Complex Medical Problems Research Articles

Епідеміологічні особливості хвороб органів травлення в дітей та підлітків в Україні

Актуальність. Питання ранньої діагностики, лікування та профілактики хвороб органів травлення в дітей останніми роками вийшли за рамки власне педіатрії та становлять собою складну і велику медико-соціальну проблему. Тому метою дослідження було проведення аналізу поширеності та захворюваності на хвороби органів травлення серед дитячого населення України протягом 4 останніх років (2013–2016 рр.). Матеріали та методи. Аналіз проводили за офіційними звітними даними, що подаються до Центру медичної статистики МОЗ України в 25 регіонах. Результати. Незважаючи на те, що зміна динамічного ряду поширеності та захворюваності на хвороби органів травлення має тенденцію до зниження, гастроентерологічна патологія посідає 2-ге місце в структурі поширеності та 4-те місце в структурі захворюваності за класами хвороб серед дітей та підлітків. Статевий розподіл дозволив виявити переважання дівчат серед хворих на захворювання органів травлення. Висновки. Установлені регіональні аспекти поширеності та захворюваності на гастроентерологічні захворювання в дітей та підлітків: найвищий рівень поширеності зареєстрований у м. Києві, Полтавській, Чернігівській та Рівненській областях, а найнижчий — у Запорізькій, Луганській та Одеській областях; найвищі значення захворюваності спостерігали в Івано-Франківській, Рівненській та Чернівецькій, а найнижчі — в Одеській, Запорізькій, Луганській, Донецькій та Херсонській областях.

Assessment, Treatment, and Referrals for Military Veterans With Behavioral Health Challenges.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

MP51-19 COMPLIANCE RATES AMONG PEDIATRIC CONGENITAL NEUROGENIC BLADDER PATIENTS PARTICIPATING IN A TRANSITIONAL CARE PROGRAM

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-19 COMPLIANCE RATES AMONG PEDIATRIC CONGENITAL NEUROGENIC BLADDER PATIENTS PARTICIPATING IN A TRANSITIONAL CARE PROGRAM Aleksandar Blubaum, Jennifer Lewis, Dominic Frimberger, and Gennady Slobodov Aleksandar BlubaumAleksandar Blubaum More articles by this author , Jennifer LewisJennifer Lewis More articles by this author , Dominic FrimbergerDominic Frimberger More articles by this author , and Gennady SlobodovGennady Slobodov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Advancements in medical care have improved the prognosis of patients born with congenital urologic conditions. These patients have complex medical problems and often extensive surgical histories with altered anatomy, requiring specialized knowledge and close urologic follow-up. To assist these patients moving from pediatric to adult care, we developed a single specialty, urology-based transition clinic. Four readiness stages (T1-T4) that we have previously published about guide the transition. This study aims to update our experience with the transition clinic and report on its results. METHODS: We performed a retrospective chart review of all patients seen in the transition clinic since inception in 2014. We collected demographic and clinical data, including most recent T stage, appointment dates, transition time, as well as number of appointments and no show/cancellations. We analyzed this data to determine success rates and patient compliance with the transition process. RESULTS: 162 patients were seen in the transition clinic. 57/60 (95%) patients ready to transition to the adult clinic successfully completed this transition, with 3/60 (5%) failing to do so. The majority of inactive patients (last visit >365 days prior) were lost during pediatric stages with 34/60 (56.7%) at T1 and 13/60 (21.7%) at T2. Table 1 displays average transition time, average number of visits, and average number of no show/cancellations amongst active and inactive patients. 28 fully transitioned patients progressed per pathway, while 29 skipped from T2 to T4 due to losing their established pediatric provider. 7/29 (24.1%) expedited patients compared to 3/28 (10.7%) pathway patients were lost to follow-up (p=0.297). CONCLUSIONS: Patients with congenital urologic conditions who participated in a single specialty, urology-based transition clinic were successful completing the transition from pediatric to adult care. Active participation in a transition clinic was associated with increased clinic appointment attendance and fewer no show/cancellations. Non-compliance with pediatric provider visits predicted non-compliance with adult provider visits. Increased transition time and number of visits between stages were associated with increased transition completion rates. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e903-e904 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aleksandar Blubaum More articles by this author Jennifer Lewis More articles by this author Dominic Frimberger More articles by this author Gennady Slobodov More articles by this author Expand All Advertisement Loading ...

