Selective placement of autogenous arteriovenous fistulae in an over 80-year-old population

2018 ◽  
Vol 19 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Keagan Werner-Gibbings ◽  
Liesl Ischia ◽  
William Butcher ◽  
Richard Ward-Harvey ◽  
Jonathan Stewart ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Demographic Data ◽  
Survival Rates ◽  
Primary Patency ◽  
University Hospital ◽  
Selective Placement ◽  
Minimal Evidence ◽  
Better Than

Introduction: With improved life expectancy and quality of life, elderly patients constitute a progressively larger fraction of consumers utilising renal replacement therapy (RRT). Although substantial data exist for younger cohorts, minimal evidence exists for outcomes of arteriovenous fistula (AVF) and central catheters (CVC) placed in those patients over 80 years. We examined outcomes of primary AVF placement in this cohort to ascertain durability and benefits of AVF in the over 80-year-old population. Methods: Retrospective analysis was undertaken of all autogenous AVFs and CVCs placed in patients aged over 80 years at Gold Coast University Hospital between March 2010 and February 2016. Prospectively collected demographic data, co-morbidities and operative factors were analysed. Results: Sixty-five AVF and 12 CVC patients were identified. Mean age at intervention was 83.9 years and 76% of the patients were male. The majority of procedures were autogenous radio-cephalic AVF; median post-operative length of stay was 2 days. Cumulative AVF patient survival at 12 and 24 months was 82% and 72%, respectively. This was significantly better than survival rates of CVC patients, with 12-month survival of 45%. Primary patency at 6, 12 and 24 months was 58%, 39% and 31%. There were 113 follow-up procedures in 41 patients required to maintain patency. Conclusions: Although patency rates are inferior and re-intervention rates higher than in younger patients, AVF can be a durable option for RRT in selected elderly patients with improved mortality rates compared with CVC. Age alone should not preclude primary AVF placement.

scholarly journals Health-related quality of life in different trimesters during pregnancy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Huailiang Wu ◽  
Weiwei Sun ◽  
Hanqing Chen ◽  
Yanxin Wu ◽  
Wenjing Ding ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pregnant Women ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Health Related Quality ◽  
Cross Sectional ◽  
Related Quality ◽  
Health Related

Abstract Background Pregnant women experience physical, physiological, and mental changes. Health-related quality of life (HRQoL) is a relevant indicator of psychological and physical behaviours, changing over the course of pregnancy. This study aims to assess HRQoL of pregnant women during different stages of pregnancy. Methods This cross-sectional study was performed using the The EuroQoL Group’s five-dimension five-level questionnaire (EQ-5D-5L) to assess the HRQoL of pregnant women, and demographic data were collected. This study was conducted in a regional university hospital in Guangzhou, China. Results A total of 908 pregnant women were included in this study. Pregnant women in the early 2nd trimester had the highest HRQoL. The HRQoL of pregnant women rose from the 1st trimester to the early 2nd trimester, and dropped to the bottom at the late 3rd trimester due to some physical and mental changes. Reports of pain/discomfort problem were the most common (46.0%) while self-care were the least concern. More than 10% of pregnant women in the 1st trimester had health-related problems in at least one dimension of whole five dimensions. In the whole sample, the EuroQoL Group’s visual analog scale (EQ-VAS) was 87.86 ± 9.16. Across the gestational stages, the HRQoL remained stable during the pregnancy but the highest value was observed in the 1st trimester (89.65 ± 10.13) while the lowest was in the late 3rd trimester (87.28 ± 9.13). Conclusions During pregnancy, HRQoL were associated with gestational trimesters in a certain degree. HRQoL was the highest in the early 2nd trimester and then decreased to the lowest in the late 3rd trimester due to a series of physical and psychological changes. Therefore, obstetric doctors and medical institutions should give more attention and care to pregnant women in the late 3rd trimester.

