Nonoperative Management of Hip Osteoarthritis

Chronic hip pain is an extremely common condition, significantly impacting the quality of life and mobility of affected individuals. The dissemination of comprehensive guidelines on nonoperative management of chronic hip osteoarthritis (OA) is essential for enhancing the quality of care provided by primary care providers (PCPs). These guidelines should encompass evidence-based recommendations on physical therapy, pharmacologic interventions, and lifestyle modifications tailored to the individual patient\u27s needs. By equipping PCPs with standardized, accessible information, we can ensure consistent and effective management of chronic hip OA, ultimately improving patient outcomes and reducing the burden on specialized healthcare services. Enhanced education and resources for PCPs are imperative to bridge the gap in current practice and promote the optimal nonoperative care of patients with chronic hip OA.https://scholarworks.uvm.edu/fmclerk/2140/thumbnail.jp

Efficacy of Mindful Art and Eating Interventions in Vermont Elementary School Children

Background: Anxiety disorders have been shown to comprise a large majority of the mental health disorders among adolescents. (Merikangas et al., 2010). In addition, the COVID-19 pandemic has had an exacerbating effect on anxiety in this population. (Wang et. al., 2022). Prior research with adolescents has shown the effectiveness of mindfulness exercises on anxiety reduction in the academic environment (Hofmann et al., 2010). Collaborating with the Milton Family Community Center in Vermont, our team developed the hypothesis that implementing mindfulness exercises into the afterschool program would reduce anxiety indicators in the classroom. Methods: Mindful art and eating interventions were chosen based on their effectiveness in previous studies examining similar developmental age groups. Each intervention was implemented for a two-week period, during which teacher respondents were surveyed using the Strengths and Difficulties Questionnaire at set intervals to gauge their perceptions on classroom performance. Additionally, virtual interviews were conducted and coded to obtain qualitative data and themes from teachers. Results: Our study found no significant changes when surveying staff members regarding classroom performance. However, all teachers reported in the interview that they believed mindfulness exercises generally benefited students and, if implemented for a longer period, they may create a more impactful change. Conclusion: Future studies which implement a longer intervention period and a greater sample size of teachers for reporting classroom performance are needed to further explore the use of mindfulness exercises in mitigating anxiety-related learning difficulties in students.https://scholarworks.uvm.edu/comphp_gallery/1343/thumbnail.jp

Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus

Background: There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies. Objective: This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique. Study design: A 4-round focus group discussion and a 3-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a focus group discussion panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A 3-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa, which the experts were asked to rate on a 5-point Likert scale (from "strongly disagree"=1 to "strongly agree"=5). Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of ≤3 were deemed to have had no consensus and were excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and nonconsensus statements were then aggregated. Results: A total of 68 international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on 5 continents and have contributed to >80% of published cohort studies on vasa previa, as well as national and international society guidelines. Completion rates were 84%, 93%, and 91% for the first, second, and third rounds, respectively, and 71% completed all 3 rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including the following: (1) although there is no agreement on the distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2-cm distance; (2) all pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; (3) when a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at approximately 32 weeks to rule out vasa previa; (4) outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; (5) asymptomatic patients with vasa previa should be delivered by scheduled cesarean delivery between 35 and 37 weeks of gestation; and (6) there was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa. Conclusion: Through focus group discussion and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical guidelines

Vasa previa in singleton pregnancies: Diagnosis and clinical management based on an international expert consensus

There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies. (s): To systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions (FGD) and a Delphi technique. A four-round FGD and a three-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected based on their publication record on vasa previa. First, we convened an FGD panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A three-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa that the experts were asked to rate on a 5-point Likert scale (from strongly disagree = 1 to strongly agree = 5). Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of 3 or less were deemed to have had no consensus and excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and non-consensus statements were then aggregated. Sixty-eight international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on five continents and have contributed to over 80% of published cohort studies on vasa previa, as well as national and international society guidelines. Completion rates were 84%, 93%, 91% for the first, second, and third rounds, respectively, and 71% completed all three rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including: 1) While there is no agreement on a distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2 cm distance; 2) All pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; 3) When a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at around 32 weeks to rule out vasa previa; 4) Outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; 5)Asymptomatic patients with vasa previa should be delivered by scheduled cesarean between 35- and 37-weeks of gestation; and 6) There was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa. Through FGD and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical guidelines. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.

Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty

Objectives We aimed to evaluate the effect of technical aspects of fetal aortic valvuloplasty (FAV) on procedural risks and pregnancy outcomes.Background FAV is performed in cases of severe mid-gestation aortic stenosis with the goal of preventing hypoplastic left heart syndrome (HLHS).Methods The International Fetal Cardiac Intervention Registry was queried for fetuses who underwent FAV from 2002 to 2018, excluding one high-volume center.Results The 108 fetuses had an attempted cardiac puncture (mean gestational age [GA] 26.1 +/- 3.3 weeks). 83.3% of attempted interventions were technically successful (increased forward flow/new aortic insufficiency). The interventional cannula was larger than 19 g in 70.4%. More than one cardiac puncture was performed in 25.0%. Intraprocedural complications occurred in 48.1%, including bradycardia (34.1%), pericardial (22.2%) or pleural effusion (2.7%) requiring drainage, and balloon rupture (5.6%). Death within 48 hr occurred in 16.7% of fetuses. Of the 81 patients born alive, 59 were discharged home, 34 of whom had biventricular circulation. More than one cardiac puncture was associated with higher complication rates (p < .001). Larger cannula size was associated with higher pericardial effusion rates (p = .044). On multivariate analysis, technical success (odds ratio [OR] = 10.9, 95% confidence interval [CI] = 2.2-53.5, p = .003) and later GA at intervention (OR = 1.5, 95% CI = 1.2-1.9, p = .002) were associated with increased odds of live birth.Conclusions FAV is an often successful but high-risk procedure. Multiple cardiac punctures are associated with increased complication and fetal mortality rates. Later GA at intervention and technical success were independently associated with increased odds of live birth. However, performing the procedure later in gestation may miss the window to prevent progression to HLHS

Term Vaginal Delivery following Fetoscopic Laser Photocoagulation of Type II Vasa Previa

Unrecognized vasa previa carries a significant risk of fetal mortality. Advances in ultrasound have improved detection of vasa previa and led to a dramatic reduction in fetal morbidity and mortality. However, current management strategies require prolonged hospitalized surveillance, preterm delivery prior to the onset of labor or rupture of membranes, and a cesarean delivery. Fetoscopic laser ablation of type II vasa previa allows for the possibility of term vaginal delivery. We present a patient who underwent successful laser photocoagulation of a type II vasa previa at 32&lt;sup&gt;5&lt;/sup&gt;/&lt;sub&gt;7&lt;/sub&gt; weeks' gestation. She subsequently delivered vaginally at term without complications. The potential benefits of definitive in utero treatment of non-type I vasa previa, such as vaginal delivery at term, must be weighed against the procedure-related risks of operative fetoscopy.</jats:p