Cost of Caregiving on Parents of Children With Medical Complexity and Life-Limiting Conditions.

* Abbreviations: CMC — : children with medical complexity LLC — : life-limiting condition In this issue of Pediatrics , two studies are presented in which researchers explore challenges faced by parent caregivers. Hartley et al1 draw attention to reduced physical health among parents caring for children with life-limiting conditions (LLCs), whereas Bayer et al2 highlight decreased mental and emotional health in parents of children with medical complexity (CMC). For >10 years, I have worked in biomedical ethics and patient advocacy with families of CMC, many of whom also have LLCs. Sadly, I find it unsurprising that Hartley et al1 found 84% of studies in which researchers look at the physical health of caregivers for children with LLCs showed “parent health was directly and negatively impacted by the nature of the care they provided to their child,” whereas Bayer et al2 found “almost one-fifth of parents of CMC self-report poor or fair mental health.” I can speak to these truths both professionally and personally. Among caregivers with whom I have worked (most of whom are mothers), the inability to achieve time for self-care (whether emotional, mental, or physical) is a common topic. This ranges from one mother unable to leave her child with complex medical problems long enough to get a haircut for over 2 years, to multiple mothers repeatedly missing physical or mental health appointments for themselves. Inability to address these needs presents further in our conversations as reports of long-standing sleep deprivation, frequent health problems like colds and tooth abscesses, increased irritability, and anxiety over their ability to fulfill caregiving and family obligations. My professional insight is built on my own caregiving experiences because both of my children were born with a complex rare disease that can shorten life expectancy. My daughter, the more affected child, died shortly before age five. My son is stable at the age … Address correspondence to Jessica Shriver, MA, MS, 123 Lawrence St #1, Clinton, MA 01510. E-mail: jessica.e.shriver{at}gmail.com

Clinical Utility and Functionality of an Artificial Intelligence-Based App to Predict Mortality in COVID-19: Mixed Methods Analysis.

BackgroundThe artificial neural network (ANN) is an increasingly important tool in the context of solving complex medical classification problems. However, one of the principal challenges in leveraging artificial intelligence technology in the health care setting has been the relative inability to translate models into clinician workflow.ObjectiveHere we demonstrate the development of a COVID-19 outcome prediction app that utilizes an ANN and assesses its usability in the clinical setting.MethodsUsability assessment was conducted using the app, followed by a semistructured end-user interview. Usability was specified by effectiveness, efficiency, and satisfaction measures. These data were reported with descriptive statistics. The end-user interview data were analyzed using the thematic framework method, which allowed for the development of themes from the interview narratives. In total, 31 National Health Service physicians at a West London teaching hospital, including foundation physicians, senior house officers, registrars, and consultants, were included in this study.ResultsAll participants were able to complete the assessment, with a mean time to complete separate patient vignettes of 59.35 (SD 10.35) seconds. The mean system usability scale score was 91.94 (SD 8.54), which corresponds to a qualitative rating of “excellent.” The clinicians found the app intuitive and easy to use, with the majority describing its predictions as a useful adjunct to their clinical practice. The main concern was related to the use of the app in isolation rather than in conjunction with other clinical parameters. However, most clinicians speculated that the app could positively reinforce or validate their clinical decision-making.ConclusionsTranslating artificial intelligence technologies into the clinical setting remains an important but challenging task. We demonstrate the effectiveness, efficiency, and system usability of a web-based app designed to predict the outcomes of patients with COVID-19 from an ANN.

