scholarly journals Complications associated with pre-hospital open thoracostomies: a rapid review

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Stian Mohrsen ◽  
Niall McMahon ◽  
Alasdair Corfield ◽  
Sinéad McKee
Keyword(s):  
Clinical Features ◽  
Complication Rate ◽  
Final Analysis ◽  
Standard Of Care ◽  
Original Description ◽  
Rapid Review ◽  
Positive Pressure ◽  
Chest Injuries ◽  
Patient Will ◽  
Effective Assessment

Abstract Background Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax. Main findings A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases. Conclusion There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.

scholarly journals Phase III Randomized Clinical Trial Comparing Tremelimumab With Standard-of-Care Chemotherapy in Patients With Advanced Melanoma

2013 ◽  
Vol 31 (5) ◽  
pp. 616-622 ◽  
Author(s):  
Antoni Ribas ◽  
Richard Kefford ◽  
Margaret A. Marshall ◽  
Cornelis J.A. Punt ◽  
John B. Haanen ◽  
...  
Keyword(s):  
Cytotoxic T Lymphocyte ◽  
Objective Response ◽  
Response Duration ◽  
Final Analysis ◽  
Standard Of Care ◽  
Advanced Melanoma ◽  
Phase Iii ◽  
Test Statistic ◽  
Treatment Naïve ◽  
Intent To Treat

PurposeIn phase I/II trials, the cytotoxic T lymphocyte–associated antigen-4–blocking monoclonal antibody tremelimumab induced durable responses in a subset of patients with advanced melanoma. This phase III study evaluated overall survival (OS) and other safety and efficacy end points in patients with advanced melanoma treated with tremelimumab or standard-of-care chemotherapy.Patients and MethodsPatients with treatment-naive, unresectable stage IIIc or IV melanoma were randomly assigned at a ratio of one to one to tremelimumab (15 mg/kg once every 90 days) or physician's choice of standard-of-care chemotherapy (temozolomide or dacarbazine).ResultsIn all, 655 patients were enrolled and randomly assigned. The test statistic crossed the prespecified futility boundary at second interim analysis after 340 deaths, but survival follow-up continued. At final analysis with 534 events, median OS by intent to treat was 12.6 months (95% CI, 10.8 to 14.3) for tremelimumab and 10.7 months (95% CI, 9.36 to 11.96) for chemotherapy (hazard ratio, 0.88; P = .127). Objective response rates were similar in the two arms: 10.7% in the tremelimumab arm and 9.8% in the chemotherapy arm. However, response duration (measured from date of random assignment) was significantly longer after tremelimumab (35.8 v 13.7 months; P = .0011). Diarrhea, pruritus, and rash were the most common treatment-related adverse events in the tremelimumab arm; 7.4% had endocrine toxicities. Seven deaths in the tremelimumab arm and one in the chemotherapy arm were considered treatment related by either investigators or sponsor.ConclusionThis study failed to demonstrate a statistically significant survival advantage of treatment with tremelimumab over standard-of-care chemotherapy in first-line treatment of patients with metastatic melanoma.

scholarly journals Concomitant Laparoscopic Burch Urethropexy and Combined Vaginal-Laparoscopic Mesh Sling Removal (x2) for Pain and Persistent Stress Urinary Incontinence

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Sarah A. Huber ◽  
LaChanda Dunlap-Wright ◽  
John R. Miklos ◽  
Robert D. Moore
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Standard Of Care ◽  
Subsequent Treatment ◽  
Female Stress Urinary Incontinence ◽  
Concomitant Treatment ◽  
Dual Approach ◽  
Patient Will ◽  
Vaginal Pain ◽  
Laparoscopic Removal

Although midurethral mesh tape slings are considered the standard of care in the treatment of female stress urinary incontinence (SUI), complications such as pain, dyspareunia, or erosion are known to occur in addition to persistent incontinence. The management of these types of mesh sling complications can be very complex, especially when the pain is not just isolated to the vagina but extends into other areas, such as the abdomen which requires a much more extensive dissection. Additionally, if a mesh sling needs to be removed, the patient will most likely have a return of her SUI that often necessitates subsequent treatment. Vaginal and/or laparoscopic removal or revision of mesh tape slings should be considered in patients presenting with complications such as vaginal pain, abdominal pain, dyspareunia, or urinary obstructive symptoms. In those patients who demonstrate persistent SUI, concomitant laparoscopic Burch urethropexy can be considered and can safely be performed at the time mesh removal. In this case report we present a patient who required a dual-approach removal of two painful midurethral slings in addition to concomitant treatment of persistent SUI with a laparoscopic Burch urethropexy procedure.

