For more than 75 years, the American Academy of Pediatrics has been the nation's leading and most trusted child health expert. The all-new full color AAP Textbook continues the tradition by providing a wealth of expert guidance spanning every aspect of current clinical practice and sets a new standard for one-stop pediatric references! Directed by a distinguished editorial team, and featuring contributions from experienced clinicians nationwide, the new AAP Textbook of Pediatric Care is a resource you'll use with complete confidence. Look here for expert guidance spanning every aspect of current clinical practice. Comprehensive scope: Covers screening, pathophysiology, diagnosis, treatment, management, prevention, critical care, practice management, ethical and legal concerns and much more. Practical focus: Directly addresses day-to-day practice concerns for efficient patient problem-solving. Essential clinical guidance: Step-by-step recommendations on what to do, when and how to do it, when to admit, and when to refer. Evidence-based approach: State-of-the-art approach includes the evidence base for recommendations and lists detailed references within each chapter. Topical coverage: Highlights new priorities for 21st century practice: evidence-based medicine, environmental concerns, electronic health records, quality improvement, community-wide health approaches, confidentiality, cultural issues, and psychosocial issues.
Introduction Prediction of mortality and morbidity in newborns with congenital diaphragmatic hernia (CDH) is too complex for practical use and may not be accurate. The main objective of this study was to evaluate the usefulness of the CDH Study Group equation and Score of Neonatal Acute Physiology Perinatal Extension (SNAPPE) II score to predict short-term outcomes of newborns with CDH. Materials and Methods Fifty-two neonates were admitted with CDH at Children's Hospital of Michigan from November 2001 to July 2009. Retrospective chart analysis was performed. Predicted survival rates were calculated using the equation published by the CDH Study Group in 2001. SNAPPE II scores were also obtained within 12 hours of admission. Statistical analysis was performed using SPSS statistical package. Results Thirty out of 52 (58%) neonates survived to discharge. SNAPPE II score was significantly lower (p < 0.0001) in survivors (20 ± 15) versus nonsurvivors (41 ± 16). When neonates were stratified according to the CDH Study Group, low-risk patients had a survival rate of 68% (predicted 84%), moderate-risk patients had a survival rate of 43% (predicted 57%), and high-risk patients had a survival rate of 33% (predicted 36%). A total of 83% of the newborns who survived were operated within 48 hours of life, while only 17% of the nonsurvivors were operated within 48 hours of life. Conclusion SNAPPE II scores were better predictors of mortality than the CDH Study Group equation published in 2001. Further exploration is warranted to evaluate validity of survival advantage for those who were operated within 48 hours of life. A future study of combination of prenatal and postnatal factors may help in improved outcomes of the newborns with CDH.
Because the reported frequency of pre-eclampsia in Taiwan varies significantly, the aims of this study were to measure the current incidence of pre-eclampsia and its correlated morbidity and mortality for both mothers and fetuses in Taiwan.We retrospectively studied all reported cases of pre-eclampsia and eclampsia from January 1, 1993 to December 31, 1997 in the 14 tertiary medical centers and regional hospitals in Taiwan. Recruiting criteria were pregnancy-induced hypertension (systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg) with proteinuria (> or = 300 mg of urinary protein per 24 hours) and independent part edema.There were 4,193 patients with pre-eclampsia and eclampsia for a frequency of 2.03% of 206,551 deliveries during the study period. Of these, 58.9% of patients were classified as having mild pre-eclampsia while 38.4% had severe pre-eclampsia. Advanced maternal age (> 35 years) (odds ratio [OR] = 4.56; 95% confidence interval [CI] = 4.23-4.90; p < 0.001), primiparity (OR = 1.71; 95% CI = 1.61-1.82; p = 0.02) and twin pregnancy (OR = 1.92; 95% CI = 1.64-2.25; p = 0.01) were significant risk factors for developing pre-eclampsia. However, multivariate analysis showed that only advanced maternal age was a significant risk factor for pre-eclampsia (OR = 3.21; 95% CI = 2.95-3.50; p < 0.001). In contrast to mild pre-eclampsia, severe pre-eclampsia resulted in significantly worse outcomes for both mothers and fetuses. Complications in patients with severe pre-eclampsia included placental abruption, acute renal failure, pulmonary edema, postpartum hemorrhage, pleural effusion, preterm labor, intrauterine growth retardation, stillbirth, neonatal mortality and low birth weight infants, all of which occurred significantly more frequently than in patients with mild pre-eclampsia (p < 0.001).Pre-eclampsia remains a big challenge in modern obstetrics in Taiwan. Early diagnosis and management of patients with pre-eclampsia to prevent progression would significantly improve outcomes for mothers and fetuses.