A Novel Region-Extreme Convolutional Neural Network for Melanoma Malignancy Recognition

Melanoma malignancy recognition is a challenging task due to the existence of intraclass similarity, natural or clinical artefacts, skin contrast variation, and higher visual similarity among the normal or melanoma-affected skin. To overcome these problems, we propose a novel solution by leveraging “region-extreme convolutional neural network” for melanoma malignancy recognition as malignant or benign. Recent works on melanoma malignancy recognition employed the traditional machine learning techniques based on various handcrafted features or the recently introduced CNN network. However, the efficient training of these models is possible, if they localize the melanoma affected region and learn high-level feature representation from melanoma lesion to predict melanoma malignancy. In this paper, we incorporate this observation and propose a novel “region-extreme convolutional neural network” for melanoma malignancy recognition. Our proposed region-extreme convolutional neural network refines dermoscopy images to eliminate natural or clinical artefacts, localizes melanoma affected region, and defines precise boundary around the melanoma lesion. The defined melanoma lesion is used to generate deep feature maps for model learning using the extreme learning machine (ELM) classifier. The proposed model is evaluated on two challenge datasets (ISIC-2016 and ISIC-2017) and performs better than ISIC challenge winners. Our region-extreme convolutional neural network recognizes the melanoma malignancy 85% on ISIC-2016 and 93% on ISIC-2017 datasets. Our region-extreme convolutional neural network precisely segments the melanoma lesion with an average Jaccard index of 0.93 and Dice score of 0.94. The region-extreme convolutional neural network has several advantages: it eliminates the clinical and natural artefacts from dermoscopic images, precisely localizes and segments the melanoma lesion, and improves the melanoma malignancy recognition through feedforward model learning. The region-extreme convolutional neural network achieves significant performance improvement over existing methods that makes it adaptable for solving complex medical image analysis problems.

Knowledge, attitude and practice of dentists toward providing care to the geriatric patients

BackgroundTooth loss, systemic diseases and medications add to the complexity of the oral conditions in geriatric popuation, making this age group a special group in need of specific preventive and curative oral health care. Therefore, the dental teams need to be equipped with specific knowledge and skills to provide the appropriate dental care. This study was iaimed to assess the knowledge, attitude, practice and willingness of general dentists to provide dental care to geriatric patients.MethodsThis cross-sectional study was conducted on 231 dentists using a questionnaire including demographic characteristics, knowledge, attitude and practice sections. The availability of the facilities for providing services to the older people in the office was also evaluated. Data were fed into SPSS-22 and analysed using descriptive statistics, t-test, Chi-squared, ANOVA and correlation coefficient tests (α = 0.05).Results62.8% of the participants were women and their mean age was 34. 4±8. 1 years. The knowledge mean score was 13.3± 2.9 (out of 30). 86. 5% of the participants had moderate knowledge, and 2.6% displayed good knowledge. The mean score related to the attitudes toward geriatric was 55.8 ± 6. 1 (out of 85), which was not significantly different based on gender. The mean score of practice was 21. 4± 4.3. There was a significantly positive correlation between knowledge and attitude. Dentists with a higher knowledge score had moderately a more positive attitude towards the older people (R = 0.33, p_ value < 0.001). However, over 60% preferred to provide care to the young patients. Significant correlation was observed between their practice and attitude (R = 0. 2, P-value = 0.006). Nearly 30% of the dentists found their knowledge and experience insufficient in treating the older people with complex medical problems. 40% believed that the current dental education in dental schools did not provide adequate training in geriatric dental care.ConclusionAlthough the dentists in this study had average knowledge and capacity, they mostly displayed a positive attitude towards the old. A high percentage of them were unsatisfied with the sufficiency of geriatric dental education in dental schools.