The AIM-HN and SEQ-HN study: A pivotal study evaluating the efficacy of tipifarnib in patients with head and neck squamous cell carcinoma (HNSCC) with hras mutations (AIM-HN) and the impact of hras mutations on response to first line systemic therapies for HNSCC (SEQ-HN).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS6593-TPS6593
Author(s):  
Robert I. Haddad ◽  
Kevin Joseph Harrington ◽  
Lisa F. Licitra ◽  
Amanda Psyrri ◽  
Nabil F. Saba ◽  
...  
Keyword(s):  
Final Analysis ◽  
Standard Of Care ◽  
Patient Characteristics ◽  
Unknown Primary ◽  
Missense Mutations ◽  
First Line ◽  
Open Label ◽  
Significance Level ◽  
Standard Of Care Treatment ◽  
The Impact

TPS6593 Background: HRAS mutations define a unique molecular subset of ~ 5% of HNSCC. Evidence suggests that these tumors respond poorly to standard systemic therapy but the impact of HRAS missense mutations on clinical outcomes has not been formally characterized. Tipifarnib is a potent and selective inhibitor of farnesyltransferase, a critical enzyme for HRAS activity. Phase 2 Proof of concept for tipifarnib in HRAS mutant HNSCC was recently achieved in study KO-TIP-001 (NCT02383927, Ho et. al. ESMO 2018). Methods: The AIM-HN and SEQ-HN Study (KO-TIP-007, NCT03719690) is an ongoing international, multicenter, open-label, 2 cohort (AIM-HN and SEQ-HN), pivotal trial designed to determine the Overall Response Rate (ORR) of tipifarnib in patients (pts) with HRAS mutant HNSCC (AIM-HN). SEQ-HN will retrospectively investigate how the ORR to first line treatment compares between the accrued HRAS mutant pts to matched-case control HRAS wild type (wt) HNSCC pts. Information on subsequent lines of therapy for HRAS mutant and wt pts will also be collected. AIM-HN will enroll at least 59 pts (oral cavity, pharynx, larynx, sinonasal, nasopharyngeal, or unknown primary) who are refractory or have relapsed from at least one prior line of systemic platinum-based therapy and have measurable disease by RECIST 1.1. AIM-HN pts must have tumors with >35% HRAS mutant variant allele frequency (VAF) or >20% VAF if serum albumin is >3.5 g/l. AIM-HN pts will receive treatment with tipifarnib at 600 mg bid on days 1-7 and 14-21 of 28-day cycles. Using Simon's Two-Stage Minimax design, if true ORR is > 30%, the study will have 80% power to detect ORR > 15% at 0.025 significance level. Both interim (after first 31 pts) and final analysis, 2-sided 95% CI on ORR, will be performed on the modified intent to treat population. The SEQ-HN observational cohort will enroll ~225 control pts who will receive standard of care treatment. A subset of SEQ-HN pts will be matched to the HRAS mutant AIM-HN pts according to defined patient characteristics and compared for responses to therapy. Clinical trial information: NCT02383927 .

scholarly journals Understanding the impact of professional motivation on the workforce crisis in medicine

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0005
Author(s):  
Efioanwan Andah ◽  
Blessing Essang ◽  
Charlotte Friend ◽  
Sarah Greenley ◽  
Kathryn Harvey ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
English Language ◽  
Medical Profession ◽  
Secondary Analysis ◽  
Final Analysis ◽  
Rapid Review ◽  
Medical Professionals ◽  
Medical Workforce ◽  
Design Quality ◽  
The Impact

BackgroundThe NHS is facing a workforce crisis. Responses to date have focused on improving recruitment of staff, but with less attention paid to retention.AimTo conduct a rapid review using Moss Kanter’s 3M’s model of workforce motivation as a sensitising framework to examine the current medical workforce crisis. Our work considers how insights from research in other professions offers new thinking for understanding what motivates doctors to continue working.Design & settingRapid literature review with secondary analysis of existing research examining reasons for leaving medicine.MethodA systematic search strategy was developed with the aid of an Information Specialist. (Search terms: medical professionals, retention, NHS; exclusions: commentaries, non-medical professionals, non-English language etc; limited to post-1990). Applied to three electronic databases, MEDLINE, EMBASE and HMIC. This produced a dataset describing study design/quality; and factors related to motivation for leaving the medical profession. Comparative thematic analysis distilled core themes explaining the reasons for leaving and their relation to the 3M’s model.ResultsOf 3,389 abstracts identified, screening and assessment produced 82 papers included in the final analysis. Thematic analysis identified four key themes: low morale, disconnect, unmanageable change and lack of personal and professional support. The themes of mastery, membership and meaning were substantially present within the dataset.ConclusionThe 3M’s model of motivation can be applied to the medical workforce to understand retention issues. This work supports the development of targeted solutions to tackle the worsening workforce crisis.

