The authors' recommendations for minimizing fistulas and stricture rate, following free jejunal reconstruction, include the gastrointestinal stapler for bowel anastomosis whenever possible, and the use of a prophylactic pedicled pectoralis major muscle flap for patients exposed to previous radiotherapy.
Craniosynostosis has an incidence of 1 in 2000 to 2500 live births and may be corrected through several methods including total calvarial remodeling and frontal orbital advancement remodeling. Blood loss during craniosynostosis surgery can be substantial, ranging from 20% to 500% of total circulating volume with a high associated risk of transfusion-related adverse events. The authors performed a retrospective analysis of all patients undergoing surgery for craniosynostosis at a tertiary pediatric craniofacial center with a focus on blood loss and subsequent transfusion.The authors reviewed 40 patients with craniosynostosis >16 years at a single-center. Data on perioperative blood loss and transfusion were obtained, including pre-, intra-, and postoperative hemoglobin, hematocrit, and use of tranexamic acid. The authors calculated estimated percentage of circulating red cell volume lost and transfused.The majority of patients had sagittal synostosis and underwent total calvarial remodeling (n = 20); the rest underwent frontal orbital advancement remodeling (n = 19) or lambdoid correction (n = 1). The average estimated volume red cell loss was 77% of circulating volume and 90% of patients received blood transfusion with an average 88.3% transfusion of circulating red cell volume. Longer operative time, younger age, and lower weight predisposed to >50% blood volume transfusion (P = 0.032, <0.005, <0.005 respectively).This single-center observational study reports red cell volume loss and volume of transfusion in children undergoing surgical correction of craniosynostosis. Red cell volume loss was comparative to that in the literature and in this cohort longer operative time, younger age, and lower weight predisposed to >50% blood volume transfusion.
The COVID-19 pandemic has caused, and continues to cause, unprecedented disruption in England. The impact of the pandemic on the English education system has been significant, especially for children and young people with special educational needs and disabilities (SEND). While it was encouraging that the educational rights of children and young people with SEND were highlighted during the COVID-19 pandemic, Government decision-making appeared to be centered around the needs of pupils in mainstream schools. In this article, co-authored by an academic researcher and senior leaders from the Pan London Autism Schools Network (PLASN; a collective of special schools in London and the South East of England, catering for pupils on the autistic spectrum), we reflect on the impact of the COVID-19 pandemic on special schools in England. We document and discuss a range of challenges experienced by PLASN schools, including the educational inequalities that were exposed and perpetuated by the COVID-19 pandemic, as well as the manner in which the needs and realities of special schools were overlooked by the Government. We also detail the creative and innovative solutions implemented by PLASN schools to overcome barriers that they encountered. These solutions centered on facilitating holistic approaches to support, ensuring clear and regular communication with families, providing effective support for home learning, and promoting collaborative ways of working; all of which align with good practice principles in autism education more generally, and are essential elements of practice to maintain post-pandemic. We additionally reflect on how the COVID-19 pandemic could be a catalyst for much-needed change to the SEND system: leading to better educational provision, and therefore better outcomes, for pupils with SEND.
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