5 Standard Management of Eclampsia

2015 ◽  
pp. 29-30
Keyword(s):  
Standard Management

scholarly journals Strategies for the management of pulmonary arterial hypertension in patients with congenital heart disease

2020 ◽  
Vol 4 (S1) ◽  
Author(s):  
Nathalie Liew ◽  
Zoya Rashid ◽  
Robert Tulloh
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Standard Management ◽  
Advanced Therapies ◽  
Pulmonary Arterial ◽  
The Uk

Abstract Background Pulmonary hypertension (PH) is commonly seen in adults who have congenital heart disease (CHD). Therapy is available for pulmonary arterial hypertension (PAH) and has greatly benefitted many patients with PAH related to CHD (PAH-CHD) over the last 15 years, with evidence of improved quality of life and prognosis in those with Eisenmenger syndrome and repaired PAH-CHD. In this review, we describe the standard management and advanced therapies for PAH, which are available in specialist PH centres around the UK and Ireland, and how these are used in PAH-CHD. Decisions around the choice of therapy are governed by commissioning and available evidence. Conclusion We explain the different pathways for action and the variety of medications now at our disposal to help this important group of patients.

scholarly journals Hypotension in Preterm Infants (HIP) randomised trial

2021 ◽  
pp. fetalneonatal-2020-320241
Author(s):  
Eugene M Dempsey ◽  
Keith J Barrington ◽  
Neil Marlow ◽  
Colm Patrick Finbarr O'Donnell ◽  
Jan Miletin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Intraventricular Haemorrhage ◽  
Standard Group ◽  
Double Blind ◽  
Group Assignment ◽  
Standard Management ◽  
Postmenstrual Age ◽  
Registration Number

ObjectiveTo determine whether restricting the use of inotrope after diagnosis of low blood pressure (BP) in the first 72 hours of life affects survival without significant brain injury at 36 weeks of postmenstrual age (PMA) in infants born before 28 weeks of gestation.DesignDouble-blind, placebo-controlled randomised trial. Caregivers were masked to group assignment.Setting10 sites across Europe and Canada.ParticipantsInfants born before 28 weeks of gestation were eligible if they had an invasive mean BP less than their gestational age that persisted for ≥15 min in the first 72 hours of life and a cerebral ultrasound free of significant (≥ grade 3) intraventricular haemorrhage.InterventionParticipants were randomly assigned to saline bolus followed by either a dopamine infusion (standard management) or placebo (5% dextrose) infusion (restrictive management).Primary outcomeSurvival to 36 weeks of PMA without severe brain injury.ResultsThe trial terminated early due to significant enrolment issues (7.7% of planned recruitment). 58 infants were enrolled between February 2015 and September 2017. The two groups were well matched for baseline variables. In the standard group, 18/29 (62%) achieved the primary outcome compared with 20/29 (69%) in the restrictive group (p=0.58). Additional treatments for low BP were used less frequently in the standard arm (11/29 (38%) vs 19/29 (66%), p=0.038).ConclusionThough this study lacked power, we did not detect major differences in clinical outcomes between standard or restrictive approach to treatment. These results will inform future studies in this area.Trial registration numberNCT01482559, EudraCT 2010-023988-17.

scholarly journals Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Ryan G. Rogero ◽  
Emmanuel M. Illical ◽  
Daniel Corr ◽  
Steven M. Raikin ◽  
James Krieg ◽  
...  
Keyword(s):  
Gold Standard ◽  
Ankle Fracture ◽  
Management Strategies ◽  
Ankle Fractures ◽  
Multinomial Regression ◽  
Orthopaedic Surgeons ◽  
Suture Button ◽  
Standard Management ◽  
Management Protocol ◽  
Usage Patterns

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

scholarly journals Effectiveness of more strict managements after achievement of standard target value of low-density lipoprotein cholesterol in secondary prevention of Japanese patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Endo ◽  
Y Kagawa ◽  
H Sato ◽  
Y Morita ◽  
H Kawahara ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Coronary Revascularization ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Japanese Patients ◽  
Cardiac Ischemia ◽  
Low Density Lipoprotein Cholesterol ◽  
Standard Management ◽  
Coronary Events

