scholarly journals Surgical Results of Retrograde Mastoidectomy with Primary Reconstruction of the Ear Canal and Mastoid Cavity

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Chao-Yin Kuo ◽  
Bor-Rong Huang ◽  
Hsin-Chien Chen ◽  
Cheng-Ping Shih ◽  
Wei-Kang Chang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Mastoid Cavity ◽  
Surgical Results ◽  
Ear Canal ◽  
Hearing Results ◽  
Hearing Gain ◽  
Before And After ◽  
Hearing Outcomes ◽  
The Impact

The aim of this study was to retrospectively review the long-term hearing results and the impact of mastoid exclusion/obliteration in patients with cholesteatoma (102 ears) who underwent retrograde tympanomastoidectomy and in whom bone chips/paté were applied as the sole materials during the procedure. In 79 ears, this was combined with ossiculoplasty in a single-stage procedure. In >71% of ears, the results of audiometric testing were monitored for more than 2 years. The results suggested there was a significant gain in hearing following surgery, with respect to the postoperative change in both air-conduction thresholds and air-bone gaps (P<0.001). Linear regression analyses of pure-tone averages at different frequencies, before and after surgery, demonstrated that patients benefitted from a postoperative hearing gain at low and middle frequencies, but their hearing often deteriorated at frequencies of 8000 Hz. As for the impact of the type of tympanoplasty on hearing outcomes, type III-interposition markedly increased hearing gain. The overall rate of postoperative adverse events was 8.8%. We conclude that reconstruction of the ear canal and mastoid via mastoid exclusion/obliteration using bone chips/paté can be considered as an alternative procedure following retrograde mastoidectomy. It gives excellent surgical results and has fewer postoperative adverse events.

scholarly journals The Demerger Impact upon Sustainable Development of Economic Entities: Evidence from Romania

2021 ◽  
Vol 13 (15) ◽  
pp. 8316
Author(s):  
Camelia Mirela Baba ◽  
Constantin Duguleană ◽  
Marius Sorin Dincă ◽  
Liliana Duguleană ◽  
Gheorghița Dincă
Keyword(s):  
Sustainable Development ◽  
Business Strategies ◽  
The Sustainable Development ◽  
Ex Post ◽  
Before And After ◽  
Almost All ◽  
The Impact ◽  
Profitability Ratios ◽  
Positive Effect

The Covid-19 induced economic crisis has significantly affected almost all businesses from nearly every sector, causing severe financial problems, lack of cash assets, and decrease of revenues. In this context, the economic entities were forced to look for adjustment and rescue solutions of their activities. One possible solution for the recovery and reorganization of economic entities’ activities is demerger. This paper evaluates the impact of demerger upon the sustainable development of economic entities in terms of economic efficiency and financial performances. To achieve this goal, a statistical analysis of profitability ratios before and after the demerger, as well as a structural analysis of 268 demerger projects for the April 2012–April 2021 period, were performed. The results attest there are no significant differences between the ex-ante and ex-post financial performances. However, demerger seems to have a positive effect upon analyzed companies helping them to overcome economic hardships, rethink their business strategies, and continue their activity in the medium and long-term time horizon.

Accrual management and the decision to sell or hold shares acquired from the exercise of employee stock options

2020 ◽  
pp. 0000-0000
Author(s):  
Thomas Smith ◽  
G. Ryan Huston ◽  
Richard M. Morton
Keyword(s):  
Stock Option ◽  
Employee Stock Options ◽  
Short Term ◽  
Post Exercise ◽  
Employee Stock Option ◽  
Holding Period ◽  
Before And After ◽  
Accrual Management ◽  
The Impact

This study extends the employee stock option literature by examining the impact of accrual management, before and after stock option exercise, on the timing of sales of shares acquired at exercise. We find evidence that accrual management prior to exercise is positively associated with the decision to quickly sell shares after exercise, facilitating a short-term exercise-and-sell strategy. Alternatively, we find that, among executives initially choosing to hold at exercise, tax incentives appear to drive both post-exercise accrual management and the timing of sale transactions. Specifically, our results suggest that executives use income-increasing accruals during the holding period to bolster their stock option gains sand then sell immediately after satisfying the minimum (twelve month) holding period for long-term capital gain treatment. These results provide context for prior research that found evidence of earnings management leading up to option exercise on the expectation of an immediate sale.

scholarly journals Prospective Evaluation of the Strategy of Functionally Optimized Coronary Intervention

