Shoulder dystocia is an unpredictable intrapartum emergency with potentially devastating consequences. In this article, the etiology, pathophysiology, and clinical management of shoulder dystocia are reviewed; institutional readiness and potential legal implications are discussed. Also considered are posttraumatic stress disorder and secondary traumatic stress, adverse psychological consequences that may be experienced by women, midwives, and other intrapartum care providers, including staff. © 2020 by the American College of Nurse-Midwives.Seventeen children at six institutions with neurofibromatosis type 2 (NF2)-related vestibular schwannomas received bevacizumab. Eight of the 13 patients with initial hearing loss (61%) showed objective hearing improvement within six months of treatment. No patients showed hearing deterioration during therapy; however, only two patients showed objective radiological response. Seven of eight patients had tumor progression or worsening hearing loss upon cessation of treatment. Bevacizumab was well tolerated with no patients discontinuing therapy. Bevacizumab appears to postpone hearing loss in childhood NF2-associated vestibular schwannomas, but responses are not durable, suggesting that either longer maintenance therapy or new strategies are required. © 2020 Wiley Periodicals, Inc.This study is based on Gerardo Ruiz's doctoral thesis on the information seeking patterns of psychiatrists in Mexico City, which he completed in January 2018 from the Autonomous National University of Mexico. The paper presents the key findings from a survey and interview involving 92 psychiatrists to identify the differing roles and information behaviours of three types of mental health practitioners. Similarities and divergences were found in their behavioural patterns in obtaining information to make clinical decisions, depending on purpose for the sought information which aligned to the role of the psychiatrist and on the information contexts of institutions in which they work. The implications for practice highlighted in this study focus on the influencing factors of time and availability of sources in enabling the mental health specialist to search, disseminate and evaluate information to be used in clinical practice, as well as to have in place broader communication with colleagues in order to enrich clinical care for better diagnosis and treatment.F.J. © 2019 Health Libraries Group.This study considers the status of trends in value and impact research in health libraries and discusses how return on investment approaches such as social value analysis could be used. It uses an example, based on the Health Education England evaluation framework for health library and knowledge services, to outline how a theory of change can be developed. Health libraries now work more closely with health care staff and researchers in co-creating value and impact for improving patient care. Therefore, collection of data to assess social value should be drawn not only from performance data already collected by libraries, but also data collection by and for the health care organisation on evaluation of care quality and professional competence. © 2020 Health Libraries Group.BACKGROUND The role of adjuvant radiotherapy (RT) remains unclear in patients with localized, completely resected (group I) alveolar rhabdomyosarcoma (ARMS). https://www.selleckchem.com/products/selnoflast.html PROCEDURE Patients with group I ARMS enrolled on any one of three prior Children's Oncology Group (COG) clinical trials (D9602, D9803, or ARST0531) were analyzed. All patients received systemic chemotherapy and 36 Gy adjuvant RT (if given) to the primary site at week 12 or week 4 for D9602/D9803 and ARST0531, respectively. RESULTS Thirty-six patients with group I ARMS were treated on D9602 (n = 6), D9803 (n = 17), or ARST0531 (n = 13), of whom 24 (67%) were male. The median age was 4.1 years (range, 0.8-45.8). Twenty (56%) patients had an unfavorable primary site, and 10 (28%) had tumors > 5 cm. FOXO1-fusion status was negative, positive, and unknown in 10 (28%), 15 (42%), and 11 (30%) tumors, respectively. Twenty-two (61%) patients received RT. Overall, the four-year event-free survival (EFS) and overall survival (OS) were 70.8% and 88.3%, respectively. Patients with FOXO1 positivity who received RT had superior EFS compared with those who did not (77.8% vs 16.7%; P = 0.03). Among 10 patients who were FOXO1 negative, the outcome was similar with or without RT. CONCLUSIONS Although limited by a small sample size, data from this study support the routine use of adjuvant RT in patients with FOXO1-positive disease even after complete resection. Additionally, omitting adjuvant RT is rational for patients with FOXO1-negative ARMS and will be prospectively investigated in the current COG trial ARST1431. © 2020 Wiley Periodicals, Inc.KBG syndrome (MIM #148050) is an autosomal dominant disorder characterized by developmental delay, intellectual disability, distinct craniofacial anomalies, macrodontia of permanent upper central incisors, skeletal abnormalities, and short stature. This study describes clinical features of 28 patients, confirmed by molecular testing of ANKRD11 gene, and three patients with 16q24 deletion encompassing ANKRD11 gene, diagnosed in a single center. Common clinical features are reported, together with uncommon findings, clinical expression in the first years of age, distinctive associations, and familial recurrences. Unusual manifestations emerging from present series include juvenile idiopathic arthritis, dysfunctional dysphonia, multiple dental agenesis, idiopathic precocious telarche, oral frenula, motor tics, and lipoma of corpus callosum, pilomatrixoma, and endothelial corneal polymorphic dystrophy. Facial clinical markers suggesting KBG syndrome before 6 years of age include ocular and mouth conformation, wide eyebrows, synophrys, long black eyelashes, long philtrum, thin upper lip. General clinical symptoms leading to early genetic evaluation include developmental delay, congenital malformations, hearing anomalies, and feeding difficulties. It is likely that atypical clinical presentation and overlapping features in patients with multiple variants are responsible for underdiagnosis in KBG syndrome. Improved knowledge of common and atypical features of this disorder improves clinical management. © 2020 Wiley Periodicals, Inc.


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Last-modified: 2025-01-23 (木) 06:16:51 (22d)