scholarly journals Optimal Positioning for ERCP: Efficacy and Safety of ERCP in Prone versus Left Lateral Decubitus Position

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Mashal Batheja ◽  
M. Edwyn Harrison ◽  
Ananya Das ◽  
Rodney Engel ◽  
Michael Crowell
Keyword(s):  
Bile Duct ◽  
Prone Position ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Efficacy And Safety ◽  
Inclusion Criteria ◽  
Left Lateral Decubitus Position ◽  
Potential Alternative ◽  
Lateral Decubitus

Background. ERCP is customarily performed with the patient in prone position. For patients intolerant of prone positioning, ERCP in left lateral decubitus (LLD) position offers a potential alternative. Aims. To compare efficacy and safety of ERCP in the LLD position versus prone position. Methods. Consecutive ERCP reports from August 2009 to October 2010 at Mayo Clinic Arizona were reviewed. Inclusion criteria. Age > 18 years, native papilla, and biliary indication. Primary outcome measure. Bile duct cannulation rate. Secondary outcomes. Times to ampullary localization and bile duct cannulation and complication rate. Results. ERCPs reviewed from 59 patients in two positions: 39 prone and 20 LLD. Cannulation Rate. 100% prone versus 90% in LLD (P=0.11). Median (IRQ) times. (1) Ampullary localization: 90 sec (70–110) prone versus 100 sec (80–118) (P=0.16); (2) bile duct cannulation: 140 sec (45–350) prone versus 165 sec (55–418) LLD (P=0.54). Complications. No periprocedure; postprocedure 4 (10%) prone versus 3 (15%) LLD (P=0.65). Conclusion. ERCP performed in LLD position allowed deep bile duct cannulation in 90% of patients without significantly increased procedural times or rate of complications as compared to prone position.

Phacoemulsification plus endoscopic cyclophotocoagulation versus phacoemulsification alone in primary open-angle glaucoma

2018 ◽  
Vol 28 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Francisco Pérez Bartolomé ◽  
Ian A. Rodrigues ◽  
Saurabh Goyal ◽  
Edward Bloch ◽  
Wei S. Lim ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Open Angle Glaucoma ◽  
Outcome Measure ◽  
Matched Control ◽  
Open Angle Glaucoma ◽  
Primary Outcome Measure ◽  
Open Angle ◽  
Efficacy And Safety ◽  
Normal Limits ◽  
Clinical Records

Purpose: To examine the efficacy and safety of combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) compared to phacoemulsification alone in patients with primary open-angle glaucoma (POAG). Methods: We performed a retrospective notes review of 99 consecutive clinical records of patients with POAG from 2 London eye departments. A total of 69 patients who underwent phaco-ECP and 30 sex- and age-matched control patients who underwent cataract surgery alone were included. Data on intraocular pressure (IOP), visual acuity (VA), number of ocular hypotensive medications, and postoperative complications were collected over 12 months. The primary outcome measure was defined as an IOP within normal limits (<21 mm Hg) and at least a 20% reduction in IOP from baseline. Results: Mean IOP was significantly decreased in both groups after 1 year (p<0.001 from baseline). The success rate was significantly higher in the phaco-ECP group (69.6%) than in the phaco group (40%) after 1 year (p = 0.004). Reduction in mean IOP and number of medications was also greater in the phaco-ECP group after 1 year (IOP reduction: 4.5 ± 5.13 mm Hg vs 1.83 ± 3.61 mm Hg; p = 0.007; number of medications reduction: 0.73 ± 0.71 vs 0.23 ± 0.56; p = 0.001). Both groups achieved a similar improvement in VA. There was a higher incidence of minor and self-limiting complications in the phaco-ECP group (p<0.047). Conclusions: Phaco-ECP resulted in a greater reduction in IOP and number of medications than phacoemulsification alone in POAG.

scholarly journals Study of the therapeutic efficacy and safety of intralesional tranexamic acid (25 mg/ml) for the treatment of melasma in male patients: A single centered “before-after” observational study

2021 ◽  
Vol 7 (6) ◽  
pp. 827
Author(s):  
Yog R. Verma ◽  
Karaninder S. Mehta ◽  
Pushpinder S. Chauhan ◽  
Vikram K. Mahajan ◽  
Monika Chandel ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Cost Effective ◽  
Primary Outcome Measure ◽  
Efficacy And Safety ◽  
Great Tendency ◽  
Time Saving ◽  
Male Patients

<p class="abstract"><strong>Background:</strong> Melasma is a common and difficult to treat hypermelanosis of poorly understood etiopathogenesis with great tendency to relapse. Tranexamic acid (TA) has been used in various formulations for its treatment, but there is paucity of studies/data and no consensus on the optimum dosage of intradermal TA, especially among the male patients. To study the efficacy and safety of intralesional TA 25 mg/ml for the treatment of melasma in male patients.</p><p class="abstract"><strong>Methods: </strong>Total 58 males were enrolled for study from July 2019 to June 2020. TA in 25 mg/ml strength injection and about 0.05 ml was injected intradermally at 1 cm apart on the entire melasma lesion, not exceeding 50 mg per visit and repeated every 4 weekly for 12 weeks. The percentage reduction in MASI was the primary outcome measure. It was determined every 4th week till 12 weeks and finally at 24 weeks for recurrence.</p><p class="abstract"><strong>Results: </strong>Mean MASI decreased from baseline score of 8.42±5.63 to 6.71±4.65, 5.09±3.59 and 3.41±3.06 at the follow up week 4, 8 and 12 respectively with a significant decrease from 8th week onwards. Majority of the patients were satisfied with their improvement after treatment (67.2%) without any significant adverse effects.</p><p class="abstract"><strong>Conclusions:</strong> However, the TA was found to effective in all the three histopathological types of melasma but the dermal melasma was least responsive as well as earliest to relapse. We recommend monthly therapy at 25 mg/ml as more efficacious, time saving and cost effective to all the three types of melasma.</p><p class="abstract"> </p>