2020 ◽  
Vol 9 (3) ◽  
Author(s):  
Barry F. Uretsky ◽  
Shiv K Agarwal ◽  
Srikanth Vallurupalli ◽  
Malek Al‐Hawwas ◽  
Rimsha Hasan ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Interquartile Range ◽  
Fractional Flow ◽  
Long Term Outcomes ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Percutaneous Coronary ◽  
Before And After ◽  
The Impact

Background Long‐term outcomes after percutaneous coronary intervention (PCI) relate in part to residual ischemia in the treated vessel, as reflected by post‐PCI fractional flow reserve (FFR). The strategy of FFR after PCI and treatment of residual ischemia—known as functionally optimized coronary intervention (FCI)—may be feasible and capable of improving outcomes. Methods and Results Feasibility and results of FCI using an optical‐sensor pressure wire were prospectively evaluated in an all‐comer population with 50% to 99% lesions and ischemic FFR (≤0.80; ClinicalTrials.gov identifier NCT03227588). FCI was attempted in 250 vessels in 226 consecutive patients. The PCI success rate was 99.6% (249/250 vessels). FCI technical success—that is, FFR before and after PCI and PCI itself using the FFR wire—was 92% (230/250 vessels). Incidence of residual ischemia in the treated vessel was 36.5%. Approximately a third of these vessels (34.5%, n=29) were considered appropriate for further intervention, with FFR increasing from 0.71±0.07 to 0.81±0.06 ( P <0.001). Pressure wire pullback showed FFR ≤0.8 at distal stent edge was 7.9% and 0.7% proximal to the stent. FFR increase across the stent was larger in the ischemic than in the nonischemic group (0.06 [interquartile range: 0.04–0.08] versus 0.03 [interquartile range: 0.01–0.05]; P <0.0001) compatible with stent underexpansion as a contributor to residual ischemia. Conclusions FCI is a feasible and safe clinical strategy that identifies residual ischemia in a large proportion of patients undergoing angiographically successful PCI. Further intervention can improve ischemia. The impact of this strategy on long‐term outcomes needs further study.

Description of a pharmacist-driven safety algorithm in Staphylococcus aureus bacteremia: Compliance, interventions, and good saves

2020 ◽  
Vol 41 (8) ◽  
pp. 921-925
Author(s):  
Tara H. Lines ◽  
Whitney J. Nesbitt ◽  
Matthew H. Greene ◽  
George E. Nelson
Keyword(s):  
Staphylococcus Aureus ◽  
Adverse Events ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Safety Net ◽  
Definitive Therapy ◽  
Before And After ◽  
Bundle Compliance ◽  
The Impact ◽  
Major Adverse Events

AbstractObjective:To evaluate the impact of a pharmacist-driven Staphylococcus aureus bacteremia (SAB) safety bundle supported by leadership and to compare compliance before and after implementation.Design:Retrospective cohort study with descriptive and before-and-after analyses.Setting:Tertiary-care academic medical center.Patients:All patients with documented SAB, regardless of the source of infection, were included. Patients transitioned to palliative care were excluded from before-and-after analysis.Methods:A pharmacist-driven safety bundle including documented clearance of bacteremia, echocardiography, removal of central venous catheters, and targeted intravenous therapy of at least 2 weeks duration was implemented in November 2015 and was supported by leadership with stepwise escalation for nonresponse. A descriptive analysis of all patients with SAB during the study period included pharmacy interventions, acceptance rates, and escalation rates. A pre–post implementation analysis of 100 sequential patients compared bundle compliance and descriptive parameters.Results:Overall, 391 interventions were made in the 20-month period following implementation, including 20 “good saves” avoiding potentially major adverse events. No statistically significant differences in complete bundle compliance were detected between the periods (74% vs 84%; P = .08). However, we detected a significant increase in echocardiography after the bundle was implemented (83% vs 94%; P = .02) and fewer patients received suboptimal definitive therapy after the bundle was implemented (10% vs 3%; P = .045).Conclusions:This pharmacist-driven SAB safety bundle with leadership support showed improvement in process measures, which may have prevented major adverse events, even with available infectious diseases (ID) consultation. It provides a critical safety net for institutions without mandatory ID consultation or with limited antimicrobial stewardship resources.

