scholarly journals Urologic guidelines for the care and management of people with spina bifida

2020 ◽  
Vol 13 (4) ◽  
pp. 479-489
Author(s):  
David B. Joseph ◽  
Michelle A. Baum ◽  
Stacy T. Tanaka ◽  
Dominic C. Frimberger ◽  
Rosalia Misseri ◽  
...  
Keyword(s):  
Renal Function ◽  
Spina Bifida ◽  
Best Practice ◽  
Case Reports ◽  
English Literature ◽  
Age Groups ◽  
Standard Of Care ◽  
Urinary Continence ◽  
Clinical Questions ◽  
High Level

PURPOSE: The life expectancy for people with spina bifida has increased, thus resulting in greater need for guidelines in urologic care in order to protect normal renal function, to develop strategies for urinary continence, and to advance independence through adult years. METHODS: The English literature was assessed from 2002–2015; greater than 300 publications identified. Case reports and opinion pieces were eliminated leaving 100 for in depth review. Clinical questions were then established for each age group that allowed for focused assessment. RESULTS: There was no Level 1 evidence for any of the defined clinical questions. This resulted in group consensus for all questions throughout all age groups. Guidelines were provided for identifying a symptomatic urinary infection, the role of urodynamic bladder testing and identification of bladder hostility, determining methods of renal function assessment and surveillance, the initiation of continence control, and transitioning to self-care through the teen and adult years. CONCLUSION: Urologic guidelines continue to be based on clinical consensus due to the lack of high level evidence-based research. Further research is required in all aspects of urologic management. While not the “Standard of Care,” these guidelines should be considered “Best Practice”.

EP.FRI.82 Using NCEPOD guidelines to develop an evidence based pathway for acute bowel obstruction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
William Bierrum ◽  
Varvara Bashkirova ◽  
Thomas Jones
Keyword(s):  
Bowel Obstruction ◽  
Best Practice ◽  
Standard Of Care ◽  
Large Bowel Obstruction ◽  
Adhesive Small Bowel Obstruction ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Status Assessment ◽  
High Level ◽  
The Impact

Abstract Bowel obstruction is a common presentation and poses a significant challenge for clinicians. This condition is associated with a high level of mortality and morbidity. The aim of this project was to assess the clinical pathway for patients presenting with bowel obstruction and improve the overall care they received. This was achieved using guidance from the 2020 NCEPOD report looking at bowel obstruction management. Best practice guidelines from the NCEPOD report were used to assess aspects of patient care such as the time to senior review, assessment of nutrition/fluid status and risk of mortality/morbidity assessment. This identified areas where the standard of care was good, such as the majority of patients being assessed by a consultant within 14 hours. However, it also identified areas such as hydration and nutritional status assessment, documentation of ceilings of care/treatment escalation plans and calculation of risk of mortality and morbidity, which required improvement. An admission checklist and nutritional scoring sheet was created to help prompt clerking doctors when admitting patients with acute bowel obstruction. All cases of bowel obstruction were then prospectively audited over a 2 month period to assess the impact of these changes. The findings were presented at the departmental meetings to increase clinician awareness. Following the audit period, local guidelines were amended to incorporate the NCEPOD recommendations, specific pathways were also made for adhesive small bowel obstruction and malignant large bowel obstruction due to the specific requirements of these conditions. 

A Study on Knowledge, Attitude, Awareness and Practice About HIV/AIDS among different age group of Karachi, Pakistan

2017 ◽  
Vol 3 (3) ◽  
pp. 328-333
Author(s):  
Safia Mehmood ◽  
Sheema Zia ◽  
Nida Aziz ◽  
Omama Sajid
Keyword(s):  
Hiv Transmission ◽  
Age Groups ◽  
World Population ◽  
Major Barrier ◽  
Initial Stage ◽  
Awareness Programs ◽  
And Gender ◽  
Strongly Agree ◽  
High Level ◽  
Lack Of Knowledge

The AIDS is one of the most complicated health problems of the 21st century and it threatens the world population. AIDS spread at an alarming rate. This was a descriptive study to determine the knowledge, awareness, and practice about HIV among different age groups. The study carried out in Karachi, Pakistan during the period of January 2016-april 2016, in which 82 peoples are participated; 65 peoples having age in between 18-30, people’s lies in 31-40 years, while only 4 peoples having age above 40. From which 91% peoples thought HIV is dangerous virus and 51% peoples having misconception that it cause AIDS on initial stage and does not have any effect on CD4+. Majority of peoples aware about transmission of AIDS through intercourse, and during pregnancy. But the study show the high level of misbelieve also in mode of transmission that HIV transmit through sweat, saliva etc. Majority of the peoples have knowledge that HIV-1 is the most common type found worldwide. Also large number of peoples have knowledge that HIV weak immune system by destroying CD4+ and require long exposure to progress AIDS. Less than 15% of peoples strongly agree that AIDS is common in women. This misconception reflex the lack of knowledge and awareness in the HIV transmission and gender relation. Also majority of peoples thought that lack of knowledge is major barrier in the proper cure of disease. So increasing knowledge by awareness programs; sexual prevention; by starting national testing resources and curing poverty will cured AIDS in Pakistan. Newly drugs are introduced which can stop the progression of AIDS.

