Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identifi ed signifi cant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
This study surveyed 46 hemodialysis patients about arrhythmia symptoms and willingness to use an implantable cardiac monitor. The key findings were:
1) Arrhythmia symptoms were common, with 74% reporting at least one symptom such as heart palpitations or feeling like passing out.
2) Acceptability of the implantable cardiac monitor was high, with 59% of symptomatic patients and 50% of asymptomatic patients willing to consider it.
3) The main reason patients gave for not wanting the monitor was simply not wanting an implanted device, not concerns about the procedure or complications.
Transradial PCI is increasing in the US as it provides value by reducing costs through lower bleeding rates and shorter length of stays. The author's hospital implemented several strategies to increase value, including increased use of transradial PCI, a same-day discharge program, and a patient-centered approach focusing on individualized risk assessment. These strategies led to lower costs, improved outcomes, and increased patient satisfaction while maintaining the ability to treat high-risk patients. The hospital estimates annual savings of over $3 million from these strategies along with improved revenue from quality programs.
Transradial access for femoral artery intervention was evaluated in a pilot study of 98 patients. The study found:
1. Femoral artery angioplasty can be safely performed via transradial access using sheathless guiding catheters, with a technical success rate of 94.9% and major access site complication rate of 3.1%.
2. While complication rates were promising, larger studies are still needed to determine long-term success rates of this transradial approach to femoral interventions.
3. Selecting the left radial access provided advantages like easier access to the descending aorta and use of shorter delivery systems, though the right radial access was used in most cases (77.6
This study compared central venous catheters (CVCs) and peripherally inserted central venous catheters (PICCs) in 149 patients who required central venous access. The patients were either randomized to receive a CVC or PICC, or were evaluated based on the total number who received each type of catheter. The study found no significant differences between CVCs and PICCs in terms of complications, function, or risk of treatment interruptions. While CVC patients received antibiotics more frequently, both catheter types were used for similar durations and had comparable complication rates. The study concluded that among patients with serious gastrointestinal disorders, CVCs and PICCs did not differ in safety or function for providing central venous access.
Chronic Kidney Injury in Patients after Cardiac Catheterization or Percutaneous Coronary Intervention. A Comparison of Radial and Femoral Approaches (from the British Columbia Cardiac and Renal Registries).
This document describes a study that compared outcomes of intravascular ultrasound (IVUS)-guided drug-eluting stent implantation versus angiography-guided implantation in all patients (all-comers) undergoing percutaneous coronary intervention. The study found that IVUS guidance resulted in a significantly lower rate of the primary endpoint, target vessel failure, at 12-month follow-up compared to angiography guidance. Patients who had an IVUS-defined optimal procedure also had lower rates of the primary endpoint than those with a suboptimal procedure.
Our Experience with Pre-Operative Haemostatic Assessment of Paediatric Patien...Dr Gav Terna
: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, preoperative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. But because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in Paediatric patients undergoing adenoidectomy, tonsillectomy or both in our Centre
This study surveyed 46 hemodialysis patients about arrhythmia symptoms and willingness to use an implantable cardiac monitor. The key findings were:
1) Arrhythmia symptoms were common, with 74% reporting at least one symptom such as heart palpitations or feeling like passing out.
2) Acceptability of the implantable cardiac monitor was high, with 59% of symptomatic patients and 50% of asymptomatic patients willing to consider it.
3) The main reason patients gave for not wanting the monitor was simply not wanting an implanted device, not concerns about the procedure or complications.
Transradial PCI is increasing in the US as it provides value by reducing costs through lower bleeding rates and shorter length of stays. The author's hospital implemented several strategies to increase value, including increased use of transradial PCI, a same-day discharge program, and a patient-centered approach focusing on individualized risk assessment. These strategies led to lower costs, improved outcomes, and increased patient satisfaction while maintaining the ability to treat high-risk patients. The hospital estimates annual savings of over $3 million from these strategies along with improved revenue from quality programs.
Transradial access for femoral artery intervention was evaluated in a pilot study of 98 patients. The study found:
1. Femoral artery angioplasty can be safely performed via transradial access using sheathless guiding catheters, with a technical success rate of 94.9% and major access site complication rate of 3.1%.
2. While complication rates were promising, larger studies are still needed to determine long-term success rates of this transradial approach to femoral interventions.
3. Selecting the left radial access provided advantages like easier access to the descending aorta and use of shorter delivery systems, though the right radial access was used in most cases (77.6
This study compared central venous catheters (CVCs) and peripherally inserted central venous catheters (PICCs) in 149 patients who required central venous access. The patients were either randomized to receive a CVC or PICC, or were evaluated based on the total number who received each type of catheter. The study found no significant differences between CVCs and PICCs in terms of complications, function, or risk of treatment interruptions. While CVC patients received antibiotics more frequently, both catheter types were used for similar durations and had comparable complication rates. The study concluded that among patients with serious gastrointestinal disorders, CVCs and PICCs did not differ in safety or function for providing central venous access.
Chronic Kidney Injury in Patients after Cardiac Catheterization or Percutaneous Coronary Intervention. A Comparison of Radial and Femoral Approaches (from the British Columbia Cardiac and Renal Registries).
This document describes a study that compared outcomes of intravascular ultrasound (IVUS)-guided drug-eluting stent implantation versus angiography-guided implantation in all patients (all-comers) undergoing percutaneous coronary intervention. The study found that IVUS guidance resulted in a significantly lower rate of the primary endpoint, target vessel failure, at 12-month follow-up compared to angiography guidance. Patients who had an IVUS-defined optimal procedure also had lower rates of the primary endpoint than those with a suboptimal procedure.
Our Experience with Pre-Operative Haemostatic Assessment of Paediatric Patien...Dr Gav Terna
: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, preoperative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. But because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in Paediatric patients undergoing adenoidectomy, tonsillectomy or both in our Centre
The document discusses major late bleeding complications (MLBCs) occurring between 30 days and 1 year after transcatheter aortic valve replacement (TAVR) based on results from the PARTNER trial. It was found that MLBCs occurred in around 6% of patients and were associated with increased mortality. Experts discussed that while MLBCs were frequent in PARTNER, TAVR remains a viable option for inoperable or high-risk patients. With improvements to antithrombotic therapy and device technology, the risk of MLBCs can be reduced, allowing TAVR to be more widely used in clinical practice for treating severe aortic stenosis.