Complete Donor T-Cell Chimerism Predicts Lower Relapse Incidence after Standard Double Umbilical Cord Blood Reduced Intensity Conditioning Regimen Allogeneic Transplantation in Adults

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2479-2479
Author(s):  
Pierre Peterlin ◽  
Jacques Delaunay ◽  
Thierry Guillaume ◽  
Thomas Gastinne ◽  
Beatrice Mahe ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cord Blood ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Allogeneic Transplantation ◽  
Reduced Intensity Conditioning Regimen ◽  
Before And After ◽  
The Impact

Abstract Double umbilical cord blood (dUCB) allogeneic transplantation following low dose TBI, cyclophosphamide and Fludarabine (TCF regimen)-based reduced-intensity conditioning regimen (RIC) is increasingly used in adults lacking a suitable related or unrelated donor. Currently, there is little data regarding the impact on long-term outcome of CD3+ T cell chimerism (TCC) in this particular setting. Thirty-six adults with various hematological diseases and who receieved dUCB conditioned with TCF were included in this retrospective study. Peripheral blood CD3+ TCC was considered until day +100 post-tranplant in order to determine the impact of full versus mixed chimerism on long-term outcomes. Twenty-nine and 7 patients were documented with full and mixed CD3+ TCC, respectively, within the first 100 days post-transplant. With a median follow-up of 36 months, 3 year-OS, DFS, and relapse incidence were 61%, (95% CI 43-75); 50% (95% CI 32.5-66) and 28% (95% CI 16-44), respectively. In univariate analysis, a full CD3+ TCC was associated with a better 3-year DFS : 59% (95% CI 39-75.5) versus 14% (95% CI 7-46), (HR=0.24 [0.09-0.65], p=0.005) and a lower cumulative incidence of relapse : 24% (95% CI 21.5-57) versus 78% (95% CI 52-99), (HR=0.18 [0.05-0.5], p=0.004). In multivariate analysis, a full CD3+ TCC remained associated with a lower incidence or relapse (HR=0.17, 95% CI 0.028-0.99, p=0.049). CD3+ TCC has no impact on GVHD and NRM in this study. In conclusion, in our study, full CD3+ TCC was independently associated with a lower risk of relapse after dUCB TCF RIC allogeneic transplant in adults, highlighting the need to develop immunotherapy approaches allowing for early conversion to full chimerism after dUCB. Abstract 2479. Table 1 Patients, sustained cord blood and transplantation characteristics. Patients, sustained cord blood and transplantation characteristics Full TCC (n=29) Mixed TCC (n=7) p No.of patients % No.of patients % Patients characteristic Age at transplant, years, median (range) 57 (22-69) 47 (17-64) NS Sex female 14 48 3 43 NS Hematological malignancy : Lymphoid / myeloid 14 / 15 48 / 52 3 / 4 43 / 57 NS Statut at transplant : RC / RP 23 / 6 79 / 21 6 / 1 86 / 14 NS Time to transplant, days, median (range) 395 (137-5645) 216 (92-604) NS Cord blood characteristics Age of cord blood, months, median (range) 31 (9-165) 116 (23-140) NS Matching cordon with patient NS 4/6 10 35 3 43 5/6 19 65 3 43 6/6 0 0 1 14 Number of total nucleated cell 10^8/kg before and after thawing, respectively, median (range) 0,28 (0,16-0,455) ; 0,248 (0,157-0,406) 0,222 (0,135-0,492) ; 0,22 (0,11-0,392) NS Number of CD34+ cell 10^6/kg before and after thawing, respectively, median (range) 0,066 (0,022-0,215) ; 0,043 (0,02-0,2) 0,078 (0,031-0,427) ; 0,041 (0,019-0,259) NS Mismatch between cord blood and patient Sex 14 48 3 43 NS Serology CMV 13 45 3 43 NS ABO 16 55 2 28 NS Rhesus 22 76 6 86 NS Graft Neutrophil count recovery >0.5 G/L, days, median (range) 17 (6-32) 11 (7-20) NS Platellet recovery >20G/L, days, median (range) 41 (0-164) 31 (0-67) NS Acute GVHD (grade II-IV / grade III-IV) 19 (12 / 6) 65 (41 / 21) 4 (3 / 1) 57 (43 / 14) NS Chronic GVHD (Limited / Extensive) 11 (8 / 3) 38 (28 / 10) 3 (2 / 1) 43 (28 / 14) NS Chimerism Rate, %, median (range) 100 (96-100) 82 (14-94) <0,001 Table 2 Multivariate analysis for DFS, OS and CIR. Multivariate analysis Hazard Ratio 95% CI P values DFS Age (continuos variable) 0.97 0.93 to 1.01 0.174 Sex 0.37 0.10 to 1.26 0.111 TCC full versus mixed 0.28 0.074 to 1.04 0.058 Chronic GVHD : noversus yes 4.68 1.12 to 19.53 0.034 OS Age (continuous variable) 0.95 0.91 to 0.99 0.022 myeloid vs lymphoid 9.13 1.7 to 49.05 0.010 Acute GVHD : none vs grade 3-4 0.24 0.06 to 0.93 0.038 TCC full versus mixed 0.62 0.15 to 2.46 0.495 CIR Age (continuos variable) 0.95 0.91 to 1.00 0.057 Sex 0.88 0.15 to 5.26 0.892 TCC full versus mixed 0.17 0.028 to .99 0.049 Chronic GVHD : no versus yes 8.19 0.46 to 146.41 0.153 Disclosures No relevant conflicts of interest to declare.

