A retrospective comparison of all endoscopic bronchial foreign body (BFB) removals performed at Children's Hospital and Medical Center, Seattle, Washington, during two separate 5-year periods is reported. There were 54 patients between July 1, 1964, and June 30, 1969, and 119 patients between July 1, 1984, and June 30, 1989. Bronchoscopic removal of foreign bodies in the late cohort was performed almost exclusively with Hopkins telescope-guided foreign body graspers as opposed to traditional forceps guided by the naked eye in the first group. There were no differences in the average age, foreign body type, anesthetic technique, operative length, or anatomic distribution between cohorts. There were significantly fewer complications in the late cohort than the early. Complication rates increased with the duration of the BFB in situ. There were significantly fewer missed BFBs at initial bronchoscopy in the late cohort (4) than the early (10). Inability to endoscopically remove the BFB resulted in thoracotomy in 3 patients in the early cohort and 1 patient in the late cohort. There was one instance in which foreign body migration from right to left main stem occurred during the delay between diagnosis and operation, resulting in the necessity for emergent bronchoscopy with the patient in extremis. Prompt endoscopy in patients with suspected BFBs using the Hopkins rod bronchoscopic system will result in fewer complications and fewer missed foreign bodies.
This study represents the most comprehensive cost-benefit analysis of an MST clinical trial to date and demonstrates that an evidence-based treatment such as MST can produce modest economic benefits well into adulthood. Implications of the authors' findings for policymakers and public service agencies are discussed.
There is a well-known subgroup of children and adolescents with complex medical conditions who have many psychosocial challenges that put them at risk for repeated and, at times, avoidable hospitalizations. Intensive behavioral health interventions that address the multitude of problems associated with complex medical conditions have proven effective in improving adherence to treatment, improving overall psychosocial functioning, and reducing avoidable hospitalizations. Based largely on this research, we adapted and augmented a family-based problem-solving intervention for youth with complex medical conditions who have been repeatedly hospitalized. The intervention involves intensive family based problem solving augmented with care coordination and case management. The intervention is implemented in the family’s home, in the hospital, in the clinic, over e-mail, via video teleconferencing, and by text. To our knowledge, this effort is a first in the application of intensive behavioral health care for youth with complex medical conditions who are repeatedly hospitalized. We describe the theoretical and empirical underpinnings of the intervention, provide a description of the intervention using a case example, and present “lessons learned” from our efforts toward reducing hospitalizations and utilization of services in a population of youth with complex medical conditions who have repeatedly experienced avoidable hospitalizations.
Background: There is growing evidence for the feasibility of text-based interventions for pediatric patients with type 1 diabetes (T1D). However, less is known regarding whether the use of personalized text messages with high-risk youth and their caregivers is associated with improvements in youth health. This study examines the use of diabetes-specific texts and associated health outcomes for participants of the Novel Interventions in Children's Healthcare (NICH) program.
Methods:Text messages sent to youth with T1D and their caregivers during NICH intervention were coded regarding diabetes relevance and adherence-related content. Health outcome data (eg, HbA1c values, hospital admissions) prior to and following NICH program enrollment were collected.Results: Fewer than half (43%) of texts sent to patients and their caregivers were identified as being related to diabetes, and over 95% of diabetes-related texts were identified as adherence-related. Participants in the NICH program demonstrated a significant decrease in HbA1c values, t(23) = 2.78, p ≤ .05, and DKA-related hospital visits, t(24) = 2.78, p ≤ .01, during program involvement. Although no relationships were identified between patient-recipient text characteristics and health outcomes, the frequency and type of text messaging with caregivers was significantly associated with changes in health outcomes.
Conclusions:This study represents the most extensive evaluation of diabetes-related SMS use and health outcomes for NICH participants to date. Findings demonstrate improvements in patient health during NICH program involvement. Implications include that sending frequent, personalized, and adherence-reinforcing texts to patients' caregivers may result in improved patient health, decreased utilization, and, potentially, associated reductions in health care costs.
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