A surge in the availability of fetal neurology consultation services across various centers is evident; however, the institutional experience remains underreported. Fetal characteristics, pregnancy progression, and the impact of fetal consultations on perinatal results remain poorly documented. To gain an understanding of the institutional fetal neurology consult process, this study aims to pinpoint areas of strength and weakness within the system.
We undertook a retrospective electronic chart review at Nationwide Children's Hospital, examining fetal consults documented between April 2, 2009, and August 8, 2019. The study sought to detail clinical characteristics, the concurrence of prenatal and postnatal diagnoses supported by the optimal imaging tools available, and the subsequent postnatal trajectory of these patients.
From the 174 maternal-fetal neurology consults, 130 were eligible for inclusion after review of the available data. Of the projected 131 anticipated fetuses, 5 experienced fetal demise, 7 underwent elective termination, and 10 met their demise in the period after birth. Among the admitted infants, a majority were transferred to the neonatal intensive care unit; 34 (31%) required intervention for feeding, breathing, or hydrocephalus, and a further 10 (8%) experienced seizures during their stay in the NICU. learn more Prenatal and postnatal brain imaging of 113 infants was examined, with the primary diagnosis used to categorize the outcomes of the imaging studies. learn more Midline anomalies (37% prenatal, 29% postnatal), posterior fossa abnormalities (26% prenatal, 18% postnatal), and ventriculomegaly (14% prenatal, 8% postnatal) were the most frequently observed malformations. Fetal imaging showed no evidence of additional neuronal migration disorders; however, 9% of postnatal studies showed the presence of these disorders. MRI scans conducted prenatally and postnatally on 95 infants exhibited a moderate level of concordance in diagnoses (Cohen's kappa = 0.62, 95% confidence interval = 0.5-0.73; percentage agreement = 69%, 95% confidence interval = 60%-78%). The postnatal care approach was shaped by consulting recommendations for neonatal blood tests in 64 out of 73 cases in which the infant survived and data was available.
A multidisciplinary fetal clinic, offering timely counseling and rapport building with families, ensures a seamless continuity of care crucial for prenatal and postnatal management, including birth planning. Radiographic prenatal diagnosis, while providing insight, necessitates a cautious approach to prognosis, given the potential for significant variability in neonatal outcomes.
Through a multidisciplinary fetal clinic, timely counseling and rapport-building with families can ensure continuity of care throughout birth planning and the postnatal management of their child. Despite prenatal radiographic diagnoses, neonatal outcomes may vary considerably, highlighting the need for cautious prognosis.
Within the United States, cases of tuberculosis causing meningitis in children are rare, and the neurological sequelae can be severe. Among the rare causes of moyamoya syndrome, tuberculous meningitis stands out, with only a handful of previously reported cases.
A female patient, initially diagnosed with tuberculous meningitis (TBM) at six years old, later presented with moyamoya syndrome, requiring a revascularization surgical intervention.
In her, basilar meningeal enhancement and right basal ganglia infarcts were found. Following 12 months of antituberculosis therapy and 12 months of enoxaparin, she was maintained on a daily dose of aspirin indefinitely. Amongst her health issues, recurrent headaches and transient ischemic attacks were symptomatic of a progressively developing bilateral moyamoya arteriopathy. In her eleventh year, bilateral pial synangiosis was performed on her to address her moyamoya syndrome.
Moyamoya syndrome, a rare yet serious complication following tuberculosis meningitis (TBM), may demonstrate a particular predisposition in pediatric patients. In carefully chosen patients, the possibility of stroke can be decreased by pial synangiosis, or by other strategies for revascularization.
The potential for increased prevalence of Moyamoya syndrome, a rare and serious sequela of TBM, exists in pediatric cases. For carefully selected patients, pial synangiosis, or similar revascularization procedures, represent a possible way to reduce the risk of stroke.
The study's objectives included examining the healthcare costs for patients with video-electroencephalography (VEEG)-confirmed functional seizures (FS), comparing health care utilization of patients with clear functional neurological disorder (FND) diagnostic explanations against those with unsatisfactory explanations, and determining the overall healthcare costs two years prior to and two years following diagnosis for those receiving distinct explanations.
