Reduced length of stay after implementation of a clinical pathway following repair of ventricular septal defect

Background: There is variation in care and hospital length of stay following surgical repair of ventricular septal defects. The use of clinical pathways in a variety of paediatric care settings has been shown to reduce practice variability and overall length of stay without increasing the rate of adverse events. Methods: A clinical pathway was created and used to guide care following surgical repair of ventricular septal defects. A retrospective review was done to compare patients two years prior and three years after the pathway was implemented. Results: There were 23 pre-pathway patients and 25 pathway patients. Demographic characteristics were similar between groups. Univariate analysis demonstrated a significantly shorter time to initiation of enteral intake in the pathway patients (median time to first enteral intake after cardiac ICU admission was 360 minutes in pre-pathway patients and 180 minutes in pathway patients, p \u3c 0.01). Multivariate regression analyses demonstrated that the pathway use was independently associated with a decrease in time to first enteral intake (-203 minutes), hospital length of stay (-23.1 hours), and cardiac ICU length of stay (-20.5 hours). No adverse events were associated with the use of the pathway, including mortality, reintubation rate, acute kidney injury, increased bleeding from chest tube, or readmissions. Conclusions: The use of the clinical pathway improved time to initiation of enteral intake and decreased length of hospital stay. Surgery-specific pathways may decrease variability in care while also improving quality metrics

Effectiveness of facet joint nerve blocks in managing chronic axial spinal pain of facet joint origin: A systematic review and meta-analysis

Background:Chronic axial spinal pain is one of the major causes of disability. Literature shows that spending on low back and neck pain and musculoskeletal disorders continues to escalate, not only with disability, but also with increasing costs, accounting for the highest amount of various disease categories. Based on the current literature utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been shown as potential sources of spinal pain. Therapeutic facet joint interventional modalities of axial spinal pain include radiofrequency neurotomy, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections. Objective:The objective of this systematic review and meta-analysis is to evaluate the effectiveness of facet joint nerve blocks as a therapeutic modality in managing chronic axial spinal pain of facet joint origin. Study design:A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methods:The available literature on facet joint nerve blocks in axial spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane review criteria to assess risk of bias, the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials, and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for nonrandomized studies. The evidence was graded according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment criteria. The level of evidence was based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. A comprehensive literature search of multiple databases from 1966 to July 2023, including manual searches of the bibliography of known review articles was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into qualitative and quantitative evidence synthesis. Outcome measures:The primary outcome measure was the proportion of patients with significant relief and functional improvement of greater than 50% of at least 3 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months). Results:This assessment identified 8 high-quality and one moderate quality RCTs and 8 high quality and 4 moderate quality non-randomized studies with application of spinal facet joint nerve blocks as therapeutic modalities. However, based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high levels of evidence and clinical applicability, with 11 studies showing moderate levels of GRADE evidence and clinical applicability. Limitations:Despite the paucity of literature is considered as the major drawback. Based on Grading of Recommendations, Assessment Development, and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high levels of evidence and clinical applicability. Conclusion:Based on the present systematic review and meta-analysis with 9 RCTs and 12 non-randomized studies, the evidence is Level II with moderate to strong recommendation for therapeutic facet joint nerve blocks in managing spinal facet joint pain

e-Ethics, 2003 August

The Park Ridge Center, Chicago, IL: Issue of e-Ethics , a publication from The Park Ridge Center for the Study of Health, Faith and Ethics, associated with Lutheran General Hospital. This issue has case studies and a discussion around consent, permission, and assent in pediatric research.https://institutionalrepository.aah.org/alldocuments/1529/thumbnail.jp

e-Ethics, 2001 November

The Park Ridge Center, Chicago, IL: Issue of e-Ethics , a publication from The Park Ridge Center for the Study of Health, Faith and Ethics, associated with Lutheran General Hospital. This issue has a case study and discussion about home care and patient education.https://institutionalrepository.aah.org/alldocuments/1510/thumbnail.jp

e-Ethics, 2000 October

The Park Ridge Center, Chicago, IL: Issue of e-Ethics , a publication from The Park Ridge Center for the Study of Health, Faith and Ethics, associated with Lutheran General Hospital. This issue has a discussion on organ and tissue donation.https://institutionalrepository.aah.org/alldocuments/1497/thumbnail.jp

Predictive value of general movements assessment for developmental delay at 18 months in children with complex congenital heart disease

Background:Infants with complex congenital heart disease are at increased risk of impaired fetal brain growth, brain injury, and developmental impairments. The General Movement Assessment (GMA) is a valid and reliable tool to predict cerebral palsy (CP), especially in preterm infants. Predictive properties of the GMA in infants with complex congenital heart disease (CCHD) are unknown. Aim:To evaluate predictive properties of the GMA to predict developmental outcomes, including cerebral palsy (CP), at 18-months corrected age (CA) in children with CCHD undergoing heart surgery in the first month of life. Methods:A prospective cohort of 56 infants with CCHD (35 males, 21 females) was assessed with GMA at writhing age (0-6 weeks CA) and fidgety age (7-17 weeks CA) and the Bayley Scales of Infant Development at 18 months. GMA focused on markedly reduced GM-variation and complexity (definitely abnormal (DA) GM-complexity) and fidgety movements. Predictive values of GMA for specific cognitive, language and motor delay (composite scores Results:At fidgety age, all infants had fidgety movements and no child was diagnosed with CP. DA GM-complexity at fidgety age predicted general developmental delay at 18 months (71 % sensitivity, 90 % specificity), but predicted specific developmental delay less robustly. DA GM-complexity at writhing age did not predict developmental delay, nor did it improve prediction based on DA GM-complexity at fidgety age. Conclusions:In infants with CCHD and fidgety movements, DA GM-complexity at fidgety age predicted general developmental delay

e-Ethics, 2003 October

The Park Ridge Center, Chicago, IL: Issue of e-Ethics , a publication from The Park Ridge Center for the Study of Health, Faith and Ethics, associated with Lutheran General Hospital. This issue has a discussion on business decisions and favoritism.https://institutionalrepository.aah.org/alldocuments/1531/thumbnail.jp

e-Ethics, 2002 February

The Park Ridge Center, Chicago, IL: Issue of e-Ethics , a publication from The Park Ridge Center for the Study of Health, Faith and Ethics, associated with Lutheran General Hospital. This issue has a discussion on the usefulness of a code of ethics.https://institutionalrepository.aah.org/alldocuments/1513/thumbnail.jp