Сhylothorax

Objective — to determine and analyze, on our own experience, effective methods of treating chylothorax.&#x0D; Materials and methods. For the last 15 years on the basis of the department of surgical treatment of tuberculosis and invasive diagnostic methods of the SI «National Institute of Phthisiology and Pulmono­logy named after F.G. Yanovsky NAMS of Ukraine» was treated 21 patients with a diagnosis of chylothorax. Among the concomitant pathologies, the following diseases were most often diagnosed: ischemic heart disease 5 (23.8 %) cases, gynecological diseases 7 (32.9 %), obesity 4 (18.8 %).&#x0D; Results and discussion. An analysis was perfomed, which allows us to conclude that most often (10 cases, 47.6 %) chylothorax was diagnosed in women as a manifestation of lymphangioleiomyomatosis (LAM). It should be noted that in 4 (36.3 %) patients, LAM was diagnosed only by lung biopsy. In 2 (18.1 %) women, chylothorax was bilateral. In 6 (54.5 %) cases, a history of spontaneous pneumothorax (a characteristic diagnostic sign of LAM). The second place among the causes of chylothorax was by intrathoracic lymph node dissection during surgery for lung cancer. In all 3 (14.2 %) cases, the patients underwent left­sided pulmonectomy. Chylothorax usually developed by about 5—7 days, which coincided with the mobilization of patients and the restoration of adequate nutrition. In 2 (9.5 %) patients, the cause of chylothorax was damage to the thoracic duct during neurosurgical intervention through the transpleural approach. Such chylothorax is characterized by an aggressive course, quickly leads to exhaustion of the patient and requires immediate surgical intervention to ligate the thoracic duct below the level of injury. In 2 (9.5 %) patients, chylothorax was one of the manifestations of idiopathic pulmonary ossification. It should be noted that the diagnosis of pulmonary ossification was established only after a histological examination of a biopsy specimen, while such patients were admitted to the clinic with a diagnosis of recurrent pleurisy. In both cases, it was possible to achieve cessation of lymphorrhea by using parietal pleurectomy and conservative therapy. A feature of these patients is the fact that even with the elimination of chylothorax, moderate manifestations of respiratory failure remained in them. Chylothorax in lymphoproliferative diseases — in 2 cases (9.5 %) was the result of the prevalence of the oncological process, and therefore after its diagnosis, only pleural punctures and symptomatic treatment were performed. In no case was it possible to achieve complete cessation of lymphorrhea. In 1 (4.7 %) patient, idiopathic right­sided recurrent chylothorax was observed with moderate hilar lymphadenopathy. Videothoracoscopic biopsy of the intrathoracic lymph nodes was supplemented with parietal pleurectomy. This made it possible to achieve a reliable cessation of lymphorrhea, however, according to the data of a histopathological study, only reactive nonspecific changes were presented in the lymph nodes. In another 1 (4.7 %) case, on the 4th day after right­sided parietal pleurectomy for chronic pleural tuberculosis, lymphorrhea developed on the side of the operation. Short­term conservative therapy made it possible to achieve a positive result.Thus, the overall effectiveness of the treatment of such a pathological condition as chylothorax was 85.7 %. &#x0D; Conclusions. Chylothorax is a complex medical problem, the effective solution of which depends on a complex of conservative and surgical methods of treatment.The most common cause of chylothorax is lymphangioleiomyomatosis (47.6 %). The overall effectiveness of chylothorax treatment in the clinic is 85.7 %.

A Closer Look at Delayed Primary Cleft Surgery and Unrepaired Cleft Lip and/or Palate in 5 UK Cleft Centers.