scholarly journals Hemisensory syndrome: Hyperacute symptom onset and age differentiates ischemic stroke from other aetiologies

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pei Xuan Koh ◽  
Joanna Ti ◽  
Seyed Ehsan Saffari ◽  
Zhen Yu Isis Claire Lim ◽  
Tianming Tu
Keyword(s):  
Ischemic Stroke ◽  
Clinical Features ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Diagnostic Yield ◽  
Clinical Information ◽  
Final Analysis ◽  
Observation Study ◽  
Mri Brain ◽  
Hospitalised Patients

Abstract Background An important cause of hemisensory syndrome is ischemic stroke. However, the diagnostic yield of neuroradiological imaging on hemisensory syndrome is low. Therefore, we aim to describe patients hospitalized with isolated hemisensory syndrome, and to identify clinical features associated with an aetiology of ischemic stroke. Methods We performed a single centre retrospective observation study, identifying patients who were hospitalised with hemisensory syndrome from October 2015 to March 2016, and whom underwent a magnetic resonance imaging (MRI) brain during the admission. Ischemic stroke was defined as the presence of restricted diffusion-weighted image on the MRI brain. Clinical information was analysed and compared between patients with and without stroke seen on MRI brain. Results 79 patients, 36 (45.6%) males and 43 (54.4%) females, aged between 30 to 87 years (mean 54), were included in the final analysis. 18 (22.8%) patients were identified to have an acute ischemic stroke. Clinical features associated with ischemic stroke in hospitalised patients with hemisensory syndrome include symptom onset of ≤24 h at presentation (odds ratio 31.4, 95% CI 3.89–254.4), advanced age (odds ratio 1.14, CI 1.05–1.25) and smoking (odds ratio 7.35, 95% CI 1.20–45). Conclusion Older patients, with a history of smoking, and who present with an acute onset of symptoms, are more likely to have ischemic stroke as the cause of their hemisensory syndrome.

scholarly journals Association of Lung Adenocarcinoma Subtypes According to the IASLC/ATS/ERS Classification and Programmed Cell Death Ligand 1 (PD-L1) Expression in Tumor Cells

2021 ◽  
Vol 27 ◽  
Author(s):  
Graciela Cruz-Rico ◽  
Alejandro Avilés-Salas ◽  
Xitlally Popa-Navarro ◽  
Luis Lara-Mejía ◽  
Rodrigo Catalán ◽  
...  
Keyword(s):  
Cell Death ◽  
Programmed Cell Death ◽  
Lung Adenocarcinoma ◽  
Tumor Cells ◽  
Clinical Features ◽  
Final Analysis ◽  
Small Cell Lung ◽  
Entire Cohort ◽  
C 50 ◽  
L1 Protein

Background: Programmed cell death-ligand 1 (PD-L1) protein expression is one of the most extensively studied biomarkers in patients with non-small cell lung cancer (NSCLC). However, there is scarce information regarding its association with distinct adenocarcinoma subtypes. This study evaluated the frequency of PD-L1 expression according to the IASLC/ATS/ERS classification and other relevant histological and clinical features.Patients and Methods: PD-L1 expression was assessed by immunohistochemistry (IHC). According to its positivity in tumor cells membrane, we stratified patients in three different tumor proportions score (TPS) cut-off points: a) <1% (negative), b) between 1 and 49%, and c) ≥50%; afterward, we analyzed the association among PD-L1 expression and lung adenocarcinoma (LADC) predominant subtypes, as well as other clinical features. As an exploratory outcome we evaluated if a PD-L1 TPS score ≥15% was useful as a biomarker for determining survival.Results: A total of 240 patients were included to our final analysis. Median age at diagnosis was 65 years (range 23–94 years). A PD-L1 TPS ≥1% was observed in 52.5% of the entire cohort; regarding specific predominant histological patterns, a PD-L1 TPS ≥1 was documented in 31.2% of patients with predominant-lepidic pattern, 46.2% of patients with predominant-acinar pattern, 42.8% of patients with a predominant-papillary pattern, and 68.7% of patients with predominant-solid pattern (p = 0.002). On the other hand, proportion of tumors with PD-L1 TPS ≥50% was not significantly different among adenocarcinoma subtypes. At the univariate survival analysis, a PD-L1 TPS cut-off value of ≥15% was associated with a worse PFS and OS.Conclusion: According to IASLC/ATS/ERS lung adenocarcinoma classification, the predominant-solid pattern is associated with a higher proportion of PD-L1 positive samples, no subtype was identified to be associated with a high (≥50%) TPS PD-L1.

