scholarly journals Ultrasound Guided Intravenous Access by Nursing versus Resident Staff in a Community Based Teaching Hospital: A “Noninferiority” Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Thomas Carter ◽  
Chris Conrad ◽  
J. Link Wilson ◽  
Godwin Dogbey
Keyword(s):  
Success Rate ◽  
Nursing Staff ◽  
Community Hospital ◽  
Ultrasound Guided ◽  
Community Based ◽  
Intravenous Access ◽  
Didactic Instruction ◽  
Significant Difference ◽  
Hands On

Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective “noninferiority” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs.Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years’ experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be “difficult sticks” and randomly assigned to either a nurse or resident, based on the day they presented.Results. A total of 90 attempts, consisting of trials on 90 patients, were recorded with a success rate of 85% and 86% for residents and nurses, respectively. With apvalue of .305, there was no statistically significant difference in the success rate between the residents and nurses.Conclusion. Properly trained nursing staff can be as equally successful as EM residents in placing US guided intravenous lines.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial

2018 ◽  
Vol 42 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Zahra Jamali ◽  
Vajiheh Alavi ◽  
Ebrahim Najafpour ◽  
Naser Asl Aminabadi ◽  
Sajjad Shirazi
Keyword(s):  
Success Rate ◽  
Primary Teeth ◽  
Root Resorption ◽  
Controlled Trial ◽  
Sinus Tract ◽  
Primary Molars ◽  
Periapical Lesion ◽  
External Root Resorption ◽  
Significant Difference

Objective: This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars. Study design: 114 children aged 3–6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion. Results: 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X2=2.43, df = 2, P =0.27). Conclusion: Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

1998 ◽  
Vol 89 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Manucher J. Javid ◽  
Eldad J. Hadar
Keyword(s):  
Success Rate ◽  
Herniated Disc ◽  
Lumbar Stenosis ◽  
Content Type ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Significant Difference ◽  
Fine Print

Object. Decompressive laminectomy for stenosis is the most common operation performed in the lumbar spine in older patients. This prospective study was designed to evaluate long-term results in patients with symptomatic lumbar stenosis. Methods. Between January 1984 and January 1995, 170 patients underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). The male/female ratio for each group was 43:43, 39:22, and 14:9, respectively. The average age for all groups was 61.4 years. For patients with lumbar stenosis, the success rate was 88.1% at 6 weeks and 86.7% at 6 months. For patients with lumbar stenosis and herniated disc, the success rate was 80% at 6 weeks and 77.6% at 6 months, with no statistically significant difference between the two groups. For patients with lateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, the sample was not large enough to be statistically significant. One year after surgery a questionnaire was sent to all patients; 163 (95.9%) responded. The success rate in patients with stenosis had declined to 69.6%, which was significant (p = 0.012); the rate for patients with stenosis and herniated disc was 77.2%; and that for lateral recess stenosis was 65.2%. Another follow-up questionnaire was sent to patients 1 to 11 years after surgery (average 5.1 years); 146 patients (85.9%) responded, 10 (5.9%) were deceased, and 14 (8.2%) were lost to follow-up review. At 1 to 11 years the success rate was 70.8% for patients with stenosis, 66.6% for those with stenosis and herniated disc, and 63.6% for those with lateral recess stenosis. Eleven patients who underwent reoperation were included in the group of patients whose surgeries proved unsuccessful, regardless of their ultimate outcome. There was no statistically significant difference in outcome between 1 year and 1 to 11 years with respect to stenosis, stenosis with herniated disc, and lateral recess stenosis. Conclusions. In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

scholarly journals A retrospective study of efficacy and cost efficiency of medical vs. surgical management of abortions in first trimester

2021 ◽  
Vol 10 (9) ◽  
pp. 3429
Author(s):  
Meetangi Agarwal ◽  
Sailatha Ramanujam ◽  
Anuradha C. Ramachandran
Keyword(s):  
Success Rate ◽  
Pregnancy Termination ◽  
Transvaginal Ultrasound ◽  
Cost Effective ◽  
Medical Abortion ◽  
First Trimester ◽  
Observational Research ◽  
Medical Termination ◽  
Significant Difference