There may be many reasons for delays to primary cleft surgery. Our aim was to investigate the age of children undergoing primary cleft lip or primary cleft palate repair in 5 cleft centers within the United Kingdom. Identify the reasons for delayed primary cleft lip repair (beyond 6 months) and delayed primary palate repair (beyond 13 months). Identify children who had a cleft lip and/or palate (CL±P) that was intentionally unrepaired and the reasons for this. A retrospective, multicenter review of patients born with a CL±P between December 1, 2012, and December 31, 2016. Three regional cleft centers, comprising of 5 cleft administrative units in the United Kingdom participated. In all, 1826 patients with CL±P were identified. Of them, 120 patients had delayed lip repair, outside the expected standard of 183 days. And, 178 patients in total had delayed palate repair, outside the expected standard of 396 days. Twenty (1%) patients had an unrepaired cleft palate. This large retrospective review highlights variations between centers regarding the timing of lip and palate surgery and details the reasons stated for delayed primary surgery. A small number of patients with an unrepaired cleft palate were identified. All had complex medical problems or comorbidities listed as a reason for the decision not to operate and 50% had a syndromic diagnosis. The number of patients receiving delayed surgery due to comorbidities, being underweight or prematurity, highlights the importance of the cleft specialist nurse and pediatrician within the cleft multidisciplinary team.

Evaluation of immediate and long-term results of treatment of post-radiation injuries of the rectum

Introduction. Treatment of post-radiation damage to the rectum is a complex medical problem. The search for new methods of treatment for this category of patients based on modern achievements in regenerative surgery is urgent.The aim of the study was to evaluate the immediate and long-term results of treatment of post-radiation lesions of the rectum using microfat grafting.Materials and methods. The study involved 66 patients — women aged 28 to 83 years inclusive with complications of radiation therapy (rectovaginal fistulas, radiation proctitis, radiation ulcers).Results and discussion. After the treatment, there is a tendency to improve the condition. So, if before the procedure the average sizes of fistulas and ulcers were 1.67 ± 0.54 cm in diameter, then after 3 months these indicators were 1.39 ± 0.54, and after 6 months — 1.1 ± 0.56 cm Complete epithelialization of the defect was observed in all patients. The period for which it was possible to achieve complete epithelialization varies from 6 months to 2 years. On average, to achieve complete epithelialization of post-radiation damage to the rectum, most patients required 3 injections of autologous adipose tissue. Also, all patients showed an improvement in elastometry indices over time. As a result of treatment, there is a tendency to improve the quality of life of patients.Conclutions. The study allows us to conclude about the effectiveness of the treatment, as well as that in the long term, the treatment will also be effective, the likelihood of relapse is minimal.

MO239ORAL FUNGAL INFECTION IN ESRD PATIENTS

Abstract Background and Aims Chronic Kidney Disease is an increasing health alarm worldwide with systemic signs like hematologic changes, bone metabolic error, and compromised immune status presenting to a dental practitioner with oral complications. Hence a study was done to assess the oral health condition, cytological changes, and presence or absence of candida in patients with chronic renal disease undergoing dialysis aged between 30 to 65 years and controls in South India. Method A cross sectional study was conducted among 80 adults with CKD and controls, attending KMC and MCODS, Mangalore. Oral manifestations and oral hygiene were assessed; Cytological smears were taken for morphometric analysis of buccal mucosal cells from the subjects. Oral smears were cultured to check for the growth of fungal species in subjects and controls. Statistical analysis was done using SPSS Version 13. Chi square test was used to compare categorical variables between the groups. Results There was a significant difference in oral hygiene status and cytological changes in patients with CKD. Oral Fungal Infection was found in 32% of our patients on dialysis and oral lesions, defined as clinical signs associated with OFI such as erythematous oral stomatitis, membranous candidiasis, or angular cheilitis, were found in 37% of the patients with OFI, while 5% of the patients without findings of fungal infection presented oral lesions associated with OFI (p=0.0002). Furthermore, patients with self-reported mouth dryness were three times more likely (p=0.02) to be diagnosed with OFI. Conclusion Hemodialysis patients are found to have significantly more OFI than controls. Oral dryness and dental plaque formation also seem to be at risk of developing OFI. Detection of oral lesions associated with OFI should be combined with a histopathological diagnosis before antifungal treatment. The prevalence of oral candida in these cases is alarming and can be a predictor of a poor prognostic index. As medicine advances, oral health care professionals should have a holistic approach to the management of patients with complex medical problems especially to diseases of the renal system as it is pivotal in maintaining a stable internal environment and homeostasis.