scholarly journals Efficacy and safety of urate-lowering therapy in people with kidney impairment: a GCAN-initiated literature review

2021 ◽  
Author(s):  
Hamish Farquhar ◽  
Ana B Vargas-Santos ◽  
Huai Leng Pisaniello ◽  
Mark Fisher ◽  
Catherine Hill ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Case Reports ◽  
Serum Urate ◽  
Cochrane Library ◽  
Future Studies ◽  
Kidney Impairment ◽  
The Cochrane Library ◽  
Study Designs ◽  
Different Levels

Abstract Objectives To evaluate the efficacy, defined as achieving target serum urate <6.0 mg/dl, and safety of urate-lowering therapies (ULT) for people with gout and CKD stages 3–5. Methods PubMed, The Cochrane Library, and EMBASE, were searched from 1 January 1959 to 31 January 2018 for studies that enrolled people with gout, who had an estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) of < 60 mL/min, and exposure to allopurinol, febuxostat, probenecid, benzbromarone, lesinurad or pegloticase. All study designs other than case reports were included, except for people on dialysis, for which we did include case reports. Results There were 36 reports with an analysis of efficacy and/or safety based upon renal function – allopurinol (n = 12), febuxostat (n = 10), probenecid (n = 3), benzbromarone (n = 5), lesinurad (n = 5), and pegloticase (n = 1). There were 108 reports that involved people with gout and renal impairment but did not contain any analysis on efficacy and/or safety based upon renal function – allopurinol (n = 84), febuxostat (n = 14), benzbromarone (n = 1), lesinurad (n = 3), and pegloticase (n = 6). Most studies excluded people with more severe degrees of renal impairment (eGFR or CrCl of < 30mL/min). For allopurinol in particular, there was significant variability in the dose of drug used, and efficacy in terms of urate lowering, across all levels of renal impairment. Conclusion There is a lack of evidence regarding efficacy and/or safety of currently used ULT according to different levels of renal function. Future studies should include patients with CKD and should report study outcomes stratified by renal function.

A proposal to enhance national capability to manage epidemics: The critical importance of expert statistical input including official statistics

2021 ◽  
pp. 1-17
Author(s):  
N.I. Fisher ◽  
D.J. Trewin
Keyword(s):  
Data Streams ◽  
Age Groups ◽  
Quantitative Information ◽  
Economic Welfare ◽  
Way Of Life ◽  
Policy Makers ◽  
The Social ◽  
Novel Virus ◽  
High Level ◽  
Integration Analysis

Given the high level of global mobility, pandemics are likely to be more frequent, and with potentially devastating consequences for our way of life. With COVID-19, Australia is in relatively better shape than most other countries and is generally regarded as having managed the pandemic well. That said, we believe there is a critical need to start the process of learning from this pandemic to improve the quantitative information and related advice provided to policy makers. A dispassionate assessment of Australia’s health and economic response to the COVID-19 pandemic reveals some important inadequacies in the data, statistical analysis and interpretation used to guide Australia’s preparations and actions. For example, one key shortcoming has been the lack of data to obtain an early understanding of the extent of asymptomatic and mildly symptomatic cases or the differences across age groups, occupations or ethnic groups. Minimising the combined health, social and economic impacts of a novel virus depends critically on ongoing acquisition, integration, analysis, interpretation and presentation of a variety of data streams to inform the development, execution and monitoring of appropriate strategies. The article captures the essential quantitative components of such an approach for each of the four basic phases, from initial detection to post-pandemic. It also outlines the critical steps in each stage to enable policy makers to deal more efficiently and effectively with future such events, thus enhancing both the social and the economic welfare of its people. Although written in an Australian context, we believe most elements would apply to other countries as well.

scholarly journals Implant Treatment with 12-Year Follow-Up in a Patient with Severe Chronic Periodontitis: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Keisuke Seki ◽  
Yoshiyuki Hagiwara
Keyword(s):  
Periodontal Disease ◽  
Chronic Periodontitis ◽  
Case Reports ◽  
English Literature ◽  
Supportive Therapy ◽  
Periodontal Treatment ◽  
Periodontal Tissues ◽  
Severe Periodontitis ◽  
And Control ◽  
Implant Treatment

Tooth loss among adults is associated with progressive periodontitis. Implant prosthetic treatment has long been utilized in periodontal patients. Even when the implants are applied, ongoing management of periodontal disease and control of inflammation is necessary to maintain a healthy oral cavity. Lack of appropriate periodontal treatment can result in recurrence of periodontal disease during a maintenance period; loss of the supportive capacity of the periodontal tissues will increase the susceptibility of residual teeth to traumatic force. For this reason, it is worthwhile to improve oral function by applying implants as a fixed device. Here, we report that implant treatment in a patient with generalized severe chronic periodontitis helped maintain the periodontal and peri-implant tissue for a long term. We propose that initial periodontal treatment and ongoing supportive therapy can help maintain implants in patients with severe periodontitis. In addition, we reviewed case reports in the English literature so far.