Background: The aim of the study was to assess and comparatively evaluate the efficacy of different methods of first trimester abortions (medical, surgical) in terms of its safety, cost and effectiveness.Methods: We present a retrospective observational research study done at Chettinad hospital and research institute, Kelambakkam Chennai which included a total of 70 patients of first trimester abortions, in the period from June 2019 to June 2020. 55 patients were offered medical treatment (MTOP) and were followed up with a repeat scan after 2 weeks. In cases of failed medical abortion patient underwent curettage. Though, in some cases after an attempt at medical abortion, if the products didn’t expel at all within 48 hours, dilatation and evacuation was offered. Transvaginal ultrasound was performed to confirm the success of the treatment. In 15 cases who presented with incomplete abortion, surgical treatment (STOP) was offered. The outcomes considered were successful complete abortions, failed medical abortions, side effects and complications including blood transfusion.Results: The baseline characteristics of women were similar in both the groups like mean age, parity, history of previous termination of pregnancy (TOP). The success rate in MTOP was 67.2% and in STOP 100%.The amount of bleeding experienced was moderate to heavy in MTOP and minimal to moderate in STOP.37 women who underwent only medical termination who returned for the 2-week follow-up, the rate of complete pregnancy termination was 94% and for the remaining 2 women surgical intervention was required. In the surgical group, at the 2-week follow up, no woman underwent a repeat vacuum aspiration with an efficacy of 100%. No significant difference was found in the mean total cost for the medical and surgical groups after adding the subsequent costs (including additional manual vacuum evacuation).Conclusions: Medical termination of abortion should be preferred over surgical termination as it is safer, cost effective, with fewer complications and high success rate. 

scholarly journals Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jindong Li ◽  
Liangliang Bai ◽  
Xinwei Han ◽  
Jianzhuang Ren
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference

Abstract Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.

scholarly journals A comparative study of surgical outcomes of ossiculoplasty using biomaterials and autologous implants

2013 ◽  
Vol 19 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Rahul Kawatra ◽  
Puneet Maheshwari
Keyword(s):  
Cost Effectiveness ◽  
Success Rate ◽  
Pure Tone ◽  
Suppurative Otitis Media ◽  
Extrusion Rate ◽  
Hearing Sensitivity ◽  
Pure Tone Audiogram ◽  
Significant Difference ◽  
And Cartilage

Objective: To determine amongst biomaterials (Teflon and Silicon) and autologous materials (autologous incus and cartilage), the one which give the best results of ossiculoplasty, in terms of increase in hearing sensitivity including cost effectiveness. Methods: Study was conducted in Era’s Lucknow Medical College & Hospital, Lucknow, India. Randomized prospective crossover study with eighteen months follow up. 80 patients of Chronic Suppurative Otitis Media (CSOM) were randomly assigned for ossiculoplasty using biomaterials (Teflon and silicon) and autologous materials (bone and cartilage ). Surgical outcome was compared for all the four types of implant material used, in terms of increase in hearing sensitivity, extrusion rate, cost effectiveness. Pre-operatively all patients had a pure tone audiogram with a four frequency average (0.5/1/2/4 kHz) calculated for both air conduction and bone conduction. Post-operatively a pure tone audiogram using (0.5/1/2/4 kHz) was performed at 18 months follow-up. Results: Mean hearing gain (change in A-B gap) was 20.80±7.08 dB in autologous group and 19.93±7.27 dB in biomaterials. Hearing Success Rate-It indicates, total no. of patients, whose postoperative AB Gap (calculated at 500Hz,1,2,3 KHz) is equal to or less than 20 dB. In the present study the overall hearing success rate at follow up period of 4 months is 78.8%. For autologous implants it is 80% and for biomaterials it is 77.5%. Conclusion: The study concluded that there is no significant difference in improvement in AB gap, extrusion rate of implant and overall success rate between biomaterials (Teflon, silicon) and autologous implants (autologous incus, cartilage). The only significant difference between the two groups was the cost effectiveness. Hence, it is concluded in our study that the biomaterials and autologous implants used in the study have equal overall efficacy. The autologous material requires no extra cost so it can be considered as a preferred choice of implant, in comparison to biomaterial in SAARC countries, where the majority is of poor patients. DOI: http://dx.doi.org/10.3329/bjo.v19i1.12619 Bangladesh J Otorhinolaryngol 2013; 19(1): 29-35

P2839The golden age of ablation: results for atypical flutter ablation in the very elderly

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Lozano-Granero ◽  
J Moreno ◽  
R Matia ◽  
A Hernandez-Madrid ◽  
I Sanchez-Perez ◽  
...  
Keyword(s):  
Success Rate ◽  
Median Survival ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atrial Arrhythmias ◽  
Atrial Volume ◽  
Significant Difference

Abstract Introduction Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks. Purpose To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients. Methods From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months. Results 107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence. Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference. Survival function Conclusion AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.