This document summarizes a retrospective cohort study that analyzed data from the COREA-AMI registry to compare long-term clinical outcomes of IVUS-guided PCI versus angiography-guided PCI in patients with acute myocardial infarction (AMI). The study found that IVUS-guided PCI was associated with reduced risks of major adverse cardiovascular events, cardiovascular death, myocardial infarction, and target lesion revascularization compared to angiography-guided PCI. However, the study was limited by its retrospective design and selection bias in how IVUS was used. Randomized controlled trials are still needed to provide stronger evidence on whether IVUS guidance specifically improves outcomes for AMI patients.
This document discusses vascular access complications from central venous catheterization and arterial catheterization in emergency medicine settings. It summarizes that approximately 8% of emergency department patients require invasive vascular access procedures. Central lines are commonly used for resuscitation, medications, dialysis, and monitoring but can cause infections, thrombosis, embolism, and injury. Infectious complications like central line-associated bloodstream infections occur in 0.5-1.2% of central line patients and increase costs and hospital stays. Proper technique and guidelines have reduced infection rates. Thrombotic complications also occur and increase risks of infection, embolism, and complications.
Patients prescribed novel oral anticoagulants (NOACs) in University Hospital Limerick were generally elderly with moderate risk of stroke and bleeding. Adherence to NOAC dosing guidelines was 68.2% and adherence to prescribing restrictions was 58.3%. Risk assessment scores were rarely documented and clinical decision making was not well documented. The study found significant non-compliance with NOAC dosing guidelines and prescribing restrictions, highlighting the need for improved risk assessment, documentation and guideline adherence when prescribing NOACs.
Retrospective Analysis of Intra Operative Blood Loss in Pelvic Oncological Su...Premier Publishers
To study intraoperative blood loss and analyse average blood loss and number of transfusions in patients who underwent pelvic oncological surgeries in this oncology centre in South India from January 2012 – December 2018. A retrospective analysis of medical records of 257 patients who had undergone pelvic oncological surgeries in our institute from January 2012 and December 2018 was done and information regarding blood loss and transfusions was analysed with student’s T test. Out of 257 patients, 72 underwent pelvic exenteration of which 18 were operated for primary and 54 were operated for recurrences, 105 underwent Wertheim’s hysterectomy, 19 patients underwent APR, 8 underwent LAR, 5 underwent AR, 36 underwent surgical staging 8 underwent Cystectomy and 4 underwent sacrectomy. In our analysis we found that laparoscopic surgeries had less blood loss (average 354 ml) compared to open surgeries (average 811 ml) and upfront surgeries (531 ml) had less blood loss compared to surgeries done post chemoradiotherapy (668 ml) resulting in less number of transfusions, transfusion reactions, infections and early recovery in laparoscopic and upfront surgeries. Laparoscopic surgery in pelvic oncological surgeries has become a benefit to surgeons because of less intraoperative blood loss, reduced hospital stay and better outcomes. Though laparoscopic surgeries require a learning curve, extensive anatomical knowledge about the procedure during open surgeries made learning curve less steep. Blood loss in upfront cases is less than that of post chemoradiotherapy cases leading to less infection rates, better recovery and with increase in duration of surgery, blood loss is more.
The document discusses chronic kidney disease (CKD) and different machine learning algorithms that can be used to predict CKD. It first provides background on CKD, defining it as long-term damage to the kidneys that can progressively get worse over time. The document then reviews literature on predicting CKD and discusses methodologies like Naive Bayes, Decision Trees, K-Nearest Neighbors, and Support Vector Machines. It finds that the K-Nearest Neighbor algorithm produced the best results, with 98% accuracy in predicting CKD stages when applied to a dataset.
This document summarizes a randomized controlled trial that compared the effectiveness of talc pleurodesis administered through an indwelling pleural catheter versus placebo among patients with malignant pleural effusions. The trial recruited 154 patients across 18 UK centers who underwent catheter insertion and were randomly assigned to receive either talc or placebo through the catheter. The primary outcome was successful pleurodesis at day 35, defined as less than 50ml of fluid drained on 3 consecutive occasions and less than 25% chest radiograph opacification. At day 35, successful pleurodesis was achieved in 43% of the talc group versus 23% of the placebo group, demonstrating talc administered through a catheter was more effective at inducing pleuro
This document discusses guidelines for a clinical practice guideline on perioperative care. It summarizes discussions between guideline writing committees on how to address controversies surrounding certain clinical trials. Specifically, it was agreed that the controversial DECREASE trials led by Poldermans would be excluded from systematic reviews and recommendations. Nonretracted publications from these trials could be cited but not used as the basis for recommendations. The committees aimed to balance transparency with the availability of new evidence in developing their guidelines.
1) The AURA OF ARTEMIS study was a randomized trial comparing transulnar versus transradial arterial access as the default strategy for coronary procedures.
2) In the interim analysis, the composite primary endpoint was significantly higher in the ulnar arm compared to the radial arm, with a 24.3% difference between arms. The study was terminated early due to the inferiority of the transulnar approach.
3) Complications associated with the transulnar approach included pseudoaneurysms, perforations, occlusions and arteriovenous fistulas. Crossover from ulnar to other access sites was also more common.
This study analyzed trends in complications from 2000-2012 using a nationwide database of inpatient therapeutic ERCP procedures in the US. The study found:
1) Mortality rates decreased from 1.77% to 1.24%, and time series analysis confirmed this downward trend.
2) Perforation rates increased from 0.07% to 0.10% but time series analysis found no significant trend.
3) GI hemorrhage rates increased from 1.36% to 1.57% and time series analysis confirmed an upward trend.
The study concluded that while therapeutic ERCPs have become safer as shown by decreasing mortality rates, GI hemorrhage rates increased over the same period according to their analysis of
This document summarizes the results of a journal club presentation on using stellate ganglion block (SGB) to treat electrical storm. The following key points were discussed:
1. SGB significantly reduced the number of ventricular arrhythmia episodes and defibrillator shocks per day compared to before SGB.