Can Acute Appendicitis be Treated by Antibiotics Alone?

2007 ◽  
Vol 73 (11) ◽  
pp. 1161-1165 ◽  
Author(s):  
Katherine Liu ◽  
Sadie Ahanchi ◽  
Mark Pisaneschi ◽  
Irene Lin ◽  
Robert Walter
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Alternative Treatment ◽  
Complication Rate ◽  
Standard Of Care ◽  
Group I ◽  
Recurrent Appendicitis ◽  
Group Ii

Emergency appendectomy at presentation has been the standard of care for acute appendicitis. We examined the use of antibiotics as an alternative treatment. From September 2002 to August 2003, 170 consecutive patients diagnosed with acute appendicitis without abscess were reviewed retrospectively. Patients were divided into two groups: Group I (n = 151) underwent emergency appendectomy and Group II (n = 19) received antibiotics alone. The mode of treatment was at the attending surgeon's discretion. The overall complication rate was eight per cent for Group I and 10 per cent for Group II patients ( P = 0.22). Group II patients suffered no complications during antibiotic treatment, and any complications that did occur developed after subsequent appendectomy. One Group II patient had recurrent appendicitis (5%). The length of stay was 2.61 ± 0.21 days for Group I and 2.95 ± 0.38 days for Group II patients ( P = 0.57). Patients with acute appendicitis may be treated safely with antibiotics alone without emergency appendectomy.

Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a high risk of developing primary headache: A longitudinal study

Cephalalgia ◽  
2019 ◽  
Vol 39 (10) ◽  
pp. 1236-1240 ◽  
Author(s):  
Romina Moavero ◽  
Laura Papetti ◽  
Maria Chiara Bernucci ◽  
Caterina Cenci ◽  
Michela Ada Noris Ferilli ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Features ◽  
Age At Onset ◽  
Primary Headache ◽  
Final Analysis ◽  
Cyclic Vomiting Syndrome ◽  
Previous Diagnosis ◽  
Increased Risk ◽  
Cyclic Vomiting

Background and aim Episodic syndromes that may be associated with migraine are a group of disorders affecting patients with migraine or with an increased risk of presenting it, and likely represent an early life expression of migraine. Cyclic vomiting syndrome and benign paroxysmal torticollis are well characterized and represent a frequent cause of request for specialist consultations. The aim of this study is to longitudinally assess the rate of headache in patients presenting with cyclic vomiting syndrome and benign paroxysmal torticollis during infancy, and to define the main clinical features of the disorder. Methods We administered a questionnaire to the parents of all our pediatric patients with previous diagnosis of cyclic vomiting syndrome and/or benign paroxysmal torticollis according to ICHD-3; questions were focused on the main clinical features of the disorder as well as the prognosis, with particular emphasis on the development of headache. Results For the final analysis we considered 82 patients with cyclic vomiting syndrome and 33 with benign paroxysmal torticollis. Seventy-nine percent of patients with cyclic vomiting syndrome presented with headache during the follow-up, with a mean age at onset of 6 years; 67% of patients with benign paroxysmal torticollis suffered from headache during the follow-up, with a mean age at onset of 5 years. Discussion Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a very high risk of developing headache, mostly migraine, later in life. In both groups of patients, the vast majority presented with different episodic syndromes that may be associated with migraine at different ages, thus suggesting an age-dependent evolution of migraine-like symptoms before the onset of clear migrainous headache.