Bifurcated bypass in severe chronic limb threatening ischaemia

Vascular ◽  
2021 ◽  
pp. 170853812199985
Author(s):  
Daniele Adami ◽  
Michele Marconi ◽  
Alberto Piaggesi ◽  
Davide M Mocellin ◽  
Raffaella N Berchiolli ◽  
...  
Keyword(s):  
Survival Rates ◽  
Primary Patency ◽  
Free Survival ◽  
Mortality And Morbidity ◽  
Bypass Patency ◽  
Stage 4 ◽  
Endovascular Approach ◽  
The Mean ◽  
Clinical Records

Objectives Revascularization according to the angiosome concept is of proven importance for limb salvage in chronic limb threatening ischaemia but it is not always practicable. Bifurcated bypasses could be considered as an option when an endovascular approach is not feasible or has already failed and a single bypass would not allow direct revascularization of the ischaemic area. Bifurcated bypasses are characterized by landing on two different arteries, the main artery (in direct continuity with the foot vessels) and the secondary one (perfusing the angiosome district). The aim of this study is to evaluate the safety and effectiveness of bifurcated bypass in chronic limb threatening ischaemia. Methods Thirty-five patients were consecutively treated with a bifurcated bypass for chronic limb threatening ischaemia from January 2014 to December 2019 in a single vascular surgery centre. Data from clinical records and operative registers were collected prospectively in an electronic database and retrospectively analysed. Primary and primary assisted bypass patency, amputation-free survival, morbidity and mortality rates at 12 and 24 months were analysed. Results Mean follow-up period was 25.1 months (range 2–72 months). Thirty-six bifurcated bypasses were performed on 35 patients (age 75.3 ± 7.2 years; 69.4% were male). According to Wound, Ischemia, foot Infection classification 22.2% belonged to stage 3 and 77.8% to stage 4 and the mean Rutherford’s class was 5.1 ± 0.7. Immediate technical success was 100%. Early mortality and morbidity rates were respectively 5.5%, and 33.3%; foot surgery was performed in 50% of cases with wound healing in all patients. Primary patency and primary assisted bypass patency were 96.7% and 100% at 6 months; 85.2% and 92% at 12 months, 59.9% and 73.4% at 24 months, respectively. Amputation-free survival at 12 and 24 months was, respectively, 95.6% and 78.8%. Overall survival rates at 12 and 24 months were respectively 94.4% and 91.6%. Conclusions Bifurcates bypass can provide good results in patients with chronic limb threatening ischaemia without endovascular option, especially in diabetic ones. Bifurcated bypass is a complex surgical solution, both to be planned and performed, and it is quite invasive for frail patients that should be accurately selected.

TREATMENT OF SPINAL TUMORS USING CYBERKNIFE FRACTIONATED STEREOTACTIC RADIOSURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 297-307 ◽  
Author(s):  
Gregory J. Gagnon ◽  
Nadim M. Nasr ◽  
Jay J. Liao ◽  
Inge Molzahn ◽  
David Marsh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stereotactic Radiosurgery ◽  
University Hospital ◽  
Postoperative Treatment ◽  
Spinal Tumors ◽  
Radiation Toxicity ◽  
Pain Scores ◽  
Component Scores

Abstract OBJECTIVE Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system (Accuray, Inc., Sunnyvale, CA) is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors. METHODS We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment. RESULTS Mean pain scores decreased significantly from 40.1 to 28.6 after treatment (P < 0.001) and continued to decrease over the entire 4-year follow-up period (P < 0.05). SF-12 Physical Component scores demonstrated no significant change throughout the follow-up period. Mental Component scores were significantly higher after treatment (P < 0.01), representing a quality-of-life improvement. Early side effects of radiosurgery were mild and self-limited, and no late radiation toxicity was observed. CONCLUSION CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile.