Thrombophilia in the pathogenesis of fetal growth retardation

Fetal growth retardation (FGR) is a complication of pregnancy that determines perinatal morbidity and mortality. It is a complex and multifaceted medical problem that does not lose its relevance. Impaired fetal development and delayed growth result from various etiopathogenesis of pathological processes occurring in the "mother–placenta–fetus" interface. Thrombophilia is one of the factors that can initiate disturbed placental function and the utero-placental blood flow. Here we describe the clinical FGR variants and etiopathogenetic factors of developing this complication of pregnancy (placental, maternal, and fetal). Special attention is paid to genetic and acquired thrombophilia (due to the circulation of antiphospholipid antibodies) and their role in development of such complication of pregnancy.

Diagnostics and Treatment of Cerebral Venous Thrombosis

BACKGROUND This article is devoted to the discussion of a life-threatening and difficult to diagnose disease — cerebral venous thrombosis (CVT). The article lists clinical manifestations, features of diagnosis and treatment of CVT. Cerebral venous thrombosis is an emergency that requires a quick decision to start therapy in order to prevent the development of venous cerebral infarction, intracranial hemorrhage, severe disability and death. Cerebral venous thrombosis is a rare and rather difficult to recognize form of acute cerebrovascular accident (ACVA). Considering the variability of the clinical and radiological picture, as well as the large number of risk factors, CVT is a complex medical problem. Despite the fact that CVTs account for less than 1% of all ACVA, significant differences in treatment necessitate the earliest possible differential diagnosis of CVT with arterial stroke. The diagnosis is often made with a delay due to a wide range of clinical manifestations, subacute onset of the disease, as well as low alertness of specialists in relation to CVT. In patients with cryptogenic stroke, CVT should be ruled out as a potential cause of stroke. Among other things, in the case of CVT, as in the case of thrombosis of the cerebral arteries, the establishment of the leading etiological factor is one of the priority tasks, the solution of which allows choosing the optimal means of secondary prevention. AIM OF STUDY Raising awareness of doctors of multidisciplinary hospitals about clinical manifestations, methods of diagnosis and treatment of CVT. MATERIAl AND METHODS To achieve this goal, the results of domestic and foreign scientific research on the diagno-sis and treatment of CVT were analyzed. Literature searches were carried out in electronic search engines Scopus, eLibrary, PubMed using the keywords: cerebral venous thrombosis, cryptogenic stroke, intracerebral hemorrhage, anticoagulant therapy, neurological imaging in cerebral venous thrombosis. For the analysis, scientific articles published between 1828 and 2020 were selected. Thirty percent of the analyzed works on the subject of CVT are not older than 5 years. CONClUSION Due to the various clinical manifestations and the absence of pathognomonic symptoms, neuroimaging plays a leading role in establishing the diagnosis. Early diagnosis of cerebral venous thrombosis and the use of anticoagulants lead to a decrease in disability and mortality.

A Patient-Centered Approach to Opioid Use Disorder.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Periprosthetic fractures in the hip joint – own study by the Department of Orthopedics and Traumatology in Kalisz

Every year, the number of total hip replacement treatments increases and along with it, so does the number of local and systemic complications, including periprosthetic fractures. These fractures usually occur among elderly people with deteriorated bone quality and other general and neurological disorders. Treatment of periprosthetic femoral fractures imposes a difficult and complex medical problem, which requires adequate experience and a rational combination of traumatological and orthopedical knowledge from the surgeon. In this article we review management of periprosthetic femoral fractures in the Department of Orthopedics and Traumatology in Kalisz.

Hyperkinetic Movements in Children

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

BackgroundThe incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).MethodsThis study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.ResultsSeven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.ConclusionsMerged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.