Prospective, Randomized Trial of Two Different Modalities of Flushing Central Venous Catheters in Pediatric Patients With Cancer

2009 ◽  
Vol 27 (12) ◽  
pp. 2059-2065 ◽  
Author(s):  
Simone Cesaro ◽  
Gloria Tridello ◽  
Mara Cavaliere ◽  
Laura Magagna ◽  
Patrizia Gavin ◽  
...  
Keyword(s):  
Normal Saline ◽  
Complication Rate ◽  
Pediatric Patients ◽  
Central Venous Catheters ◽  
Positive Pressure ◽  
Cumulative Probability ◽  
Central Venous ◽  
Patients With Cancer ◽  
Heparin Solution ◽  
Premature Removal

Purpose There are limited prospective data on whether the method of flushing affects the complication rate of tunnelled central venous catheters (CVCs). Patients and Methods During a 25-month period, 203 pediatric patients who had newly placed Broviac-Hickman CVCs were randomly assigned to standard flushing with heparin solution or to experimental flushing with normal saline via a positive-pressure cap. Results Two hundred twenty-one complications were recorded among 75,249 CVC-days (2.94 per 1,000 CVC-days). A higher incidence of CVC occlusion (83 v 41 episodes; P = .0002) and bacteremia (24 v 9; P = .01) were found in the experimental arm. The cumulative probability of developing at least one CVC complication was higher in the experimental arm than in the standard arm (65.1% [95% CI, 55% to 75%] v 43.8% [95% CI, 34% to 54%], respectively; P = .01). No difference was found in either the cause or the frequency of premature removal of CVCs between the two study arms. After a median follow-up of 360 days (range, 4 to 1,073), CVC survival was similar: 77% (95% CI, 66% to 84%) for the experimental arm and 69% (95% CI, 53% to 80%) for the standard arm (P = .7). The factors associated with the occurrence of CVC complication were a diagnosis of leukemia/lymphoma, double-lumen CVC, and experimental flushing. The only factor significantly associated with premature removal of a CVC was a diagnosis of leukemia/lymphoma (hazard rate, 2.3; 95% CI, 1.1 to 4.7). Conclusion An increased complication rate was found with normal saline flushing, but additional investigation is warranted to clarify whether it is related to saline use or to once-a-week flushing.

Quality of life (QOL) impact of adjuvant chemotherapy for early stage non-small cell lung cancer (NSCLC): Final analysis of JBR.10 randomized trial

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7585-7585 ◽  
Author(s):  
A. Bezjak ◽  
C. W. Lee ◽  
K. Ding ◽  
T. Winton ◽  
M. Brundage ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Randomized Trial ◽  
Early Stage ◽  
Symptom Burden ◽  
Final Analysis ◽  
Standard Of Care ◽  
Functional Domains ◽  
Point Change ◽  
Entire Study ◽  
Change Scores

7585 Background: Adjuvant chemotherapy for early stage NSCLC is now standard of care, but its impact on QOL is not known. We report the final QOL analysis of JBR.10, a North American intergroup randomized trial of adjuvant cisplatin/vinorelbine compared to observation in patients (pts) with completely resected stage IB/II NSCLC (n=482). Methods: QOL, a secondary endpoint of JBR.10, was assessed using the EORTC QLQ-C30 and a trial-specific checklist at baseline, weeks 5 and 9 for those on chemotherapy, and at 3, 6, 9, 12, 18, 24, 30 and 36 months of follow up. A 10-point change in QOL scores from baseline was considered clinically significant. Results: QOL assessment was not mandatory for all pts; 186/242 (76.9%) pts randomized to chemotherapy completed the baseline QOL assessment, compared to 173/240 (72.1%) pts on the observation arm. The overall survival of pts contributing QOL data, and the effect of adjuvant chemotherapy, was not different from the entire study population. Baseline QOL in the two study arms was comparable, with low global QOL scores and a significant symptom burden, especially pain and fatigue, following thoracotomy. A significantly greater proportion of chemotherapy pts experienced worsening symptoms including fatigue (p=0.02), appetite, hair loss, nausea and vomiting. At 6 months, a higher proportion of pts on the observation arm reported improved QOL in the global (p = 0.002), physical (p=0.02) and functional domains, compared to pts on the chemotherapy arm. However, by the 9 month time-point, global QOL of patients on chemotherapy was comparable to QOL of patients on observation, as were the five functional domains. Numbness (change scores: 22 vs 6, p<0.01) and pins & needles in fingers/toes (change scores: 21 vs 5, p<0.01) were the only symptoms that persisted, up to 24 months. Conclusion: Patients on adjuvant chemotherapy experience an initial slower recovery of QOL after thoracotomy, but following completion of treatment reach levels comparable to patients treated with surgery alone, in most aspects of QOL. [Table: see text]

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