2. The efficacy of SGB in reducing arrhythmias was independent of left ventricular function, presence or type of cardiomyopathy, and subtype of ventricular arrhythmia.
3. While SGB shows promise as an effective treatment for electrical storm, larger prospective randomized studies are still needed due to limitations of current retrospective studies.
This study evaluated the predictive value of red cell distribution width (RDW) on the development of anastomotic leak or readmission within 30 days following colectomy. The study reviewed 118 patients who underwent colectomy and found that an elevated RDW (greater than or equal to 14.0) had a sensitivity of 89.8% for predicting readmission or leak. A normal RDW below 14.0 had a negative predictive value of 87.7% for predicting an uncomplicated postoperative course without readmission or leak. The RDW test was found to be a readily available and effective criterion for predicting readmissions and leaks following colectomy.
- The LEADERS FREE trial compared outcomes of patients at high risk of bleeding who received either a polymer-free drug-coated stent releasing umirolimus (BioFreedom stent) or a bare-metal stent, both with 1 month of dual antiplatelet therapy.
- Use of the drug-coated stent was associated with lower rates of the primary safety composite of cardiac death, MI, or stent thrombosis and the primary efficacy endpoint of clinically-driven TLR compared to the bare-metal stent.
- The drug-coated stent showed benefit over the bare-metal stent in reducing rates of MI, likely driven by lower rates of in-stent restenosis, without increasing the risk of bleeding which
1. This document discusses erectile dysfunction following radical prostatectomy. It addresses factors such as who is a candidate for nerve-sparing surgery, why rates of post-surgery erectile dysfunction vary, and how erectile function should be defined.
2. The document focuses on rehabilitation protocols to preserve erectile function after surgery. It examines questions such as where and when rehabilitation should be used, what protocols should be considered, and when rehabilitation efforts should be stopped.
3. The overall goal of the document is to provide guidance to doctors on discussing risks and managing expectations regarding erectile function with patients undergoing prostatectomy surgery.
This document describes a study that evaluated using a single injection of diluted sodium bicarbonate while monitoring exhaled carbon dioxide levels to confirm correct placement of intravenous catheters before chemotherapy. The study involved injecting either sodium bicarbonate or saline through catheters in 67 oncology patients and monitoring exhaled CO2 levels. A rise in exhaled CO2 levels confirmed correct placement, identifying all 56 catheters deemed positively placed and 10 of 11 deemed questionable. This simple test could help prevent chemotherapy extravasation injuries by verifying catheter placement before treatment.
This study evaluated long-term outcomes of 1292 ICU patients with acute kidney injury treated with renal replacement therapy (AKI-RRT) over an 8-year period. Mortality increased from 59.7% at hospital discharge to 72.1% at 3 years. Complete renal recovery occurred in 48.4% of hospital survivors at 1 year, while 19% required long-term dialysis. The composite endpoint of major adverse kidney events (MAKE), defined as death, incomplete renal recovery, or end-stage renal disease, increased from 83.1% at discharge to 93.7% at 3 years. Severity of illness, continuous RRT, older age, and comorbidities like diabetes and chronic kidney disease
This document summarizes a presentation on using non-invasive FFRCT (computed tomography-derived fractional flow reserve) to assess coronary artery disease. It discusses studies showing FFRCT has high diagnostic accuracy compared to invasive FFR measurements. The PLATFORM trial found FFRCT was associated with fewer unnecessary invasive angiograms showing no obstructive lesions compared to usual care. FFRCT also led to lower healthcare costs without differences in clinical outcomes. A larger randomized trial is still needed to establish FFRCT's role in routine clinical care.
This document summarizes a study on vascular access surveillance techniques to reduce thrombosis rates among hemodialysis patients. It introduces different monitoring and surveillance tools like access flows, pressures, and physical exams. It then focuses on intra-access pressures (IAP), specifically venous access pressures (VAP) and mean VAP ratios. The study was conducted at a single dialysis center over 2 years, comparing thrombosis rates before and after implementing an automated surveillance algorithm based on VAP ratios. Results showed reduced thrombosis rates with active surveillance generating alerts to refer patients for further evaluation and treatment of detected stenoses. The conclusion is that access surveillance can reduce thrombosis by detecting pressure ratio changes to allow for more elective interventions on patent grafts/
Efek varicocelectomy tentang aliran arteri antara laaproskopik dengan mikroandilania
This study investigated the effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal varicocelectomy (MV) on testicular blood flow and semen quality. Color Doppler Flow Imaging was used to measure blood flow parameters in the testicular arteries before and after surgery. Both LV and MV significantly improved testicular blood flow and semen parameters. However, MV resulted in greater improvements in testicular blood flow earlier after surgery compared to LV. The study concludes that varicocelectomy improves testicular function by enhancing blood supply and microperfusion to the testes.
Duke OHNS Lumbar Drain AN Poster 44x44 vfinalMatthew Crowson
- The study examines whether the pre-operative use of a lumbar drain reduces post-operative cerebrospinal fluid leaks in patients undergoing acoustic neuroma resection.
- 282 patients were included in the study, with 220 receiving a pre-operative lumbar drain and 62 not receiving one. No significant difference was found in CSF leak rates between the two groups.
- While CSF leaks are a common complication, the routine use of pre-operative lumbar drains is not recommended due to the 5.3% complication rate associated with lumbar drain use and no evidence that it decreases CSF leak rates.
Evaluation of Obstructive Uropathy with Computed Tomography Urography and Mag...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses major late bleeding complications (MLBCs) occurring between 30 days and 1 year after transcatheter aortic valve replacement (TAVR) based on results from the PARTNER trial. It was found that MLBCs occurred in around 6% of patients and were associated with increased mortality. Experts discussed that while MLBCs were frequent in PARTNER, TAVR remains a viable option for inoperable or high-risk patients. With improvements to antithrombotic therapy and device technology, the risk of MLBCs can be reduced, allowing TAVR to be more widely used in clinical practice for treating severe aortic stenosis.