External Versus Endoscopic Dacryocystorhinostomy for Recurrent Dacryocystitis after Endoscopic Dacryocystorhinostomy

2020 ◽  
Author(s):  
Haitao Zhang ◽  
Shuhao Shen ◽  
Jiajun Yang ◽  
Zhe Xu
Keyword(s):  
General Anesthesia ◽  
Success Rate ◽  
Clinical Effects ◽  
Endoscopic Dacryocystorhinostomy ◽  
Nasal Tumors ◽  
Computed Tomography Scanning ◽  
Significant Difference ◽  
External Dacryocystorhinostomy ◽  
One Year

Abstract Purpose The aim of this study was to retrospectively compare the clinical effects of external dacryocystorhinostomy (EX-DCR) and endoscopic dacryocystorhinostomy (EN-DCR) on recurrent dacryocystitis after EN-DCR. Methods Thirty cases involving thirty eyes with post-EN-DCR recurrent dacryocystitis in our hospital between January 2015 and December 2018 were analyzed retrospectively. All of the patients underwent routine preoperative examination, including probing and irrigation of the lacrimal passage, nasal endoscopy, and maxilla-facial computed tomography scanning. Patients with nasal adhesions, nasal tumors and severe deviation of the nasal septum were excluded. Under general anesthesia, twelve patients underwent EN-DCR, and eighteen patients experienced EX-DCR under general anesthesia. Anti-inflammatory treatment was carried out after surgery for one week. The medical records of all the patients were tracked for one year. Results At the third month, all of the EN-DCR patients achieved good results with unobstructed lacrimal irrigation after removal of the bicanalicular tube stents. Sixteen EX-DCR patients had patency of the lacrimal passage, while two other patients exhibited obstructed lacrimal passage. However, at the twelfth month, ten EN-DCR patients had an obstructed lacrimal passage again, and there were only two patients remaining patency in lacrimal duct with a (success rate of 16.7%). In contrast, among the eighteen EX-DCR patients, fifteen cases achieved success with smooth irrigation of the lacrimal passage with a (success rate of 83.3%). There was a statistically significant difference between the two groups in the success rate for the longer follow-up period. No major intra- or post -treatment complications occurred. Conclusions EX-DCR is effective and safe with a higher success rate for the treatment of recurrent dacryocystitis after EN-DCR and might be considered as a primary compensate therapy for EN-DCR.

Myringoplasty: a comparison of bismuth iodoform paraffin paste gauze pack and tri-adcortyl ointment ear dressing

2006 ◽  
Vol 121 (4) ◽  
pp. 329-332 ◽  
Author(s):  
V Nakhla ◽  
Y M Takwoingi ◽  
A Sinha
Keyword(s):  
Retrospective Study ◽  
Success Rate ◽  
Tympanic Membrane ◽  
Surgical Approach ◽  
Suitable Alternative ◽  
Significant Difference ◽  
Study Population ◽  
The Mean ◽  
Gauze Pack

Objectives: To assess the myringoplasty graft take rate, comparing two methods of post-operative ear packing: bismuth iodoform paraffin paste (BIPP) gauze versus tri-adcortyl ointment (TAO).Methods: A retrospective study of patients who had undergone myringoplasty at our department within a three-year period was undertaken. Data, including age, site and size of perforation, grade of surgeon, surgical approach, use of post-operative ear dressings, complications, and audiometric outcome, were collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at six months) was noted.Results: One hundred and seventy myringoplasties were performed over the study period, but data were complete on 154 patients and these constituted the study population. Age ranged from nine to 71 years (mean age 34 years) and the mean follow-up period was seven months. Consultants performed 62 per cent of the operations, with an 85 per cent success rate, whereas trainees performed the remaining 38 per cent, with a success rate of 73 per cent (p=0.059). The overall success rate was 80 per cent; 79 per cent for BIPP and 83 per cent for TAO (p=0.55), and 87 per cent for small perforations and 75 per cent for subtotal perforations (p=0.22). There was audiometric improvement in 74 per cent of cases.Conclusion: We found no significant difference in outcome between patients packed with TAO and BIPP. Packing with TAO is therefore a suitable alternative to BIPP gauze ear dressing following myringoplasty.