Abstract Background In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL is recommended as standard management in Japanese guideline. The guideline also stated that strict management of LDL-C targeting <70 mg/dL is considered in some high risk patients. However, in Japanese patients, effectiveness of more strict management of LDL-C lowering therapy for prevention of long-term cardiovascular events remains unclear. Purpose The purpose of the present study was to evaluate whether the strict management of LDL-C targeting <70 mg/dL was effective to prevent recurrence of long-term coronary events than standard management in patients with previous percutaneous coronary intervention (PCI). Methods We investigated 344 patients with previous PCI who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C <70mg/dL (n=53), 70 to <100mg/dL (n=130) and ≥100mg/dL (n=161). Endpoints of this study were recurrence of cardiac ischemia presenting as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization. Results During average 7.1 years follow-up, 200 patients (58%) underwent any late coronary revascularization. In 94 of those patients, recurrence-ACS was observed. The incidence of recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.009 and p=0.001, respectively), however, there was no difference between patients with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.140). Any late revascularization was significantly lower in patients with achieved LDL-C <70mg/dL and in those with LDL-C 70 to <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.002 and p<0.001, respectively), however, no difference was found between patients with LDL-C <70mg/dL and LDL-C 70 to <100mg/dL (p=0.119). Moreover, in patients with achieved LDL-C <100mg/dL (n=183), multivariate analysis identified that LDL-C (HR 1.035, p=0.007) and HbA1c (HR 1.338, p=0.001) were independent predictors of recurrence-ACS. In contrast, only using statins (HR 0.461, p=0.009) was an independent predictor of recurrence-ACS in patients with achieved LDL-C ≥100mg/dL. Conclusions LDL-C was the important residual risk of recurrence-ACS even after recommended standard LDL-C lowering management had been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered to prevent recurrence-ACS for wider range of Japanese patients in secondary prevention. Incidence of late coronary events Funding Acknowledgement Type of funding source: None

scholarly journals Pulmonary Thromboembolism in a Child with Sickle Cell Hemoglobin D Disease in the Setting of Acute Chest Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Hazel Villanueva ◽  
Sandeepkumar Kuril ◽  
Jennifer Krajewski ◽  
Aziza Sedrak
Keyword(s):  
Pulmonary Artery ◽  
Sickle Cell ◽  
Pulmonary Thromboembolism ◽  
Acute Chest Syndrome ◽  
Standard Management ◽  
Pulmonary Angiogram ◽  
Right Pulmonary Artery ◽  
Ct Pulmonary Angiogram ◽  
Complete Thrombosis ◽  
The Right

Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD.Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pulmonary artery and multiple small pulmonary artery emboli seen on computed tomography (CT) pulmonary angiogram and thrombosis of the right brachial vein seen on Doppler ultrasound. Our patient responded to treatment with anticoagulant therapy.Conclusion. There are no cases reported in children with HbSD disease presenting as ACS with pulmonary thromboembolism. We suggest that PE should be suspected in patients presenting with ACS who do not show improvement with standard management. CT pulmonary angiogram should be utilized for early diagnosis and appropriate management as there is no current protocol for management of PE/DVT in pediatric patients with SCD.

scholarly journals Are Routine Postoperative X-rays Needed Following Surgery for Hallux Valgus? An Evaluation of their Use After Scarf Osteotomy

2007 ◽  
Vol 89 (3) ◽  
pp. 281-284 ◽  
Author(s):  
Richard J Murphy ◽  
Christopher M Blundell
Keyword(s):  
Hallux Valgus ◽  
Teaching Hospital ◽  
Retrospective Data ◽  
X Rays ◽  
X Ray ◽  
Orthopaedic Surgeons ◽  
Scarf Osteotomy ◽  
Standard Management ◽  
Large Teaching Hospital