This document summarizes a retrospective cohort study that analyzed data from the COREA-AMI registry to compare long-term clinical outcomes of IVUS-guided PCI versus angiography-guided PCI in patients with acute myocardial infarction (AMI). The study found that IVUS-guided PCI was associated with reduced risks of major adverse cardiovascular events, cardiovascular death, myocardial infarction, and target lesion revascularization compared to angiography-guided PCI. However, the study was limited by its retrospective design and selection bias in how IVUS was used. Randomized controlled trials are still needed to provide stronger evidence on whether IVUS guidance specifically improves outcomes for AMI patients.
This document discusses vascular access complications from central venous catheterization and arterial catheterization in emergency medicine settings. It summarizes that approximately 8% of emergency department patients require invasive vascular access procedures. Central lines are commonly used for resuscitation, medications, dialysis, and monitoring but can cause infections, thrombosis, embolism, and injury. Infectious complications like central line-associated bloodstream infections occur in 0.5-1.2% of central line patients and increase costs and hospital stays. Proper technique and guidelines have reduced infection rates. Thrombotic complications also occur and increase risks of infection, embolism, and complications.
Patients prescribed novel oral anticoagulants (NOACs) in University Hospital Limerick were generally elderly with moderate risk of stroke and bleeding. Adherence to NOAC dosing guidelines was 68.2% and adherence to prescribing restrictions was 58.3%. Risk assessment scores were rarely documented and clinical decision making was not well documented. The study found significant non-compliance with NOAC dosing guidelines and prescribing restrictions, highlighting the need for improved risk assessment, documentation and guideline adherence when prescribing NOACs.
Retrospective Analysis of Intra Operative Blood Loss in Pelvic Oncological Su...Premier Publishers
To study intraoperative blood loss and analyse average blood loss and number of transfusions in patients who underwent pelvic oncological surgeries in this oncology centre in South India from January 2012 – December 2018. A retrospective analysis of medical records of 257 patients who had undergone pelvic oncological surgeries in our institute from January 2012 and December 2018 was done and information regarding blood loss and transfusions was analysed with student’s T test. Out of 257 patients, 72 underwent pelvic exenteration of which 18 were operated for primary and 54 were operated for recurrences, 105 underwent Wertheim’s hysterectomy, 19 patients underwent APR, 8 underwent LAR, 5 underwent AR, 36 underwent surgical staging 8 underwent Cystectomy and 4 underwent sacrectomy. In our analysis we found that laparoscopic surgeries had less blood loss (average 354 ml) compared to open surgeries (average 811 ml) and upfront surgeries (531 ml) had less blood loss compared to surgeries done post chemoradiotherapy (668 ml) resulting in less number of transfusions, transfusion reactions, infections and early recovery in laparoscopic and upfront surgeries. Laparoscopic surgery in pelvic oncological surgeries has become a benefit to surgeons because of less intraoperative blood loss, reduced hospital stay and better outcomes. Though laparoscopic surgeries require a learning curve, extensive anatomical knowledge about the procedure during open surgeries made learning curve less steep. Blood loss in upfront cases is less than that of post chemoradiotherapy cases leading to less infection rates, better recovery and with increase in duration of surgery, blood loss is more.
The document discusses chronic kidney disease (CKD) and different machine learning algorithms that can be used to predict CKD. It first provides background on CKD, defining it as long-term damage to the kidneys that can progressively get worse over time. The document then reviews literature on predicting CKD and discusses methodologies like Naive Bayes, Decision Trees, K-Nearest Neighbors, and Support Vector Machines. It finds that the K-Nearest Neighbor algorithm produced the best results, with 98% accuracy in predicting CKD stages when applied to a dataset.
This document summarizes a randomized controlled trial that compared the effectiveness of talc pleurodesis administered through an indwelling pleural catheter versus placebo among patients with malignant pleural effusions. The trial recruited 154 patients across 18 UK centers who underwent catheter insertion and were randomly assigned to receive either talc or placebo through the catheter. The primary outcome was successful pleurodesis at day 35, defined as less than 50ml of fluid drained on 3 consecutive occasions and less than 25% chest radiograph opacification. At day 35, successful pleurodesis was achieved in 43% of the talc group versus 23% of the placebo group, demonstrating talc administered through a catheter was more effective at inducing pleuro
This document discusses guidelines for a clinical practice guideline on perioperative care. It summarizes discussions between guideline writing committees on how to address controversies surrounding certain clinical trials. Specifically, it was agreed that the controversial DECREASE trials led by Poldermans would be excluded from systematic reviews and recommendations. Nonretracted publications from these trials could be cited but not used as the basis for recommendations. The committees aimed to balance transparency with the availability of new evidence in developing their guidelines.
1) The AURA OF ARTEMIS study was a randomized trial comparing transulnar versus transradial arterial access as the default strategy for coronary procedures.
2) In the interim analysis, the composite primary endpoint was significantly higher in the ulnar arm compared to the radial arm, with a 24.3% difference between arms. The study was terminated early due to the inferiority of the transulnar approach.
3) Complications associated with the transulnar approach included pseudoaneurysms, perforations, occlusions and arteriovenous fistulas. Crossover from ulnar to other access sites was also more common.
This study analyzed trends in complications from 2000-2012 using a nationwide database of inpatient therapeutic ERCP procedures in the US. The study found:
1) Mortality rates decreased from 1.77% to 1.24%, and time series analysis confirmed this downward trend.
2) Perforation rates increased from 0.07% to 0.10% but time series analysis found no significant trend.
3) GI hemorrhage rates increased from 1.36% to 1.57% and time series analysis confirmed an upward trend.
The study concluded that while therapeutic ERCPs have become safer as shown by decreasing mortality rates, GI hemorrhage rates increased over the same period according to their analysis of
This document summarizes the results of a journal club presentation on using stellate ganglion block (SGB) to treat electrical storm. The following key points were discussed:
1. SGB significantly reduced the number of ventricular arrhythmia episodes and defibrillator shocks per day compared to before SGB.
2. The efficacy of SGB in reducing arrhythmias was independent of left ventricular function, presence or type of cardiomyopathy, and subtype of ventricular arrhythmia.
3. While SGB shows promise as an effective treatment for electrical storm, larger prospective randomized studies are still needed due to limitations of current retrospective studies.
