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Ray Postuma

Publications and source records attributed to Ray Postuma.

2 recordsLinked to original sources

Telepediatric surgery: capturing clinical outcomes.

PURPOSE: The aim of this study is to compare outcomes and patient characteristics of telehealth vs in-person contacts in pediatric surgery ambulatory care patients. METHODS: All non-Winnipeg telehealth patients (group 1), non-Winnipeg in-person patients (group 2), and a convenience sample of Winnipeg in-person patients (group 3) seen in the pediatric ambulatory surgical clinic and day surgery by one pediatric surgeon in a tertiary urban (Winnipeg, Manitoba) hospital between April 2002 and June 2003 were analyzed. RESULTS: There were 118, 205, and 120 (total, 443) patients and 153, 427, and 246 (total, 826) patient contacts in groups 1, 2, and 3, respectively. Of 826 patient contacts, 272 were day surgery procedures and 554 were consults and follow-ups, of which 27% (n = 152) were seen via telehealth. Of the non-Winnipeg contacts, 33.4% of consults and 51.5% of follow-ups used telehealth. Variations were seen between the telehealth and the 2 in-person groups on average age at contact, patient no-show rates, intraoperative complication rates, and postoperative complication rates. The interval to consult by telehealth decreased significantly during the course of the study. CONCLUSIONS: This is the first comparative analysis of telehealth outcomes in a population of pediatric surgery ambulatory care patients. Telehealth improves access to pediatric surgical services without untoward clinical outcomes.

Age Factors↗

Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline.

OBJECTIVES: To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries. DESIGN: A chart review. SETTING: Winnipeg Children's Hospital. PATIENTS: All patients with splenic injuries under the age of 17 years admitted to the hospital between December 1994 and April 1999. OUTCOME MEASURES: These included patient demographics, length of stay, location of care, grade of splenic injury (American Association for the Surgery of Trauma Organ Injury Scale), imaging tests performed in hospital and after discharge, follow-up care and time to return to full activity. RESULTS: Forty-four patients received nonoperative management. The mean age of the patients was 10.4 years. The average grade of splenic injury was 2.8. Sixteen patients (36%) were admitted to the intensive care unit for an average of 1.9 days. Mobilization was allowed after a mean of 5.2 days. Average length of hospital stay was 9.2 days. At the time of admission 98% of the patients underwent computed tomography, but at follow-up only 20% of patients underwent this investigation. None of the follow-up imaging studies altered the postdischarge management plan. The median time to full activity was 12 weeks (range from 0-17 wk). One patient had a delayed hemorrhage and required splenectomy. CONCLUSIONS: Reduced admissions to the intensive care unit, shorter overall stays, omission of follow-up imaging and an earlier return to full activity should be considered in the management of children with blunt splenic injuries. Standardization of nonoperative care for such children would result in safe and more efficient delivery of health care.

Adolescent↗