The Effects of 3 Peripherally Inserted Central Catheter Insertion Techniques in Chinese Patients With Different Vascular Status

2013 ◽  
Vol 18 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Ling Yuan ◽  
Rong Fu ◽  
Rong-Mei Li ◽  
Miao-Miao Guo ◽  
Xiang-Yu Chen
Keyword(s):  
Success Rate ◽  
The Other ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Ultrasound Guided ◽  
Insertion Technique ◽  
Significant Difference ◽  
Insertion Techniques ◽  
The Individual ◽  
Vascular Status

Abstract Objective: To provide evidence for selecting an appropriate peripherally inserted central catheter (PICC) insertion technique by comparing the insertion success rate and the incidence of complications with 3 PICC insertion techniques. Methods: We assigned enrolled patients to 3 groups according to the insertion technique selected by the individual patient: Group A, usual insertion technique (traditional, blind insertion); Group B, Modified Seldinger Technique (MST) insertion without ultrasound guidance; and group C, ultrasound-guided MST insertion. We compared the insertion success rate and the incidence of complications among these groups. Results: When comparing these 3 PICC insertion techniques, no significant difference was seen with respect to the insertion success rate and the incidence of catheter malposition (P &gt; 0.05), although a significant difference existed in the incidence of bleeding at the insertion site after the PICC procedure (P &lt; 0.05), with the ultrasound-guided MST insertion technique superior to the other 2 techniques; the incidence of mechanical phlebitis and catheter occlusion during the use of PICC had no significant difference among the 3 groups (P &gt; 0.05); but a significant difference was seen in the incidence of thrombosis and catheter-related infections (P &lt; 0.05), with a lower incidence in the ultrasound-guided MST insertion group than that in the other 2 groups. Conclusions: Ultrasound-guided MST insertion technique may address the problems occurring in patients with poor vascular access during the PICC procedure, whereas the usual insertion technique is the best choice for patients with good vascular access and poor economic status. Therefore, the selection of an appropriate insertion technique should be based on the economic and vascular status of the individual patient in clinical practice.

scholarly journals Clinical Comparative Study of Lower Limb PICC and Deep Venous Catheterization

2020 ◽  
Author(s):  
FengXian Li ◽  
YuFen Hao ◽  
MeiJing Tian ◽  
YanPing Li ◽  
HongYang Zhang ◽  
...  
Keyword(s):  
Success Rate ◽  
Malignant Tumor ◽  
Average Length ◽  
Superior Vena ◽  
Bilateral Breast Cancer ◽  
Vena Cava ◽  
Lower Limbs ◽  
Ultrasound Guided ◽  
Venous Catheterization ◽  
Significant Difference

Abstract Objective: To compare the clinical application effects of peripherally inserted central catheter (PICC) and deep venous catheters placed through the lower limbs in adults, and to explore the advantages of ultrasound-guided PICC through the lower limbs in adults. Methods: A retrospective study was conducted on 27 bedridden patients with advanced malignant tumor between February 2017 and February 2019. The success rate of one-time catheterization, the length of catheterization puncture time, the number of catheterizations, and the occurrence of catheter-related complications of the two methods were compared. Results: Results of the study showed that ultrasound-guided PICC through the lower limbs has a higher success rate than deep venous catheterization. The average length of puncture time in adults with PICC through the lower limbs under ultrasound guidance was shorter than that in the femoral vein group. There was no significant difference in the incidence of catheter-related complications between the two groups. Conclusion: The indications for PICC through the lower limbs in adults include patients with advanced malignant tumor after bilateral breast cancer lymphadenectomy or superior vena cava obstruction syndrome, and mainly bedridden patients. This technique has certain advantages over deep venous catheterization and is an effective choice for venous access.

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