scholarly journals Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Samantha Chakraborty ◽  
Bianca Brijnath ◽  
Jacinta Dermentzis ◽  
Danielle Mazza
Keyword(s):  
Qualitative Research ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
International Guideline ◽  
Novel Approach ◽  
Clinical Questions ◽  
Key Questions

Abstract Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.

scholarly journals Novel operative technique of advancement urethral meatoplasty utilizing buccal mucosa for Vulvar Paget’s disease with urethral invasion: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Masaki Nakamura ◽  
Yuji Hakozaki ◽  
Shohei Iwata ◽  
Yusuke Sato ◽  
Katsuhiro Makino ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Case Reports ◽  
Paget’S Disease ◽  
External Genitalia ◽  
Skin Grafting ◽  
Standard Of Care ◽  
Paget's Disease ◽  
Vaginal Mucosa ◽  
Vulvar Paget’S Disease

Abstract Background Vulvar Paget’s disease (VPD) is a rare malignant disorder originating in the external genitalia. It occasionally invades into urethral or vaginal mucosa of female, making surgical treatment more complicating. In case of urethral invasion of Paget’s cells, systematic mapping biopsy of urethral mucosa is the standard of care to determine the range of surgical resection. Resection of urethral mucosa and simple skin grafting often result in urethral stricture after surgery, which severely deteriorates patient’s quality of life. Case presentation We applied a new technique of advancement urethral meatoplasty using buccal mucosa, in two Japanese cases of VPD with urethral invasion. After broad resection of vulvar skin together with the urethral mucosa, buccal mucosa was implanted between advanced urethral mucosa and skin graft. In both cases, we could prevent urethral stricture one year and two years after surgery, respectively. Conclusion This technique prevented urethral stricture after surgery and could be a useful technique as part of urethroplasty for VPD.

scholarly journals Management of lymphoma in pregnancy

2009 ◽  
Vol 2 (2) ◽  
pp. 46-51 ◽  
Author(s):  
K Hodby ◽  
P A Fields
Keyword(s):  
Health Care Professionals ◽  
Personal Experience ◽  
Best Practice ◽  
Current Practice ◽  
Case Reports ◽  
Current Opinion ◽  
Diagnosis Of Cancer ◽  
Relative Rarity ◽  
The Impact ◽  
Common Malignancy

One in every thousand pregnancies is complicated by a concurrent diagnosis of cancer. Lymphoma is currently the fourth most common malignancy diagnosed during pregnancy and its incidence is rising. The diagnosis and management of any malignancy during pregnancy is clearly a clinical and emotional minefield for both patients and health-care professionals. The major challenge is to optimize medical treatment offered to the mother, while limiting the impact on the fetus. Given the relative rarity of the situation, current practice is guided by case reports and personal experience of management of similar patients. Our centre has a large and busy lymphoma practice, and has cared for several women diagnosed with a variety of subtypes of lymphoma over the years. This review aims to summarize current opinion about best practice regarding these patients and discusses options available from the current literature.

Perioperative Outcomes of Percutaneous Nephrolithotomy in Septuagenarians and Beyond

2021 ◽  
Vol 104 (9) ◽  
pp. 1497-1502
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Renal Calculus ◽  
Perioperative Outcomes ◽  
Kidney Calculi ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Background: Life expectancy has continuously risen worldwide. Because the elderly may tolerate complications poorly, the risks and benefits of percutaneous nephrolithotomy (PCNL) in those patients should be discussed thoroughly. Objective: To analyze utility and operative outcomes of PCNL with respect to age. Materials and Methods: A retrospective study of PCNL was performed at Ramathibodi Hospital between 2011 and 2020. The patients were divided into two age groups, 1) below 70 years old and 2) 70 years old and above. Comparison of demographics, operative data, and postoperative outcomes were analyzed. Results: Of the 253 patients, the overall stone-free rate (SFR) was 59.7%. The SFR in younger groups and older groups were 59.4% (126/212) and 61.0% (25/41), respectively, which was not significantly different (p=0.999). There was a similar in-stone burden between the two groups (p=0.573). Patients in the older group had worse renal function, higher American Society of Anesthesiologists score, and more comorbidities, including hypertension and ischemic heart disease. However, estimated blood loss, length of hospital stay, operative time, percent change in eGFR, and complications were comparable between the groups. Conclusion: PCNL is a safe and effective treatment of kidney calculi in septuagenarians and older patients, even with the risk of higher comorbidities and poorer renal function than in younger patients. Keywords: Percutaneous nephrolithotomy; Renal calculus; Stone-free status; Septuagenarians

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