Efeito de intervenção educativa sobre eventos adversos pós-vacina pentavalente: estudo quase-experimental

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Francisca Agda Alexandre Porto ◽  
Allan Raniere Santos Silva ◽  
Lívia Maia Pascoal ◽  
Ismália Cassandra Costa Maia Dias ◽  
Leonardo Hunaldo Dos Santos ◽  
...  
Keyword(s):  
Adverse Events ◽  
Maternity Hospital ◽  
Single Group ◽  
Pentavalent Vaccine ◽  
Intervention Method ◽  
Before And After ◽  
Quasi Experimental ◽  
Level Of Understanding ◽  
Study Participants

Aim:  To  evaluate  the  knowledge  of  mothers  regarding  adverse consequences from the pentavalent vaccination before and after they participated in an educative  intervention.  Method:  This is  a  quasi-experimental  study,  with  a  before-and-after analysis, of a single group of 100 mothers of breastfeeding babies, from September to October 2014, in an outpatient clinic of a public maternity hospital in the municipality of  Imperatriz,  Brazil.  Results:  Following  the  intervention, a  significant  increase  in understanding  was  observed  among  the  study  participants  in  all  questions  (p<0.05) regarding adverse events after the pentavalent vaccine. After the intervention, there was a significant increase of right answers to the questions: who to seek advice from after an adverse  event  due  to  the  vaccine  (p=0.004)  and  which  adverse  events  from  the pentavalent vaccine are known to mothers (p=0.04). Conclusion: The results indicate a positive change in the  level  of  understanding  of  mothers regarding the  adverse  events after the  pentavalent vaccination.  The  study  provides  a  basis  for the  adoption  of long-term intervention strategies for nurses.

S232 – Hearing Gain Following Stapes Surgery Maintained Long-term?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P153-P153
Author(s):  
Purushotam Sen ◽  
Abir K Bhattacharyya
Keyword(s):  
Observational Studies ◽  
Quality Evaluation ◽  
Data Extraction ◽  
Bone Conduction ◽  
Stapes Surgery ◽  
Long Term Results ◽  
Hearing Results ◽  
Hearing Gain ◽  
Air Conduction

Objectives To analyse whether the hearing gain following stapes surgery is maintained long-term. Methods Databases (PubMed, EMBASE and MEDLINE) were searched systematically, with no limits on the year or language of publications, for observational studies on the long-term hearing results of stapedectomy (>10 years). References identified from pertinent reviews and articles were also retrieved. 2 reviewers independently searched the databases and selected the studies using pre-specified standardized criteria. These criteria included appropriate adjustments for confounding factors in the analyses. The terms used in the search included stapes surgery, stapedectomy, stapedotomy, long-term results, hearing gain. Data extraction and study quality evaluation were performed independently and results were pooled quantitatively. Results Early studies noted that both air conduction (AC) and bone conduction (BC) deteriorated with time, resulting in a return to baseline pre-operative hearing in the long-term. More recent studies showed that in the long term, the hearing gain was maintained by 75% of patients despite the advent of presbycusis. Surgeons' experience may play a more important role than the type of stapes surgery. On average, studies have shown that the air bone gap tended to increase at a rate of 0.9 dB per year. Conclusions Though some earlier studies were equivocal, recent studies indicate that most stapes surgery patients maintain good hearing long-term, even though there is a gradual decline in the air conduction and bone conduction thresholds. Longitudinal studies are required to better understand this subject.

