitalized in the network were included in this retrospective observational trial over a period of 30 months. Primary outcome was the incidence of PTX. Secondary outcomes were the treatment modality, the length of stay (LOS), and the number of chest X-rays. RESULTS: Among the 173 neonates included, the overall incidence of PTX was 0.56 per 100 births with a large range among the hospitals (0.12-1.24). Thirty-nine percent of pneumothoraces were treated conservatively, 41% by CT drainage, 13% by NA, and 7% by combined treatment. Failure rate was higher for NA (37%) than for CT drainage (9%). However, the number of X-rays was lower for patients treated by NA, with a median of 6 (interquartile range [IQR] 4-6.25), than by CT drainage, with a median of 9 (IQR 7-12). LOS was shorter for NA than for CT drainage, with a median of 2 (IQR 1-4.25) and 6 days (IQR 3-15), respectively. Complications, including apnea and urinary retention, occurred in 28% of patients managed with CT drainage, whereas none was observed with NA. CONCLUSION: High variability of PTX incidence was observed among the hospitals within the network, but these values correspond to the literature. NA showed to reduce the number of X-rays, the LOS, and complications compared with CT drainage, but it carries a high failure rate. This study helped provide a new decisional management algorithm to harmonize and improve PTX treatment within our network. KEY POINTS: · Neonatal PTX is a frequent pathology with a high incidence requiring urgent management.. · We report a large variability of PTX incidence between different hospitals of the same network.. · Needle aspiration carries higher failure rate, shorter hospital stay duration without complications reported..

Twelve tips for how institutional ethnography (IE) is conducted in health professions education research.

Institutional ethnography (IE), a term coined by sociologist Dorothy Smith, explores the nuances of institutions and their complex relationships in sociology. IE is an approach to studying and analysing social organization, and it provides a more holistic understanding of 'invisible' relationships that govern institutions and how those relationships interact with each other. Health sciences researchers in patient care, patient experience, and allied health professionals have recently become more interested in the use of this methodology and how to incorporate it into their research. However, in health professions education (HPE) there is little use of IE. We hypothesize this may be because of limited practical knowledge of this methodology. This paper serves as an introduction to the use of IE in HPE, describing the differences between IE and traditional ethnographies, recognizing the common pitfalls when utilising IE, and incorporating texts into IE. While ethnographies may be daunting to researchers less familiar with these approaches, the tips in this paper will provide an introduction and help educators and researchers successfully navigate the use of IE in health profession scholarship and education.

Conceptualizing Community Mental Health Service Utilization for BIPOC Youth.

Historically, children and adolescents who identify as Black, Indigenous, and other people of Color (BIPOC) have had inequitable access to mental healthcare, and research shows that they are significantly less likely than their white American counterparts to utilize available services. Research identifies barriers that disproportionately impact racially minoritized youth; however, a need remains to examine and change systems and processes that create and maintain racial inequities in mental health service utilization. The current manuscript critically reviews the literature and provides an ecologically based conceptual model synthesizing previous literature relating to BIPOC youth barriers for service utilization. The review emphasizes client (e.g. stigma, system mistrust, childcare needs, help seeking attitudes), provider (e.g. implicit bias, cultural humility, clinician efficacy), structural/organizational (clinic location/proximity to public transportation, hours of operation, wraparound services, accepting Medicaid and other insurance-related issues), and community (e.g. improving experiences in education, the juvenile criminal-legal system, medical, and social service systems) factors that serve as barriers and facilitators contributing to disparities in community mental health service utilization for BIPOC youth. Importantly, we conclude with suggestions for dismantling inequitable systems, increasing accessibility, availability, appropriateness, and acceptability of services, and ultimately reducing disparities in efficacious mental health service utilization for BIPOC youth.

Racial and ethnic underrepresentation in dermatology clinical trials.

BACKGROUND: Including participants of diverse racial and ethnic populations in clinical trials is important to reduce disparities and promote health care equity. OBJECTIVE: To evaluate racial and ethnic representation in dermatology clinical trials. METHODS: Participant data from dermatology trials completed in the United States from 2017 to 2021 from ClinicalTrials.gov were compared to census data to determine if minority groups were represented at rates that reflect population demographics. Participation was compared with prevalence rates for the most underrepresented racial group. RESULTS: Of 246 trials that met inclusion criteria, 87.4% (215) reported racial data. Compared to census data, Black/African American, American Indian/Alaskan Native, and 2 or more races were underrepresented. Hispanic or Latinos were an underrepresented ethnic group. LIMITATIONS: The search was limited to ClinicalTrials.gov registered studies that fell within search parameters. Race reporting methods were not specified. Detailed analysis was only performed for the most underrepresented racial group. CONCLUSION: Certain minority groups were underrepresented in dermatology trials. Black/African Americans were most underrepresented and underrepresented even when accounting for prevalence rates. Trial representation that accurately reflects population demographics and subgroup prevalence rates can help reduce health inequity, improve clinical understanding, and enhance treatment access for the growing diverse population.

Minimally Invasive Facial Cosmetic Procedures for the Millennial Aesthetic Patient.

Millennials, defined as the generation of individuals born between 1981 and 1996, have emerged as one of the leading patient demographics seeking minimally invasive cosmetic procedures. Worldwide, millennials are more likely to consider preventative treatments compared to any other age-group. The three most popular minimally invasive facial procedures in this demographic include botulinum toxin, dermal fillers (eg, hyaluronic acid, calcium hydroxylapatite, facial fat-fillers), and microdermabrasion. Given their impact on the expanding aesthetic medicine market and their favorable disposition towards cosmetic procedures, it is necessary for dermatologists and cosmetic providers to understand their motivations and perspectives. While some research studies have elicited the opinions of millennials on social issues, education, and technology, there is a paucity of literature on millennials' impressions, opinions, and perceptions of aesthetic procedures. As a generation that has been reshaping the culture of healthcare delivery and encouraging the innovation of products and procedures with their unique values and perspectives, accounting for their beliefs and fostering a better understanding of their experiences will promote an elevation in the quality of their care.

Developing a population wide cost estimating framework and methods for technological intervention enabling ageing in place: An Australian case.

PURPOSE: Ageing in place is one of the greatest desires of elderly people. Assistive digital technologies could potentially delay the institutionalization of the elderly people and allow them ageing in place. This study develops a population-wide cost estimating framework for adopting digital technologies that can improve the quality of life of elderly people through examining an Australian region. METHODS: We developed a five-stage cost estimation framework, which involved progressive forecasting of elderly population and direct cost estimation methods. The forecasting and cost estimation models have been set for a 10-year period because the prediction accuracy from cross-sectional data is better in the short to medium term compared to the long-term. For cost estimation, we categorised the ageing population on the basis of the number of chronic diseases that they have contracted. Costs of assistive technologies were collected from open sources. The model has been tested in the Fitzroy and Central West, a regional area of Queensland in Australia. A stakeholder panel discussion in a workshop format was used to validate the appropriateness of the proposed framework and the study findings. RESULTS: This study identified eight common chronic diseases with different comorbidity patterns in Australia. We also identified the required assistive technologies to assist patients with chronic diseases. This study estimated that annual per capita cost for technological intervention could range from AUD 4,169 to AUD 7,551 on the basis of different price margins of the technologies. CONCLUSION: The approach of categorising the aged cohorts on the basis of the number of chronic diseases helps estimate population-wide costs compared to using single technology intervention costs for a particular chronic disease cohort. The cost estimation framework and the method developed in this study can assist the government to estimate costs for ageing-in-place programs.