Dignity Health

Objectives: Half of childhood ischemic stroke (CIS) survivors experience long-term impairments but the economic cost of CIS is poorly characterized. This study examined the economic burden, and the associated quality-adjusted life years (QALYs) and life years (LYs) lost among a national cohort of Australian CIS patients. Methods: A Markov cohort model was developed to quantify per-capita, national healthcare and societal costs of CIS. Associated lifetime loss of QALYs and LYs were determined for Australian CIS patients aged 1 month to 18 years. The model comprised seven health states using the modified Rankin scale (mRS, scores 0-6), adapted from previous modelling in adults. Key inputs including post-stroke outcome (i.e. mRS<90 days) and length of acute hospital stay were sourced from eight Australian representative tertiary children's hospitals between 2015 – 2017. Additional costing data on indirect costs, family out-of-pocket expenses, and education and disability services were obtained from published literature and government statistics. Extensive sensitivity analyses and model validation were conducted to assess the robustness of the results. Results: Based on data from 176 CIS patients (average age 8 years at onset), estimated per-capita costs are A$111,807 in healthcare, A$131,048 in indirect costs, A$4,948 in family out-of-pocket expenses, A$479 in education system costs, and A$9,947 in National Disability Insurance Scheme costs. At the national level, the lifetime economic burden is approximately A$14.8 million from a healthcare perspective, and A$33.4 million from a societal perspective per year. Each CIS patient is associated with a loss of 33.64 QALYs and 37.82 LYs, compared to their counterparts without CIS (Table 1). Conclusions: This study provides the first comprehensive assessment of the economic burden of CIS in Australia, demonstrating the substantial impact of CIS on healthcare resources and quality of life. These findings highlight the need for better access to reperfusion therapies which minimize extent of brain injury and targeted rehabilitation strategies. These results may inform resource allocation and policy formulation to optimize care for childhood stroke survivors.

Despite decades of progress in tobacco control, exposure to secondhand smoke (SHS) remains a persistent public health issue. Low-income communities and communities of color continue to experience high smoking rates and limited protection from smoke-free policies, contributing to disproportionate rates of disease. Guided by the Health Equity Framework, this study examined SHS exposure and support for smoke-free housing among households with vulnerable members, such as young children, older adults, and individuals with chronic conditions. Youth were trained in data collection methods and administered door-to-door surveys (n = 309) at multi-unit housing (MUH) to assess tenants' SHS exposure, attitudes toward smoke-free housing, and household vulnerability. Findings revealed that 36.6% of respondents experienced smoke drifting into their homes, yet few complained to building management or to the smoker. Households with vulnerable members were significantly more likely to prevent smoke from entering individual units (p = .007) and support comprehensive smoke-free MUH policies (p = .031). The study also found a statistically significant relationship between SHS exposure and support of eviction for repeat violators. These findings underscore the need for and potential impact of smoke-free MUH policies in historically marginalized communities. They also highlight the value of youth-led research in building capacity to engage in tobacco control advocacy. Future research should explore systemic barriers to implementing and enforcing smoke-free housing policies, and advocate for their integration into broader housing equity efforts.

Abstract Wooden chest syndrome is a rare, potentially fatal complication of high-dose fentanyl therapy, characterized by generalized muscle rigidity, reduced chest wall compliance, and acute respiratory distress. Frequently underdiagnosed in the intensive care unit (ICU). In this case report, we present a case of WCS in a patient with worsening respiratory distress in a 48-year-old female with history of asthma who presented for evaluation of shortness of breath, chills, myalgias, productive cough of yellow sputum. In ED Received albuterol, steroids and abx, placed on bipap and subsequently admitted to ICU. The patient was on continuous bipap for 16 hours without improvements on ABG, and the patient was subsequently intubated. The patient had difficult ventilation management. Started on bronchodilators, systemic steroids, azithromycin, lung protective ventilator strategy with permissive hypercapnia. Day 2; Patient became desynchronous with the vent. The patient started on a paralytic agent. The patient was also on ketamine, propofol and fentanyl infusions for sedation. Day 5; Bronchoscopy was done and showed a narrowed right mainstem bronchus with degree of bronchomalacia. Day 7; PEAK and Plateau pressures were high! Day 8; Fentanyl stopped and plateau pressure improved in 12-24 hours. Patient improved dramatically and she was extubated to nasal canula. What is Fentanyl rigid chest?It is a rare but serious medical emergency caused by fentanyl that results in extreme rigidity of the chest and abdominal muscles, severely impairing breathing. This syndrome is characterized by high-pressure ventilation, respiratory acidosis, and the sudden onset of respiratory failure. WCS remains an underrecognized complication of fentanyl therapy in the ICU, as illustrated by this case of a 48-year-old female who developed profound muscle rigidity and worsening respiratory failure after a few days from initiating a fentanyl infusion. Fentanyl is widely used for analgesia in ICU and we need to pay close attention to its complication. This rare entity, characterized by decreased chest wall compliance and acute ventilatory failure, poses a silent threat to critically ill patients. Our patient’s deterioration and lack of improvement after using all treatment modalities for asthma exacerbation by worsening Peak and Plateau pressures on PCV mode and respiratory acidosis; was quickly and nicely reversed through prompt discontinuation of fentanyl, successful extubation the very next day. The case highlights the need for heightened vigilance during opioid administration, especially with continuous infusions exceeding 8 hours. This abstract is funded by: None

Background: Dancers are uniquely susceptible to musculoskeletal injuries due to the repetitive, high-impact, and technical demands of their art form. When conservative measures are insufficient or expedited recovery is needed, injection therapy may be considered as part of a comprehensive treatment plan. Purpose: This narrative review provides a high-level overview of musculoskeletal injections relevant to dancers. As many dancers receive education and initial guidance from non-physician professionals, this review is designed to support these providers by summarizing common injection options, the conditions for which they are most appropriate, and dancer-specific considerations. Methods: A comprehensive literature search of PubMed, MEDLINE, and Google Scholar was conducted through March 2025. Peer-reviewed studies, systematic reviews, and case reports were analyzed qualitatively. Injections in this review are organized by clinical indication rather than preference, reflecting how decisions are made in practice. Selecting an injection requires consideration of multiple contextual factors, including the dancer's diagnosis, performance schedule, symptom chronicity, therapeutic goals, and comorbid medical issues. Results: Five main categories of injections were identified: (1) fluid aspiration, (2) corticosteroid injections, (3) regenerative medicine, (4) peripheral nerve hydrodissections, and (5) spine injections. Image guidance with ultrasound and/or fluoroscopy enhances accuracy and safety across injection types. Corticosteroid injections offer potent anti-inflammatory effects and rapid symptom relief. Regenerative medicine injections (hyaluronic acid, prolotherapy, platelet-rich plasma [PRP], and mesenchymal stromal cell-based therapies), aim to enhance tissue healing and may be beneficial for chronic tendinopathies and mild to moderate osteoarthritis. Peripheral nerve hydrodissection provides a minimally invasive approach for nerve entrapment syndromes, and spinal injections may be indicated for persistent axial or radicular pain. Post-injection care and return-to-dance protocols should be individualized based on the injectate, anatomical target, and performance goals. Conclusion: Musculoskeletal injections can be a valuable tool in a dancer's treatment plan alongside multidisciplinary care for successful return to dance.