Abstract 2130: Long-term Outcomes of Adult Atrial Septal Defect With Severe Pulmonary Hypertension After Surgical Closure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jeong-Hoon Kim ◽  
Duk-Hyun Kang ◽  
Jong-Young Lee ◽  
Jong-Min Song ◽  
Tae-Jin Yun ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Elderly Patients ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Survival Rates ◽  
Severe Pulmonary Hypertension ◽  
Term Survival ◽  
Surgical Closure

The benefits of surgical closure has been unclear in adult atrial septal defect (ASD) with severe pulmonary hypertension (PHT), and we tried to evaluate improvement of PHT and long-term survival after surgical closure compared to medical follow-up. Methods: From 1996 to 2006, we included a total of 71 adult ASD patients (age; 43±15 years) with severe PHT documented by echocardiography. The inclusion criteria were defined as ASD diameter > 15 mm, enlarged right ventricle, and the baseline peak velocity of tricuspid regurgitation (TR) ≥ 4.0 m/sec. We excluded 5 patients with Eisenmenger syndrome documented by cardiac catheterization. Surgical closure was performed on 55 patients (OP group) and the remaining 16 patients were followed up medically (MED group). The improvement of PHT was defined as TR velocity ≤ 3.5 m/sec on follow-up echo. Results: Baseline characteristics and clinical results were compared between the two groups in table . There were no significant differences in terms of gender, ASD diameter, cardiac rhythm, and TR velocity, but the MED group was significantly older. During follow-up of 46±33 months, there were 5 deaths in the MED group and no operative or late death in the OP group, and the 5-year actuarial survival rate of the OP group was significantly higher than the MED group (58±15%, p<0.05). On subgroup analysis according to age, the OP group showed significantly better survival rates than the MED group (p<0.05) in elderly patients (age > 50). In the OP group, TR velocity was significantly decreased from 4.5±0.4 to 3.0±0.7 m/sec on follow-up echo, and improvement of PHT was observed in 47 (85%) patients. On multivariate analysis, female gender and lower baseline TR velocity were the significant independent predictors of improved PHT after surgery. Conclusions: In adult ASD with severe PHT, surgical closure can be safely performed and improve PHT effectively. Especially in elderly patients, ASD closure is significantly related with the better survival rates.

scholarly journals Follow-up of Newborns, Infants, and Children with Sepsis

2017 ◽  
Vol 07 (01) ◽  
pp. e38-e41
Author(s):  
P. Dahlem ◽  
P. Biggar
Keyword(s):  
Survival Rates ◽  
Newborn Infants ◽  
Infants And Children ◽  
Older Children ◽  
Follow Up Studies ◽  
Related Quality ◽  
Health Related ◽  
Considerable Impact

AbstractMortality in newborn infants and children with sepsis is high with survival rates of generally more than 50% in recent studies. Longitudinal follow-up studies have the potential to reveal short-term and lifelong physical, mental, and psychological sequelae. Although no comprehensive follow-up research has yet been performed, a small number of follow-up studies have shown that there is a considerable impact on the patients' lives and their families after hospital discharge. Health-related quality of life also seems to be affected; however, it does not correlate with severity of sepsis or handicap per se. Prematurely born infants, who can develop sequelae directly attributable to prematurity and its consequences, suffer differently from sepsis-related lifelong sequelae compared with older children. Fortunately, time may heal some wounds due to the effect of growth in children. In future, large centers should establish structural follow-up programs for clinical and research purposes to learn more about the needs of affected children and their families.

scholarly journals Charlson Comorbidity Index Predicts 5-Year Survivorship of Surgically Treated Hip Fracture Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931880644 ◽  
Author(s):  
Lei Jiang ◽  
Andrew Chia Chen Chou ◽  
Nivedita Nadkarni ◽  
Caris En Qi Ng ◽  
Yun San Chong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Charlson Comorbidity Index ◽  
Demographic Data ◽  
Survival Rates ◽  
Predictive Ability ◽  
Fracture Pattern ◽  
Mortality Data ◽  
Comorbidity Index