Quality and Readability of Web-Based Information for Patients With Pancreatic Cysts: DISCERN and Readability Test Analysis.

BackgroundPancreatic cysts are a complex medical problem with several treatment options. Patients use web-based health information to understand their conditions and to guide treatment choices.ObjectiveThe goal of this study was to describe the quality and readability of publicly available web-based information on pancreatic cysts and to compare this information across website affiliations.MethodsA Google search for “pancreatic cysts” was performed and the first 30 websites were evaluated. Website affiliations were classified as academic, media, nonprofit, government, or not disclosed. Information describing cancer risk was recorded. The DISCERN instrument measured the quality of content regarding treatment choices. Four standardized tests were used to measure readability.ResultsTwenty-one websites were included. The majority of the websites (20/21, 95%) described the cancer risk associated with pancreatic cysts. Nearly half of the websites were written by an academic hospital or organization. The average DISCERN score for all websites was 40.4 (range 26-65.5, maximum 80). Websites received low scores due to lack of references, failure to describe the risks of treatment, or lack of details on how treatment choices affect quality of life. The average readability score was 14.74 (range 5.76-23.85, maximum 19+), indicating a college reading level. There were no significant differences across website affiliation groups.ConclusionsWeb-based information for patients with pancreatic cysts is of moderate quality and is written above the reading level of most Americans. Gastroenterological, cancer treatment organizations, and physicians should advocate for improving the available information by providing cancer risk stratification, treatment impact on quality of life, references, and better readability.

Delirious Mania

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Фактор роста фибробластов 23 (FGF-23) и хроническая болезнь почек у детей

Chronic kidney disease (CKD) in children is a complex medical and social problem in healthcare. One of the serious complications is mineral bone disorder (MBD), the pathogenesis of which is related to a new biomarker of bone origin - fibroblast growth factor 23 (FGF-23). The aim. To study the features of fibroblast growth factor 23 (FGF-23) in children with chronic kidney disease. Material and methods. A cross-sectional study was carried out on 73 children with CKD and 14 healthy children. Inclusion criteria: chronic kidney disease stage 1-5, written informed consent of the participants. The exclusion criteria: tubulopathy, infectious and inflammatory processes, oncological diseases, kidney transplant, condition after surgery, taking glucocorticosteroids, calcium and vitamin D drugs. We took fasting blood samples of participants and carried out an enzyme-linked immunosorbent assay in order determine the level of FGF-23 (Biomedica Medizinprodukte GmbH, Austria). The obtained data were analyzed using IBM SPSS, version 22 (New York, USA). Results and discussion. In healthy children, the median (Q1-Q3) level of FGF-23 in serum was 0.65 (0.22-0.98) pmol/l, in patients with stage 1 CKD it was 0.65 (0.22-1.08) pmol/l. At stage 2, the level of FGF-23 significantly increased in comparison with healthy individuals and with patients of stage 1, p≤0.05. Further, there is a gradual increase by stages, p≤0.05. Thus, in stage 3 patients, the median FGF-23 value was 1.9 (1.15-3.5) pmol/l, at stage 4 - 3.55 (2.48-6.35) pmol/l, at 5 stages - 14 (7.5-18.75) pmol/l. As a percentage, there were 7.1% of patients at the stage 1 with increased levels of phosphatonin, at stage 2 - 53.3%, at stage 3 - 69.2%, respectively. At stages 4 and 5, absolutely 100% of patients had high levels of FGF-23. At the same time, FGF-23 did not depend on gender, age, birth weight and type of renal replacement therapy at stage 5, p&gt;0.05. Conclusions. Thus, in our study, we determined the features of changes FGF-23 in serum in children at various stages of CKD. The obtained results allow us to consider FGF-23 as a predictor of the clinical course of CKD. Keywords: fibroblast growth factor 23, phosphatonin, pediatric nephrology, chronic kidney disease, mineral-bone disorder.