INTRODUCTION Postoperative X-rays, following a scarf osteotomy, are generally carried out as routine. The aim of this study was to assess the value of performing such investigations. PATIENTS AND METHODS Retrospective data were collected regarding all scarf osteotomies performed by three consultant orthopaedic surgeons at a large teaching hospital. A review of routine postoperative X-rays was carried out. RESULTS A total of 274 scarf osteotomies were included in the study. Of these, 95% were followed by at least one routine postoperative X-ray. In total, 412 X-rays were performed of which 11% were not commented upon by a radiologist or a surgeon. Of the X-rays with comments from both specialists, only one case was reported as abnormal by both radiologist and surgeon, with no change in management made as a result of these reports. In two cases, changes to standard management were made on the basis of the routine postoperative X-rays and only one of these was implemented solely on the basis of the routine postoperative images. CONCLUSIONS The value of postoperative X-rays following a scarf osteotomy is questionable. We propose, on the basis of this study, that, unless clinically indicated, the routine use of postoperative X-rays following a scarf osteotomy should be abandoned.

scholarly journals Clinical Pattern and Management of Acute Pancreatitis – Our Experience

2014 ◽  
Vol 31 (3) ◽  
pp. 122-127
Author(s):  
MM Hasan ◽  
SZ Laila ◽  
MH Mamun
Keyword(s):  
Acute Pancreatitis ◽  
Gall Stone ◽  
Multiple Organ ◽  
High Serum ◽  
Military Hospital ◽  
Average Hospital ◽  
Systemic Involvement ◽  
Standard Management ◽  
Management Protocol ◽  
Upper Abdomen

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. It is a life threatening disease that has many causes, few effective treatments, numerous serious complications, and an often unpredictable course. The objectives of this study are to develop our knowledge about presentation and diagnosis of acute pancreatitis, to assess the patient with acute pancreatitis accurately and to develop a standard management protocol. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, CMH Momenshahi and CMH Ghatail during the period of June 2007 to December 2010. A total 25 patients of Acute Pancreatitis were studied retrospectively, evaluated and managed.Results: In this study 25 patients 19 (76%) were male (male : female = 3.17:1), age range 08 to 55 years, Mean age – 38.92 years. Maximum number of the patients fall into fourth and fifth decades. All patients presented with abdominal pain, specially in upper abdomen. Laboratory test revealed leucocytosis and high serum and urinary amylase, positive findings in Ultrasonogram and CT scan found in all patients. Gall stone was the leading cause 14 (56%). 20 (80%) patient developed some form of complications. 24 patients were treated conservatively. Average hospital stay was 15.52 days. Serious regional and systemic involvement in Acute Pancreatitis causes multiple organ or system failure. Conclusion: Early diagnosis and effective treatment can significantly reduce the morality and morbidity. DOI: http://dx.doi.org/10.3329/jbcps.v31i3.20977 J Bangladesh Coll Phys Surg 2013; 31: 122-127

scholarly journals The Standardization of Down-Streamed Small Business Social Responsibility (SBSR)

2017 ◽  
Vol 30 (4) ◽  
pp. 39-52 ◽  
Author(s):  
Laura Corazza
Keyword(s):  
Small Business ◽  
Social Responsibility ◽  
Management Practice ◽  
Principal Component ◽  
Sustainability Reporting ◽  
Csr Reporting ◽  
Standard Management ◽  
Corporate Social ◽  
Sustainability Report ◽  
Small Business Social Responsibility

Scholars have begun to investigate the prevalence of Corporate Social Responsibility (CSR) within the context of small and medium-sized enterprises (SMEs). This paper studies the implementation of non-financial sustainability reporting tools in Italian SMEs as part of their Small Business Social Responsibility (SBSR) long supply chain compact with large multinationals. The fundamental finding of this work is that because of the down-streaming effect of CSR reporting from large companies to small ones, SMEs approach sustainability as a standard management practice. The sample is composed of 73 Italian multi-certified entities (SA8000/ISO14001/EMAS) that have published their sustainability report online between 2011 and 2013. Principal Component Analysis (PCA) was used to discover three otherwise un-observable underlying effects.

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