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Case report on speech treatment of a young adult with Down syndrome
Published in Margaret Walshe, Nick Miller, Clinical Cases in Dysarthria, 2021
DS was 34 years old at the time of the study. She was born 13 weeks premature and diagnosed with DS at three days. She was hospitalised several times during her first year of life for underdevelopment and failure to thrive. A heart murmur was diagnosed at three months of age, and she was treated with mitral valve replacement and a pacemaker. No other significant medical history was reported. DS received early intervention services including speech-language pathology until three years of age. Her mother reported that she was delayed in her production of speech sounds and did not begin using single words until after three years of age. She continued to receive services for language and cognition whilst at school until age 21 but did not receive services for dysarthria. DS began attending an interactive day programme for adults with developmental disabilities after she left the public school system with the hope of developing skills to gain employment and increase social participation and independence. She was referred for speech-language pathology services to address these goals by improving speech understandability.
Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Heart murmurs in children can be innocent and may present with a concurrent febrile illness. These tend to be systolic in nature. If a child has a diastolic murmur or a murmur that does not settle with the febrile illness, an echocardiogram should be performed.
Clinical specialties
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A newborn is seen by the paediatric SHO for a routine baby check. On examination, a heart murmur is noted. Further investigation is undertaken, and the baby is found to have a congenital heart disease. What prenatal investigation can be used to detect congenital heart diseases? (1)In which direction is blood flowing in the heart in acyanotic congenital heart disease? (1)Give two causes of acyanotic congenital heart disease. (2)In which direction is blood flowing in the heart in cyanotic congenital heart disease? (1)Give two causes of cyanotic congenital heart disease. (2)In decompensated congenital heart disease, give two clinical features which may be seen. (2)What is Eisenmenger’s syndrome? (1)
Interrater and intrarater agreement on heart murmurs
Published in Scandinavian Journal of Primary Health Care, 2022
Stian Andersen, Anne H. Davidsen, Henrik Schirmer, Hasse Melbye, Mark Spigt, Juan Carlos Aviles-Solis
However, ultrasound and heart auscultation are not mutually exclusive. Clear benefits of detecting asymptomatic patients for timely intervention still suggest that efforts should be made to identify these individuals in primary care, where the stethoscope presently is much more available than ultrasound [7]. To defend heart auscultation as a cornerstone of clinical examination in the future, efforts are needed to provide better education and medical doctor proficiency regarding the identification and description of heart murmurs. There is also a point to be made about the development of smart stethoscopes which use deep learning algorithms to provide heart sound evaluation. If proven to perform on expert human level or better, it might render human assessment unnecessary, and over time replace the traditional stethoscope [27].
Digitalising medical education: sacrificing skills for knowledge?
Published in Medical Education Online, 2019
Cardiac auscultation is a subtle sensory skill that is often found difficult by many medical students. As such, using technological aids in teaching this topic have been trialled for many years. As early as 1991, Mangione et al. [2]. demonstrated that computer-assisted instruction with graphics and digitised heart sounds was just as effective as seminars at improving the identification of murmurs by students. These early studies, however, were focused on improving the understanding of cardiac auscultation in a classroom setting. The handheld echocardiogram (HHE) and digital stethoscope technique used by Leggett, on the other hand, enable students to engage with real patients whilst following a structured approach to understanding murmurs. The privilege of being able to auscultate a patient and then playback the murmur allows reinforcement of the knowledge gained from the experience. It takes a step away from the commonly heard and frustratingly vague notion that the ability to distinguish heart murmurs ‘comes with time’. Furthermore, the inability to standardise the sounds heard by teacher and student in traditional bedside teaching can cause a misinterpretation effect, where the student may alter their recollection of the sounds they heard on auscultation to fit the description of the teacher. This can lead to confusion and a lack of self-confidence in auscultation. Digital stethoscopes mitigate this effect.
Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: A Clinical Update
Published in Structural Heart, 2020
Simrat Kaur, Rabel Misbah Rameez, Wael Jaber, Brian P. Griffin, Bo Xu
Fever accompanied by other signs of systemic inflammatory response syndrome is common, immediately post TAVR and is typically transient.16 Unrelenting fever, congestive cardiac failure, persistently elevated biomarkers and positive blood cultures should raise the suspicion and prompt a thorough evaluation for IE. A suggested diagnostic pathway for suspected TAVR – IE is shown in Figure 2. Presence of heart murmurs may not be as valuable in the diagnosis of TAVR-IE contrary to native valve endocarditis (NVE), due to the frequent occurrence of mitral regurgitation in these patients.17 Since advanced age, multiple comorbidities and frailty are common in TAVR recipients, infections in these patients usually present in an atypical manner.