Postpartum fever is a common problem for obstetricians, but fever of unknown origin (FUO) occurring in the puerperium may be relatively unfamiliar and a challenge to the majority of obstetricians.A 29-year-old woman had a FUO detected during the puerperium. Despite serial examinations and therapeutic trials, the fever persisted for three weeks without a clinical improvement or definite infection source. The presence of a huge uterine myoma was observed. The patient finally underwent myomectomy, and a pathology review revealed a cellular leiomyoma associated with massive infarction and acute inflammation. The fever subsided substantially on the third day postoperatively.Although a uterine leiomyoma as a cause of fever in the puerperium is not new, rarely does it cause prolonged fever. It should be taken into consideration in pregnant women known to have uterine myomas during pregnancy and in the puerperium, especially if FUO develops. Nonsteroidal antiinflammatory drugs can be a tool for making the differential diagnosis in such a patient, and exploratory laparotomy can be delayed until an emergency condition occurred, especially important during pregnancy.
Abstract Objective: To assess the impact of a carer support group organised by the Kowloon Hospital Psychogeriatric Team for providing education, support, advice, and recreational activities to carers, with the aim of reducing the carers' burden. Patients and Methods: Carers of elderly patients with dementia who attended the outpatient department or day hospital, or who were inpatients at Kowloon Hospital Psychiatric Unit were invited to join the psychogeriatric carer support group. Carers who were interested in the support group were enrolled as members and regarded as the study group in a questionnaire survey. Carers who were unable to attend were invited to complete the questionnaires and were considered to be the control group for data comparison. Results: There were 12 carers in the study group and 8 carers in the control group. The study group had a significantly greater decrease in stress level score than the control group (10.58 versus 0.63) after participating in the support activities between July 2002 and August 2003. Conclusion: The carer support group is effective for alleviating carers' distress. Key words: Dementia, Social support, Stress Introduction It has been established that carers of elderly people with dementia have higher stress levels and depression and are more likely to have lower levels of subjective well-being, physical health, and self-esteem than non-caregivers. (1,2) It has also been observed that neither cognitive nor functional status predict the burden of care. Behavioural disturbance, in particular, and informal support are significant determining factors of the burden for carers. (3,4) All aspects of behavioural and psychological symptoms of dementia (BPSD) can be associated with caregiver burden. However, paranoia, aggression, and sleep-wake cycle disturbance appear to be particularly important drivers of burden of care. (5) A carer support group was organised by the Kowloon Hospital Psychogeriatric Team to provide education, support, advice, and recreational activities to carers, with the aim of reducing the carers' burden. (6,7) The carers' burden was assessed according to the method of Hepburn et al (7) before and after carers participated in the carer support group to assess the effectiveness of the group for alleviating carers' distress. The patients' cognitive function, measured by the Mini-Mental State Examination (MMSE) and selected items of BPSD were analysed according to the methods of Arai et al (8) and Burns et al (9) to establish the correlation with the carers' burden. Carers' demographic data were also analysed to establish any significant relationship with their burden. Patients and Methods Carers of elderly patients with dementia who attended the outpatient department or day hospital, or who were inpatients at Kowloon Hospital Psychiatric Unit were invited to join the psychogeriatric carer support group. Medical and nursing staff, occupational therapists, and medical social workers recruited the carers and organised the activities. Carers who were interested in the support group were enrolled as members and were regarded as the study group in a questionnaire survey. Carers who were unable to attend were invited to complete the questionnaires and were considered to be the control group for data comparison. Twenty carers were approached and 12 joined the carer support group. The remaining 8 carers were interested in joining but were unable to come, either because they were working when the training sessions were organised or were unable to find somebody to care for their relative at home. The revised Chinese version of the Zarit Burden Scale was administered to the carers before and after joining the support group. The total scores and subscores were compared. The Chinese version of the Zarit Burden Scale (Appendix 1) was administered to the 20 carers before the start of the study. …
Abstract Objectives We aimed to operationalize a head and neck microvascular free tissue transfer (MVFTT) program at a Veterans Affairs (VA) hospital with the emphasis on initiating radiotherapy within 6 weeks of surgery for cancer patients and minimizing readmissions. Study Design Case series. Setting Tertiary care VA hospital. Methods A retrospective analysis was performed on consecutive head and neck MVFTT patients from May 1, 2017 and April 30, 2022. Demographics, patient and disease characteristics, per‐operative data and postoperative outcomes were recorded from the electronic medical record. We sought to compare our rate of 30‐day readmissions with those published in the literature. Results One hundred and forty‐one procedures were performed in the queried timeframe. Eighty‐four percent (119) were performed after oncologic resections and 16% (22) were for nononcologic procedures. The rate of total flap loss was <1% and the rate of partial flap loss was 3.5%. For mucosal defects, the fistula rate was 2.3%. The rate of return to the OR for any reason within 30 days was 7.8%. The 30‐day readmission rate was 6.4% while the rates reported in the literature range from 13% to 20%. One hundred and four patients required postoperative radiotherapy (PORT) and 76% started PORT within 42 days of surgery. Conclusion Operationalizing a head and neck MVFTT program with a VA hospital is safe and allows for the successful delivery of multimodality treatment to cancer patients. These resources can be expanded for the care of head and neck cancer treatment sequelae, such as osteoradionecrosis, and other nononcologic patient needs.
