Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ...ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.
Background
Headaches with marked, specific response to indomethacin occur in children, but the phenotypic spectrum of this phenomenon has not been well-studied.
Methods
We reviewed pediatric patients ...with headache showing ≥80% improvement with indomethacin, from seven academic medical centers.
Results
We included 32 pediatric patients (16 females). Mean headache onset age was 10.9 y (range 2–16 y). Headache syndromes included hemicrania continua (n = 13), paroxysmal hemicrania (n = 10), primary stabbing headache (n = 2), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (n = 1), primary exercise headache (n = 1) and primary cough headache (n = 1). Adverse events were reported in 13, most commonly gastrointestinal symptoms, which often improved with co-administration of gastro-protective agents.
Conclusion
Indomethacin-responsive headaches occur in children and adolescents, and include headache syndromes, such as primary cough headache, previously thought to present only in adulthood. The incidence of adverse events is high, and patients must be co-treated with a gastroprotective agent.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Veterans Health Administration system is one of the largest integrated health care providers in the United States, delivering medical care to > 9 million veterans. Barriers to delivering ...efficient health care include geographical limitations as well as long wait times. Telehealth has been used as a solution by many different health care services. However, it has not been as widely used in cancer care. In 2018, the US Department of Veterans Affairs (VA) Pittsburgh Healthcare System expanded the use of telehealth to provide antineoplastic therapies to rural patients by creating a clinical video telehealth clinic of the Virtual Cancer Care Network. This allows oncologists located at the tertiary center to virtually deliver care to remote sites. The recent COVID-19 pandemic forced oncologists across the VA system to adopt telehealth to provide continuity of care. On the basis of our review and personal experience, we have outlined opportunities for telehealth to play a role in every step of the cancer care journey from diagnosis to therapy to surveillance to clinical trials for medical, surgical, and radiation oncology. There are many advantages, such as decreased travel time and potential cost savings; however, there continues to be challenges with veterans having access to devices and the Internet as well as understanding how to use telehealth equipment. The lessons learned from this assessment of the VA telehealth system for cancer care can be adopted and integrated into other health systems. In the future, there needs to be evaluation of how telehealth can be further incorporated into oncology, satisfaction of veterans using telehealth services, overcoming telehealth barriers, and defining metrics of success.
Over the past decade, new health care reforms, due to the Patient Protection and Affordable Care Act, have introduced all-cause hospital readmission as a determinate metric for quality of care. ...Concurrently, payers have started to implement bundled payment systems, in which hospitals will be accountable for the costs of readmissions for any reason, up to 90 days from discharge. Therefore, decreasing the readmission rate will allow for cost savings.
The aim of the current study was to assess factors associated with 30-90 day readmission after spine and total joint replacement surgeries.
We compiled a randomized list of 999 spine and total joint patients who underwent surgery at our institution between 2014-2015. From this, we compiled a database with information regarding the length of stay, number of consults, 30- and 90-day readmission, medical comorbidities, and patient demographics. Pearson correlation coefficients were calculated between the variables of interest.
We compiled a randomized list of 999 spine and total joint patients who underwent surgery at our institution between 2014-2015.
A database with information regarding the length of stay, number of consults, 30- and 90-day readmission, medical comorbidities, and patient demographics was compiled. Outcomes measures included 30- and 90-day readmission rates.
A randomized study including 999 spine procedures and total joint arthroplasties were collected from 2014-2015. A retrospective chart review was then performed.
A 90-day readmission correlation coefficient of -0.13 was observed when compared to the number of consults obtained after surgery (P<0.05). Additionally, a -0.11 correlation coefficient was observed when correlated with length of stay (P<0.05). A 30-day readmission correlation coefficient of -0.09 was observed when correlated with number of consults (P<0.05). A -0.07 correlation coefficient was observed when correlating 30-day re-admission and length of stay (P<0.05).
Our results indicate that those patients who are optimized medically for discharge, following spine or total joint surgery, have a significantly lower likelihood of readmission at 30 and 90 days. Furthermore, our results demonstrate that patients with longer lengths of stay necessary, for medical optimization, will lead to a lower likelihood of readmission. Based on the findings of the current study, the authors recommend, medically optimizing patients prior to discharge to decrease readmission and the associated penalties. This may require more consults and longer length of hospital stay.
This abstract does not discuss or include any applicable devices or drugs.
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