Subdural hemorrhage in association with D2-hydroxyglutaric aciduria (D2-HGA) Type II has only been described once in the medical literature in a 15-month-old child (1). Our case report describes a much younger 3-month-old infant previously diagnosed with D2-HGA Type II, who presented clinically with seizures and identified to have bilateral subdural hematomas concerning for possible physical abuse. This case report discusses the genetic diagnosis of D2-HGA and interpretation of subdural hemorrhage in context of evaluating possible physical abuse concerns. When an underlying medical condition is known to be present and a child presents with findings that may be concerning for physical abuse, it is critical to consider the possibility that the underlying medical condition may contribute to or may be the cause of the findings.
Background An integrated care pathway (ICP) was developed and piloted for cataract surgery in the ophthalmic department of a district general hospital in the UK. Objectives To evaluate the pilot care pathway for feasibility and acceptability. Methods Compliance with documentation, variance analysis and staff experience with the ICP were analysed for the pilot. Results Good compliance and variance assessment with the pilot document was noted. User involvement was deficient in certain user groups, like doctors and patients. Evaluation of the pilot project also identified certain shortcomings in the system development method. Conclusions Implementation of the audit recommendations has simplified the patient journey. Working group consultation including all user groups aims to increase ownership and modify the care pathway document to a universally acceptable format. Incorporation of audit and electronic care pathways are recommended to improve resource management and provide early benefits for users.
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