Introduction: This study aims to assess the correlation of the age-adjusted Charlson comorbidity index (ACCI) with 5-year mortality in a surgically treated hip fracture population. Materials and Methods: A retrospective analysis was performed on 1057 patients aged 60 years and above who underwent surgery for hip fracture with a minimum of 5-year follow-up (92.2% 5-year follow-up rate) in a tertiary hospital. Manual review of patients’ electronic hospital records was performed to record demographic data, comorbidities, and length of stay. Mortality data were extracted from the hospital’s electronic medical records and corroborated with the National Electronic Health Record. Results: Of the 1057 patients, 283 (26.8%) were male. The majority of patients were 80 years of age and above (42.5%), with the oldest patient operated on age 102 with a mean age of 77.8 (8.6) years. Four hundred eighteen (39.5%) patients sustained extracapsular intertrochanteric fractures. The mean follow-up duration was 8 years and 3 days with an overall survivorship of 37.2%. A multiple regression model constructed with ACCI, age, gender, and fracture pattern demonstrated satisfactory predictive ability with a concordance statistic of 0.68. Patients with a higher ACCI category (≥6) had an increased 5-year mortality rate (41.8%) with an odds ratio of 13.6 (6.7-31.8, P < .001) compared to those with an ACCI category of 3 and below (89.3%). Discussion: The study demonstrates that ACCI correlated with 5-year mortality after surgical treatment of hip fracture. This information is pertinent in the counseling of patients with regard to their midterm survival following hip fracture surgery and may inform policy makers of the varied midterm survival rates in patients with differing ACCI scores and educate the allocation of health-care resources. Conclusion: The ACCI correlates with 5-year mortality after surgical treatment of hip fracture.

scholarly journals Improvement in childhood cancer survival in Lithuania over three decades

2020 ◽  
Vol 27 (1) ◽  
pp. 1-9
Author(s):  
Jelena Rascon ◽  
Giedrė Smailytė
Keyword(s):  
Childhood Cancer ◽  
Cancer Survival ◽  
Survival Rates ◽  
Population Based ◽  
Early Years ◽  
University Hospital ◽  
Entire Cohort ◽  
Background Population ◽  
Childhood Cancer Survival

Background. Population-based EUROCARE-5 studies demonstrated that childhood cancer survival rates in Lithuania were 10–20% lower than the European mean. We aimed to analyse the change in the outcome of treatment of paediatric malignancies in Lithuania over 30 years. Methods. A single-centre retrospective analysis of children below 18 years of age treated for cancer at Vilnius University Hospital Santaros Klinikos between 1982 and 2011 was carried out. The minimal requirement of 5-year follow-up after diagnosis was specified for survival estimation. The vital status was assessed using data from the population-based Lithuanian Cancer Registry. To evaluate changes over time, the entire cohort was split into three groups according to the time of diagnosis: 1982–1991, 1992–2001, and 2002–2011. Results. A total of 1268 children met the inclusion criteria. The shortest median follow-up was 8.9 (IQR 6.4–11.5) years for patients treated in the third decade. The 5-year overall survival of the entire cohort increased from 37.3% (95% CI 30.2–44.3) in 1982–1991 to 70.7% (95% CI 66.4–74.1) in 2002–2011 (p < 0.0001). The same trend was evident when calculated separately for leukaemia (p < 0.0001), lymphoma (p < 0.0005), and solid tumours (p < 0.004). The percentage of cure rose from zero in the early years of the period analysed to 80% in 2010 and 2011. The improvement in the treatment outcome was attributable to the reduction of treatment-related mortality from 45.8% in 1982–1991 to 12.4% in 2002–2011 and disease recurrence from 30.4% to 19.6% for the same periods, respectively. Conclusions. Significant progress in the cure rate of children treated for cancer at our institution was observed over 30 years. Collaborative national and international clinical and research efforts are crucial to ensure further advances in care and cure.

scholarly journals URINARY INCONTINENCE;

2017 ◽  
Vol 24 (06) ◽  
pp. 824-827
Author(s):  
Ambreen Amna ◽  
Farkhunda Nadeem ◽  
Pushpa Srichand
Keyword(s):  
Urinary Incontinence ◽  
Stress Incontinence ◽  
Urinary Fistula ◽  
University Hospital ◽  
Persistent Symptoms ◽  
Grade 3 ◽  
Time Of Admission ◽  
Study Setting