This study evaluated the predictive value of red cell distribution width (RDW) on the development of anastomotic leak or readmission within 30 days following colectomy. The study reviewed 118 patients who underwent colectomy and found that an elevated RDW (greater than or equal to 14.0) had a sensitivity of 89.8% for predicting readmission or leak. A normal RDW below 14.0 had a negative predictive value of 87.7% for predicting an uncomplicated postoperative course without readmission or leak. The RDW test was found to be a readily available and effective criterion for predicting readmissions and leaks following colectomy.
- The LEADERS FREE trial compared outcomes of patients at high risk of bleeding who received either a polymer-free drug-coated stent releasing umirolimus (BioFreedom stent) or a bare-metal stent, both with 1 month of dual antiplatelet therapy.
- Use of the drug-coated stent was associated with lower rates of the primary safety composite of cardiac death, MI, or stent thrombosis and the primary efficacy endpoint of clinically-driven TLR compared to the bare-metal stent.
- The drug-coated stent showed benefit over the bare-metal stent in reducing rates of MI, likely driven by lower rates of in-stent restenosis, without increasing the risk of bleeding which
1. This document discusses erectile dysfunction following radical prostatectomy. It addresses factors such as who is a candidate for nerve-sparing surgery, why rates of post-surgery erectile dysfunction vary, and how erectile function should be defined.
2. The document focuses on rehabilitation protocols to preserve erectile function after surgery. It examines questions such as where and when rehabilitation should be used, what protocols should be considered, and when rehabilitation efforts should be stopped.
3. The overall goal of the document is to provide guidance to doctors on discussing risks and managing expectations regarding erectile function with patients undergoing prostatectomy surgery.
This document describes a study that evaluated using a single injection of diluted sodium bicarbonate while monitoring exhaled carbon dioxide levels to confirm correct placement of intravenous catheters before chemotherapy. The study involved injecting either sodium bicarbonate or saline through catheters in 67 oncology patients and monitoring exhaled CO2 levels. A rise in exhaled CO2 levels confirmed correct placement, identifying all 56 catheters deemed positively placed and 10 of 11 deemed questionable. This simple test could help prevent chemotherapy extravasation injuries by verifying catheter placement before treatment.
This study evaluated long-term outcomes of 1292 ICU patients with acute kidney injury treated with renal replacement therapy (AKI-RRT) over an 8-year period. Mortality increased from 59.7% at hospital discharge to 72.1% at 3 years. Complete renal recovery occurred in 48.4% of hospital survivors at 1 year, while 19% required long-term dialysis. The composite endpoint of major adverse kidney events (MAKE), defined as death, incomplete renal recovery, or end-stage renal disease, increased from 83.1% at discharge to 93.7% at 3 years. Severity of illness, continuous RRT, older age, and comorbidities like diabetes and chronic kidney disease
This document summarizes a presentation on using non-invasive FFRCT (computed tomography-derived fractional flow reserve) to assess coronary artery disease. It discusses studies showing FFRCT has high diagnostic accuracy compared to invasive FFR measurements. The PLATFORM trial found FFRCT was associated with fewer unnecessary invasive angiograms showing no obstructive lesions compared to usual care. FFRCT also led to lower healthcare costs without differences in clinical outcomes. A larger randomized trial is still needed to establish FFRCT's role in routine clinical care.
This document summarizes a study on vascular access surveillance techniques to reduce thrombosis rates among hemodialysis patients. It introduces different monitoring and surveillance tools like access flows, pressures, and physical exams. It then focuses on intra-access pressures (IAP), specifically venous access pressures (VAP) and mean VAP ratios. The study was conducted at a single dialysis center over 2 years, comparing thrombosis rates before and after implementing an automated surveillance algorithm based on VAP ratios. Results showed reduced thrombosis rates with active surveillance generating alerts to refer patients for further evaluation and treatment of detected stenoses. The conclusion is that access surveillance can reduce thrombosis by detecting pressure ratio changes to allow for more elective interventions on patent grafts/
Efek varicocelectomy tentang aliran arteri antara laaproskopik dengan mikroandilania
This study investigated the effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal varicocelectomy (MV) on testicular blood flow and semen quality. Color Doppler Flow Imaging was used to measure blood flow parameters in the testicular arteries before and after surgery. Both LV and MV significantly improved testicular blood flow and semen parameters. However, MV resulted in greater improvements in testicular blood flow earlier after surgery compared to LV. The study concludes that varicocelectomy improves testicular function by enhancing blood supply and microperfusion to the testes.
Duke OHNS Lumbar Drain AN Poster 44x44 vfinalMatthew Crowson
- The study examines whether the pre-operative use of a lumbar drain reduces post-operative cerebrospinal fluid leaks in patients undergoing acoustic neuroma resection.
- 282 patients were included in the study, with 220 receiving a pre-operative lumbar drain and 62 not receiving one. No significant difference was found in CSF leak rates between the two groups.
- While CSF leaks are a common complication, the routine use of pre-operative lumbar drains is not recommended due to the 5.3% complication rate associated with lumbar drain use and no evidence that it decreases CSF leak rates.
Evaluation of Obstructive Uropathy with Computed Tomography Urography and Mag...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Transrectal ultrasound guided prostate biopsies in patients taking aspirin fo...anemo_site
This study analyzed whether continued aspirin use increases the risk of bleeding complications from transrectal ultrasound-guided prostate biopsies. A meta-analysis was conducted of 3218 patients from published studies and the authors' own series. The results showed a small increased risk of minor hematuria in aspirin users, but no increased risk of moderate or severe hematuria. Rectal bleeding and hematospermia risks were also not significantly increased. The study concludes that continuing aspirin use does not increase overall bleeding risks from prostate biopsies and stopping aspirin before the procedure is unnecessary.
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation due to concerns over failure rates particularly if the diameter is small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this study was to review the outcomes of intraoperative Plain Balloon Angioplasty (PBA) in patients with small cephalic veins during AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
This study investigated the impact of age on the patency of arteriovenous fistulas (AVFs) used for hemodialysis in 442 patients over 7 years. Patients were divided into two groups: those under 40 years old (Group I, n=201) and those over 40 (Group II, n=241). Primary patency rates, defined as the time until any intervention to maintain or reestablish patency or until thrombosis, were found to be lower in patients over 40. The study concludes that more care should be taken when creating AVFs and increased follow-up is needed for older patients, as primary patency rates decrease with age over 40.
