AdventHealth Gordon

This article explores the use of individual music psychotherapy for patients with psychosis who are frequently readmitted into hospital. It explores the extent to which music psychotherapy can support patients to stay out of hospital, thus reducing the costs of treatment. The high cost of inpatient stays is a major factor in shaping clinical services across both inpatient and outpatient zones of secondary care in the United Kingdom. Whether music therapy is seen as value for money may influence how it is provided and for how long. This article presents an empirical illustration of the frequency and duration of psychotic patients’ readmissions in England, and in London. An analysis of these data is provided in an attempt to ascribe meaning to these figures, through relevant literature and hypotheses. Finally, readmission rates are considered as a potential objective outcome measure of clinical effectiveness, by providing a comparison between patients treated with individual music psychotherapy and those receiving treatment as usual.

Due to the high-risk and technically demanding complexity of a partial nephrectomy, the adoption of nephron-sparing surgery in any modality has been gradual despite demonstrating benefits of nephron preservation. Laparoendoscopic single-site surgery (LESS) has been one surgical approach of interest that has demonstrated advantages with respect to reduction of narcotic requirements and hospital stay as well as cosmesis. Since the late 2000s, multiple studies have demonstrated feasibility and safety of LESS partial nephrectomy for both transperitoneal and retroperitoneal approaches for select tumors. Currently, we can perform LESS partial nephrectomy both by laparoscopic and robotic instruments. However, there are still challenges posed by lack of advanced, flexible instrumentation to avoid instrument clashing. With the advent and development of new technologies in minimally invasive surgery, we will surely be able to take full advantage of LESS surgery in the near future.

Phelps, Malcolm E. M.D.1; Hall, Mary B. M.D.2; Abramson, Lewis M.D.3; Endres, Gregory L. M.D.4; Voris, Frank B. M.D.5; Modern, Fred W. S. M.D.6; Adams, Mark E. M.D.7; McClure, Ross M.D.8; Briggs, George M.9; Hood, Maude Pye10; Crowder, Elaine11; Wilson, Margaret A. Ph.D.12; Constantine, M.13; Hadden, Ruth P.14; Barry, Marjorie H.15; Williams, Izola F.16; Loomis, Richard W. R.N.17; Harris, Beverly J. R.N.18; Goldsmith, Thomas D.D.S19; Stacey, Dorothy J.20; Zupko, Arthur G.21; Kreutter, Joan22 Author Information

<h3>Introduction</h3> Percutaenous vertebroplasty has a well-established role in the treatment of pathologic fractures in patients with multiple myeloma. Despite this, there is a scarcity of literature surrounding its use and efficacy in the sacrum. We present a case of successful symptom resolution in a patient with painful sacral fracture following sacroplasty. Case presentation An 81 year-man with multiple myeloma presented to the hematology/oncology clinic with a history of excruciating pain while seated. The impact of this pain on his quality of life subjectively was rated to be particularly high. Plain radiographs of the sacrum confirmed the presence of pathologic fracture within the body of S2, later characterized with computed tomography. Under fluoroscopic guidance, polymethyl methacrylate (PMMA) bone cement was injected via an 18 gage needle using a far-lateral approach. No immediate post-procedural complications occurred, such as foraminal extravasation and venous injection. The patient reported himself to be pain-free one day following the procedure and this remains the case to-date at two years of follow-up. <h3>Discussion</h3> Sacroplasty is technically feasible and can provide durable relief of symptoms in patients with both painful pathologic fractures of the sacrum. It is likely underused and can offer tremendous benefit to myeloma patients. Analgesia intolerance and functional obstacles to quality of life (e.g., sitting up) should be common clinical considerations. Important technical considerations include cement volume delivered and the potential for complications. <h3>Disclosures</h3> A. Dmytriw: None. R. Smith: None.