Background: Genitourinary fistula remains a major cause of morbidity worldwide.Approximately 2 million of women suffer from urinary leakage. Since the establishment ofGenito urinary Fistula center at Isra University Hospital –Hyderabad Sindh. We are able to shareour experience of fistulous women at the time of admission and at follow up visit. Objectives:To determine the different types of urinary incontinence in a woman after genitourinary fistularepair. Study Design: A Follow-up Descriptive study. Study Setting: This Study was done atFistula center Isra University Hospital Hyderabad GU – 11 from January 2011 to December2013. All the women who were admitted with true incontinence followed by Obstetrical andmajor gynecological surgeries were included. However women with stress incontinence andurge incontinence and women who are not willing to include in the study were excluded.Result: Out of one hundred and ten (110) women included in this study, 59 (53.6%) were foundto have obstetrical fistula, while 43 (39%) were suffering from Iatrogenic fistula. Continencestatus were explored at follow up visit. Out of 110 women, 108 (98.18%) & 96 (87.27 %) werehaving no signs of incontinence on examination at first visit and after six week and secondvisit after three month respectively. Only 7 % women fell into incontinence grade 2 at six weekfollow up and only one percent had persistent symptoms of stress incontinence at 3 monthrespectively. Women fall on incontinence grade 3, 4 and 5 were completely cured at 3 month.Conclusion: Success rate of genitor- urinary fistula repair is 98 %. Majority of women (96 %)on short term follow up at 6 weeks showed improved urinary symptoms. Moreover on follow upvisit at 3 months, these women reported improved quality of life and social reintegration afterfistula closure.

Evaluation of Hepatitis C Patients' Satisfaction Regarding Care and Treatment in Different Hospitals in Cairo, Egypt, 2020

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Shaimaa S Yousef ◽  
Lamyaa S Al Bagoury ◽  
Sahar A Dewedar ◽  
Sahar M Sabbour ◽  
Wagida A Anwar
Keyword(s):  
Viral Hepatitis ◽  
Demographic Data ◽  
University Hospital ◽  
Health Providers ◽  
Cross Sectional ◽  
Indirect Measure ◽  
Patients Satisfaction ◽  
Significant Difference ◽  
Care And Treatment

Abstract Background Patient satisfaction can be considered as an indirect measure of health outcomes and quality of provided services. Objectives To compare HCV patients' satisfaction regarding care and treatment in different selected Viral Hepatitis Outpatients Clinics in Cairo. Method: The current study is a cross sectional study. It recruited 300 HCV patients from Viral Hepatitis Outpatients Clinics in University, Ministry of Health (MOH) and Insurance Hospitals (100 HCV patients from each clinic). Recruited HCV patients attended at least 2 visits to the Viral Hepatitis Clinics. They completed an interview questionnaire about socio- demographic data, history of diagnosis of HCV, onset and type of treatment and Hepatitis Patients Satisfaction Questionnaire (HPSQ). Results Mean age of HCV patients were (48.9 ±13.5), (50.4 ± 10.4), and (54.8 ± 10.9) from University, MOH and Insurance Hospitals, respectively. Females accounted for (63%) of HCV patients in University Hospital sample however, males were (54%) and (57%) in MOH and Insurance Hospitals, respectively. Most of studied HCV patients were referred by specialists; (59%), (86%) and (87%) from University, MOH, and Insurance Hospitals, respectively. A statistically significant difference was found between the 3 Clinics as regards rating the quality of received HCV services, meeting patients’ needs, coping with HCV disease, and helping patients access to specialist services (p &lt; 0.01). The study revealed that the majority of health providers in the 3 Viral Hepatitis Clinics didn't involve HCV patients in making decisions about their treatment. Conclusion HPSQ findings identified University Hospital's patients more satisfied about their HCV treatment management than MOH and Insurance Hospitals' patients except for involvement of HCV patients in making decisions which was lacking in the 3 hospitals.

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