This study was conducted to evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones larger than 2 cm and to compare its results with percutaneous nephrolithotomy (PCNL).
This survey aimed to assess clinicians' use of stereotactic radiotherapy and targeted therapies for metastatic renal cell carcinoma and determine support for future clinical trials. The primary objective was to evaluate the proportion of clinicians using radiotherapy for metastatic renal cell carcinoma. Secondary objectives included evaluating the proportion using targeted therapies and radiotherapy simultaneously, stopping targeted therapies for radiotherapy, and supporting further research. The online survey was distributed to members of urology and oncology groups in Australia and New Zealand to collect data on current practices. Results and conclusions will be presented at an upcoming conference.
This study retrospectively analyzed 69 patients who underwent total thyroidectomy with lymph node dissection for papillary thyroid cancer with clinical nodal metastases. The rate of locoregional recurrence with positive cervical lymph nodes after an average 8-year follow-up was 34.7%, which was higher than the 4.2% recurrence rate reported in patients without nodal metastases. Nodal metastases were found to be a predictor of local recurrence. Male gender and age under 50 were associated with higher risk of nodal recurrence. The study concludes that nodal metastases increase the likelihood of local recurrence after surgery for papillary thyroid cancer.
Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these patients, including surveillance follow-up.Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defi ned based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological parameters) were analysed.
This document reviews the use of focused assessment with sonography for trauma (FAST) techniques in veterinary emergency and critical care settings. It discusses how the FAST technique, originally developed for humans to rapidly screen for free fluid in body cavities from blunt or penetrating trauma, has been adapted for veterinary use. For veterinary applications, the 'T' in FAST can represent trauma, triage, and tracking. The document outlines the development of an abdominal FAST (AFAST) technique and abdominal fluid scoring system for dogs. It finds that AFAST detected intraabdominal injuries like hemorrhage at higher rates than previous studies without ultrasound. The fluid scoring system aims to help guide therapy by correlating with anemia severity rather than
Journal of the Formosan Medical Association (2011) 110, 695e70.docxcroysierkathey
Journal of the Formosan Medical Association (2011) 110, 695e700
Available online at www.sciencedirect.com
journal homepage: www.jfma-online.com
ORIGINAL ARTICLE
A multivariable logistic regression equation to
evaluate prostate cancer
Jhih-Cheng Wang a, Steven K. Huan a, Jinn-Rung Kuo b, Chin-Li Lu c,
Hung Lin a, Kun-Hung Shen a,*
a Division of Urology, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
b Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
c Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
Received 29 January 2010; received in revised form 14 May 2010; accepted 9 August 2010
KEYWORDS
Logistic regression;
men’s health;
probability;
prostate cancer;
risk factor;
score
* Corresponding author. Division of U
Taiwan 710.
E-mail address: [email protected]
0929-6646/$ - see front matter Copyr
doi:10.1016/j.jfma.2011.09.005
Background/Purpose: A possible means of decreasing prostate cancer mortality is through
improved early detection. We attempted to create an equation to predict the likelihood of
having prostate cancer.
Methods: Between January 2005 and May 2008, patients who received prostate biopsies were
retrospective evaluated. The relationship between the possibility of prostate cancer and the
following variables were evaluated: age; serum prostate specific antigen (PSA) level, prostate
volume, numbers of prostatic biopsies, digital rectal examination (DRE) findings, and the pres-
ence of hypoechoic nodule under transrectal ultrasonography.
Results: A multivariate regression model was created to predict the possibility of having pros-
tate cancer, and a receiver-operating characteristic (ROC) curve was drawn based on the
predictive scoring equation. Using a predictive equation, P Z 1/(1 � e�x), where X Z
�4.88, þ 1.11 (if DRE positive), þ 0.75 (if hypoechoic nodule of prostate present), þ 1.27
(when 7 < PSA � 10), þ 2.02 (when 10 < PSA � 24), þ 2.28 (when 24 < PSA � 50), þ 3.93 (when
50 < PSA), þ 1.23 (when 65 < age � 75), þ 1.66 (when 75 < age), followed by ROC curve
analysis, we showed that the sensitivity was 88.5% and specificity was 79.1% in predicting
the possibility of prostate cancer.
Conclusion: Clinicians can tailor each patient’s follow-up according to the nomogram based on
this equation to increase the efficacy of evaluating for prostate cancer.
Copyright ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
rology, Department of Surgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan,
il.com (K.-H. Shen).
ight ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.jfma.2011.09.005
www.sciencedirect.com/science/journal/09296646
http://www.jfma-online.com
http://dx.doi.org/10.1016/j.jfma.2011.09.005
http://dx.doi.org/10.1016/j.jfma.2011.09.005
696 J.-C. Wang et al.
Prostate cancer is the most common solid malignancy ...
Wound dehiscence in surgical procedures and its relationship to increased mor...AI Publications
This study aims to determine outcomes for Wound dehiscence in surgical procedures and its relationship to increased mortality. Twenty-five patients were collected from different hospitals in Iraq with intestinal obstruction, and they were distributed into two groups according to gender (15 males, ten females), and the average age ranged between 25-50 years. This retrospective study included those patients who were after bowel surgery at different hospitals in Iraq between January 6, 2020, and May 27, 2021, where information was obtained by reviewing clinical records.The statistical analysis program IBM SPSS SOFT 18 was also relied upon for the purpose of knowing the true value and standard regression in addition to the percentage of healthy variables to patients. Microsoft Excel 2013 was used for the purpose of describing and analysing demographic data. the results which found of this study collected 25 patients, and MEAN VALUE with slandered div of age patients was 39.4800 ± 6.8, and the type of anaesthesia used in this study was general anaesthesia. Causes of the bowel surgery according to the sex of the patients were (Mesenteric Ischaemia for one female patient and three male patients and Blunt trauma was one patient for both sexes. Bowel surgery, according to emergency basis and elective basis, was the emergency basis for 19 patients and elective for six patients. Association between Surgery * sex * presence of leaks Cross-tabulation were nine patients for an emergency basis and one patient for Elective. In this study, the mortality rate was higher for males than for females (1.4 patients), respectively and we concluded that there is a statistical relationship between the death rate and its prevalence among men
Researchers studied trends in surgical treatment of localized kidney cancers between 1995-2005. They found that while minimally invasive laparoscopic radical nephrectomy (LRN) increased rapidly, replacing open radical nephrectomy, this was offset by a decline in nephron-sparing partial nephrectomy. As a result, the utilization of kidney-preserving techniques increased only modestly, even though they reduce risks of chronic kidney disease and may improve survival. The study indicates a need for greater adoption of partial nephrectomy over radical nephrectomy approaches.
