Wollesenreilly2826

We also describe methods of preserving the privacy of collected videos and prior efforts of incorporating humans in the diagnostic loop. Finally, we summarize existing digital therapeutic interventions that allow for data capture and longitudinal outcome tracking as the diagnosis moves along a positive trajectory. Digital phenotyping of autism is paving the way for quantitative psychiatry more broadly and will set the stage for more scalable, accessible, and precise diagnostic techniques in the field. INTRODUCTION Spasmodic dysphonia (SD) is a focal dystonia of the larynx where involuntary spasms of its intrinsic muscles are triggered by specific phonemes. The diagnosis is challenging and is performed by listening to the patient's voice, supported by nasolaryngoscopy. There is no diagnostic tool in Spanish for SD. The objective of our study is to establish phonetically studied vocal tasks in Spanish language to diagnose patients with SD. MATERIAL AND METHOD This is a prospective study in three groups of patients 11 with SD, 11 with another vocal disease, and 11 with no vocal disease, recruited in the Voice Unit of Hospital Clínico Universidad Católica. Of the patients with SD, 10 (90.9%) had adductor SD and 1 (9.1%) abductor SD. Vocal tasks phonetically studied by a speech language pathologist as laryngeal spasm triggers were recorded. The audio recordings were randomized and analyzed by nine evaluators three experts and six otolaryngology residents. The correlation between the different professionals for the correct diagnosis was analyzed. RESULTS The audio recordings were analyzed and patients with SD presented irregular voice breaks that occurred during the trigger phonemes. Evaluators classified the audio recordings the expert group presented 100% sensitivity, 95-100% specificity and individual consistency of κ=0.73-0.82. The interrater agreement was 81.8%. The resident group presented 55-100% sensitivity, 58-95% specificity, and individual consistency of κ=0.36-0.82. The interrater agreement was 67.0%. DISCUSSION AND CONCLUSIONS We obtained a strong to almost perfect interrater agreement in experts and fair to almost perfect in residents. This study shows that the established list of phonetically studied and standardized words can be a useful tool for the diagnosis of SD. The number of caesarean sections performed worldwide is increasing, and with it, the need for the optimal analgesia strategies. Deficient postoperative analgesia increases the need for opioids, delays recovery, and is associated with chronic pain and postpartum depression. It is essential to find good postoperative pain control strategies that facilitate early mobility, early recovery, and early hospital discharge with minimal side effects on the mother and infant. Multimodal analgesia based on neuroaxial anaesthesia with morphine in combination with non-opioids such as non-steroidal anti-inflammatory drugs and paracetamol, gives the best post-caesarean analgesia outcome, and allows anaesthesiologists to reserve opioids, corticoids, gabapentin, magnesium or ketamine for situations where neuroaxial anaesthesia cannot be performed, for high-risk patients, or when pain is difficult to control. Peripheral nerve block techniques can also be added, such as transverse abdominis plane block, erector spinae block, or continuous wound infiltration. This interactive session was held at the 51st Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) in preparation for the transition of Pediatric Surgery training in Canada to Competency by Design (a CBME-based model of residency training developed by the Royal College of Physicians and Surgeons of Canada). PURPOSE We sought to identify implementation barriers and opportunities to increase utilization of the Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative's clinical practice guideline. METHODS A validated readiness assessment was sent via SurveyMonkey™ to CAPSNet site coordinators and local CDH stakeholders. The survey was open from 11/2018 to 02/2019. Data and responses were analyzed using descriptive statistics (REB 2019-4753). RESULTS Eighty-six responses were received, of which 65% (n = 56/86) were fully completed. The greatest number of responses came from neonatology (n = 27), pediatric surgery (n = 25), and respiratory therapy (n = 10). Seventy-eight percent (n = 67/86) of respondents were aware of the CDH guideline, and 63% (n = 54/86) used the entire guideline, while 23% (n = 20/86) used only certain sections. Besides recommendations pertaining to fetal intervention and ECLS, interdisciplinary long-term surveillance and prenatal diagnosis were considered most difficult to implement owing to funding limitations. Most respondents (n = 49/56; 87.5%) felt they could implement >75% of the recommendations. Establishing common team goals [i.e., minimize care variations] (n = 33/58;57%), provider buy-in [commitment of all health professionals to the guideline] (n = 28/58;48%), and regular compliance assessment (n = 23/58;40%) would increase uptake. CONCLUSION There is national awareness of the CDH guideline. Implementation strategies ensuring common team goals, provider buy-in, and regular compliance assessment should increase guideline uptake/utilization. Consolidating funding for interdisciplinary long-term surveillance and prenatal diagnosis is necessary for any site-specific implementation strategy. LEVEL OF EVIDENCE Level 4 qualitative, survey. PURPOSE We sought to describe long-term outcomes of infants with severe surgical necrotizing enterocolitis (NEC). METHODS Data were collected on infants with surgical NEC (2009-2018). Severe surgical NEC was defined by extensive bowel loss with residual bowel length less then 30 cm, and "NEC totalis" was identified per operative report. Post-operative management and long-term outcomes were assessed, including enteral autonomy, severe neurodevelopmental disability, and educational attainment. RESULTS Of 268 infants with surgical NEC, 41 (15%) had severe surgical NEC, and 14/41 were identified as "NEC totalis". Zero severe NEC vs. 8 (57%) "NEC totalis" patients were placed on comfort measures following initial surgery (p  less then  0.001). Twenty-five patients (93%) with severe NEC survived vs 3/6 with "NEC totalis" (p  less then  0.001). The 28 survivors (68%) were followed for a median (IQR) duration of 8(4,10) years. Nine (32%) with severe NEC were weaned from parenteral nutrition. Vactosertib Eight (29%) had ≥1 marker for severe neurodevelopmental disability, and 11/16(69%) (7-16 years) were attending school at last follow-up.