Patients meeting the criteria of VEEG-confirmed pure focal seizures (pFS) or a combination of functional and epileptic seizures during the period from July 1, 2017, to July 1, 2019, underwent evaluation procedures. The quality of the diagnosis explanation, judged as satisfactory or unsatisfactory by a self-designed rubric, and health care utilization data, gathered via an itemized list, were both documented. Expenditures incurred two years following an FND diagnosis were compared with those two years preceding the diagnosis. The cost outcomes were then assessed in each group.
Among those patients (n=18) who were given a satisfying explanation, total healthcare costs were lowered from $169,803 to $117,133 USD, a decrease of 31%. Patients with pPNES who were given unsatisfactory explanations saw a considerable jump in costs, from $73,430 to $186,553 USD – a 154% increase. (n = 7). Individual-level analysis reveals that 78% of patients receiving satisfactory explanations experienced a reduction in annual healthcare costs, decreasing from a mean of $5111 USD to $1728 USD. Conversely, unsatisfactory explanations resulted in increased costs for 57% of patients, increasing from a mean of $4425 USD to $20524 USD. A parallel response was noted from explanations given to patients with both diagnoses.
Subsequent healthcare utilization is directly related to the approach taken in communicating an FND diagnosis. Patients receiving comprehensive and acceptable explanations about their health conditions demonstrated lower healthcare utilization; however, those with unsatisfactory explanations experienced elevated healthcare expenditures.
Healthcare use following an FND diagnosis is substantially influenced by the communication method. Explanations found to be satisfactory led to lower healthcare utilization rates, in stark contrast to unsatisfactory explanations, which resulted in higher associated healthcare costs.
Through shared decision-making (SDM), patient preferences find alignment with the healthcare team's treatment plans. In the neurocritical care unit (NCCU), this quality improvement initiative introduced a standardized SDM bundle to overcome the considerable challenges of unique demands on existing provider-driven SDM practices.
An interprofessional team, guided by the Institute for Healthcare Improvement Model for Improvement, leveraging the Plan-Do-Study-Act cycles, ascertained key issues, recognized limitations, and forged change initiatives to propel the implementation of the SDM bundle. learn more The SDM bundle included a pre- and post-SDM healthcare team huddle; a social worker-led SDM discussion with the patient's family, incorporating core standardized communication elements for consistency and quality; and an SDM documentation tool within the electronic medical record to ensure all healthcare team members could access the SDM discussion. The percentage of documented SDM conversations was the principle metric used to evaluate outcomes.
By implementing the intervention, the documentation of SDM conversations saw a substantial 56% rise, increasing from 27% pre-intervention to 83% post-intervention. The duration of NCCU stays saw no substantial alteration, and the frequency of palliative care consultations did not increment. Following the intervention, the SDM team's huddle adherence rate reached an impressive 943%.
Team collaboration fostered by a standardized SDM bundle, integrated into healthcare team workflows, enabled earlier SDM conversations and resulted in improved documentation of these conversations. Team-based SDM bundles are a potential catalyst for improved communication and early alignment with patient family goals, preferences, and values.
Healthcare team workflows, enhanced by a standardized, collaboratively developed SDM bundle, facilitated earlier SDM conversations, improving documentation of these interactions. Improved communication and early alignment with patient families' goals, values, and preferences are potential benefits of team-driven SDM bundles.
Policies detailing insurance coverage for CPAP therapy specify the diagnostic standards and adherence expectations for patients seeking initial and ongoing treatment of obstructive sleep apnea, the gold standard in therapy. It is unfortunate that many CPAP users, enjoying the positive effects of treatment, nevertheless, do not meet the stipulated criteria. Fifteen cases are examined, where patients were found to be ineligible for CMS guidelines, underscoring the policies' shortcomings in ensuring patient care. Lastly, we assess the expert panel's recommendations to elevate CMS policies, proposing methods for physicians to enhance CPAP accessibility while navigating existing regulatory constraints.
Patients with epilepsy who are on newer second- and third-generation antiseizure medications (ASMs) potentially receive care of higher quality. We aimed to determine if racial/ethnic variations were present in their utilization.
Medicaid claims data enabled us to categorize and count antiseizure medications (ASMs), along with determining adherence rates, for people living with epilepsy during the years 2010 through 2014. An examination of the link between newer-generation ASMs and adherence was conducted using multilevel logistic regression models.