Researchers studied treatment approaches for small renal masses between 1995-2005 using national Medicare data. They found that while partial nephrectomy and laparoscopic procedures increased, radical nephrectomy rates also rose significantly. Specifically, the utilization of laparoscopic radical nephrectomy increased much faster than partial nephrectomy. As a result, overall rates of nephron-sparing surgery only increased modestly, despite evidence it reduces chronic kidney disease risk compared to radical nephrectomy. The increasing preference for less invasive but nephron-removing laparoscopic radical nephrectomy over partial nephrectomy is a concern, as it does not provide the long-term renal protection benefits of kidney
Similar to Advanced Journal of Vascular Medicine (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page - 007
Advanced Journal of Vascular Medicine
INTRODUCTION
The vein graft is considered to be the conduit of choice for infra-
inguinal bypass surgery [1]. The graft failure rate maybe as high as
30% at 1 year [2]. The failure rate is higher for distal bypasses and
patients with chronic critical limb ischemia due to the increased
atherosclerotic burden [1]. Graft failure can be divided into early,
mid and late. Early failure, up to 30 days, is caused predominantly
by technical factors including patient selection [3]. Midterm failure,
between 1 to 24 months, is mainly related to Neo-Intimal Hyperplasia
(NIH) [4]. Late failure, at more than 24 months, is mostly due to the
progression of atherosclerotic disease in the native arteries [1,5].
Midterm patency rates can be improved by early identification of at
risk grafts by a surveillance programme and timely intervention [6].
Duplex ultrasound scanning is currently the method of choice
for detecting anastomotic and graft stenosis that may threaten graft
patency [7]. Although some small trials have shown benefit from a
surveillance programme [6,8], a larger multi-center randomized
controlled trial data and literature review have shown no overall
benefit [9,10]. The role of delay from the diagnosis of a failing graft to
intervention has not been taken into account in the studies, but it is
clearly desirable to minimise this. The aim of this study was to assess
whether the introduction of FTS on surveillance programme has an
impact on graft salvage on patients after a small number of grafts
with significant stenoses at scanning were found to have occluded at
angiography.
METHODS
All duplex scans carried out between March 2010 and February
2013 were included in this study. Patients who had infra-inguinal
bypass using vein routinely underwent duplex surveillance by an
accredited vascular technologist in the Vascular Laboratory at 3, 6,
9, 12 and 18 months. This surveillance programme was restarted
again if an intervention was performed (angioplasty or revision of
a failing graft). A graft at risk of failure, was defined as having an
Ankle Brachial Pressure Index (ABPI) fall more than 0.15 [11], a peak
systolic velocity (PSV) greater than 300 cm/s, a slow peak systolic
flow velocity of less than 45 cm/s [12] or peak systolic Velocity Ratio
(VR) more than 2.5 [13]. The presence of inflow, outflow disease,
graft dilatation or arteriovenous fistula was noted. After comparison
with the previously recorded scan results, at risk grafts were referred
urgently by the vascular sonographer to vascular surgery and
interventional radiology.
Previously, there was a time-delay between detecting a failing
graft and an intervention to correct the underlying cause. A Fast
Track System (FTS) for referring patients from vascular laboratory
to radiology directly was introduced in February 2011. Instead of
waiting until the scan is seen by the treating surgeon, patients with
grafts at risk were referred on the same day to interventional radiology
by the vascular laboratory. The request was processed on the same
day and a date and time were given for the planned intervention with
conventional angiography in view for angioplasty.
Data on all scans between the periods March 2010 to Feb 2013
were collected prospectively and entered onto a database. This
includes the number of scans, the number of at risk grafts, the number
of interventions, the number of occluded grafts and the time-delay
between scans, referrals and interventions. Data were categorised into
two groups, pre and post - FTS. The main outcomes were the time-
delay and the graft occlusion rate by the time of the angiogram.
DATA ANALYSIS
The database was created using SPSS software, version 15.0.
Median days between the two groups were compared using Mann
- Whitney U test. The numbers of occluded and non-occluded grafts
between the groups were compared using Yates continuity corrected
Chi-squared test. A P-value less than 0.05 were considered to be
significant. Kaplan-Meier analysis was used to show the one-year
patency rate curve of both groups with censoring the occluded grafts
on the duplex scan.
RESULTS
One hundred and eleven duplex scans on 65 patients which
were carried out between March 2010 and February 2011 (pre -
FTS) were compared to 190 scans on 112 patients from the period
between March 2011 and February 2013 (post - FTS). These grafts
were either to below or above the knee popliteal arteries. No spliced
graft was used in both groups. Grafts at risk were identified in 22%
and 18% of duplex scans before and after FTS respectively. There was
an improvement in the median delay from duplex scan to referral
ABSTRACT
Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass
grafts with identified significant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were
performed post-FTS introduction over two years.
Results: Significant stenoses were identified in 24 scans (22%) before FTS, of which, 6 (25%) had no intervention, 15 (62.5%) had
interventions and 3 (12.5%) were occluded by the time of intervention. The median delays from duplex to referral to radiology and from
duplex to intervention were 32 and 56 days respectively. After the introduction of FTS, 35 scans were noted to have significant stenoses.
Only 23 (66%) of them had interventions. The median delays from duplex scan to referral to radiology and from duplex to intervention
were 0 and 20 days respectively. There was one graft (3%) occlusion after the introduction of FTS by the time of the angiogram compared
with 3 (12.5%) in the pre-FTS group (p = 0.35).
Conclusions: Approximately 20% of the scans performed over one year for infra-inguinal bypass are at risk of failure. The FTS has
reduced the time - delay from Duplex scan to referral to radiology and the number of occluded grafts. Further improvement is needed to
reduce the delay between the referral and intervention.