The impact of a TV report in schizophrenia stigma reduction: A quasi-experimental study

2017 ◽  
Vol 63 (3) ◽  
pp. 275-277 ◽  
Author(s):  
Nathaly de Oliveira Bosoni ◽  
Geraldo Busatto Filho ◽  
Daniel Martins de Barros
Keyword(s):  
Brief Intervention ◽  
Social Distance ◽  
Mass Communication ◽  
Long Term Effects ◽  
Stigma Reduction ◽  
The Social ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact

Background: Stigma is a major problem in schizophrenia, and the most effective way to reduce it is to provide information. But literature lacks studies evaluating long-term efficacy of mass communication. Aims: This is a pilot study to assess if a brief intervention (TV report) may have long-term effects. Method: Assessing stigma scores from subjects before and after seeing a vignette. Results: We found that the social distance and restriction to patients not only fell after a brief intervention but also kept lower after 1 and 3 months. Conclusion: We conclude that even brief intervention may create persistent impact in reducing discrimination.

Soft-Wall Reconstruction of the Posterior External Ear Canal Wall

1986 ◽  
Vol 94 (3) ◽  
pp. 355-359 ◽  
Author(s):  
Peter G. Smith ◽  
Malcolm H. Stroud ◽  
Joel A Goebel
Keyword(s):  
Functional Results ◽  
Mastoid Cavity ◽  
Canal Wall ◽  
Ear Canal ◽  
Mastoid Obliteration ◽  
Simple Method ◽  
Acoustic Characteristics ◽  
Modified Radical Mastoidectomy ◽  
Soft Wall

A simple method of reconstructing a previously removed posterior ear canal with an autogenous, bilaminar membrane is described. The resulting air-filled mastoid cavity is an anatomic extension of the middle ear cleft and is separated from the ear canal by a functional barrier that is continuous with the tympanic membrane. The acoustic characteristics of an associated tympanoplasty are not significantly altered, and many of the problems that are associated with an exteriorized cavity are avoided. In contradistinction to other methods of mastoid obliteration or reconstruction, the semitransparent nature of the soft canal wall allows inspection of the underlying cavity for residual or recurrent disease. The technique can be used to repair either a newly created cavity or a previous radical (or modified radical) mastoidectomy defect. The functional results of thirty ears reconstructed in this fashion are detailed. A variable amount of soft-wall retraction was noted postoperatively in 47% of the ears; however, the long-term functional results in these cases remain satisfactory.

scholarly journals Transurethral Catheterization in Early Training: The Impact of Peer-Led Mentorship

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Mohamed Mubarak ◽  
Qasim Isa ◽  
Mahmood Alsaeed ◽  
Mohamed Alalawi
Keyword(s):  
Procedural Knowledge ◽  
Junior Doctors ◽  
Confidence Levels ◽  
Transurethral Catheterization ◽  
Before And After ◽  
Long Term Impact ◽  
The Impact ◽  
Average Domain ◽  
Early Training

Introduction. Transurethral catheterization (TUC) is a common hospital procedure. According to the literature, junior doctors contribute to the majority of TUC-related injuries. Our aim is to evaluate the immediate and long-term impact of a short procedure-centric TUC workshop on junior doctor’s confidence, procedural knowledge, and ability to identify potential complications of catheterization. Materials and Methods. Intern doctors were invited to attend a one-hour workshop on TUC. A questionnaire was completed before and after the workshop. Three months later, the questionnaire was readministered to assess the workshop’s long-term impact. The questionnaire consisted of three domains. A: experience, training, and confidence levels (using 5-point Likert scales), B: procedural knowledge (the highest possible score was 10 points), and C: identification of TUC-related complications (the highest possible score was 3 points). Results. 81 interns participated and reported a confidence level of 3.03 ± 1.05 in performing a straightforward TUC. Preworkshop domain B and domain C were 3.92 ± 1.63 and 1.75 ± 0.69 points, respectively. After the workshop, reported confidence levels improved to 3.71 + 1.02 ( p < 0.05 ). Likewise, the scores in domains B and C increased significantly to 8.85 ± 1.40 ( p < 0.005 ) and 2.65 ± 0.6 ( p < 0.005 ), respectively. Three months later, the same parameters were evaluated, and confidence levels were higher than those of the preworkshop levels at 3.83 ± 0.77 ( p < 0.05 ). The average domain B score was 7.85 ± 1.88 ( p < 0.005 ), and domain C score was 2.69 ± 0.53 ( p < 0.005 ). All scores reported after three months were significantly better than the preworkshop levels ( p < 0.005 ), but there were no statistically significant differences when compared to the immediate postworkshop scores ( p > 0.05 ). Conclusion. Short peer-led TUC workshops positively impact intern doctors’ confidence levels, procedural knowledge, and identifying complications.

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