Nebulized Budesonide Is as Effective as Nebulized Adrenaline in Moderately Severe Croup

PEDIATRICS ◽  
1996 ◽  
Vol 97 (5) ◽  
pp. 722-725
Author(s):  
Dominic Fitzgerald ◽  
Craig Mellis ◽  
Mark Johnson ◽  
Hugh Allen ◽  
Peter Cooper ◽  
...  
Keyword(s):  
Symptom Score ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Upper Airway ◽  
Primary Outcome Measure ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Parallel Group ◽  
Significant Difference ◽  
Duration Of Hospitalization

Objective. Nebulized budesonide and nebulized adrenaline have been shown to be effective in the treatment of moderately severe croup. However, there has been no direct comparison of these therapies. We undertook a multicenter, randomized, double-blind, parallel group study in 66 hospitalized children with viral or spasmodic croup. Methods. Children 0.5 to 6 years of age were assessed using a validated croup symptom score (stridor, 0 through 4; cough, 0 through 3; retractions, 0 through 3; dyspnea, 0 through 3; and color, 0 through 4) at 0.5, 1, 1.5, 2, 12, and 24 hours after nebulization. Patients received either budesonide (2 mg/4 mL) or L-adrenaline (4 mg/4 mL) via nebulization. The primary outcome measure was change in the total croup symptom score. Results. Thirty-five children received budesonide and 31 received adrenaline. There was no significant difference in baseline features, including croup score (mean [95% confidence interval]: budesonide, 7.1 [6.7- 7.5]; adrenaline, 7.7 [7.3-8.1]). All patients had significant improvement from baseline, and there was no significant difference between the two treatments, as measured by change in croup scores, change in oxygen saturation, duration of hospitalization, number of subsequent treatments with systemic steroids or adrenaline, and adverse events. No child required intubation. Conclusion. This study does not show any difference in efficacy and safety between nebulized budesonide and nebulized adrenaline in the treatment of acute upper airway obstruction in patients with moderately severe croup.

scholarly journals Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuta Seko ◽  
Takao Kato ◽  
Yuhei Yamaji ◽  
Yoshisumi Haruna ◽  
Eisaku Nakane ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Conduction Block ◽  
Primary Outcome Measure ◽  
Excess Risk ◽  
Major Adverse Cardiovascular Events ◽  
Prognostic Impact ◽  
Axis Deviation ◽  
The Right

AbstractWhile the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

scholarly journals Telephone-guided self-help for mental health difficulties in neurological conditions: a randomised pilot trial

2021 ◽  
pp. archdischild-2019-318577
Author(s):  
Sophie D Bennett ◽  
Isobel Heyman ◽  
Anna E Coughtrey ◽  
Sophia Varadkar ◽  
Terence Stephenson ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Mental Health Problems ◽  
Pilot Trial ◽  
Primary Outcome Measure ◽  
Self Help ◽  
Mental Health Difficulties ◽  
Neurological Conditions

ObjectiveThis study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions.DesignPreliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire.SettingNeurology clinics in a national tertiary paediatric hospital.PatientsYoung people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment.Interventions12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14).Results124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable.ConclusionsFurther feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended.Trial registration numberISRCTN21184717.

scholarly journals COMPARISON RESULTS OF SURGICAL TREATMENT LOCALIZED AND EXTENDED UTERINE CANCER

2010 ◽  
Vol 1 (3) ◽  
pp. 56-61
Author(s):  
I I Ushakov ◽  
E A Artoshina ◽  
P G Brousov ◽  
I V Nazvantsev ◽  
S A Levakov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Adjuvant Radiotherapy ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Uterine Cancer ◽  
Primary Outcome Measure ◽  
Pelvic Lymphadenectomy ◽  
Peritoneal Washing ◽  
Comparison Results

We selected 145 patients with endometrial carcinoma who had been treated with standard surgery (hysterectomy and BSO, peritoneal washing, palpation pelvic and para-aortic nodes) and with complete systematic pelvic lymphadenectomy (n=30 patients) or combined pelvic and para-aortic lymphadenectomy (n=30). Patients at intermediate or high risk of recurrence were offered adjuvant radiotherapy. The primary outcome measure was results of the surgical therapy.

scholarly journals Change in timed walk as primary outcome measure of treatment response in HAMLET-P: HAM/TSP MuLticentre Efficacy trial-Prednisolone

Retrovirology ◽  
2014 ◽  
Vol 11 (S1) ◽  
Author(s):  
Fabiola Martin ◽  
Eisuke Inoue ◽  
Maria Fernanda Rios Grassi ◽  
Ramon de Almeida Kruschewsky ◽  
Irene Cortese ◽  
...  
Keyword(s):  
Treatment Response ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Efficacy Trial
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