Keywords: Vein graft; Infra - inguinal bypass; Surveillance scan
3. SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page - 008
Advanced Journal of Vascular Medicine
to radiology and from duplex to intervention which was statistically
significant (Table 1).
Graft occlusion rate between surveillance and attempted
intervention was 12.5% of at-risk grafts in the pre-FTS group
compared with 3% in the post - FTS group, P-value = 0.35 (Table
2; Figure 1). Two of the four patients who had occluded graft on the
scan have lost their limbs after one year.
The intervention rates were 62.5% in the pre-FTS group and 66%
in the post - FTS group. There were no reported complications after
theangioplastyprocedures.Theremaininggroupwithnointervention
were monitored closely at three monthly intervals. Two scanned
grafts in the pre - FTS which were under close observation have been
treated after a follow up scan the year after. Another two grafts had
angioplasty two and three years later. One graft was scanned twice in
the pre - FTS group and findings were stable. One case in the post-
FTS group which thought to have significant findings on the scan was
found to have a normal arteriogram and no intervention was needed.
Four scans were performed on the same patient in the post - FTS
group who was deemed to have significant duplex findings and there
was no change in the results and graft continued to be patent proving
stable lesion. Another scan result was referred to radiology and a date
was set for angioplasty but the patient didn’t attend and had died
three months later. In terms of limb loss; one patient lost his limb in
the no intervention pre - FTS subgroup, while no limb loss was noted
in the no intervention post-FTS subgroup.
DISCUSSION
The fast track system of referring patients with grafts at risk
directly to Radiology has shown a trend of decreasing the number of
grafts found to be occluded by the time of angiogram in this study.
The main aim of a graft surveillance programme is to prevent graft
occlusion and thus prevent limb loss. It is known that intervention
on a diseased but patent graft has a better patency rate compared
with occluded grafts [14]. Reducing the period between the scan and
the intervention by a fast track system can improve the value of graft
surveillance.
There was a delay between the duplex scan and decision to list
the patient in the pre - FTS group (median 32 days). This was due to
the previous practice of scanning the grafts and sending the report
to surgeons or waiting until the patients are reviewed in the clinic.
Despite the improvement in the time-delay from scan to referral after
introducing the FTS, there is still a room for an improvement from
referral to the intervention. A delay can be due to the availability of
elective day case beds. Reduction in this delay would require the use
of emergency facilities or an increase in day case capacity. Afurther
factor may be the limited capacity in the interventional radiology
department. This could be addressed by role extension. Vascular
surgeons and other allied professionals can be trained to carry out
interventions and capacity can be further increased by making use of
the increasing number of hybrid theatres. Priority should be given to
at risk grafts when planning lists [15].
The decision to intervene or to observe a stenosis depends on the
previous angiogram, surgical findings and whether the stenosis will
progress, stabilise or regress over the follow-up period. A study by
Mattos, et al. [16], concluded that a high number of stenotic grafts
stay patent whether treated or not . Various studies have aimed
to identify criteria which can be used to predict the risk of failure
according to early manifestation of flow disturbance. Grafts can
be categorised into high, medium or low risk for failure based on
predefined duplex criteria. The high-risk category was defined as
critical stenosis with PSV > 300 cm/s or Vr > 4. This group merits
intervention with arteriography and angioplasty while medium and
low-risk categories can be closely observed [17]. Selective surveillance
can be adopted in grafts performed distal to the knee or when using
poor quality veins. This would minimise the work load but still
can miss critical stenosis in other grafts. In the current study, there
were 25% and 31% of the risk of failure scans that did not undergo
intervention in the pre and post-FTS groups respectively. Only two
of the observed grafts progressed on subsequent follow-up scans
suggesting the criteria used in the current study was effective in
identifying high-risk grafts. However, predicting the progression of
a lesion detected on the early duplex scan has proved to be difficult
[8]. In some patients, conservative management was recommended
based on the surgical findings or a recent angioplasty. These have
shown small graft caliber, anatomical bands or disease in distal native
arteries which can give findings of failing graft on the scan. In other
cases, the decision whether to intervene or to observe was made on
the basis of the radiologist’s interpretation of the previous angiogram
and intervention or documented letters from the surgeon and the
Multidisciplinary Team (MDT) discussion. However, FTS was
introduced not to bypass the MDT but to reduce the delay waiting for
the decision which will be mostly supporting an intervention.
Table 1: Median number of days from scan to referral and to intervention.
Median number of
days
From duplex to
referral
From duplex to
intervention
Pre - FTS 32 56
Post - FTS 0 20
P-value*
< 0.001 0.002
*
Yates continuity corrected Chi-squared test.
Table 2: The number of the failing grafts and the outcome.
Number of failing grafts
Pre - FTS (%)
n = 24/111
Post - FTS (%)
n = 35/190
P-value*
No intervention 6 (25) 11 (31)
Intervention 15 (62.5) 23 (66)
Occluded 3 (12.5) 1 (3) 0.35
*
Mann-Whitney U tests. Values are given as n (%) of failing grafts
Figure 1: Kaplan-Meier curve showing the one year patency rate in both
groups (pre and post-FTS).
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Advanced Journal of Vascular Medicine
There was no information from the published RCT about the
time gap from detecting a failing graft to the time of intervention.
This could have a major impact on the results of limb salvage which
was shown to be the same in the clinical and duplex surveillance
arms [9]. The current study provides some insight into how a graft
surveillance programme can be effective when reducing the time-
delay from the scan to intervention. It is retrospective study analysing
prospectively collected data. It has a small number of graft occlusions
but it is encouraging that the number of occluded grafts appears to
have decreased following the introduction of the fast-track protocol.
Although no significant difference could be shown, this would be due
to the small numbers of the scans included. RCT with more details
about the time frame is needed to draw a conclusion on the efficacy of
a surveillane programme.
CONCLUSION
The current surveillance programme has identified approximately
20% of infra-inguinal bypass vein grafts to be at risk of failure. FTS
has reduced the total time-delay for intervention thus contributed to
graft salvage. Improvement is needed to decrease the waiting before
the intervention. The benefit of FTS on long-term limb salvage
is unknown. If a surveillance programme is to be successful, it is
essential to be linked to a prompt re-intervention service.
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